Table 1: Standard Charges,,,,,,,,,,,,,,,,,,,,,,
Last Updated 02/11/2022,,,,,,,,,,,,,,,,,,,,,,
Facility ID,Charge Code,Description,NDC/ Supply ID,CPT(R)/HCPCS Code,Revenue Code,Gross Charge/Unit,Cash Price,Min Allowble,Max Allowable,Community Care Network OP,Evolutions Healthcare OP,Health Alliance (IP/OP),HealthSmart Benefit Solutions (IP) ,HealthSmart Benefit Solutions (OP) ,HFN (IP/OP),Humana Choice Care (IP/OP),Multiplan (IP),Multiplan (OP),PHCS (IP/OP),Three Rivers (IP/OP),United Healthcare (IP/OP),Zelis (IP/OP)
Carle Richland Memorial Hospital,8010110,PRIVATE ROOM,,,110,"$1,820.00 ","$1,820.00 ","$1,390.48 ","$1,638.00 ",N/A,N/A,"$1,547.00 ","$1,601.60 ",N/A,"$1,601.60 ","$1,601.60 ","$1,583.40 ",N/A,"$1,547.00 ","$1,547.00 ","$1,390.48 ","$1,638.00 "
Carle Richland Memorial Hospital,8014110,PRIVATE ROOM,,,110,"$1,820.00 ","$1,820.00 ","$1,390.48 ","$1,638.00 ",N/A,N/A,"$1,547.00 ","$1,601.60 ",N/A,"$1,601.60 ","$1,601.60 ","$1,583.40 ",N/A,"$1,547.00 ","$1,547.00 ","$1,390.48 ","$1,638.00 "
Carle Richland Memorial Hospital,8000110,EXTENDED CARE WING PRIVATE ROOM & BOARD,,,110,$235.00 ,$235.00 ,$179.54 ,$211.50 ,N/A,N/A,$199.75 ,$206.80 ,N/A,$206.80 ,$206.80 ,$204.45 ,N/A,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8011120,SEMI-PRIVATE,,,120,"$1,160.00 ","$1,160.00 ",$886.24 ,"$1,044.00 ",N/A,N/A,$986.00 ,"$1,020.80 ",N/A,"$1,020.80 ","$1,020.80 ","$1,009.20 ",N/A,$986.00 ,$986.00 ,$886.24 ,"$1,044.00 "
Carle Richland Memorial Hospital,8000120,SWINGBED SEMI-PRIVATE,,,120,$530.00 ,$530.00 ,$404.92 ,$477.00 ,N/A,N/A,$450.50 ,$466.40 ,N/A,$466.40 ,$466.40 ,$461.10 ,N/A,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8012170,L2 NICU/NURSERY/PEDS ROOM,,,170,"$1,820.00 ","$1,820.00 ","$1,390.48 ","$1,638.00 ",N/A,N/A,"$1,547.00 ","$1,601.60 ",N/A,"$1,601.60 ","$1,601.60 ","$1,583.40 ",N/A,"$1,547.00 ","$1,547.00 ","$1,390.48 ","$1,638.00 "
Carle Richland Memorial Hospital,8019013,NICU/NEONAT/PEDS LEVEL 1,,,170,"$1,820.00 ","$1,820.00 ","$1,390.48 ","$1,638.00 ",N/A,N/A,"$1,547.00 ","$1,601.60 ",N/A,"$1,601.60 ","$1,601.60 ","$1,583.40 ",N/A,"$1,547.00 ","$1,547.00 ","$1,390.48 ","$1,638.00 "
Carle Richland Memorial Hospital,8018170,NURSERY ROOM CHARGE,,,170,$950.00 ,$950.00 ,$725.80 ,$855.00 ,N/A,N/A,$807.50 ,$836.00 ,N/A,$836.00 ,$836.00 ,$826.50 ,N/A,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8019170,TRANSITION NURSERY,,,170,$950.00 ,$950.00 ,$725.80 ,$855.00 ,N/A,N/A,$807.50 ,$836.00 ,N/A,$836.00 ,$836.00 ,$826.50 ,N/A,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8001170,LVL 2 NICU/NEONATE/PEDS,,,170,"$1,820.00 ","$1,820.00 ","$1,390.48 ","$1,638.00 ",N/A,N/A,"$1,547.00 ","$1,601.60 ",N/A,"$1,601.60 ","$1,601.60 ","$1,583.40 ",N/A,"$1,547.00 ","$1,547.00 ","$1,390.48 ","$1,638.00 "
Carle Richland Memorial Hospital,8000180,LEAVE OF ABSENCE,,,180,$530.00 ,$530.00 ,$404.92 ,$477.00 ,N/A,N/A,$450.50 ,$466.40 ,N/A,$466.40 ,$466.40 ,$461.10 ,N/A,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8001180,LEAVE OF ABSENCE ECW,,,180,$235.00 ,$235.00 ,$179.54 ,$211.50 ,N/A,N/A,$199.75 ,$206.80 ,N/A,$206.80 ,$206.80 ,$204.45 ,N/A,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8000200,ICU,,,200,"$3,480.00 ","$3,480.00 ","$2,658.72 ","$3,132.00 ",N/A,N/A,"$2,958.00 ","$3,062.40 ",N/A,"$3,062.40 ","$3,062.40 ","$3,027.60 ",N/A,"$2,958.00 ","$2,958.00 ","$2,658.72 ","$3,132.00 "
Carle Richland Memorial Hospital,8160013,SEVOFLURANE,,,250,$1.03 ,$1.03 ,$0.79 ,$0.93 ,$0.88 ,$0.88 ,$0.88 ,$0.91 ,$0.88 ,$0.91 ,$0.91 ,$0.90 ,$0.88 ,$0.88 ,$0.88 ,$0.79 ,$0.93
Carle Richland Memorial Hospital,8160014,ISOFLURANE,,,250,$23.60 ,$23.60 ,$18.03 ,$21.24 ,$20.06 ,$20.06 ,$20.06 ,$20.77 ,$20.06 ,$20.77 ,$20.77 ,$20.53 ,$20.06 ,$20.06 ,$20.06 ,$18.03 ,$21.24
Carle Richland Memorial Hospital,8160015,NITROUS OXIDE,,,250,$1.39 ,$1.39 ,$1.06 ,$1.25 ,$1.18 ,$1.18 ,$1.18 ,$1.22 ,$1.18 ,$1.22 ,$1.22 ,$1.21 ,$1.18 ,$1.18 ,$1.18 ,$1.06 ,$1.25
Carle Richland Memorial Hospital,8160017,DESFLURANE,,,250,$2.14 ,$2.14 ,$1.63 ,$1.93 ,$1.82 ,$1.82 ,$1.82 ,$1.88 ,$1.82 ,$1.88 ,$1.88 ,$1.86 ,$1.82 ,$1.82 ,$1.82 ,$1.63 ,$1.93
Carle Richland Memorial Hospital,8980250,acetaminophen 120 mg rectal suppository,45802073230,J3490,250,$0.82 ,$0.82 ,$0.63 ,$0.74 ,$0.70 ,$0.70 ,$0.70 ,$0.72 ,$0.70 ,$0.72 ,$0.72 ,$0.71 ,$0.70 ,$0.70 ,$0.70 ,$0.63 ,$0.74
Carle Richland Memorial Hospital,8980250,acetaminophen 120 mg-codeine 12 mg/5 mL (5 mL) oral solution,121050405,,250,$11.58 ,$11.58 ,$8.85 ,$10.42 ,$9.84 ,$9.84 ,$9.84 ,$10.19 ,$9.84 ,$10.19 ,$10.19 ,$10.07 ,$9.84 ,$9.84 ,$9.84 ,$8.85 ,$10.42
Carle Richland Memorial Hospital,8980250,acetaminophen 300 mg-codeine 30 mg tablet,406048462,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,acetaminophen 300 mg-codeine 60 mg tablet,68084037301,,250,$9.83 ,$9.83 ,$7.51 ,$8.85 ,$8.36 ,$8.36 ,$8.36 ,$8.65 ,$8.36 ,$8.65 ,$8.65 ,$8.55 ,$8.36 ,$8.36 ,$8.36 ,$7.51 ,$8.85
Carle Richland Memorial Hospital,8980250,acetaminophen 300 mg-codeine 60 mg tablet,68084037311,,250,$9.83 ,$9.83 ,$7.51 ,$8.85 ,$8.36 ,$8.36 ,$8.36 ,$8.65 ,$8.36 ,$8.65 ,$8.65 ,$8.55 ,$8.36 ,$8.36 ,$8.36 ,$7.51 ,$8.85
Carle Richland Memorial Hospital,8980250,acetaminophen 32 mg/mL oral syringe (FOR ORAL USE ONLY),68094058758,,250,$2.25 ,$2.25 ,$1.72 ,$2.03 ,$1.91 ,$1.91 ,$1.91 ,$1.98 ,$1.91 ,$1.98 ,$1.98 ,$1.96 ,$1.91 ,$1.91 ,$1.91 ,$1.72 ,$2.03
Carle Richland Memorial Hospital,8980250,"lidocaine 20 mg/mL (2 %)-epinephrine 1:100,000 injection solution",409318231,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"lidocaine 20 mg/mL (2 %)-epinephrine 1:100,000 injection solution",63323048327,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"lidocaine 20 mg/mL (2 %)-epinephrine 1:100,000 injection solution",63323048357,,250,$52.87 ,$52.87 ,$40.39 ,$47.58 ,$44.94 ,$44.94 ,$44.94 ,$46.53 ,$44.94 ,$46.53 ,$46.53 ,$46.00 ,$44.94 ,$44.94 ,$44.94 ,$40.39 ,$47.58
Carle Richland Memorial Hospital,8980250,lidocaine 4 % topical cream,52565012207,,250,$146.79 ,$146.79 ,$112.15 ,$132.11 ,$124.77 ,$124.77 ,$124.77 ,$129.18 ,$124.77 ,$129.18 ,$129.18 ,$127.71 ,$124.77 ,$124.77 ,$124.77 ,$112.15 ,$132.11
Carle Richland Memorial Hospital,8980250,lidocaine 5 % topical patch,591352530,,250,$40.91 ,$40.91 ,$31.26 ,$36.82 ,$34.77 ,$34.77 ,$34.77 ,$36.00 ,$34.77 ,$36.00 ,$36.00 ,$35.59 ,$34.77 ,$34.77 ,$34.77 ,$31.26 ,$36.82
Carle Richland Memorial Hospital,8980250,lidocaine HCl (bulk) 100 % powder,38779008205,,250,$10.50 ,$10.50 ,$8.02 ,$9.45 ,$8.93 ,$8.93 ,$8.93 ,$9.24 ,$8.93 ,$9.24 ,$9.24 ,$9.14 ,$8.93 ,$8.93 ,$8.93 ,$8.02 ,$9.45
Carle Richland Memorial Hospital,8980250,lidocaine HCL 2 % mucosal jelly,17478071110,,250,$52.39 ,$52.39 ,$40.03 ,$47.15 ,$44.53 ,$44.53 ,$44.53 ,$46.10 ,$44.53 ,$46.10 ,$46.10 ,$45.58 ,$44.53 ,$44.53 ,$44.53 ,$40.03 ,$47.15
Carle Richland Memorial Hospital,8980250,lidocaine HCL 2 % mucosal solution,50383077515,,250,$7.36 ,$7.36 ,$5.62 ,$6.62 ,$6.26 ,$6.26 ,$6.26 ,$6.48 ,$6.26 ,$6.48 ,$6.48 ,$6.40 ,$6.26 ,$6.26 ,$6.26 ,$5.62 ,$6.62
Carle Richland Memorial Hospital,8980250,lidocaine HCL 2 % mucosal solution,50383077504,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,lidocaine HCL 4 % (40 mg/mL) mucosal solution,52565000950,,250,$322.24 ,$322.24 ,$246.19 ,$290.02 ,$273.90 ,$273.90 ,$273.90 ,$283.57 ,$273.90 ,$283.57 ,$283.57 ,$280.35 ,$273.90 ,$273.90 ,$273.90 ,$246.19 ,$290.02
Carle Richland Memorial Hospital,8980250,"lidocaine-epinephrine (PF) 1 %-1:200,000 injection solution",63323048717,J3490,250,$54.97 ,$54.97 ,$42.00 ,$49.47 ,$46.72 ,$46.72 ,$46.72 ,$48.37 ,$46.72 ,$48.37 ,$48.37 ,$47.82 ,$46.72 ,$46.72 ,$46.72 ,$42.00 ,$49.47
Carle Richland Memorial Hospital,8980250,"lidocaine-epinephrine 0.5 %-1:200,000 injection solution",409317701,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,linaCLOtide 145 mcg capsule,456120130,,250,$73.57 ,$73.57 ,$56.21 ,$66.21 ,$62.53 ,$62.53 ,$62.53 ,$64.74 ,$62.53 ,$64.74 ,$64.74 ,$64.01 ,$62.53 ,$62.53 ,$62.53 ,$56.21 ,$66.21
Carle Richland Memorial Hospital,8980250,linaCLOtide 290 mcg capsule,456120230,,250,$73.57 ,$73.57 ,$56.21 ,$66.21 ,$62.53 ,$62.53 ,$62.53 ,$64.74 ,$62.53 ,$64.74 ,$64.74 ,$64.01 ,$62.53 ,$62.53 ,$62.53 ,$56.21 ,$66.21
Carle Richland Memorial Hospital,8980250,linaGLIPtin 5 mg tablet,597014061,,250,$76.11 ,$76.11 ,$58.15 ,$68.50 ,$64.69 ,$64.69 ,$64.69 ,$66.98 ,$64.69 ,$66.98 ,$66.98 ,$66.22 ,$64.69 ,$64.69 ,$64.69 ,$58.15 ,$68.50
Carle Richland Memorial Hospital,8980250,linezolid 600 mg tablet,50268047111,,250,$651.01 ,$651.01 ,$497.37 ,$585.91 ,$553.36 ,$553.36 ,$553.36 ,$572.89 ,$553.36 ,$572.89 ,$572.89 ,$566.38 ,$553.36 ,$553.36 ,$553.36 ,$497.37 ,$585.91
Carle Richland Memorial Hospital,8980250,linezolid 600 mg tablet,50268047112,,250,$651.01 ,$651.01 ,$497.37 ,$585.91 ,$553.36 ,$553.36 ,$553.36 ,$572.89 ,$553.36 ,$572.89 ,$572.89 ,$566.38 ,$553.36 ,$553.36 ,$553.36 ,$497.37 ,$585.91
Carle Richland Memorial Hospital,8980250,"lipase-protease-amylase 12,000-38,000-60,000 unit capsule,delayed rel",32121201,,250,$22.17 ,$22.17 ,$16.94 ,$19.95 ,$18.84 ,$18.84 ,$18.84 ,$19.51 ,$18.84 ,$19.51 ,$19.51 ,$19.29 ,$18.84 ,$18.84 ,$18.84 ,$16.94 ,$19.95
Carle Richland Memorial Hospital,8980250,lisinopriL 10 mg tablet,68001033400,,250,$7.01 ,$7.01 ,$5.36 ,$6.31 ,$5.96 ,$5.96 ,$5.96 ,$6.17 ,$5.96 ,$6.17 ,$6.17 ,$6.10 ,$5.96 ,$5.96 ,$5.96 ,$5.36 ,$6.31
Carle Richland Memorial Hospital,8980250,lisinopriL 2.5 mg tablet,68084076525,,250,$5.52 ,$5.52 ,$4.22 ,$4.97 ,$4.69 ,$4.69 ,$4.69 ,$4.86 ,$4.69 ,$4.86 ,$4.86 ,$4.80 ,$4.69 ,$4.69 ,$4.69 ,$4.22 ,$4.97
Carle Richland Memorial Hospital,8980250,lisinopriL 2.5 mg tablet,68084076595,,250,$5.52 ,$5.52 ,$4.22 ,$4.97 ,$4.69 ,$4.69 ,$4.69 ,$4.86 ,$4.69 ,$4.86 ,$4.86 ,$4.80 ,$4.69 ,$4.69 ,$4.69 ,$4.22 ,$4.97
Carle Richland Memorial Hospital,8980250,lisinopriL 20 mg tablet,60687033301,,250,$3.03 ,$3.03 ,$2.31 ,$2.73 ,$2.58 ,$2.58 ,$2.58 ,$2.67 ,$2.58 ,$2.67 ,$2.67 ,$2.64 ,$2.58 ,$2.58 ,$2.58 ,$2.31 ,$2.73
Carle Richland Memorial Hospital,8980250,lisinopriL 20 mg tablet,60687033311,,250,$3.03 ,$3.03 ,$2.31 ,$2.73 ,$2.58 ,$2.58 ,$2.58 ,$2.67 ,$2.58 ,$2.67 ,$2.67 ,$2.64 ,$2.58 ,$2.58 ,$2.58 ,$2.31 ,$2.73
Carle Richland Memorial Hospital,8980250,lisinopriL 40 mg tablet,68084019911,,250,$5.18 ,$5.18 ,$3.96 ,$4.66 ,$4.40 ,$4.40 ,$4.40 ,$4.56 ,$4.40 ,$4.56 ,$4.56 ,$4.51 ,$4.40 ,$4.40 ,$4.40 ,$3.96 ,$4.66
Carle Richland Memorial Hospital,8980250,lisinopriL 5 mg tablet,68084019601,,250,$6.39 ,$6.39 ,$4.88 ,$5.75 ,$5.43 ,$5.43 ,$5.43 ,$5.62 ,$5.43 ,$5.62 ,$5.62 ,$5.56 ,$5.43 ,$5.43 ,$5.43 ,$4.88 ,$5.75
Carle Richland Memorial Hospital,8980250,lisinopriL 5 mg tablet,68084019611,,250,$6.39 ,$6.39 ,$4.88 ,$5.75 ,$5.43 ,$5.43 ,$5.43 ,$5.62 ,$5.43 ,$5.62 ,$5.62 ,$5.56 ,$5.43 ,$5.43 ,$5.43 ,$4.88 ,$5.75
Carle Richland Memorial Hospital,8980250,lithium carbonate 150 mg capsule,54852625,,250,$3.21 ,$3.21 ,$2.45 ,$2.89 ,$2.73 ,$2.73 ,$2.73 ,$2.82 ,$2.73 ,$2.82 ,$2.82 ,$2.79 ,$2.73 ,$2.73 ,$2.73 ,$2.45 ,$2.89
Carle Richland Memorial Hospital,8980250,"lithium carbonate ER 450 mg tablet,extended release",68084065501,,250,$5.85 ,$5.85 ,$4.47 ,$5.27 ,$4.97 ,$4.97 ,$4.97 ,$5.15 ,$4.97 ,$5.15 ,$5.15 ,$5.09 ,$4.97 ,$4.97 ,$4.97 ,$4.47 ,$5.27
Carle Richland Memorial Hospital,8980250,"lithium carbonate ER 450 mg tablet,extended release",68084065511,,250,$5.85 ,$5.85 ,$4.47 ,$5.27 ,$4.97 ,$4.97 ,$4.97 ,$5.15 ,$4.97 ,$5.15 ,$5.15 ,$5.09 ,$4.97 ,$4.97 ,$4.97 ,$4.47 ,$5.27
Carle Richland Memorial Hospital,8980250,loperamide 2 mg capsule,60687022901,,250,$6.42 ,$6.42 ,$4.90 ,$5.78 ,$5.46 ,$5.46 ,$5.46 ,$5.65 ,$5.46 ,$5.65 ,$5.65 ,$5.59 ,$5.46 ,$5.46 ,$5.46 ,$4.90 ,$5.78
Carle Richland Memorial Hospital,8980250,loperamide 2 mg capsule,60687022911,,250,$6.42 ,$6.42 ,$4.90 ,$5.78 ,$5.46 ,$5.46 ,$5.46 ,$5.65 ,$5.46 ,$5.65 ,$5.65 ,$5.59 ,$5.46 ,$5.46 ,$5.46 ,$4.90 ,$5.78
Carle Richland Memorial Hospital,8980250,loratadine 10 mg tablet,68084024801,,250,$0.98 ,$0.98 ,$0.75 ,$0.88 ,$0.83 ,$0.83 ,$0.83 ,$0.86 ,$0.83 ,$0.86 ,$0.86 ,$0.85 ,$0.83 ,$0.83 ,$0.83 ,$0.75 ,$0.88
Carle Richland Memorial Hospital,8980250,loratadine 10 mg tablet,68084024811,,250,$0.98 ,$0.98 ,$0.75 ,$0.88 ,$0.83 ,$0.83 ,$0.83 ,$0.86 ,$0.83 ,$0.86 ,$0.86 ,$0.85 ,$0.83 ,$0.83 ,$0.83 ,$0.75 ,$0.88
Carle Richland Memorial Hospital,8980250,LORazepam 0.5 mg tablet,591024001,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,LORazepam 1 mg tablet,591024101,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,LORazepam 2 mg tablet,904600961,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,LORazepam 2 mg/mL oral concentrate,54353244,,250,$16.31 ,$16.31 ,$12.46 ,$14.68 ,$13.86 ,$13.86 ,$13.86 ,$14.35 ,$13.86 ,$14.35 ,$14.35 ,$14.19 ,$13.86 ,$13.86 ,$13.86 ,$12.46 ,$14.68
Carle Richland Memorial Hospital,8980250,losartan 25 mg tablet,68084034601,,250,$10.15 ,$10.15 ,$7.75 ,$9.14 ,$8.63 ,$8.63 ,$8.63 ,$8.93 ,$8.63 ,$8.93 ,$8.93 ,$8.83 ,$8.63 ,$8.63 ,$8.63 ,$7.75 ,$9.14
Carle Richland Memorial Hospital,8980250,losartan 50 mg tablet,68084034701,,250,$12.82 ,$12.82 ,$9.79 ,$11.54 ,$10.90 ,$10.90 ,$10.90 ,$11.28 ,$10.90 ,$11.28 ,$11.28 ,$11.15 ,$10.90 ,$10.90 ,$10.90 ,$9.79 ,$11.54
Carle Richland Memorial Hospital,8980250,losartan 50 mg tablet,68084034711,,250,$12.82 ,$12.82 ,$9.79 ,$11.54 ,$10.90 ,$10.90 ,$10.90 ,$11.28 ,$10.90 ,$11.28 ,$11.28 ,$11.15 ,$10.90 ,$10.90 ,$10.90 ,$9.79 ,$11.54
Carle Richland Memorial Hospital,8980250,lubiprostone 24 mcg capsule,64764024060,,250,$34.13 ,$34.13 ,$26.08 ,$30.72 ,$29.01 ,$29.01 ,$29.01 ,$30.03 ,$29.01 ,$30.03 ,$30.03 ,$29.69 ,$29.01 ,$29.01 ,$29.01 ,$26.08 ,$30.72
Carle Richland Memorial Hospital,8980250,lubiprostone 8 mcg capsule,64764008060,,250,$34.13 ,$34.13 ,$26.08 ,$30.72 ,$29.01 ,$29.01 ,$29.01 ,$30.03 ,$29.01 ,$30.03 ,$30.03 ,$29.69 ,$29.01 ,$29.01 ,$29.01 ,$26.08 ,$30.72
Carle Richland Memorial Hospital,8980250,magnesium citrate oral solution,869016438,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,magnesium citrate oral solution,869069338,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,magnesium hydroxide 400 mg/5 mL oral suspension,121043130,,250,$1.64 ,$1.64 ,$1.25 ,$1.48 ,$1.39 ,$1.39 ,$1.39 ,$1.44 ,$1.39 ,$1.44 ,$1.44 ,$1.43 ,$1.39 ,$1.39 ,$1.39 ,$1.25 ,$1.48
Carle Richland Memorial Hospital,8980250,"magnesium L-lactate ER 84 mg tablet,extended release",36765042019,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,magnesium sulfate (laxative) 495 mg/5 gram oral granules,37205060243,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,meclizine 12.5 mg tablet,50268052215,,250,$5.59 ,$5.59 ,$4.27 ,$5.03 ,$4.75 ,$4.75 ,$4.75 ,$4.92 ,$4.75 ,$4.92 ,$4.92 ,$4.86 ,$4.75 ,$4.75 ,$4.75 ,$4.27 ,$5.03
Carle Richland Memorial Hospital,8980250,medroxyPROGESTERone 2.5 mg tablet,59762005501,,250,$3.79 ,$3.79 ,$2.90 ,$3.41 ,$3.22 ,$3.22 ,$3.22 ,$3.34 ,$3.22 ,$3.34 ,$3.34 ,$3.30 ,$3.22 ,$3.22 ,$3.22 ,$2.90 ,$3.41
Carle Richland Memorial Hospital,8980250,megestroL 400 mg/10 mL (10 mL) oral suspension,68094025059,,250,$41.75 ,$41.75 ,$31.90 ,$37.58 ,$35.49 ,$35.49 ,$35.49 ,$36.74 ,$35.49 ,$36.74 ,$36.74 ,$36.32 ,$35.49 ,$35.49 ,$35.49 ,$31.90 ,$37.58
Carle Richland Memorial Hospital,8980250,megestroL 400 mg/10 mL (10 mL) oral suspension,68094025062,,250,$41.75 ,$41.75 ,$31.90 ,$37.58 ,$35.49 ,$35.49 ,$35.49 ,$36.74 ,$35.49 ,$36.74 ,$36.74 ,$36.32 ,$35.49 ,$35.49 ,$35.49 ,$31.90 ,$37.58
Carle Richland Memorial Hospital,8980250,melatonin 3 mg tablet,50268052411,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,melatonin 3 mg tablet,50268052415,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,memantine 5 mg tablet,60687017311,,250,$6.06 ,$6.06 ,$4.63 ,$5.45 ,$5.15 ,$5.15 ,$5.15 ,$5.33 ,$5.15 ,$5.33 ,$5.33 ,$5.27 ,$5.15 ,$5.15 ,$5.15 ,$4.63 ,$5.45
Carle Richland Memorial Hospital,8980250,menthol 2 mg lozenges,3660230001,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"mesalamine CR 500 mg capsule,controlled release",54092019112,,250,$33.65 ,$33.65 ,$25.71 ,$30.29 ,$28.60 ,$28.60 ,$28.60 ,$29.61 ,$28.60 ,$29.61 ,$29.61 ,$29.28 ,$28.60 ,$28.60 ,$28.60 ,$25.71 ,$30.29
Carle Richland Memorial Hospital,8980250,metFORMIN 500 mg tablet,60687015501,,250,$5.60 ,$5.60 ,$4.28 ,$5.04 ,$4.76 ,$4.76 ,$4.76 ,$4.93 ,$4.76 ,$4.93 ,$4.93 ,$4.87 ,$4.76 ,$4.76 ,$4.76 ,$4.28 ,$5.04
Carle Richland Memorial Hospital,8980250,metFORMIN 500 mg tablet,60687015511,,250,$5.60 ,$5.60 ,$4.28 ,$5.04 ,$4.76 ,$4.76 ,$4.76 ,$4.93 ,$4.76 ,$4.93 ,$4.93 ,$4.87 ,$4.76 ,$4.76 ,$4.76 ,$4.28 ,$5.04
Carle Richland Memorial Hospital,8980250,methadone 10 mg tablet,406577123,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,methIMAzole 5 mg tablet,60687035701,,250,$5.13 ,$5.13 ,$3.92 ,$4.62 ,$4.36 ,$4.36 ,$4.36 ,$4.51 ,$4.36 ,$4.51 ,$4.51 ,$4.46 ,$4.36 ,$4.36 ,$4.36 ,$3.92 ,$4.62
Carle Richland Memorial Hospital,8980250,methocarbamoL 500 mg tablet,70010075401,,250,$4.70 ,$4.70 ,$3.59 ,$4.23 ,$4.00 ,$4.00 ,$4.00 ,$4.14 ,$4.00 ,$4.14 ,$4.14 ,$4.09 ,$4.00 ,$4.00 ,$4.00 ,$3.59 ,$4.23
Carle Richland Memorial Hospital,8980250,methohexitaL 500 mg solution for injection,42023010501,,250,$471.84 ,$471.84 ,$360.49 ,$424.66 ,$401.06 ,$401.06 ,$401.06 ,$415.22 ,$401.06 ,$415.22 ,$415.22 ,$410.50 ,$401.06 ,$401.06 ,$401.06 ,$360.49 ,$424.66
Carle Richland Memorial Hospital,8980250,methylergonovine 0.2 mg tablet,69238160502,,250,$243.45 ,$243.45 ,$186.00 ,$219.11 ,$206.93 ,$206.93 ,$206.93 ,$214.24 ,$206.93 ,$214.24 ,$214.24 ,$211.80 ,$206.93 ,$206.93 ,$206.93 ,$186.00 ,$219.11
Carle Richland Memorial Hospital,8980250,methylphenidate 5 mg tablet,68084080511,,250,$13.97 ,$13.97 ,$10.67 ,$12.57 ,$11.87 ,$11.87 ,$11.87 ,$12.29 ,$11.87 ,$12.29 ,$12.29 ,$12.15 ,$11.87 ,$11.87 ,$11.87 ,$10.67 ,$12.57
Carle Richland Memorial Hospital,8980250,methylphenidate 5 mg tablet,68084080521,,250,$13.97 ,$13.97 ,$10.67 ,$12.57 ,$11.87 ,$11.87 ,$11.87 ,$12.29 ,$11.87 ,$12.29 ,$12.29 ,$12.15 ,$11.87 ,$11.87 ,$11.87 ,$10.67 ,$12.57
Carle Richland Memorial Hospital,8980250,metoclopramide 5 mg/5 mL oral solution,121157610,,250,$19.97 ,$19.97 ,$15.26 ,$17.97 ,$16.97 ,$16.97 ,$16.97 ,$17.57 ,$16.97 ,$17.57 ,$17.57 ,$17.37 ,$16.97 ,$16.97 ,$16.97 ,$15.26 ,$17.97
Carle Richland Memorial Hospital,8980250,acetaminophen 325 mg rectal suppository,51672211602,,250,$1.12 ,$1.12 ,$0.86 ,$1.01 ,$0.95 ,$0.95 ,$0.95 ,$0.99 ,$0.95 ,$0.99 ,$0.99 ,$0.97 ,$0.95 ,$0.95 ,$0.95 ,$0.86 ,$1.01
Carle Richland Memorial Hospital,8980250,acetaminophen 325 mg tablet,50580060002,J3490,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,acetaminophen 325 mg/10.15 mL oral solution,121131400,,250,$3.06 ,$3.06 ,$2.34 ,$2.75 ,$2.60 ,$2.60 ,$2.60 ,$2.69 ,$2.60 ,$2.69 ,$2.69 ,$2.66 ,$2.60 ,$2.60 ,$2.60 ,$2.34 ,$2.75
Carle Richland Memorial Hospital,8980250,acetaminophen 325 mg/10.15 mL oral solution,121131411,,250,$3.06 ,$3.06 ,$2.34 ,$2.75 ,$2.60 ,$2.60 ,$2.60 ,$2.69 ,$2.60 ,$2.69 ,$2.69 ,$2.66 ,$2.60 ,$2.60 ,$2.60 ,$2.34 ,$2.75
Carle Richland Memorial Hospital,8980250,acetaminophen 325 mg/10.15 mL oral suspension,68094058862,,250,$1.53 ,$1.53 ,$1.17 ,$1.38 ,$1.30 ,$1.30 ,$1.30 ,$1.35 ,$1.30 ,$1.35 ,$1.35 ,$1.33 ,$1.30 ,$1.30 ,$1.30 ,$1.17 ,$1.38
Carle Richland Memorial Hospital,8980250,acetaminophen 500 mg tablet,50580041202,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,acetaminophen 650 mg rectal suppository,45802073032,,250,$0.83 ,$0.83 ,$0.63 ,$0.75 ,$0.71 ,$0.71 ,$0.71 ,$0.73 ,$0.71 ,$0.73 ,$0.73 ,$0.72 ,$0.71 ,$0.71 ,$0.71 ,$0.63 ,$0.75
Carle Richland Memorial Hospital,8980250,acetaminophen 650 mg/20.3 mL oral solution,66689005601,,250,$3.98 ,$3.98 ,$3.04 ,$3.58 ,$3.38 ,$3.38 ,$3.38 ,$3.50 ,$3.38 ,$3.50 ,$3.50 ,$3.46 ,$3.38 ,$3.38 ,$3.38 ,$3.04 ,$3.58
Carle Richland Memorial Hospital,8980250,acetaminophen 650 mg/20.3 mL oral solution,66689005699,,250,$3.98 ,$3.98 ,$3.04 ,$3.58 ,$3.38 ,$3.38 ,$3.38 ,$3.50 ,$3.38 ,$3.50 ,$3.50 ,$3.46 ,$3.38 ,$3.38 ,$3.38 ,$3.04 ,$3.58
Carle Richland Memorial Hospital,8980250,acetaminophen 80 mg chewable tablet,904579146,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,acetaminophen 80 mg rectal suppository,51672211402,,250,$1.12 ,$1.12 ,$0.86 ,$1.01 ,$0.95 ,$0.95 ,$0.95 ,$0.99 ,$0.95 ,$0.99 ,$0.99 ,$0.97 ,$0.95 ,$0.95 ,$0.95 ,$0.86 ,$1.01
Carle Richland Memorial Hospital,8980250,acetaZOLAMIDE 250 mg tablet,68084054101,,250,$21.85 ,$21.85 ,$16.69 ,$19.67 ,$18.57 ,$18.57 ,$18.57 ,$19.23 ,$18.57 ,$19.23 ,$19.23 ,$19.01 ,$18.57 ,$18.57 ,$18.57 ,$16.69 ,$19.67
Carle Richland Memorial Hospital,8980250,acetic acid (bulk) 3 % liquid,9999401211,,250,$26.90 ,$26.90 ,$20.55 ,$24.21 ,$22.87 ,$22.87 ,$22.87 ,$23.67 ,$22.87 ,$23.67 ,$23.67 ,$23.40 ,$22.87 ,$22.87 ,$22.87 ,$20.55 ,$24.21
Carle Richland Memorial Hospital,8980250,acetic acid (bulk) 3 % liquid,51552005106,,250,$333.19 ,$333.19 ,$254.56 ,$299.87 ,$283.21 ,$283.21 ,$283.21 ,$293.21 ,$283.21 ,$293.21 ,$293.21 ,$289.88 ,$283.21 ,$283.21 ,$283.21 ,$254.56 ,$299.87
Carle Richland Memorial Hospital,8980250,acetic acid 0.25 % irrigation solution,990614309,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,acetylcholine chloride 1 % (10 mg/mL) intraocular kit,24208053920,,250,$466.13 ,$466.13 ,$356.12 ,$419.52 ,$396.21 ,$396.21 ,$396.21 ,$410.19 ,$396.21 ,$410.19 ,$410.19 ,$405.53 ,$396.21 ,$396.21 ,$396.21 ,$356.12 ,$419.52
Carle Richland Memorial Hospital,8980250,acetylcysteine 100 mg/mL (10 %) solution,517750425,J7608,250,$48.76 ,$48.76 ,$37.25 ,$43.88 ,$41.45 ,$41.45 ,$41.45 ,$42.91 ,$41.45 ,$42.91 ,$42.91 ,$42.42 ,$41.45 ,$41.45 ,$41.45 ,$37.25 ,$43.88
Carle Richland Memorial Hospital,8980250,activated charcoaL 25 gram/120 mL oral suspension,574012104,,250,$80.06 ,$80.06 ,$61.17 ,$72.05 ,$68.05 ,$68.05 ,$68.05 ,$70.45 ,$68.05 ,$70.45 ,$70.45 ,$69.65 ,$68.05 ,$68.05 ,$68.05 ,$61.17 ,$72.05
Carle Richland Memorial Hospital,8980250,activated charcoal-sorbitoL 25 gram/120 mL oral suspension,574052074,,250,$80.06 ,$80.06 ,$61.17 ,$72.05 ,$68.05 ,$68.05 ,$68.05 ,$70.45 ,$68.05 ,$70.45 ,$70.45 ,$69.65 ,$68.05 ,$68.05 ,$68.05 ,$61.17 ,$72.05
Carle Richland Memorial Hospital,8980250,acyclovir 200 mg capsule,68084010701,,250,$8.43 ,$8.43 ,$6.44 ,$7.59 ,$7.17 ,$7.17 ,$7.17 ,$7.42 ,$7.17 ,$7.42 ,$7.42 ,$7.33 ,$7.17 ,$7.17 ,$7.17 ,$6.44 ,$7.59
Carle Richland Memorial Hospital,8980250,albuterol sulfate 2 mg/5 mL oral syrup,472082516,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,albuterol sulfate HFA 90 mcg/actuation aerosol inhaler,173068224,,250,$144.33 ,$144.33 ,$110.27 ,$129.90 ,$122.68 ,$122.68 ,$122.68 ,$127.01 ,$122.68 ,$127.01 ,$127.01 ,$125.57 ,$122.68 ,$122.68 ,$122.68 ,$110.27 ,$129.90
Carle Richland Memorial Hospital,8980250,albuterol sulfate HFA 90 mcg/actuation aerosol inhaler,66993001968,,250,$311.95 ,$311.95 ,$238.33 ,$280.76 ,$265.16 ,$265.16 ,$265.16 ,$274.52 ,$265.16 ,$274.52 ,$274.52 ,$271.40 ,$265.16 ,$265.16 ,$265.16 ,$238.33 ,$280.76
Carle Richland Memorial Hospital,8980250,albuterol sulfate HFA 90 mcg/actuation aerosol inhaler,85113204,,250,$466.85 ,$466.85 ,$356.67 ,$420.17 ,$396.82 ,$396.82 ,$396.82 ,$410.83 ,$396.82 ,$410.83 ,$410.83 ,$406.16 ,$396.82 ,$396.82 ,$396.82 ,$356.67 ,$420.17
Carle Richland Memorial Hospital,8980250,allopurinoL 100 mg tablet,904657161,,250,$4.18 ,$4.18 ,$3.19 ,$3.76 ,$3.55 ,$3.55 ,$3.55 ,$3.68 ,$3.55 ,$3.68 ,$3.68 ,$3.64 ,$3.55 ,$3.55 ,$3.55 ,$3.19 ,$3.76
Carle Richland Memorial Hospital,8980250,ALPRAZolam 0.25 mg tablet,228202710,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,ALPRAZolam 1 mg tablet,51079079020,,250,$9.39 ,$9.39 ,$7.17 ,$8.45 ,$7.98 ,$7.98 ,$7.98 ,$8.26 ,$7.98 ,$8.26 ,$8.26 ,$8.17 ,$7.98 ,$7.98 ,$7.98 ,$7.17 ,$8.45
Carle Richland Memorial Hospital,8980250,aluminum chloride (bulk) powder,62991284001,,250,$533.12 ,$533.12 ,$407.30 ,$479.81 ,$453.15 ,$453.15 ,$453.15 ,$469.15 ,$453.15 ,$469.15 ,$469.15 ,$463.81 ,$453.15 ,$453.15 ,$453.15 ,$407.30 ,$479.81
Carle Richland Memorial Hospital,8980250,aluminum-mag hydroxide-simethicone 200 mg-200 mg-20 mg/5 mL oral susp,121176130,,250,$5.29 ,$5.29 ,$4.04 ,$4.76 ,$4.50 ,$4.50 ,$4.50 ,$4.66 ,$4.50 ,$4.66 ,$4.66 ,$4.60 ,$4.50 ,$4.50 ,$4.50 ,$4.04 ,$4.76
Carle Richland Memorial Hospital,8980250,amantadine HCL 100 mg capsule,832101500,,250,$11.74 ,$11.74 ,$8.97 ,$10.57 ,$9.98 ,$9.98 ,$9.98 ,$10.33 ,$9.98 ,$10.33 ,$10.33 ,$10.21 ,$9.98 ,$9.98 ,$9.98 ,$8.97 ,$10.57
Carle Richland Memorial Hospital,8980250,aMILoride 5 mg tablet,574029201,,250,$3.57 ,$3.57 ,$2.73 ,$3.21 ,$3.03 ,$3.03 ,$3.03 ,$3.14 ,$3.03 ,$3.14 ,$3.14 ,$3.11 ,$3.03 ,$3.03 ,$3.03 ,$2.73 ,$3.21
Carle Richland Memorial Hospital,8980250,amino acid 2.36 % in 6.8 % dextrose-fats 3.5 %-electrolyte IV emulsion,63323071419,,250,$303.14 ,$303.14 ,$231.60 ,$272.83 ,$257.67 ,$257.67 ,$257.67 ,$266.76 ,$257.67 ,$266.76 ,$266.76 ,$263.73 ,$257.67 ,$257.67 ,$257.67 ,$231.60 ,$272.83
Carle Richland Memorial Hospital,8980250,amino acid 2.36 % in 6.8 % dextrose-fats 3.5 %-electrolyte IV emulsion,63323071414,,250,$521.04 ,$521.04 ,$398.07 ,$468.94 ,$442.88 ,$442.88 ,$442.88 ,$458.52 ,$442.88 ,$458.52 ,$458.52 ,$453.30 ,$442.88 ,$442.88 ,$442.88 ,$398.07 ,$468.94
Carle Richland Memorial Hospital,8980250,amiodarone 200 mg tablet,65862073260,,250,$18.09 ,$18.09 ,$13.82 ,$16.28 ,$15.38 ,$15.38 ,$15.38 ,$15.92 ,$15.38 ,$15.92 ,$15.92 ,$15.74 ,$15.38 ,$15.38 ,$15.38 ,$13.82 ,$16.28
Carle Richland Memorial Hospital,8980250,amitriptyline 10 mg tablet,51079013101,,250,$3.81 ,$3.81 ,$2.91 ,$3.43 ,$3.24 ,$3.24 ,$3.24 ,$3.35 ,$3.24 ,$3.35 ,$3.35 ,$3.31 ,$3.24 ,$3.24 ,$3.24 ,$2.91 ,$3.43
Carle Richland Memorial Hospital,8980250,amitriptyline 10 mg tablet,51079013120,,250,$3.81 ,$3.81 ,$2.91 ,$3.43 ,$3.24 ,$3.24 ,$3.24 ,$3.35 ,$3.24 ,$3.35 ,$3.35 ,$3.31 ,$3.24 ,$3.24 ,$3.24 ,$2.91 ,$3.43
Carle Richland Memorial Hospital,8980250,amitriptyline 25 mg tablet,60687043301,,250,$4.73 ,$4.73 ,$3.61 ,$4.26 ,$4.02 ,$4.02 ,$4.02 ,$4.16 ,$4.02 ,$4.16 ,$4.16 ,$4.12 ,$4.02 ,$4.02 ,$4.02 ,$3.61 ,$4.26
Carle Richland Memorial Hospital,8980250,amLODIPine 5 mg tablet,904637061,,250,$9.99 ,$9.99 ,$7.63 ,$8.99 ,$8.49 ,$8.49 ,$8.49 ,$8.79 ,$8.49 ,$8.79 ,$8.79 ,$8.69 ,$8.49 ,$8.49 ,$8.49 ,$7.63 ,$8.99
Carle Richland Memorial Hospital,8980250,ammonia aromatic 15 % (w/v) solution for inhalation,39822990002,J3490,250,$0.77 ,$0.77 ,$0.59 ,$0.69 ,$0.65 ,$0.65 ,$0.65 ,$0.68 ,$0.65 ,$0.68 ,$0.68 ,$0.67 ,$0.65 ,$0.65 ,$0.65 ,$0.59 ,$0.69
Carle Richland Memorial Hospital,8980250,amoxicillin 125 mg/5 mL oral suspension,143988815,,250,$27.07 ,$27.07 ,$20.68 ,$24.36 ,$23.01 ,$23.01 ,$23.01 ,$23.82 ,$23.01 ,$23.82 ,$23.82 ,$23.55 ,$23.01 ,$23.01 ,$23.01 ,$20.68 ,$24.36
Carle Richland Memorial Hospital,8980250,amoxicillin 250 mg capsule,781202001,,250,$3.49 ,$3.49 ,$2.67 ,$3.14 ,$2.97 ,$2.97 ,$2.97 ,$3.07 ,$2.97 ,$3.07 ,$3.07 ,$3.04 ,$2.97 ,$2.97 ,$2.97 ,$2.67 ,$3.14
Carle Richland Memorial Hospital,8980250,amoxicillin 400 mg/5 mL oral suspension,143988750,,250,$9.84 ,$9.84 ,$7.52 ,$8.86 ,$8.36 ,$8.36 ,$8.36 ,$8.66 ,$8.36 ,$8.66 ,$8.66 ,$8.56 ,$8.36 ,$8.36 ,$8.36 ,$7.52 ,$8.86
Carle Richland Memorial Hospital,8980250,amoxicillin 500 mg-potassium clavulanate 125 mg tablet,65862050220,,250,$19.97 ,$19.97 ,$15.26 ,$17.97 ,$16.97 ,$16.97 ,$16.97 ,$17.57 ,$16.97 ,$17.57 ,$17.57 ,$17.37 ,$16.97 ,$16.97 ,$16.97 ,$15.26 ,$17.97
Carle Richland Memorial Hospital,8980250,amoxicillin 600 mg-potassium clavulanate 42.9 mg/5 mL oral suspension,781613957,,250,$27.10 ,$27.10 ,$20.70 ,$24.39 ,$23.04 ,$23.04 ,$23.04 ,$23.85 ,$23.04 ,$23.85 ,$23.85 ,$23.58 ,$23.04 ,$23.04 ,$23.04 ,$20.70 ,$24.39
Carle Richland Memorial Hospital,8980250,amoxicillin 875 mg-potassium clavulanate 125 mg tablet,65862050320,,250,$25.83 ,$25.83 ,$19.73 ,$23.25 ,$21.96 ,$21.96 ,$21.96 ,$22.73 ,$21.96 ,$22.73 ,$22.73 ,$22.47 ,$21.96 ,$21.96 ,$21.96 ,$19.73 ,$23.25
Carle Richland Memorial Hospital,8980250,arginine 7 gram-glutam 7 gram-CaHMB 1.5 gram-colla-mv-min oral pwd pkt,59781066687,,250,$20.00 ,$20.00 ,$15.28 ,$18.00 ,$17.00 ,$17.00 ,$17.00 ,$17.60 ,$17.00 ,$17.60 ,$17.60 ,$17.40 ,$17.00 ,$17.00 ,$17.00 ,$15.28 ,$18.00
Carle Richland Memorial Hospital,8980250,arginine 7 gram-glutam 7 gram-CaHMB 1.5 gram-colla-mv-min oral pwd pkt,59781066688,,250,$20.00 ,$20.00 ,$15.28 ,$18.00 ,$17.00 ,$17.00 ,$17.00 ,$17.60 ,$17.00 ,$17.60 ,$17.60 ,$17.40 ,$17.00 ,$17.00 ,$17.00 ,$15.28 ,$18.00
Carle Richland Memorial Hospital,8980250,ARIPiprazole 2 mg tablet,67877043003,,250,$120.17 ,$120.17 ,$91.81 ,$108.15 ,$102.14 ,$102.14 ,$102.14 ,$105.75 ,$102.14 ,$105.75 ,$105.75 ,$104.55 ,$102.14 ,$102.14 ,$102.14 ,$91.81 ,$108.15
Carle Richland Memorial Hospital,8980250,artificial tears(dextran-hypromel-glycern) 0.1 %-0.3 %-0.2 % eye drops,65042636,,250,$45.40 ,$45.40 ,$34.69 ,$40.86 ,$38.59 ,$38.59 ,$38.59 ,$39.95 ,$38.59 ,$39.95 ,$39.95 ,$39.50 ,$38.59 ,$38.59 ,$38.59 ,$34.69 ,$40.86
Carle Richland Memorial Hospital,8980250,ascorbic acid (vitamin C) 500 mg tablet,904052361,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,aspirin 300 mg rectal suppository,574703412,,250,$2.04 ,$2.04 ,$1.56 ,$1.84 ,$1.73 ,$1.73 ,$1.73 ,$1.80 ,$1.73 ,$1.80 ,$1.80 ,$1.77 ,$1.73 ,$1.73 ,$1.73 ,$1.56 ,$1.84
Carle Richland Memorial Hospital,8980250,aspirin 325 mg tablet,66553000101,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,aspirin 81 mg chewable tablet,66553000201,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"aspirin 81 mg tablet,delayed release",46122061576,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,atenoloL 25 mg tablet,51079075901,,250,$6.06 ,$6.06 ,$4.63 ,$5.45 ,$5.15 ,$5.15 ,$5.15 ,$5.33 ,$5.15 ,$5.33 ,$5.33 ,$5.27 ,$5.15 ,$5.15 ,$5.15 ,$4.63 ,$5.45
Carle Richland Memorial Hospital,8980250,atenoloL 25 mg tablet,51079075920,,250,$6.06 ,$6.06 ,$4.63 ,$5.45 ,$5.15 ,$5.15 ,$5.15 ,$5.33 ,$5.15 ,$5.33 ,$5.33 ,$5.27 ,$5.15 ,$5.15 ,$5.15 ,$4.63 ,$5.45
Carle Richland Memorial Hospital,8980250,atorvastatin 10 mg tablet,68084009701,,250,$5.27 ,$5.27 ,$4.03 ,$4.74 ,$4.48 ,$4.48 ,$4.48 ,$4.64 ,$4.48 ,$4.64 ,$4.64 ,$4.58 ,$4.48 ,$4.48 ,$4.48 ,$4.03 ,$4.74
Carle Richland Memorial Hospital,8980250,atorvastatin 40 mg tablet,68084009911,,250,$6.32 ,$6.32 ,$4.83 ,$5.69 ,$5.37 ,$5.37 ,$5.37 ,$5.56 ,$5.37 ,$5.56 ,$5.56 ,$5.50 ,$5.37 ,$5.37 ,$5.37 ,$4.83 ,$5.69
Carle Richland Memorial Hospital,8980250,atorvastatin 80 mg tablet,68084059095,,250,$11.47 ,$11.47 ,$8.76 ,$10.32 ,$9.75 ,$9.75 ,$9.75 ,$10.09 ,$9.75 ,$10.09 ,$10.09 ,$9.98 ,$9.75 ,$9.75 ,$9.75 ,$8.76 ,$10.32
Carle Richland Memorial Hospital,8980250,atovaquone 750 mg/5 mL oral suspension,31722062921,,250,$225.50 ,$225.50 ,$172.28 ,$202.95 ,$191.68 ,$191.68 ,$191.68 ,$198.44 ,$191.68 ,$198.44 ,$198.44 ,$196.19 ,$191.68 ,$191.68 ,$191.68 ,$172.28 ,$202.95
Carle Richland Memorial Hospital,8980250,atropine 1 % eye drops,17478021502,,250,$244.00 ,$244.00 ,$186.42 ,$219.60 ,$207.40 ,$207.40 ,$207.40 ,$214.72 ,$207.40 ,$214.72 ,$214.72 ,$212.28 ,$207.40 ,$207.40 ,$207.40 ,$186.42 ,$219.60
Carle Richland Memorial Hospital,8980250,atropine 1 % eye drops,65030355,,250,$291.30 ,$291.30 ,$222.55 ,$262.17 ,$247.61 ,$247.61 ,$247.61 ,$256.34 ,$247.61 ,$256.34 ,$256.34 ,$253.43 ,$247.61 ,$247.61 ,$247.61 ,$222.55 ,$262.17
Carle Richland Memorial Hospital,8980250,atropine 1 % eye ointment,24208082555,,250,$106.65 ,$106.65 ,$81.48 ,$95.99 ,$90.65 ,$90.65 ,$90.65 ,$93.85 ,$90.65 ,$93.85 ,$93.85 ,$92.79 ,$90.65 ,$90.65 ,$90.65 ,$81.48 ,$95.99
Carle Richland Memorial Hospital,8980250,azelastine 137 mcg (0.1 %) nasal spray aerosol,65162067684,,250,$699.28 ,$699.28 ,$534.25 ,$629.35 ,$594.39 ,$594.39 ,$594.39 ,$615.37 ,$594.39 ,$615.37 ,$615.37 ,$608.37 ,$594.39 ,$594.39 ,$594.39 ,$534.25 ,$629.35
Carle Richland Memorial Hospital,8980250,azithromycin 200 mg/5 mL oral suspension,42806014932,,250,$61.12 ,$61.12 ,$46.70 ,$55.01 ,$51.95 ,$51.95 ,$51.95 ,$53.79 ,$51.95 ,$53.79 ,$53.79 ,$53.17 ,$51.95 ,$51.95 ,$51.95 ,$46.70 ,$55.01
Carle Richland Memorial Hospital,8980250,azithromycin 250 mg tablet,50268009811,,250,$34.02 ,$34.02 ,$25.99 ,$30.62 ,$28.92 ,$28.92 ,$28.92 ,$29.94 ,$28.92 ,$29.94 ,$29.94 ,$29.60 ,$28.92 ,$28.92 ,$28.92 ,$25.99 ,$30.62
Carle Richland Memorial Hospital,8980250,azithromycin 250 mg tablet,50268009815,,250,$34.02 ,$34.02 ,$25.99 ,$30.62 ,$28.92 ,$28.92 ,$28.92 ,$29.94 ,$28.92 ,$29.94 ,$29.94 ,$29.60 ,$28.92 ,$28.92 ,$28.92 ,$25.99 ,$30.62
Carle Richland Memorial Hospital,8980250,azithromycin 500 mg tablet,51224012230,,250,$62.63 ,$62.63 ,$47.85 ,$56.37 ,$53.24 ,$53.24 ,$53.24 ,$55.11 ,$53.24 ,$55.11 ,$55.11 ,$54.49 ,$53.24 ,$53.24 ,$53.24 ,$47.85 ,$56.37
Carle Richland Memorial Hospital,8980250,aztreonam 1 gram solution for injection,63323040124,,250,$216.79 ,$216.79 ,$165.63 ,$195.11 ,$184.27 ,$184.27 ,$184.27 ,$190.78 ,$184.27 ,$190.78 ,$190.78 ,$188.61 ,$184.27 ,$184.27 ,$184.27 ,$165.63 ,$195.11
Carle Richland Memorial Hospital,8980250,aztreonam 2 gram solution for injection,63323040224,,250,$369.51 ,$369.51 ,$282.31 ,$332.56 ,$314.08 ,$314.08 ,$314.08 ,$325.17 ,$314.08 ,$325.17 ,$325.17 ,$321.47 ,$314.08 ,$314.08 ,$314.08 ,$282.31 ,$332.56
Carle Richland Memorial Hospital,8980250,"bacitracin 50,000 unit intramuscular solution",9024110,,250,$112.40 ,$112.40 ,$85.87 ,$101.16 ,$95.54 ,$95.54 ,$95.54 ,$98.91 ,$95.54 ,$98.91 ,$98.91 ,$97.79 ,$95.54 ,$95.54 ,$95.54 ,$85.87 ,$101.16
Carle Richland Memorial Hospital,8980250,"bacitracin 50,000 unit intramuscular solution",9024101,,250,$112.82 ,$112.82 ,$86.19 ,$101.54 ,$95.90 ,$95.90 ,$95.90 ,$99.28 ,$95.90 ,$99.28 ,$99.28 ,$98.15 ,$95.90 ,$95.90 ,$95.90 ,$86.19 ,$101.54
Carle Richland Memorial Hospital,8980250,"bacitracin 500 unit/gram topical ointment,bacitracin zinc 500 unit/gram topical ointment",51672207501,,250,$23.97 ,$23.97 ,$18.31 ,$21.57 ,$20.37 ,$20.37 ,$20.37 ,$21.09 ,$20.37 ,$21.09 ,$21.09 ,$20.85 ,$20.37 ,$20.37 ,$20.37 ,$18.31 ,$21.57
Carle Richland Memorial Hospital,8980250,"bacitracin 500 unit/gram topical ointment,bacitracin zinc 500 unit/gram topical ointment",713028031,J3490,250,$22.72 ,$22.72 ,$17.36 ,$20.45 ,$19.31 ,$19.31 ,$19.31 ,$19.99 ,$19.31 ,$19.99 ,$19.99 ,$19.77 ,$19.31 ,$19.31 ,$19.31 ,$17.36 ,$20.45
Carle Richland Memorial Hospital,8980250,"bacitracin zinc 500 unit/gram topical packet,bacitracin 500 unit/gram topical packet",54162001709,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"bacitracin-polymyxin B 500 unit-10,000 unit/gram eye ointment",17478023835,,250,$125.76 ,$125.76 ,$96.08 ,$113.18 ,$106.90 ,$106.90 ,$106.90 ,$110.67 ,$106.90 ,$110.67 ,$110.67 ,$109.41 ,$106.90 ,$106.90 ,$106.90 ,$96.08 ,$113.18
Carle Richland Memorial Hospital,8980250,"bacitracin-polymyxin B 500 unit-10,000 unit/gram topical ointment,bacitracin zinc 500 unit-polymyxin B 10,000 unit/gram topical ointment",51672204402,,250,$39.25 ,$39.25 ,$29.99 ,$35.33 ,$33.36 ,$33.36 ,$33.36 ,$34.54 ,$33.36 ,$34.54 ,$34.54 ,$34.15 ,$33.36 ,$33.36 ,$33.36 ,$29.99 ,$35.33
Carle Richland Memorial Hospital,8980250,"bacitracin-polymyxin B 500 unit-10,000 unit/gram topical ointment,bacitracin zinc 500 unit-polymyxin B 10,000 unit/gram topical ointment",810079887,,250,$48.01 ,$48.01 ,$36.68 ,$43.21 ,$40.81 ,$40.81 ,$40.81 ,$42.25 ,$40.81 ,$42.25 ,$42.25 ,$41.77 ,$40.81 ,$40.81 ,$40.81 ,$36.68 ,$43.21
Carle Richland Memorial Hospital,8980250,"bacitracin-polymyxin B 500 unit-10,000 unit/gram topical packet",12547023813,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,baclofen 10 mg tablet,68084085501,,250,$5.77 ,$5.77 ,$4.41 ,$5.19 ,$4.90 ,$4.90 ,$4.90 ,$5.08 ,$4.90 ,$5.08 ,$5.08 ,$5.02 ,$4.90 ,$4.90 ,$4.90 ,$4.41 ,$5.19
Carle Richland Memorial Hospital,8980250,baclofen 10 mg tablet,68084085511,,250,$5.77 ,$5.77 ,$4.41 ,$5.19 ,$4.90 ,$4.90 ,$4.90 ,$5.08 ,$4.90 ,$5.08 ,$5.08 ,$5.02 ,$4.90 ,$4.90 ,$4.90 ,$4.41 ,$5.19
Carle Richland Memorial Hospital,8980250,balanced salt solution combination no.2 intraocular irrigation,65079515,,250,$74.82 ,$74.82 ,$57.16 ,$67.34 ,$63.60 ,$63.60 ,$63.60 ,$65.84 ,$63.60 ,$65.84 ,$65.84 ,$65.09 ,$63.60 ,$63.60 ,$63.60 ,$57.16 ,$67.34
Carle Richland Memorial Hospital,8980250,balanced salt solution non-surgical no.3 eye wash,65053001,J3490,250,$126.38 ,$126.38 ,$96.55 ,$113.74 ,$107.42 ,$107.42 ,$107.42 ,$111.21 ,$107.42 ,$111.21 ,$111.21 ,$109.95 ,$107.42 ,$107.42 ,$107.42 ,$96.55 ,$113.74
Carle Richland Memorial Hospital,8980250,balanced salt solution non-surgical no.3 eye wash,65053004,J3490,250,$182.02 ,$182.02 ,$139.06 ,$163.82 ,$154.72 ,$154.72 ,$154.72 ,$160.18 ,$154.72 ,$160.18 ,$160.18 ,$158.36 ,$154.72 ,$154.72 ,$154.72 ,$139.06 ,$163.82
Carle Richland Memorial Hospital,8980250,baricitinib 2 mg tablet,2418230,,250,$341.13 ,$341.13 ,$260.62 ,$307.02 ,$289.96 ,$289.96 ,$289.96 ,$300.19 ,$289.96 ,$300.19 ,$300.19 ,$296.78 ,$289.96 ,$289.96 ,$289.96 ,$260.62 ,$307.02
Carle Richland Memorial Hospital,8980250,belladonna alkaloids-opium 16.2 mg-60 mg rectal suppository,574704001,,250,$127.58 ,$127.58 ,$97.47 ,$114.82 ,$108.44 ,$108.44 ,$108.44 ,$112.27 ,$108.44 ,$112.27 ,$112.27 ,$110.99 ,$108.44 ,$108.44 ,$108.44 ,$97.47 ,$114.82
Carle Richland Memorial Hospital,8980250,belladonna alkaloids-opium 16.2 mg-60 mg rectal suppository,574704012,,250,$127.58 ,$127.58 ,$97.47 ,$114.82 ,$108.44 ,$108.44 ,$108.44 ,$112.27 ,$108.44 ,$112.27 ,$112.27 ,$110.99 ,$108.44 ,$108.44 ,$108.44 ,$97.47 ,$114.82
Carle Richland Memorial Hospital,8980250,benazepriL 10 mg tablet,43547033610,,250,$7.22 ,$7.22 ,$5.52 ,$6.50 ,$6.14 ,$6.14 ,$6.14 ,$6.35 ,$6.14 ,$6.35 ,$6.35 ,$6.28 ,$6.14 ,$6.14 ,$6.14 ,$5.52 ,$6.50
Carle Richland Memorial Hospital,8980250,benazepriL 20 mg tablet,43547033710,,250,$7.22 ,$7.22 ,$5.52 ,$6.50 ,$6.14 ,$6.14 ,$6.14 ,$6.35 ,$6.14 ,$6.35 ,$6.35 ,$6.28 ,$6.14 ,$6.14 ,$6.14 ,$5.52 ,$6.50
Carle Richland Memorial Hospital,8980250,benzocaine 15 mg-menthoL 2.6 mg lozenges,63824073216,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,benzocaine 20 % mucosal aerosol spray,283067960,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,benzocaine 20 % oral mucosal liquid,573021541,,250,$35.49 ,$35.49 ,$27.11 ,$31.94 ,$30.17 ,$30.17 ,$30.17 ,$31.23 ,$30.17 ,$31.23 ,$31.23 ,$30.88 ,$30.17 ,$30.17 ,$30.17 ,$27.11 ,$31.94
Carle Richland Memorial Hospital,8980250,benzocaine 20 % topical ointment,63736003751,,250,$28.92 ,$28.92 ,$22.09 ,$26.03 ,$24.58 ,$24.58 ,$24.58 ,$25.45 ,$24.58 ,$25.45 ,$25.45 ,$25.16 ,$24.58 ,$24.58 ,$24.58 ,$22.09 ,$26.03
Carle Richland Memorial Hospital,8980250,benzocaine 20 %-menthoL 0.5 % topical aerosol,16864068002,,250,$33.16 ,$33.16 ,$25.33 ,$29.84 ,$28.19 ,$28.19 ,$28.19 ,$29.18 ,$28.19 ,$29.18 ,$29.18 ,$28.85 ,$28.19 ,$28.19 ,$28.19 ,$25.33 ,$29.84
Carle Richland Memorial Hospital,8980250,benzoin-aloe vera-storax-tolu balsam 10 %-2 %-8 %-4 % topical tincture,395024392,,250,$61.47 ,$61.47 ,$46.96 ,$55.32 ,$52.25 ,$52.25 ,$52.25 ,$54.09 ,$52.25 ,$54.09 ,$54.09 ,$53.48 ,$52.25 ,$52.25 ,$52.25 ,$46.96 ,$55.32
Carle Richland Memorial Hospital,8980250,benzonatate 100 mg capsule,60687034601,,250,$5.73 ,$5.73 ,$4.38 ,$5.16 ,$4.87 ,$4.87 ,$4.87 ,$5.04 ,$4.87 ,$5.04 ,$5.04 ,$4.99 ,$4.87 ,$4.87 ,$4.87 ,$4.38 ,$5.16
Carle Richland Memorial Hospital,8980250,benzonatate 100 mg capsule,60687034611,,250,$5.73 ,$5.73 ,$4.38 ,$5.16 ,$4.87 ,$4.87 ,$4.87 ,$5.04 ,$4.87 ,$5.04 ,$5.04 ,$4.99 ,$4.87 ,$4.87 ,$4.87 ,$4.38 ,$5.16
Carle Richland Memorial Hospital,8980250,benztropine 0.5 mg tablet,60687035601,,250,$5.07 ,$5.07 ,$3.87 ,$4.56 ,$4.31 ,$4.31 ,$4.31 ,$4.46 ,$4.31 ,$4.46 ,$4.46 ,$4.41 ,$4.31 ,$4.31 ,$4.31 ,$3.87 ,$4.56
Carle Richland Memorial Hospital,8980250,beractant 25 mg/mL in 0.9 % sodium chloride intratracheal suspension,74104008,,250,"$2,855.27 ","$2,855.27 ","$2,181.43 ","$2,569.74 ","$2,426.98 ","$2,426.98 ","$2,426.98 ","$2,512.64 ","$2,426.98 ","$2,512.64 ","$2,512.64 ","$2,484.08 ","$2,426.98 ","$2,426.98 ","$2,426.98 ","$2,181.43 ","$2,569.74 "
Carle Richland Memorial Hospital,8980250,bisacodyL 10 mg rectal suppository,574705012,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"bisacodyL 5 mg tablet,delayed release",904640761,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,bismuth subsalicylate 262 mg chewable tablet,904131546,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,bismuth subsalicylate 262 mg/15 mL oral suspension,17856131303,,250,$2.23 ,$2.23 ,$1.70 ,$2.01 ,$1.90 ,$1.90 ,$1.90 ,$1.96 ,$1.90 ,$1.96 ,$1.96 ,$1.94 ,$1.90 ,$1.90 ,$1.90 ,$1.70 ,$2.01
Carle Richland Memorial Hospital,8980250,bismuth subsalicylate 262 mg/15 mL oral suspension,24385030226,,250,$24.10 ,$24.10 ,$18.41 ,$21.69 ,$20.49 ,$20.49 ,$20.49 ,$21.21 ,$20.49 ,$21.21 ,$21.21 ,$20.97 ,$20.49 ,$20.49 ,$20.49 ,$18.41 ,$21.69
Carle Richland Memorial Hospital,8980250,bismuth subsalicylate 262 mg/15 mL oral suspension,87701041163,J3490,250,$17.92 ,$17.92 ,$13.69 ,$16.13 ,$15.23 ,$15.23 ,$15.23 ,$15.77 ,$15.23 ,$15.77 ,$15.77 ,$15.59 ,$15.23 ,$15.23 ,$15.23 ,$13.69 ,$16.13
Carle Richland Memorial Hospital,8980250,brimonidine 0.2 % eye drops,24208041105,,250,$105.46 ,$105.46 ,$80.57 ,$94.91 ,$89.64 ,$89.64 ,$89.64 ,$92.80 ,$89.64 ,$92.80 ,$92.80 ,$91.75 ,$89.64 ,$89.64 ,$89.64 ,$80.57 ,$94.91
Carle Richland Memorial Hospital,8980250,budesonide 180 mcg/actuation breath activated powder inhaler,186091612,,250,"$1,457.51 ","$1,457.51 ","$1,113.54 ","$1,311.76 ","$1,238.88 ","$1,238.88 ","$1,238.88 ","$1,282.61 ","$1,238.88 ","$1,282.61 ","$1,282.61 ","$1,268.03 ","$1,238.88 ","$1,238.88 ","$1,238.88 ","$1,113.54 ","$1,311.76 "
Carle Richland Memorial Hospital,8980250,bumetanide 0.25 mg/mL injection solution,409141204,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bumetanide 0.25 mg/mL injection solution,409141210,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bupivacaine (PF) 0.25 % (2.5 mg/mL) injection solution,409155930,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bupivacaine (PF) 0.25 % (2.5 mg/mL) injection solution,55150016710,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bupivacaine (PF) 0.5 % (5 mg/mL) injection solution,409116218,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bupivacaine (PF) 0.5 % (5 mg/mL) injection solution,409156029,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bupivacaine (PF) 0.75 % (7.5 mg/mL) in 8.25 % dextrose injection,409361301,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bupivacaine (PF) 0.75 % (7.5 mg/mL) injection solution,63323047217,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,bupivacaine HCl 0.25 % (2.5 mg/mL) injection solution,63323046557,,250,$73.53 ,$73.53 ,$56.18 ,$66.18 ,$62.50 ,$62.50 ,$62.50 ,$64.71 ,$62.50 ,$64.71 ,$64.71 ,$63.97 ,$62.50 ,$62.50 ,$62.50 ,$56.18 ,$66.18
Carle Richland Memorial Hospital,8980250,bupivacaine HCl 0.5 % (5 mg/mL) injection solution,55150025050,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"bupivacaine-epinephrine (PF) 0.25 %-1:200,000 injection solution",409904201,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"bupivacaine-epinephrine (PF) 0.25 %-1:200,000 injection solution",409174630,,250,$69.75 ,$69.75 ,$53.29 ,$62.78 ,$59.29 ,$59.29 ,$59.29 ,$61.38 ,$59.29 ,$61.38 ,$61.38 ,$60.68 ,$59.29 ,$59.29 ,$59.29 ,$53.29 ,$62.78
Carle Richland Memorial Hospital,8980250,"bupivacaine-epinephrine (PF) 0.5 %-1:200,000 injection solution",63323046204,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"bupivacaine-epinephrine (PF) 0.5 %-1:200,000 injection solution",63323046217,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"bupivacaine-epinephrine (PF) 0.5 %-1:200,000 injection solution",63323046231,,250,$61.02 ,$61.02 ,$46.62 ,$54.92 ,$51.87 ,$51.87 ,$51.87 ,$53.70 ,$51.87 ,$53.70 ,$53.70 ,$53.09 ,$51.87 ,$51.87 ,$51.87 ,$46.62 ,$54.92
Carle Richland Memorial Hospital,8980250,buprenorphine 10 mcg/hour weekly transdermal patch,93365721,,250,$412.17 ,$412.17 ,$314.90 ,$370.95 ,$350.34 ,$350.34 ,$350.34 ,$362.71 ,$350.34 ,$362.71 ,$362.71 ,$358.59 ,$350.34 ,$350.34 ,$350.34 ,$314.90 ,$370.95
Carle Richland Memorial Hospital,8980250,buprenorphine 10 mcg/hour weekly transdermal patch,93365740,,250,$412.17 ,$412.17 ,$314.90 ,$370.95 ,$350.34 ,$350.34 ,$350.34 ,$362.71 ,$350.34 ,$362.71 ,$362.71 ,$358.59 ,$350.34 ,$350.34 ,$350.34 ,$314.90 ,$370.95
Carle Richland Memorial Hospital,8980250,buprenorphine 5 mcg/hour weekly transdermal patch,42858075040,,250,$235.99 ,$235.99 ,$180.30 ,$212.39 ,$200.59 ,$200.59 ,$200.59 ,$207.67 ,$200.59 ,$207.67 ,$207.67 ,$205.31 ,$200.59 ,$200.59 ,$200.59 ,$180.30 ,$212.39
Carle Richland Memorial Hospital,8980250,buprenorphine 7.5 mcg/hour weekly transdermal patch,59011075704,,250,$486.89 ,$486.89 ,$371.98 ,$438.20 ,$413.86 ,$413.86 ,$413.86 ,$428.46 ,$413.86 ,$428.46 ,$428.46 ,$423.59 ,$413.86 ,$413.86 ,$413.86 ,$371.98 ,$438.20
Carle Richland Memorial Hospital,8980250,buPROPion HCL 100 mg tablet,51079094401,,250,$11.48 ,$11.48 ,$8.77 ,$10.33 ,$9.76 ,$9.76 ,$9.76 ,$10.10 ,$9.76 ,$10.10 ,$10.10 ,$9.99 ,$9.76 ,$9.76 ,$9.76 ,$8.77 ,$10.33
Carle Richland Memorial Hospital,8980250,buPROPion HCL 75 mg tablet,51079094301,,250,$9.54 ,$9.54 ,$7.29 ,$8.59 ,$8.11 ,$8.11 ,$8.11 ,$8.40 ,$8.11 ,$8.40 ,$8.40 ,$8.30 ,$8.11 ,$8.11 ,$8.11 ,$7.29 ,$8.59
Carle Richland Memorial Hospital,8980250,"buPROPion HCL SR 100 mg tablet,12 hr sustained-release",185041060,,250,$10.20 ,$10.20 ,$7.79 ,$9.18 ,$8.67 ,$8.67 ,$8.67 ,$8.98 ,$8.67 ,$8.98 ,$8.98 ,$8.87 ,$8.67 ,$8.67 ,$8.67 ,$7.79 ,$9.18
Carle Richland Memorial Hospital,8980250,"buPROPion HCL XL 150 mg 24 hr tablet, extended release",60687031211,,250,$24.04 ,$24.04 ,$18.37 ,$21.64 ,$20.43 ,$20.43 ,$20.43 ,$21.16 ,$20.43 ,$21.16 ,$21.16 ,$20.91 ,$20.43 ,$20.43 ,$20.43 ,$18.37 ,$21.64
Carle Richland Memorial Hospital,8980250,busPIRone 5 mg tablet,51079098520,,250,$5.92 ,$5.92 ,$4.52 ,$5.33 ,$5.03 ,$5.03 ,$5.03 ,$5.21 ,$5.03 ,$5.21 ,$5.21 ,$5.15 ,$5.03 ,$5.03 ,$5.03 ,$4.52 ,$5.33
Carle Richland Memorial Hospital,8980250,butalbital-acetaminophen-caffeine 50 mg-325 mg-40 mg tablet,68084039611,,250,$13.75 ,$13.75 ,$10.51 ,$12.38 ,$11.69 ,$11.69 ,$11.69 ,$12.10 ,$11.69 ,$12.10 ,$12.10 ,$11.96 ,$11.69 ,$11.69 ,$11.69 ,$10.51 ,$12.38
Carle Richland Memorial Hospital,8980250,butamben-tetracaine-benzocaine 2 %-2 %-14 % (200 mg/sec) topical spray,10223020103,,250,$691.91 ,$691.91 ,$528.62 ,$622.72 ,$588.12 ,$588.12 ,$588.12 ,$608.88 ,$588.12 ,$608.88 ,$608.88 ,$601.96 ,$588.12 ,$588.12 ,$588.12 ,$528.62 ,$622.72
Carle Richland Memorial Hospital,8980250,calcitrioL 0.25 mcg capsule,64380072304,,250,$8.29 ,$8.29 ,$6.33 ,$7.46 ,$7.05 ,$7.05 ,$7.05 ,$7.30 ,$7.05 ,$7.30 ,$7.30 ,$7.21 ,$7.05 ,$7.05 ,$7.05 ,$6.33 ,$7.46
Carle Richland Memorial Hospital,8980250,calcium carbonate 200 mg calcium (500 mg) chewable tablet,66553000401,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,calcium chloride 100 mg/mL (10 %) intravenous syringe,76329330401,,250,$66.26 ,$66.26 ,$50.62 ,$59.63 ,$56.32 ,$56.32 ,$56.32 ,$58.31 ,$56.32 ,$58.31 ,$58.31 ,$57.65 ,$56.32 ,$56.32 ,$56.32 ,$50.62 ,$59.63
Carle Richland Memorial Hospital,8980250,calcium citrate 315 mg calcium-vitamin D3 6.25 mcg (250 unit) tablet,77333011310,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,camphor-eucalyptus oiL-menthoL 4.8 %-1.2 %-2.6 % topical ointment,46122015754,,250,$50.64 ,$50.64 ,$38.69 ,$45.58 ,$43.04 ,$43.04 ,$43.04 ,$44.56 ,$43.04 ,$44.56 ,$44.56 ,$44.06 ,$43.04 ,$43.04 ,$43.04 ,$38.69 ,$45.58
Carle Richland Memorial Hospital,8980250,captopriL 25 mg tablet,60687031511,,250,$10.93 ,$10.93 ,$8.35 ,$9.84 ,$9.29 ,$9.29 ,$9.29 ,$9.62 ,$9.29 ,$9.62 ,$9.62 ,$9.51 ,$9.29 ,$9.29 ,$9.29 ,$8.35 ,$9.84
Carle Richland Memorial Hospital,8980250,captopriL 25 mg tablet,60687031521,,250,$10.93 ,$10.93 ,$8.35 ,$9.84 ,$9.29 ,$9.29 ,$9.29 ,$9.62 ,$9.29 ,$9.62 ,$9.62 ,$9.51 ,$9.29 ,$9.29 ,$9.29 ,$8.35 ,$9.84
Carle Richland Memorial Hospital,8980250,carbachoL 0.01 % intraocular solution,65002315,,250,$247.09 ,$247.09 ,$188.78 ,$222.38 ,$210.03 ,$210.03 ,$210.03 ,$217.44 ,$210.03 ,$217.44 ,$217.44 ,$214.97 ,$210.03 ,$210.03 ,$210.03 ,$188.78 ,$222.38
Carle Richland Memorial Hospital,8980250,carBAMazepine 100 mg chewable tablet,51079087001,,250,$5.40 ,$5.40 ,$4.13 ,$4.86 ,$4.59 ,$4.59 ,$4.59 ,$4.75 ,$4.59 ,$4.75 ,$4.75 ,$4.70 ,$4.59 ,$4.59 ,$4.59 ,$4.13 ,$4.86
Carle Richland Memorial Hospital,8980250,carBAMazepine 200 mg tablet,68084044401,,250,$9.99 ,$9.99 ,$7.63 ,$8.99 ,$8.49 ,$8.49 ,$8.49 ,$8.79 ,$8.49 ,$8.79 ,$8.79 ,$8.69 ,$8.49 ,$8.49 ,$8.49 ,$7.63 ,$8.99
Carle Richland Memorial Hospital,8980250,"carBAMazepine ER 100 mg capsule,extend release 12 hr(mood stabilizing)",30698041912,,250,$23.93 ,$23.93 ,$18.28 ,$21.54 ,$20.34 ,$20.34 ,$20.34 ,$21.06 ,$20.34 ,$21.06 ,$21.06 ,$20.82 ,$20.34 ,$20.34 ,$20.34 ,$18.28 ,$21.54
Carle Richland Memorial Hospital,8980250,"carBAMazepine ER 100 mg capsule,extended release mphase12hr",60505280507,,250,$11.48 ,$11.48 ,$8.77 ,$10.33 ,$9.76 ,$9.76 ,$9.76 ,$10.10 ,$9.76 ,$10.10 ,$10.10 ,$9.99 ,$9.76 ,$9.76 ,$9.76 ,$8.77 ,$10.33
Carle Richland Memorial Hospital,8980250,carbamide peroxide 6.5 % ear drops,87701043152,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,carbidopa 10 mg-levodopa 100 mg tablet,6391568,,250,$8.15 ,$8.15 ,$6.23 ,$7.34 ,$6.93 ,$6.93 ,$6.93 ,$7.17 ,$6.93 ,$7.17 ,$7.17 ,$7.09 ,$6.93 ,$6.93 ,$6.93 ,$6.23 ,$7.34
Carle Richland Memorial Hospital,8980250,carbidopa 25 mg-levodopa 100 mg tablet,68084009301,,250,$6.15 ,$6.15 ,$4.70 ,$5.54 ,$5.23 ,$5.23 ,$5.23 ,$5.41 ,$5.23 ,$5.41 ,$5.41 ,$5.35 ,$5.23 ,$5.23 ,$5.23 ,$4.70 ,$5.54
Carle Richland Memorial Hospital,8980250,carbidopa 25 mg-levodopa 250 mg tablet,68084009411,,250,$6.74 ,$6.74 ,$5.15 ,$6.07 ,$5.73 ,$5.73 ,$5.73 ,$5.93 ,$5.73 ,$5.93 ,$5.93 ,$5.86 ,$5.73 ,$5.73 ,$5.73 ,$5.15 ,$6.07
Carle Richland Memorial Hospital,8980250,"carbidopa ER 25 mg-levodopa 100 mg tablet,extended release",68084028111,,250,$6.22 ,$6.22 ,$4.75 ,$5.60 ,$5.29 ,$5.29 ,$5.29 ,$5.47 ,$5.29 ,$5.47 ,$5.47 ,$5.41 ,$5.29 ,$5.29 ,$5.29 ,$4.75 ,$5.60
Carle Richland Memorial Hospital,8980250,carboprost tromethamine 250 mcg/mL intramuscular solution,43598091958,,250,"$1,461.90 ","$1,461.90 ","$1,116.89 ","$1,315.71 ","$1,242.62 ","$1,242.62 ","$1,242.62 ","$1,286.47 ","$1,242.62 ","$1,286.47 ","$1,286.47 ","$1,271.85 ","$1,242.62 ","$1,242.62 ","$1,242.62 ","$1,116.89 ","$1,315.71 "
Carle Richland Memorial Hospital,8980250,carisoprodoL 350 mg tablet,50228010901,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,carvediloL 12.5 mg tablet,68382009405,,250,$12.29 ,$12.29 ,$9.39 ,$11.06 ,$10.45 ,$10.45 ,$10.45 ,$10.82 ,$10.45 ,$10.82 ,$10.82 ,$10.69 ,$10.45 ,$10.45 ,$10.45 ,$9.39 ,$11.06
Carle Richland Memorial Hospital,8980250,carvediloL 25 mg tablet,904630361,,250,$12.12 ,$12.12 ,$9.26 ,$10.91 ,$10.30 ,$10.30 ,$10.30 ,$10.67 ,$10.30 ,$10.67 ,$10.67 ,$10.54 ,$10.30 ,$10.30 ,$10.30 ,$9.26 ,$10.91
Carle Richland Memorial Hospital,8980250,carvediloL 3.125 mg tablet,51079077101,,250,$12.27 ,$12.27 ,$9.37 ,$11.04 ,$10.43 ,$10.43 ,$10.43 ,$10.80 ,$10.43 ,$10.80 ,$10.80 ,$10.67 ,$10.43 ,$10.43 ,$10.43 ,$9.37 ,$11.04
Carle Richland Memorial Hospital,8980250,carvediloL 6.25 mg tablet,68084085401,,250,$11.41 ,$11.41 ,$8.72 ,$10.27 ,$9.70 ,$9.70 ,$9.70 ,$10.04 ,$9.70 ,$10.04 ,$10.04 ,$9.93 ,$9.70 ,$9.70 ,$9.70 ,$8.72 ,$10.27
Carle Richland Memorial Hospital,8980250,cefdinir 125 mg/5 mL oral suspension,68180072210,,250,$63.42 ,$63.42 ,$48.45 ,$57.08 ,$53.91 ,$53.91 ,$53.91 ,$55.81 ,$53.91 ,$55.81 ,$55.81 ,$55.18 ,$53.91 ,$53.91 ,$53.91 ,$48.45 ,$57.08
Carle Richland Memorial Hospital,8980250,cefdinir 300 mg capsule,68001036206,,250,$26.05 ,$26.05 ,$19.90 ,$23.45 ,$22.14 ,$22.14 ,$22.14 ,$22.92 ,$22.14 ,$22.92 ,$22.92 ,$22.66 ,$22.14 ,$22.14 ,$22.14 ,$19.90 ,$23.45
Carle Richland Memorial Hospital,8980250,cefuroxime axetil 250 mg tablet,60687027211,,250,$21.55 ,$21.55 ,$16.46 ,$19.40 ,$18.32 ,$18.32 ,$18.32 ,$18.96 ,$18.32 ,$18.96 ,$18.96 ,$18.75 ,$18.32 ,$18.32 ,$18.32 ,$16.46 ,$19.40
Carle Richland Memorial Hospital,8980250,cefuroxime axetil 250 mg tablet,60687027294,,250,$21.55 ,$21.55 ,$16.46 ,$19.40 ,$18.32 ,$18.32 ,$18.32 ,$18.96 ,$18.32 ,$18.96 ,$18.96 ,$18.75 ,$18.32 ,$18.32 ,$18.32 ,$16.46 ,$19.40
Carle Richland Memorial Hospital,8980250,celecoxib 100 mg capsule,60687043601,,250,$23.85 ,$23.85 ,$18.22 ,$21.47 ,$20.27 ,$20.27 ,$20.27 ,$20.99 ,$20.27 ,$20.99 ,$20.99 ,$20.75 ,$20.27 ,$20.27 ,$20.27 ,$18.22 ,$21.47
Carle Richland Memorial Hospital,8980250,celecoxib 100 mg capsule,59762151601,,250,$23.87 ,$23.87 ,$18.24 ,$21.48 ,$20.29 ,$20.29 ,$20.29 ,$21.01 ,$20.29 ,$21.01 ,$21.01 ,$20.77 ,$20.29 ,$20.29 ,$20.29 ,$18.24 ,$21.48
Carle Richland Memorial Hospital,8980250,cephalexin 250 mg capsule,60687015201,,250,$5.65 ,$5.65 ,$4.32 ,$5.09 ,$4.80 ,$4.80 ,$4.80 ,$4.97 ,$4.80 ,$4.97 ,$4.97 ,$4.92 ,$4.80 ,$4.80 ,$4.80 ,$4.32 ,$5.09
Carle Richland Memorial Hospital,8980250,cephalexin 250 mg capsule,60687015211,,250,$5.65 ,$5.65 ,$4.32 ,$5.09 ,$4.80 ,$4.80 ,$4.80 ,$4.97 ,$4.80 ,$4.97 ,$4.97 ,$4.92 ,$4.80 ,$4.80 ,$4.80 ,$4.32 ,$5.09
Carle Richland Memorial Hospital,8980250,cherry flavor (bulk) oral syrup,395266216,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,chlordiazePOXIDE 10 mg capsule,51079037501,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,chlordiazePOXIDE 25 mg capsule,51079014101,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,chlordiazePOXIDE 5 mg capsule,51079037401,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,chlorhexidine gluconate 0.12 % mouthwash,116200116,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,chlorhexidine gluconate 0.12 % mouthwash,9999066794,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,chlorhexidine gluconate 0.12 % mouthwash,116200115,,250,$25.93 ,$25.93 ,$19.81 ,$23.34 ,$22.04 ,$22.04 ,$22.04 ,$22.82 ,$22.04 ,$22.82 ,$22.82 ,$22.56 ,$22.04 ,$22.04 ,$22.04 ,$19.81 ,$23.34
Carle Richland Memorial Hospital,8980250,chlorhexidine gluconate 4 % topical liquid,234057504,,250,$24.79 ,$24.79 ,$18.94 ,$22.31 ,$21.07 ,$21.07 ,$21.07 ,$21.82 ,$21.07 ,$21.82 ,$21.82 ,$21.57 ,$21.07 ,$21.07 ,$21.07 ,$18.94 ,$22.31
Carle Richland Memorial Hospital,8980250,chlorthalidone 25 mg tablet,60687031725,,250,$13.04 ,$13.04 ,$9.96 ,$11.74 ,$11.08 ,$11.08 ,$11.08 ,$11.48 ,$11.08 ,$11.48 ,$11.48 ,$11.34 ,$11.08 ,$11.08 ,$11.08 ,$9.96 ,$11.74
Carle Richland Memorial Hospital,8980250,cholecalciferol (vitamin D3) 10 mcg (400 unit) tablet,50268086311,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,cholecalciferol (vitamin D3) 10 mcg (400 unit) tablet,50268086315,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"cholecalciferol (vitamin D3) 25 mcg (1,000 unit) tablet",10006070033,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"cholecalciferol (vitamin D3) 25 mcg (1,000 unit) tablet",20555003300,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,cholestyramine-aspartame 4 gram oral powder for susp in a packet,245003660,,250,$26.05 ,$26.05 ,$19.90 ,$23.45 ,$22.14 ,$22.14 ,$22.14 ,$22.92 ,$22.14 ,$22.92 ,$22.92 ,$22.66 ,$22.14 ,$22.14 ,$22.14 ,$19.90 ,$23.45
Carle Richland Memorial Hospital,8980250,chondroitin-sod hyaluron 4 %-3 % (40 mg-30 mg/mL) intraocular syringe,8065183905,,250,$794.49 ,$794.49 ,$606.99 ,$715.04 ,$675.32 ,$675.32 ,$675.32 ,$699.15 ,$675.32 ,$699.15 ,$699.15 ,$691.21 ,$675.32 ,$675.32 ,$675.32 ,$606.99 ,$715.04
Carle Richland Memorial Hospital,8980250,cilostazoL 100 mg tablet,50268017715,,250,$12.82 ,$12.82 ,$9.79 ,$11.54 ,$10.90 ,$10.90 ,$10.90 ,$11.28 ,$10.90 ,$11.28 ,$11.28 ,$11.15 ,$10.90 ,$10.90 ,$10.90 ,$9.79 ,$11.54
Carle Richland Memorial Hospital,8980250,ciprofloxacin 0.3 % eye drops,61314065625,,250,$137.61 ,$137.61 ,$105.13 ,$123.85 ,$116.97 ,$116.97 ,$116.97 ,$121.10 ,$116.97 ,$121.10 ,$121.10 ,$119.72 ,$116.97 ,$116.97 ,$116.97 ,$105.13 ,$123.85
Carle Richland Memorial Hospital,8980250,"ciprofloxacin 0.3 %-dexamethasone 0.1 % ear drops,suspension",43598032675,,250,$33.99 ,$33.99 ,$25.97 ,$30.59 ,$28.89 ,$28.89 ,$28.89 ,$29.91 ,$28.89 ,$29.91 ,$29.91 ,$29.57 ,$28.89 ,$28.89 ,$28.89 ,$25.97 ,$30.59
Carle Richland Memorial Hospital,8980250,ciprofloxacin 250 mg tablet,55111012601,,250,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8980250,cisatracurium 2 mg/mL intravenous solution,74437824,,250,$940.80 ,$940.80 ,$718.77 ,$846.72 ,$799.68 ,$799.68 ,$799.68 ,$827.90 ,$799.68 ,$827.90 ,$827.90 ,$818.50 ,$799.68 ,$799.68 ,$799.68 ,$718.77 ,$846.72
Carle Richland Memorial Hospital,8980250,citalopram 20 mg tablet,904608561,,250,$14.88 ,$14.88 ,$11.37 ,$13.39 ,$12.65 ,$12.65 ,$12.65 ,$13.09 ,$12.65 ,$13.09 ,$13.09 ,$12.95 ,$12.65 ,$12.65 ,$12.65 ,$11.37 ,$13.39
Carle Richland Memorial Hospital,8980250,clarithromycin 250 mg tablet,781196160,,250,$29.20 ,$29.20 ,$22.31 ,$26.28 ,$24.82 ,$24.82 ,$24.82 ,$25.70 ,$24.82 ,$25.70 ,$25.70 ,$25.40 ,$24.82 ,$24.82 ,$24.82 ,$22.31 ,$26.28
Carle Richland Memorial Hospital,8980250,clarithromycin 500 mg tablet,781196260,,250,$29.20 ,$29.20 ,$22.31 ,$26.28 ,$24.82 ,$24.82 ,$24.82 ,$25.70 ,$24.82 ,$25.70 ,$25.70 ,$25.40 ,$24.82 ,$24.82 ,$24.82 ,$22.31 ,$26.28
Carle Richland Memorial Hospital,8980250,clindamycin 150 mg/mL injection solution,9090218,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,clindamycin 150 mg/mL injection solution,25021011504,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,clindamycin 600 mg/50 mL in 5 % dextrose intravenous piggyback,781328909,,250,$89.83 ,$89.83 ,$68.63 ,$80.85 ,$76.36 ,$76.36 ,$76.36 ,$79.05 ,$76.36 ,$79.05 ,$79.05 ,$78.15 ,$76.36 ,$76.36 ,$76.36 ,$68.63 ,$80.85
Carle Richland Memorial Hospital,8980250,clindamycin 900 mg/50 mL in 5 % dextrose intravenous piggyback,781329009,,250,$108.74 ,$108.74 ,$83.08 ,$97.87 ,$92.43 ,$92.43 ,$92.43 ,$95.69 ,$92.43 ,$95.69 ,$95.69 ,$94.60 ,$92.43 ,$92.43 ,$92.43 ,$83.08 ,$97.87
Carle Richland Memorial Hospital,8980250,clindamycin HCL 150 mg capsule,68084024311,,250,$8.17 ,$8.17 ,$6.24 ,$7.35 ,$6.94 ,$6.94 ,$6.94 ,$7.19 ,$6.94 ,$7.19 ,$7.19 ,$7.11 ,$6.94 ,$6.94 ,$6.94 ,$6.24 ,$7.35
Carle Richland Memorial Hospital,8980250,clobetasoL 0.05 % topical cream,51672125802,,250,"$1,216.12 ","$1,216.12 ",$929.12 ,"$1,094.51 ","$1,033.70 ","$1,033.70 ","$1,033.70 ","$1,070.19 ","$1,033.70 ","$1,070.19 ","$1,070.19 ","$1,058.02 ","$1,033.70 ","$1,033.70 ","$1,033.70 ",$929.12 ,"$1,094.51 "
Carle Richland Memorial Hospital,8980250,clobetasoL 0.05 % topical cream,168016360,,250,"$2,159.63 ","$2,159.63 ","$1,649.96 ","$1,943.67 ","$1,835.69 ","$1,835.69 ","$1,835.69 ","$1,900.47 ","$1,835.69 ","$1,900.47 ","$1,900.47 ","$1,878.88 ","$1,835.69 ","$1,835.69 ","$1,835.69 ","$1,649.96 ","$1,943.67 "
Carle Richland Memorial Hospital,8980250,clonazePAM 0.5 mg tablet,16729013600,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,clonazePAM 1 mg tablet,51079088201,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,clonazePAM 2 mg tablet,93321301,,250,$10.18 ,$10.18 ,$7.78 ,$9.16 ,$8.65 ,$8.65 ,$8.65 ,$8.96 ,$8.65 ,$8.96 ,$8.96 ,$8.86 ,$8.65 ,$8.65 ,$8.65 ,$7.78 ,$9.16
Carle Richland Memorial Hospital,8980250,cloNIDine 0.1 mg/24 hr weekly transdermal patch,51862045301,,250,$124.20 ,$124.20 ,$94.89 ,$111.78 ,$105.57 ,$105.57 ,$105.57 ,$109.30 ,$105.57 ,$109.30 ,$109.30 ,$108.05 ,$105.57 ,$105.57 ,$105.57 ,$94.89 ,$111.78
Carle Richland Memorial Hospital,8980250,cloNIDine 0.3 mg/24 hr weekly transdermal patch,51862045501,,250,$279.22 ,$279.22 ,$213.32 ,$251.30 ,$237.34 ,$237.34 ,$237.34 ,$245.71 ,$237.34 ,$245.71 ,$245.71 ,$242.92 ,$237.34 ,$237.34 ,$237.34 ,$213.32 ,$251.30
Carle Richland Memorial Hospital,8980250,cloNIDine HCL 0.1 mg tablet,51079029901,,250,$3.43 ,$3.43 ,$2.62 ,$3.09 ,$2.92 ,$2.92 ,$2.92 ,$3.02 ,$2.92 ,$3.02 ,$3.02 ,$2.98 ,$2.92 ,$2.92 ,$2.92 ,$2.62 ,$3.09
Carle Richland Memorial Hospital,8980250,clopidogreL 75 mg tablet,68084053601,,250,$32.00 ,$32.00 ,$24.45 ,$28.80 ,$27.20 ,$27.20 ,$27.20 ,$28.16 ,$27.20 ,$28.16 ,$28.16 ,$27.84 ,$27.20 ,$27.20 ,$27.20 ,$24.45 ,$28.80
Carle Richland Memorial Hospital,8980250,clorazepate dipotassium 3.75 mg tablet,378003001,,250,$14.12 ,$14.12 ,$10.79 ,$12.71 ,$12.00 ,$12.00 ,$12.00 ,$12.43 ,$12.00 ,$12.43 ,$12.43 ,$12.28 ,$12.00 ,$12.00 ,$12.00 ,$10.79 ,$12.71
Carle Richland Memorial Hospital,8980250,clotrimazole 10 mg troche,54414622,,250,$17.31 ,$17.31 ,$13.22 ,$15.58 ,$14.71 ,$14.71 ,$14.71 ,$15.23 ,$14.71 ,$15.23 ,$15.23 ,$15.06 ,$14.71 ,$14.71 ,$14.71 ,$13.22 ,$15.58
Carle Richland Memorial Hospital,8980250,clotrimazole 2 % vaginal cream,51672206200,,250,$72.18 ,$72.18 ,$55.15 ,$64.96 ,$61.35 ,$61.35 ,$61.35 ,$63.52 ,$61.35 ,$63.52 ,$63.52 ,$62.80 ,$61.35 ,$61.35 ,$61.35 ,$55.15 ,$64.96
Carle Richland Memorial Hospital,8980250,cloZAPine 25 mg tablet,93435919,,250,$8.50 ,$8.50 ,$6.49 ,$7.65 ,$7.23 ,$7.23 ,$7.23 ,$7.48 ,$7.23 ,$7.48 ,$7.48 ,$7.40 ,$7.23 ,$7.23 ,$7.23 ,$6.49 ,$7.65
Carle Richland Memorial Hospital,8980250,codeine 10 mg-guaifenesin 100 mg/5 mL oral liquid,50383008710,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,colchicine 0.6 mg capsule,60687035825,,250,$36.71 ,$36.71 ,$28.05 ,$33.04 ,$31.20 ,$31.20 ,$31.20 ,$32.30 ,$31.20 ,$32.30 ,$32.30 ,$31.94 ,$31.20 ,$31.20 ,$31.20 ,$28.05 ,$33.04
Carle Richland Memorial Hospital,8980250,colchicine 0.6 mg capsule,60687035895,,250,$36.71 ,$36.71 ,$28.05 ,$33.04 ,$31.20 ,$31.20 ,$31.20 ,$32.30 ,$31.20 ,$32.30 ,$32.30 ,$31.94 ,$31.20 ,$31.20 ,$31.20 ,$28.05 ,$33.04
Carle Richland Memorial Hospital,8980250,colchicine 0.6 mg tablet,60687038911,,250,$47.18 ,$47.18 ,$36.05 ,$42.46 ,$40.10 ,$40.10 ,$40.10 ,$41.52 ,$40.10 ,$41.52 ,$41.52 ,$41.05 ,$40.10 ,$40.10 ,$40.10 ,$36.05 ,$42.46
Carle Richland Memorial Hospital,8980250,collagenase clostridium histolyticum 250 unit/gram topical ointment,50484001030,,250,"$1,481.60 ","$1,481.60 ","$1,131.94 ","$1,333.44 ","$1,259.36 ","$1,259.36 ","$1,259.36 ","$1,303.81 ","$1,259.36 ","$1,303.81 ","$1,303.81 ","$1,288.99 ","$1,259.36 ","$1,259.36 ","$1,259.36 ","$1,131.94 ","$1,333.44 "
Carle Richland Memorial Hospital,8980250,compounding vehicle suspension sugar-free no.20 oral,574030316,,250,$133.62 ,$133.62 ,$102.09 ,$120.26 ,$113.58 ,$113.58 ,$113.58 ,$117.59 ,$113.58 ,$117.59 ,$117.59 ,$116.25 ,$113.58 ,$113.58 ,$113.58 ,$102.09 ,$120.26
Carle Richland Memorial Hospital,8980250,compounding vehicle syrup no.23,395009016,,250,$103.34 ,$103.34 ,$78.95 ,$93.01 ,$87.84 ,$87.84 ,$87.84 ,$90.94 ,$87.84 ,$90.94 ,$90.94 ,$89.91 ,$87.84 ,$87.84 ,$87.84 ,$78.95 ,$93.01
Carle Richland Memorial Hospital,8980250,conjugated estrogens 0.625 mg/gram vaginal cream,46087221,,250,"$2,280.14 ","$2,280.14 ","$1,742.03 ","$2,052.13 ","$1,938.12 ","$1,938.12 ","$1,938.12 ","$2,006.52 ","$1,938.12 ","$2,006.52 ","$2,006.52 ","$1,983.72 ","$1,938.12 ","$1,938.12 ","$1,938.12 ","$1,742.03 ","$2,052.13 "
Carle Richland Memorial Hospital,8980250,cyclobenzaprine 10 mg tablet,69097084607,,250,$7.73 ,$7.73 ,$5.91 ,$6.96 ,$6.57 ,$6.57 ,$6.57 ,$6.80 ,$6.57 ,$6.80 ,$6.80 ,$6.73 ,$6.57 ,$6.57 ,$6.57 ,$5.91 ,$6.96
Carle Richland Memorial Hospital,8980250,cyclopentolate 1 % eye drops,61314039603,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,cyclopentolate 1 % eye drops,65039605,,250,$298.05 ,$298.05 ,$227.71 ,$268.25 ,$253.34 ,$253.34 ,$253.34 ,$262.28 ,$253.34 ,$262.28 ,$262.28 ,$259.30 ,$253.34 ,$253.34 ,$253.34 ,$227.71 ,$268.25
Carle Richland Memorial Hospital,8980250,cycloSPORINE 0.05 % eye drops in a dropperette,23916330,,250,$51.19 ,$51.19 ,$39.11 ,$46.07 ,$43.51 ,$43.51 ,$43.51 ,$45.05 ,$43.51 ,$45.05 ,$45.05 ,$44.54 ,$43.51 ,$43.51 ,$43.51 ,$39.11 ,$46.07
Carle Richland Memorial Hospital,8980250,cyproheptadine 4 mg tablet,50742019001,,250,$7.30 ,$7.30 ,$5.58 ,$6.57 ,$6.21 ,$6.21 ,$6.21 ,$6.42 ,$6.21 ,$6.42 ,$6.42 ,$6.35 ,$6.21 ,$6.21 ,$6.21 ,$5.58 ,$6.57
Carle Richland Memorial Hospital,8980250,dabigatran etexilate 75 mg capsule,597035556,,250,$41.53 ,$41.53 ,$31.73 ,$37.38 ,$35.30 ,$35.30 ,$35.30 ,$36.55 ,$35.30 ,$36.55 ,$36.55 ,$36.13 ,$35.30 ,$35.30 ,$35.30 ,$31.73 ,$37.38
Carle Richland Memorial Hospital,8980250,desflurane 100 % inhalation liquid,10019064134,,250,$916.81 ,$916.81 ,$700.44 ,$825.13 ,$779.29 ,$779.29 ,$779.29 ,$806.79 ,$779.29 ,$806.79 ,$806.79 ,$797.62 ,$779.29 ,$779.29 ,$779.29 ,$700.44 ,$825.13
Carle Richland Memorial Hospital,8980250,desipramine 25 mg tablet,62559071101,,250,$11.67 ,$11.67 ,$8.92 ,$10.50 ,$9.92 ,$9.92 ,$9.92 ,$10.27 ,$9.92 ,$10.27 ,$10.27 ,$10.15 ,$9.92 ,$9.92 ,$9.92 ,$8.92 ,$10.50
Carle Richland Memorial Hospital,8980250,desmopressin 0.2 mg tablet,68084060411,,250,$15.49 ,$15.49 ,$11.83 ,$13.94 ,$13.17 ,$13.17 ,$13.17 ,$13.63 ,$13.17 ,$13.63 ,$13.63 ,$13.48 ,$13.17 ,$13.17 ,$13.17 ,$11.83 ,$13.94
Carle Richland Memorial Hospital,8980250,"desvenlafaxine succinate ER 50 mg tablet,extended release 24 hr",54040013,,250,$49.98 ,$49.98 ,$38.18 ,$44.98 ,$42.48 ,$42.48 ,$42.48 ,$43.98 ,$42.48 ,$43.98 ,$43.98 ,$43.48 ,$42.48 ,$42.48 ,$42.48 ,$38.18 ,$44.98
Carle Richland Memorial Hospital,8980250,dexAMETHasone 0.5 mg/5 mL oral solution,54317763,,250,$146.67 ,$146.67 ,$112.06 ,$132.00 ,$124.67 ,$124.67 ,$124.67 ,$129.07 ,$124.67 ,$129.07 ,$129.07 ,$127.60 ,$124.67 ,$124.67 ,$124.67 ,$112.06 ,$132.00
Carle Richland Memorial Hospital,8980250,dexAMETHasone sodium phosphate 0.1 % eye drops,24208072002,,250,$322.38 ,$322.38 ,$246.30 ,$290.14 ,$274.02 ,$274.02 ,$274.02 ,$283.69 ,$274.02 ,$283.69 ,$283.69 ,$280.47 ,$274.02 ,$274.02 ,$274.02 ,$246.30 ,$290.14
Carle Richland Memorial Hospital,8980250,dexmedeTOMIDine 100 mcg/mL intravenous solution,70860060541,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,dextroamphetamine-amphetamine 5 mg tablet,378454101,,250,$14.25 ,$14.25 ,$10.89 ,$12.83 ,$12.11 ,$12.11 ,$12.11 ,$12.54 ,$12.11 ,$12.54 ,$12.54 ,$12.40 ,$12.11 ,$12.11 ,$12.11 ,$10.89 ,$12.83
Carle Richland Memorial Hospital,8980250,dextromethorphan polistirex ER 30 mg/5 mL oral susp ext.release 12hr,45802043321,,250,$47.53 ,$47.53 ,$36.31 ,$42.78 ,$40.40 ,$40.40 ,$40.40 ,$41.83 ,$40.40 ,$41.83 ,$41.83 ,$41.35 ,$40.40 ,$40.40 ,$40.40 ,$36.31 ,$42.78
Carle Richland Memorial Hospital,8980250,dextromethorphan-guaifenesin 10 mg-100 mg/5 mL oral syrup,121127600,,250,$3.88 ,$3.88 ,$2.96 ,$3.49 ,$3.30 ,$3.30 ,$3.30 ,$3.41 ,$3.30 ,$3.41 ,$3.41 ,$3.38 ,$3.30 ,$3.30 ,$3.30 ,$2.96 ,$3.49
Carle Richland Memorial Hospital,8980250,dextromethorphan-guaifenesin 10 mg-100 mg/5 mL oral syrup,121127610,,250,$3.88 ,$3.88 ,$2.96 ,$3.49 ,$3.30 ,$3.30 ,$3.30 ,$3.41 ,$3.30 ,$3.41 ,$3.41 ,$3.38 ,$3.30 ,$3.30 ,$3.30 ,$2.96 ,$3.49
Carle Richland Memorial Hospital,8980250,dextromethorphan-guaifenesin 30 mg-600 mg tablet extended release12 hr,63824005640,,250,$0.73 ,$0.73 ,$0.56 ,$0.66 ,$0.62 ,$0.62 ,$0.62 ,$0.64 ,$0.62 ,$0.64 ,$0.64 ,$0.64 ,$0.62 ,$0.62 ,$0.62 ,$0.56 ,$0.66
Carle Richland Memorial Hospital,8980250,dextrose 25 % in water (D25W) intravenous syringe,409177510,,250,$70.50 ,$70.50 ,$53.86 ,$63.45 ,$59.93 ,$59.93 ,$59.93 ,$62.04 ,$59.93 ,$62.04 ,$62.04 ,$61.34 ,$59.93 ,$59.93 ,$59.93 ,$53.86 ,$63.45
Carle Richland Memorial Hospital,8980250,dextrose 40 % oral gel,574007030,,250,$5.51 ,$5.51 ,$4.21 ,$4.96 ,$4.68 ,$4.68 ,$4.68 ,$4.85 ,$4.68 ,$4.85 ,$4.85 ,$4.79 ,$4.68 ,$4.68 ,$4.68 ,$4.21 ,$4.96
Carle Richland Memorial Hospital,8980250,dextrose 50 % in water (D50W) intravenous syringe,76329330101,,250,$95.94 ,$95.94 ,$73.30 ,$86.35 ,$81.55 ,$81.55 ,$81.55 ,$84.43 ,$81.55 ,$84.43 ,$84.43 ,$83.47 ,$81.55 ,$81.55 ,$81.55 ,$73.30 ,$86.35
Carle Richland Memorial Hospital,8980250,"dextrose 50 % in water (D50W) intravenous syringe,dextrose 50 % in water (D50W) intravenous solution",409751716,J3490,250,$67.71 ,$67.71 ,$51.73 ,$60.94 ,$57.55 ,$57.55 ,$57.55 ,$59.58 ,$57.55 ,$59.58 ,$59.58 ,$58.91 ,$57.55 ,$57.55 ,$57.55 ,$51.73 ,$60.94
Carle Richland Memorial Hospital,8980250,"dextrose 50 % in water (D50W) intravenous syringe,dextrose 50 % in water (D50W) intravenous solution",409664802,J3490,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,diazePAM 10 mg tablet,51079028601,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,diazePAM 2 mg tablet,51079028401,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,diazePAM 5 mg tablet,51079028501,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,dibucaine 1 % topical ointment,45802005003,,250,$36.09 ,$36.09 ,$27.57 ,$32.48 ,$30.68 ,$30.68 ,$30.68 ,$31.76 ,$30.68 ,$31.76 ,$31.76 ,$31.40 ,$30.68 ,$30.68 ,$30.68 ,$27.57 ,$32.48
Carle Richland Memorial Hospital,8980250,diclofenac 0.1 % eye drops,61314001425,,250,$229.60 ,$229.60 ,$175.41 ,$206.64 ,$195.16 ,$195.16 ,$195.16 ,$202.05 ,$195.16 ,$202.05 ,$202.05 ,$199.75 ,$195.16 ,$195.16 ,$195.16 ,$175.41 ,$206.64
Carle Richland Memorial Hospital,8980250,diclofenac 1 % topical gel,69097052444,,250,$254.44 ,$254.44 ,$194.39 ,$229.00 ,$216.27 ,$216.27 ,$216.27 ,$223.91 ,$216.27 ,$223.91 ,$223.91 ,$221.36 ,$216.27 ,$216.27 ,$216.27 ,$194.39 ,$229.00
Carle Richland Memorial Hospital,8980250,diclofenac potassium 50 mg tablet,378247401,,250,$15.19 ,$15.19 ,$11.61 ,$13.67 ,$12.91 ,$12.91 ,$12.91 ,$13.37 ,$12.91 ,$13.37 ,$13.37 ,$13.22 ,$12.91 ,$12.91 ,$12.91 ,$11.61 ,$13.67
Carle Richland Memorial Hospital,8980250,"diclofenac sodium 50 mg tablet,delayed release",68001028006,,250,$9.19 ,$9.19 ,$7.02 ,$8.27 ,$7.81 ,$7.81 ,$7.81 ,$8.09 ,$7.81 ,$8.09 ,$8.09 ,$8.00 ,$7.81 ,$7.81 ,$7.81 ,$7.02 ,$8.27
Carle Richland Memorial Hospital,8980250,dicyclomine 10 mg capsule,60687036911,,250,$5.40 ,$5.40 ,$4.13 ,$4.86 ,$4.59 ,$4.59 ,$4.59 ,$4.75 ,$4.59 ,$4.75 ,$4.75 ,$4.70 ,$4.59 ,$4.59 ,$4.59 ,$4.13 ,$4.86
Carle Richland Memorial Hospital,8980250,digoxin 125 mcg (0.125 mg) tablet,904592161,,250,$10.18 ,$10.18 ,$7.78 ,$9.16 ,$8.65 ,$8.65 ,$8.65 ,$8.96 ,$8.65 ,$8.96 ,$8.96 ,$8.86 ,$8.65 ,$8.65 ,$8.65 ,$7.78 ,$9.16
Carle Richland Memorial Hospital,8980250,digoxin 250 mcg/mL (0.25 mg/mL) injection solution,781305972,J1160,250,$46.91 ,$46.91 ,$35.84 ,$42.22 ,$39.87 ,$39.87 ,$39.87 ,$41.28 ,$39.87 ,$41.28 ,$41.28 ,$40.81 ,$39.87 ,$39.87 ,$39.87 ,$35.84 ,$42.22
Carle Richland Memorial Hospital,8980250,dilTIAZem 5 mg/mL intravenous solution,17478093725,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,dilTIAZem 5 mg/mL intravenous solution,55390056505,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,dilTIAZem 5 mg/mL intravenous solution,55390056510,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,dilTIAZem 60 mg tablet,63739008010,,250,$3.64 ,$3.64 ,$2.78 ,$3.28 ,$3.09 ,$3.09 ,$3.09 ,$3.20 ,$3.09 ,$3.20 ,$3.20 ,$3.17 ,$3.09 ,$3.09 ,$3.09 ,$2.78 ,$3.28
Carle Richland Memorial Hospital,8980250,"dilTIAZem CD 120 mg capsule,extended release 24 hr",60687019501,,250,$4.35 ,$4.35 ,$3.32 ,$3.92 ,$3.70 ,$3.70 ,$3.70 ,$3.83 ,$3.70 ,$3.83 ,$3.83 ,$3.78 ,$3.70 ,$3.70 ,$3.70 ,$3.32 ,$3.92
Carle Richland Memorial Hospital,8980250,"dilTIAZem CD 180 mg capsule,extended release 24 hr",60687020601,,250,$4.71 ,$4.71 ,$3.60 ,$4.24 ,$4.00 ,$4.00 ,$4.00 ,$4.14 ,$4.00 ,$4.14 ,$4.14 ,$4.10 ,$4.00 ,$4.00 ,$4.00 ,$3.60 ,$4.24
Carle Richland Memorial Hospital,8980250,"dilTIAZem CD 240 mg capsule,extended release 24 hr",60687021701,,250,$6.08 ,$6.08 ,$4.65 ,$5.47 ,$5.17 ,$5.17 ,$5.17 ,$5.35 ,$5.17 ,$5.35 ,$5.35 ,$5.29 ,$5.17 ,$5.17 ,$5.17 ,$4.65 ,$5.47
Carle Richland Memorial Hospital,8980250,"dilTIAZem ER 60 mg capsule,extended release 12 hr",51079092420,,250,$20.84 ,$20.84 ,$15.92 ,$18.76 ,$17.71 ,$17.71 ,$17.71 ,$18.34 ,$17.71 ,$18.34 ,$18.34 ,$18.13 ,$17.71 ,$17.71 ,$17.71 ,$15.92 ,$18.76
Carle Richland Memorial Hospital,8980250,dimenhyDRINATE 50 mg chewable tablet,31248000200,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,diphenhydrAMINE 12.5 mg/5 mL oral elixir,121097810,,250,$5.26 ,$5.26 ,$4.02 ,$4.73 ,$4.47 ,$4.47 ,$4.47 ,$4.63 ,$4.47 ,$4.63 ,$4.63 ,$4.58 ,$4.47 ,$4.47 ,$4.47 ,$4.02 ,$4.73
Carle Richland Memorial Hospital,8980250,diphenhydrAMINE 12.5 mg/5 mL oral liquid,24385037926,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,diphenhydrAMINE 25 mg capsule,69618002401,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,diphenhydramine-zinc acetate 2 %-0.1 % topical spray,12547017004,,250,$32.69 ,$32.69 ,$24.98 ,$29.42 ,$27.79 ,$27.79 ,$27.79 ,$28.77 ,$27.79 ,$28.77 ,$28.77 ,$28.44 ,$27.79 ,$27.79 ,$27.79 ,$24.98 ,$29.42
Carle Richland Memorial Hospital,8980250,diphenoxylate-atropine 2.5 mg-0.025 mg tablet,62559049001,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,diphenoxylate-atropine 2.5 mg-0.025 mg/5 mL oral liquid,54319446,,250,$47.73 ,$47.73 ,$36.47 ,$42.96 ,$40.57 ,$40.57 ,$40.57 ,$42.00 ,$40.57 ,$42.00 ,$42.00 ,$41.53 ,$40.57 ,$40.57 ,$40.57 ,$36.47 ,$42.96
Carle Richland Memorial Hospital,8980250,"divalproex 125 mg capsule,delayed release sprinkle",68084031301,,250,$8.94 ,$8.94 ,$6.83 ,$8.05 ,$7.60 ,$7.60 ,$7.60 ,$7.87 ,$7.60 ,$7.87 ,$7.87 ,$7.78 ,$7.60 ,$7.60 ,$7.60 ,$6.83 ,$8.05
Carle Richland Memorial Hospital,8980250,"divalproex ER 250 mg tablet,extended release 24 hr",68084031001,,250,$13.73 ,$13.73 ,$10.49 ,$12.36 ,$11.67 ,$11.67 ,$11.67 ,$12.08 ,$11.67 ,$12.08 ,$12.08 ,$11.95 ,$11.67 ,$11.67 ,$11.67 ,$10.49 ,$12.36
Carle Richland Memorial Hospital,8980250,"divalproex ER 250 mg tablet,extended release 24 hr",68084031011,,250,$13.73 ,$13.73 ,$10.49 ,$12.36 ,$11.67 ,$11.67 ,$11.67 ,$12.08 ,$11.67 ,$12.08 ,$12.08 ,$11.95 ,$11.67 ,$11.67 ,$11.67 ,$10.49 ,$12.36
Carle Richland Memorial Hospital,8980250,"divalproex ER 500 mg tablet,extended release 24 hr",68084041511,,250,$20.19 ,$20.19 ,$15.43 ,$18.17 ,$17.16 ,$17.16 ,$17.16 ,$17.77 ,$17.16 ,$17.77 ,$17.77 ,$17.57 ,$17.16 ,$17.16 ,$17.16 ,$15.43 ,$18.17
Carle Richland Memorial Hospital,8980250,docusate sodium 100 mg capsule,113048672,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,docusate sodium 100 mg capsule,60687012901,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,docusate sodium 100 mg capsule,60687012911,,250,$3.08 ,$3.08 ,$2.35 ,$2.77 ,$2.62 ,$2.62 ,$2.62 ,$2.71 ,$2.62 ,$2.71 ,$2.71 ,$2.68 ,$2.62 ,$2.62 ,$2.62 ,$2.35 ,$2.77
Carle Richland Memorial Hospital,8980250,docusate sodium 50 mg/5 mL oral liquid,121054410,,250,$0.98 ,$0.98 ,$0.75 ,$0.88 ,$0.83 ,$0.83 ,$0.83 ,$0.86 ,$0.83 ,$0.86 ,$0.86 ,$0.85 ,$0.83 ,$0.83 ,$0.83 ,$0.75 ,$0.88
Carle Richland Memorial Hospital,8980250,dofetilide 250 mcg capsule,42794004510,,250,$38.12 ,$38.12 ,$29.12 ,$34.31 ,$32.40 ,$32.40 ,$32.40 ,$33.55 ,$32.40 ,$33.55 ,$33.55 ,$33.16 ,$32.40 ,$32.40 ,$32.40 ,$29.12 ,$34.31
Carle Richland Memorial Hospital,8980250,donepeziL 5 mg tablet,60687029211,,250,$5.95 ,$5.95 ,$4.55 ,$5.36 ,$5.06 ,$5.06 ,$5.06 ,$5.24 ,$5.06 ,$5.24 ,$5.24 ,$5.18 ,$5.06 ,$5.06 ,$5.06 ,$4.55 ,$5.36
Carle Richland Memorial Hospital,8980250,dorzolamide 2 % eye drops,61314001910,,250,$332.03 ,$332.03 ,$253.67 ,$298.83 ,$282.23 ,$282.23 ,$282.23 ,$292.19 ,$282.23 ,$292.19 ,$292.19 ,$288.87 ,$282.23 ,$282.23 ,$282.23 ,$253.67 ,$298.83
Carle Richland Memorial Hospital,8980250,doxazosin 2 mg tablet,68084085125,,250,$7.06 ,$7.06 ,$5.39 ,$6.35 ,$6.00 ,$6.00 ,$6.00 ,$6.21 ,$6.00 ,$6.21 ,$6.21 ,$6.14 ,$6.00 ,$6.00 ,$6.00 ,$5.39 ,$6.35
Carle Richland Memorial Hospital,8980250,doxazosin 2 mg tablet,68084085195,,250,$7.06 ,$7.06 ,$5.39 ,$6.35 ,$6.00 ,$6.00 ,$6.00 ,$6.21 ,$6.00 ,$6.21 ,$6.21 ,$6.14 ,$6.00 ,$6.00 ,$6.00 ,$5.39 ,$6.35
Carle Richland Memorial Hospital,8980250,doxepin 25 mg capsule,51079043701,,250,$6.26 ,$6.26 ,$4.78 ,$5.63 ,$5.32 ,$5.32 ,$5.32 ,$5.51 ,$5.32 ,$5.51 ,$5.51 ,$5.45 ,$5.32 ,$5.32 ,$5.32 ,$4.78 ,$5.63
Carle Richland Memorial Hospital,8980250,doxycycline hyclate 100 mg capsule,50268027815,,250,$20.96 ,$20.96 ,$16.01 ,$18.86 ,$17.82 ,$17.82 ,$17.82 ,$18.44 ,$17.82 ,$18.44 ,$18.44 ,$18.24 ,$17.82 ,$17.82 ,$17.82 ,$16.01 ,$18.86
Carle Richland Memorial Hospital,8980250,doxycycline hyclate 100 mg intravenous powder for solution,63323013011,,250,$211.31 ,$211.31 ,$161.44 ,$190.18 ,$179.61 ,$179.61 ,$179.61 ,$185.95 ,$179.61 ,$185.95 ,$185.95 ,$183.84 ,$179.61 ,$179.61 ,$179.61 ,$161.44 ,$190.18
Carle Richland Memorial Hospital,8980250,"DULoxetine 20 mg capsule,delayed release",68084067511,,250,$36.73 ,$36.73 ,$28.06 ,$33.06 ,$31.22 ,$31.22 ,$31.22 ,$32.32 ,$31.22 ,$32.32 ,$32.32 ,$31.96 ,$31.22 ,$31.22 ,$31.22 ,$28.06 ,$33.06
Carle Richland Memorial Hospital,8980250,"DULoxetine 20 mg capsule,delayed release",68084067521,,250,$36.73 ,$36.73 ,$28.06 ,$33.06 ,$31.22 ,$31.22 ,$31.22 ,$32.32 ,$31.22 ,$32.32 ,$32.32 ,$31.96 ,$31.22 ,$31.22 ,$31.22 ,$28.06 ,$33.06
Carle Richland Memorial Hospital,8980250,"DULoxetine 30 mg capsule,delayed release",68084068311,,250,$35.10 ,$35.10 ,$26.82 ,$31.59 ,$29.84 ,$29.84 ,$29.84 ,$30.89 ,$29.84 ,$30.89 ,$30.89 ,$30.54 ,$29.84 ,$29.84 ,$29.84 ,$26.82 ,$31.59
Carle Richland Memorial Hospital,8980250,"DULoxetine 60 mg capsule,delayed release",68084069201,,250,$35.10 ,$35.10 ,$26.82 ,$31.59 ,$29.84 ,$29.84 ,$29.84 ,$30.89 ,$29.84 ,$30.89 ,$30.89 ,$30.54 ,$29.84 ,$29.84 ,$29.84 ,$26.82 ,$31.59
Carle Richland Memorial Hospital,8980250,dutasteride 0.5 mg capsule,50268028211,,250,$29.32 ,$29.32 ,$22.40 ,$26.39 ,$24.92 ,$24.92 ,$24.92 ,$25.80 ,$24.92 ,$25.80 ,$25.80 ,$25.51 ,$24.92 ,$24.92 ,$24.92 ,$22.40 ,$26.39
Carle Richland Memorial Hospital,8980250,empagliflozin 10 mg tablet,597015237,,250,$84.95 ,$84.95 ,$64.90 ,$76.46 ,$72.21 ,$72.21 ,$72.21 ,$74.76 ,$72.21 ,$74.76 ,$74.76 ,$73.91 ,$72.21 ,$72.21 ,$72.21 ,$64.90 ,$76.46
Carle Richland Memorial Hospital,8980250,enalapril maleate 5 mg tablet,904550261,,250,$9.53 ,$9.53 ,$7.28 ,$8.58 ,$8.10 ,$8.10 ,$8.10 ,$8.39 ,$8.10 ,$8.39 ,$8.39 ,$8.29 ,$8.10 ,$8.10 ,$8.10 ,$7.28 ,$8.58
Carle Richland Memorial Hospital,8980250,enalaprilat 1.25 mg/mL intravenous solution,143978610,,250,$63.66 ,$63.66 ,$48.64 ,$57.29 ,$54.11 ,$54.11 ,$54.11 ,$56.02 ,$54.11 ,$56.02 ,$56.02 ,$55.38 ,$54.11 ,$54.11 ,$54.11 ,$48.64 ,$57.29
Carle Richland Memorial Hospital,8980250,epinastine 0.05 % eye drops,51991083675,,250,$519.54 ,$519.54 ,$396.93 ,$467.59 ,$441.61 ,$441.61 ,$441.61 ,$457.20 ,$441.61 ,$457.20 ,$457.20 ,$452.00 ,$441.61 ,$441.61 ,$441.61 ,$396.93 ,$467.59
Carle Richland Memorial Hospital,8980250,"EPINEPHrine 0.3 mg/0.3 mL injection, auto-injector",49502010201,J3490,250,$778.39 ,$778.39 ,$594.69 ,$700.55 ,$661.63 ,$661.63 ,$661.63 ,$684.98 ,$661.63 ,$684.98 ,$684.98 ,$677.20 ,$661.63 ,$661.63 ,$661.63 ,$594.69 ,$700.55
Carle Richland Memorial Hospital,8980250,EPINEPHrine bitartrate (bulk) powder,62991286301,,250,$49.52 ,$49.52 ,$37.83 ,$44.57 ,$42.09 ,$42.09 ,$42.09 ,$43.58 ,$42.09 ,$43.58 ,$43.58 ,$43.08 ,$42.09 ,$42.09 ,$42.09 ,$37.83 ,$44.57
Carle Richland Memorial Hospital,8980250,eplerenone 25 mg tablet,51991087733,,250,$21.74 ,$21.74 ,$16.61 ,$19.57 ,$18.48 ,$18.48 ,$18.48 ,$19.13 ,$18.48 ,$19.13 ,$19.13 ,$18.91 ,$18.48 ,$18.48 ,$18.48 ,$16.61 ,$19.57
Carle Richland Memorial Hospital,8980250,erenumab-aooe 70 mg/mL subcutaneous auto-injector,55513084101,,250,"$2,804.96 ","$2,804.96 ","$2,142.99 ","$2,524.46 ","$2,384.22 ","$2,384.22 ","$2,384.22 ","$2,468.36 ","$2,384.22 ","$2,468.36 ","$2,468.36 ","$2,440.32 ","$2,384.22 ","$2,384.22 ","$2,384.22 ","$2,142.99 ","$2,524.46 "
Carle Richland Memorial Hospital,8980250,erythromycin 5 mg/gram (0.5 %) eye ointment,574402435,,250,$107.66 ,$107.66 ,$82.25 ,$96.89 ,$91.51 ,$91.51 ,$91.51 ,$94.74 ,$91.51 ,$94.74 ,$94.74 ,$93.66 ,$91.51 ,$91.51 ,$91.51 ,$82.25 ,$96.89
Carle Richland Memorial Hospital,8980250,erythromycin 5 mg/gram (0.5 %) eye ointment,17478007031,J3490,250,$62.96 ,$62.96 ,$48.10 ,$56.66 ,$53.52 ,$53.52 ,$53.52 ,$55.40 ,$53.52 ,$55.40 ,$55.40 ,$54.78 ,$53.52 ,$53.52 ,$53.52 ,$48.10 ,$56.66
Carle Richland Memorial Hospital,8980250,esmoloL 100 mg/10 mL (10 mg/mL) intravenous solution,67457018200,,250,$54.33 ,$54.33 ,$41.51 ,$48.90 ,$46.18 ,$46.18 ,$46.18 ,$47.81 ,$46.18 ,$47.81 ,$47.81 ,$47.27 ,$46.18 ,$46.18 ,$46.18 ,$41.51 ,$48.90
Carle Richland Memorial Hospital,8980250,"esmolol 2,000 mg/100 mL (20 mg/mL) in sodium chloride,esmolol 2,000 mg/100 mL (20 mg/mL) in sterile water",44567081210,,250,$907.83 ,$907.83 ,$693.58 ,$817.05 ,$771.66 ,$771.66 ,$771.66 ,$798.89 ,$771.66 ,$798.89 ,$798.89 ,$789.81 ,$771.66 ,$771.66 ,$771.66 ,$693.58 ,$817.05
Carle Richland Memorial Hospital,8980250,estazolam 1 mg tablet,591074401,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,estradioL 0.1 mg/24 hr weekly transdermal patch,378335216,,250,$89.38 ,$89.38 ,$68.29 ,$80.44 ,$75.97 ,$75.97 ,$75.97 ,$78.65 ,$75.97 ,$78.65 ,$78.65 ,$77.76 ,$75.97 ,$75.97 ,$75.97 ,$68.29 ,$80.44
Carle Richland Memorial Hospital,8980250,estradioL 1 mg tablet,555088602,,250,$5.50 ,$5.50 ,$4.20 ,$4.95 ,$4.68 ,$4.68 ,$4.68 ,$4.84 ,$4.68 ,$4.84 ,$4.84 ,$4.79 ,$4.68 ,$4.68 ,$4.68 ,$4.20 ,$4.95
Carle Richland Memorial Hospital,8980250,ethambutoL 400 mg tablet,54879000201,,250,$5.69 ,$5.69 ,$4.35 ,$5.12 ,$4.84 ,$4.84 ,$4.84 ,$5.01 ,$4.84 ,$5.01 ,$5.01 ,$4.95 ,$4.84 ,$4.84 ,$4.84 ,$4.35 ,$5.12
Carle Richland Memorial Hospital,8980250,etomidate 2 mg/mL intravenous solution,143950601,,250,$46.82 ,$46.82 ,$35.77 ,$42.14 ,$39.80 ,$39.80 ,$39.80 ,$41.20 ,$39.80 ,$41.20 ,$41.20 ,$40.73 ,$39.80 ,$39.80 ,$39.80 ,$35.77 ,$42.14
Carle Richland Memorial Hospital,8980250,famotidine (PF) 20 mg/2 mL intravenous solution,63323073916,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,famotidine 20 mg tablet,50268030311,,250,$9.40 ,$9.40 ,$7.18 ,$8.46 ,$7.99 ,$7.99 ,$7.99 ,$8.27 ,$7.99 ,$8.27 ,$8.27 ,$8.18 ,$7.99 ,$7.99 ,$7.99 ,$7.18 ,$8.46
Carle Richland Memorial Hospital,8980250,famotidine 20 mg tablet,50268030315,,250,$9.40 ,$9.40 ,$7.18 ,$8.46 ,$7.99 ,$7.99 ,$7.99 ,$8.27 ,$7.99 ,$8.27 ,$8.27 ,$8.18 ,$7.99 ,$7.99 ,$7.99 ,$7.18 ,$8.46
Carle Richland Memorial Hospital,8980250,febuxostat 40 mg tablet,72205002830,,250,$43.38 ,$43.38 ,$33.14 ,$39.04 ,$36.87 ,$36.87 ,$36.87 ,$38.17 ,$36.87 ,$38.17 ,$38.17 ,$37.74 ,$36.87 ,$36.87 ,$36.87 ,$33.14 ,$39.04
Carle Richland Memorial Hospital,8980250,febuxostat 40 mg tablet,64764091830,,250,$54.35 ,$54.35 ,$41.52 ,$48.92 ,$46.20 ,$46.20 ,$46.20 ,$47.83 ,$46.20 ,$47.83 ,$47.83 ,$47.28 ,$46.20 ,$46.20 ,$46.20 ,$41.52 ,$48.92
Carle Richland Memorial Hospital,8980250,"felodipine ER 5 mg tablet,extended release 24 hr",13668013301,,250,$9.37 ,$9.37 ,$7.16 ,$8.43 ,$7.96 ,$7.96 ,$7.96 ,$8.25 ,$7.96 ,$8.25 ,$8.25 ,$8.15 ,$7.96 ,$7.96 ,$7.96 ,$7.16 ,$8.43
Carle Richland Memorial Hospital,8980250,fenofibrate 54 mg tablet,50268031211,,250,$10.27 ,$10.27 ,$7.85 ,$9.24 ,$8.73 ,$8.73 ,$8.73 ,$9.04 ,$8.73 ,$9.04 ,$9.04 ,$8.93 ,$8.73 ,$8.73 ,$8.73 ,$7.85 ,$9.24
Carle Richland Memorial Hospital,8980250,fenofibrate 54 mg tablet,50268031215,,250,$10.27 ,$10.27 ,$7.85 ,$9.24 ,$8.73 ,$8.73 ,$8.73 ,$9.04 ,$8.73 ,$9.04 ,$9.04 ,$8.93 ,$8.73 ,$8.73 ,$8.73 ,$7.85 ,$9.24
Carle Richland Memorial Hospital,8980250,fentaNYL 100 mcg/hr transdermal patch,60505700900,,250,$285.98 ,$285.98 ,$218.49 ,$257.38 ,$243.08 ,$243.08 ,$243.08 ,$251.66 ,$243.08 ,$251.66 ,$251.66 ,$248.80 ,$243.08 ,$243.08 ,$243.08 ,$218.49 ,$257.38
Carle Richland Memorial Hospital,8980250,fentaNYL 50 mcg/hr transdermal patch,60505708202,,250,$146.58 ,$146.58 ,$111.99 ,$131.92 ,$124.59 ,$124.59 ,$124.59 ,$128.99 ,$124.59 ,$128.99 ,$128.99 ,$127.52 ,$124.59 ,$124.59 ,$124.59 ,$111.99 ,$131.92
Carle Richland Memorial Hospital,8980250,fentaNYL 75 mcg/hr transdermal patch,60505700800,,250,$218.06 ,$218.06 ,$166.60 ,$196.25 ,$185.35 ,$185.35 ,$185.35 ,$191.89 ,$185.35 ,$191.89 ,$191.89 ,$189.71 ,$185.35 ,$185.35 ,$185.35 ,$166.60 ,$196.25
Carle Richland Memorial Hospital,8980250,fentaNYL-ropivacaine-NaCl (PF) 2 mcg/mL-0.2 % injection solution,9999054280,,250,$708.92 ,$708.92 ,$541.61 ,$638.03 ,$602.58 ,$602.58 ,$602.58 ,$623.85 ,$602.58 ,$623.85 ,$623.85 ,$616.76 ,$602.58 ,$602.58 ,$602.58 ,$541.61 ,$638.03
Carle Richland Memorial Hospital,8980250,ferric subsulfate 0.2 gram to 0.22 gram/mL topical soln and applicator,48783011208,,250,$87.77 ,$87.77 ,$67.06 ,$78.99 ,$74.60 ,$74.60 ,$74.60 ,$77.24 ,$74.60 ,$77.24 ,$77.24 ,$76.36 ,$74.60 ,$74.60 ,$74.60 ,$67.06 ,$78.99
Carle Richland Memorial Hospital,8980250,ferrous gluconate 324 mg (37.5 mg iron) tablet,904213761,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,ferrous sulfate 220 mg (44 mg iron)/5 mL oral elixir,50383077816,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,ferrous sulfate 325 mg (65 mg iron) tablet,904759161,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,finasteride 5 mg tablet,16729009001,,250,$19.23 ,$19.23 ,$14.69 ,$17.31 ,$16.35 ,$16.35 ,$16.35 ,$16.92 ,$16.35 ,$16.92 ,$16.92 ,$16.73 ,$16.35 ,$16.35 ,$16.35 ,$14.69 ,$17.31
Carle Richland Memorial Hospital,8980250,flecainide 50 mg tablet,62559038001,,250,$10.44 ,$10.44 ,$7.98 ,$9.40 ,$8.87 ,$8.87 ,$8.87 ,$9.19 ,$8.87 ,$9.19 ,$9.19 ,$9.08 ,$8.87 ,$8.87 ,$8.87 ,$7.98 ,$9.40
Carle Richland Memorial Hospital,8980250,flecainide 50 mg tablet,54001020,,250,$11.74 ,$11.74 ,$8.97 ,$10.57 ,$9.98 ,$9.98 ,$9.98 ,$10.33 ,$9.98 ,$10.33 ,$10.33 ,$10.21 ,$9.98 ,$9.98 ,$9.98 ,$8.97 ,$10.57
Carle Richland Memorial Hospital,8980250,fluconazole 10 mg/mL oral suspension,57237014935,,250,$66.70 ,$66.70 ,$50.96 ,$60.03 ,$56.70 ,$56.70 ,$56.70 ,$58.70 ,$56.70 ,$58.70 ,$58.70 ,$58.03 ,$56.70 ,$56.70 ,$56.70 ,$50.96 ,$60.03
Carle Richland Memorial Hospital,8980250,fluconazole 100 mg tablet,68084072801,,250,$92.15 ,$92.15 ,$70.40 ,$82.94 ,$78.33 ,$78.33 ,$78.33 ,$81.09 ,$78.33 ,$81.09 ,$81.09 ,$80.17 ,$78.33 ,$78.33 ,$78.33 ,$70.40 ,$82.94
Carle Richland Memorial Hospital,8980250,fluconazole 100 mg tablet,68084072811,,250,$92.15 ,$92.15 ,$70.40 ,$82.94 ,$78.33 ,$78.33 ,$78.33 ,$81.09 ,$78.33 ,$81.09 ,$81.09 ,$80.17 ,$78.33 ,$78.33 ,$78.33 ,$70.40 ,$82.94
Carle Richland Memorial Hospital,8980250,fluconazole 150 mg tablet,68001025321,,250,$57.19 ,$57.19 ,$43.69 ,$51.47 ,$48.61 ,$48.61 ,$48.61 ,$50.33 ,$48.61 ,$50.33 ,$50.33 ,$49.76 ,$48.61 ,$48.61 ,$48.61 ,$43.69 ,$51.47
Carle Richland Memorial Hospital,8980250,fludrocortisone 0.1 mg tablet,68084028811,,250,$7.25 ,$7.25 ,$5.54 ,$6.53 ,$6.16 ,$6.16 ,$6.16 ,$6.38 ,$6.16 ,$6.38 ,$6.38 ,$6.31 ,$6.16 ,$6.16 ,$6.16 ,$5.54 ,$6.53
Carle Richland Memorial Hospital,8980250,flumazeniL 0.1 mg/mL intravenous solution,36000014801,,250,$48.80 ,$48.80 ,$37.28 ,$43.92 ,$41.48 ,$41.48 ,$41.48 ,$42.94 ,$41.48 ,$42.94 ,$42.94 ,$42.46 ,$41.48 ,$41.48 ,$41.48 ,$37.28 ,$43.92
Carle Richland Memorial Hospital,8980250,fluorescein 1 mg eye strips,17238090099,,250,$3.38 ,$3.38 ,$2.58 ,$3.04 ,$2.87 ,$2.87 ,$2.87 ,$2.97 ,$2.87 ,$2.97 ,$2.97 ,$2.94 ,$2.87 ,$2.87 ,$2.87 ,$2.58 ,$3.04
Carle Richland Memorial Hospital,8980250,"fluorometholone acetate 0.1 % eye drops,suspension",65009605,,250,$524.02 ,$524.02 ,$400.35 ,$471.62 ,$445.42 ,$445.42 ,$445.42 ,$461.14 ,$445.42 ,$461.14 ,$461.14 ,$455.90 ,$445.42 ,$445.42 ,$445.42 ,$400.35 ,$471.62
Carle Richland Memorial Hospital,8980250,FLUoxetine 10 mg capsule,904578461,,250,$13.60 ,$13.60 ,$10.39 ,$12.24 ,$11.56 ,$11.56 ,$11.56 ,$11.97 ,$11.56 ,$11.97 ,$11.97 ,$11.83 ,$11.56 ,$11.56 ,$11.56 ,$10.39 ,$12.24
Carle Richland Memorial Hospital,8980250,FLUoxetine 20 mg capsule,904578561,,250,$13.91 ,$13.91 ,$10.63 ,$12.52 ,$11.82 ,$11.82 ,$11.82 ,$12.24 ,$11.82 ,$12.24 ,$12.24 ,$12.10 ,$11.82 ,$11.82 ,$11.82 ,$10.63 ,$12.52
Carle Richland Memorial Hospital,8980250,flurbiprofen 0.03 % eye drops,69292072225,,250,$222.28 ,$222.28 ,$169.82 ,$200.05 ,$188.94 ,$188.94 ,$188.94 ,$195.61 ,$188.94 ,$195.61 ,$195.61 ,$193.38 ,$188.94 ,$188.94 ,$188.94 ,$169.82 ,$200.05
Carle Richland Memorial Hospital,8980250,fluticasone furoate 100 mcg-vilanteroL 25 mcg/dose inhalation powder,173085914,,250,"$1,100.69 ","$1,100.69 ",$840.93 ,$990.62 ,$935.59 ,$935.59 ,$935.59 ,$968.61 ,$935.59 ,$968.61 ,$968.61 ,$957.60 ,$935.59 ,$935.59 ,$935.59 ,$840.93 ,$990.62
Carle Richland Memorial Hospital,8980250,fluticasone furoate 200 mcg-vilanteroL 25 mcg/dose inhalation powder,173088214,,250,$39.31 ,$39.31 ,$30.03 ,$35.38 ,$33.41 ,$33.41 ,$33.41 ,$34.59 ,$33.41 ,$34.59 ,$34.59 ,$34.20 ,$33.41 ,$33.41 ,$33.41 ,$30.03 ,$35.38
Carle Richland Memorial Hospital,8980250,"fluticasone propionate 50 mcg/actuation nasal spray,suspension",60505082901,,250,$418.30 ,$418.30 ,$319.58 ,$376.47 ,$355.56 ,$355.56 ,$355.56 ,$368.10 ,$355.56 ,$368.10 ,$368.10 ,$363.92 ,$355.56 ,$355.56 ,$355.56 ,$319.58 ,$376.47
Carle Richland Memorial Hospital,8980250,fluvoxaMINE 50 mg tablet,62559015901,,250,$14.31 ,$14.31 ,$10.93 ,$12.88 ,$12.16 ,$12.16 ,$12.16 ,$12.59 ,$12.16 ,$12.59 ,$12.59 ,$12.45 ,$12.16 ,$12.16 ,$12.16 ,$10.93 ,$12.88
Carle Richland Memorial Hospital,8980250,folic acid 1 mg tablet,62584089701,,250,$3.22 ,$3.22 ,$2.46 ,$2.90 ,$2.74 ,$2.74 ,$2.74 ,$2.83 ,$2.74 ,$2.83 ,$2.83 ,$2.80 ,$2.74 ,$2.74 ,$2.74 ,$2.46 ,$2.90
Carle Richland Memorial Hospital,8980250,folic acid 400 mcg tablet,50268034611,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,folic acid 400 mcg tablet,50268034615,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,folic acid 5 mg/mL injection solution,63323018411,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"food supplement, lactose-reduced 0.08 gram-1.5 kcal/mL oral liquid",70074064284,,250,$18.67 ,$18.67 ,$14.26 ,$16.80 ,$15.87 ,$15.87 ,$15.87 ,$16.43 ,$15.87 ,$16.43 ,$16.43 ,$16.24 ,$15.87 ,$15.87 ,$15.87 ,$14.26 ,$16.80
Carle Richland Memorial Hospital,8980250,"food supplement, lactose-reduced 0.08 gram-1.5 kcal/mL oral liquid",70074064290,,250,$18.67 ,$18.67 ,$14.26 ,$16.80 ,$15.87 ,$15.87 ,$15.87 ,$16.43 ,$15.87 ,$16.43 ,$16.43 ,$16.24 ,$15.87 ,$15.87 ,$15.87 ,$14.26 ,$16.80
Carle Richland Memorial Hospital,8980250,fosinopriL 10 mg tablet,43547038609,,250,$7.88 ,$7.88 ,$6.02 ,$7.09 ,$6.70 ,$6.70 ,$6.70 ,$6.93 ,$6.70 ,$6.93 ,$6.93 ,$6.86 ,$6.70 ,$6.70 ,$6.70 ,$6.02 ,$7.09
Carle Richland Memorial Hospital,8980250,furosemide 20 mg tablet,51079007201,,250,$3.02 ,$3.02 ,$2.31 ,$2.72 ,$2.57 ,$2.57 ,$2.57 ,$2.66 ,$2.57 ,$2.66 ,$2.66 ,$2.63 ,$2.57 ,$2.57 ,$2.57 ,$2.31 ,$2.72
Carle Richland Memorial Hospital,8980250,furosemide 20 mg tablet,51079007220,,250,$3.02 ,$3.02 ,$2.31 ,$2.72 ,$2.57 ,$2.57 ,$2.57 ,$2.66 ,$2.57 ,$2.66 ,$2.66 ,$2.63 ,$2.57 ,$2.57 ,$2.57 ,$2.31 ,$2.72
Carle Richland Memorial Hospital,8980250,furosemide 40 mg tablet,51079007301,,250,$3.11 ,$3.11 ,$2.38 ,$2.80 ,$2.64 ,$2.64 ,$2.64 ,$2.74 ,$2.64 ,$2.74 ,$2.74 ,$2.71 ,$2.64 ,$2.64 ,$2.64 ,$2.38 ,$2.80
Carle Richland Memorial Hospital,8980250,gabapentin 100 mg capsule,68084078311,,250,$5.05 ,$5.05 ,$3.86 ,$4.55 ,$4.29 ,$4.29 ,$4.29 ,$4.44 ,$4.29 ,$4.44 ,$4.44 ,$4.39 ,$4.29 ,$4.29 ,$4.29 ,$3.86 ,$4.55
Carle Richland Memorial Hospital,8980250,gabapentin 300 mg capsule,51224011950,,250,$8.53 ,$8.53 ,$6.52 ,$7.68 ,$7.25 ,$7.25 ,$7.25 ,$7.51 ,$7.25 ,$7.51 ,$7.51 ,$7.42 ,$7.25 ,$7.25 ,$7.25 ,$6.52 ,$7.68
Carle Richland Memorial Hospital,8980250,gabapentin 400 mg capsule,68084077411,,250,$8.02 ,$8.02 ,$6.13 ,$7.22 ,$6.82 ,$6.82 ,$6.82 ,$7.06 ,$6.82 ,$7.06 ,$7.06 ,$6.98 ,$6.82 ,$6.82 ,$6.82 ,$6.13 ,$7.22
Carle Richland Memorial Hospital,8980250,"gelatin sponge,absorbable-porcine skin 12 mm-7 mm topical sponge",9031508,,250,$44.43 ,$44.43 ,$33.94 ,$39.99 ,$37.77 ,$37.77 ,$37.77 ,$39.10 ,$37.77 ,$39.10 ,$39.10 ,$38.65 ,$37.77 ,$37.77 ,$37.77 ,$33.94 ,$39.99
Carle Richland Memorial Hospital,8980250,"gelatin sponge,absorbable-porcine skin 4 topical sponge",9039605,,250,$64.72 ,$64.72 ,$49.45 ,$58.25 ,$55.01 ,$55.01 ,$55.01 ,$56.95 ,$55.01 ,$56.95 ,$56.95 ,$56.31 ,$55.01 ,$55.01 ,$55.01 ,$49.45 ,$58.25
Carle Richland Memorial Hospital,8980250,gemfibroziL 600 mg tablet,60687022401,,250,$13.12 ,$13.12 ,$10.02 ,$11.81 ,$11.15 ,$11.15 ,$11.15 ,$11.55 ,$11.15 ,$11.55 ,$11.55 ,$11.41 ,$11.15 ,$11.15 ,$11.15 ,$10.02 ,$11.81
Carle Richland Memorial Hospital,8980250,gentamicin 0.3 % (3 mg/gram) eye ointment,17478028435,,250,$179.80 ,$179.80 ,$137.37 ,$161.82 ,$152.83 ,$152.83 ,$152.83 ,$158.22 ,$152.83 ,$158.22 ,$158.22 ,$156.43 ,$152.83 ,$152.83 ,$152.83 ,$137.37 ,$161.82
Carle Richland Memorial Hospital,8980250,gentamicin 0.3 % eye drops,60758018805,,250,$110.35 ,$110.35 ,$84.31 ,$99.32 ,$93.80 ,$93.80 ,$93.80 ,$97.11 ,$93.80 ,$97.11 ,$97.11 ,$96.00 ,$93.80 ,$93.80 ,$93.80 ,$84.31 ,$99.32
Carle Richland Memorial Hospital,8980250,glipiZIDE 5 mg tablet,51079081001,,250,$4.08 ,$4.08 ,$3.12 ,$3.67 ,$3.47 ,$3.47 ,$3.47 ,$3.59 ,$3.47 ,$3.59 ,$3.59 ,$3.55 ,$3.47 ,$3.47 ,$3.47 ,$3.12 ,$3.67
Carle Richland Memorial Hospital,8980250,glipiZIDE 5 mg tablet,51079081020,,250,$4.08 ,$4.08 ,$3.12 ,$3.67 ,$3.47 ,$3.47 ,$3.47 ,$3.59 ,$3.47 ,$3.59 ,$3.59 ,$3.55 ,$3.47 ,$3.47 ,$3.47 ,$3.12 ,$3.67
Carle Richland Memorial Hospital,8980250,glucosamine-chondroitin 500 mg-400 mg capsule,54458010022,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,glucose 4 gram chewable tablet,49348091609,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,glucose 4 gram chewable tablet,49348091501,,250,$1.67 ,$1.67 ,$1.28 ,$1.50 ,$1.42 ,$1.42 ,$1.42 ,$1.47 ,$1.42 ,$1.47 ,$1.47 ,$1.45 ,$1.42 ,$1.42 ,$1.42 ,$1.28 ,$1.50
Carle Richland Memorial Hospital,8980250,glycopyrrolate 0.2 mg/mL injection solution,143968201,J3490,250,$52.29 ,$52.29 ,$39.95 ,$47.06 ,$44.45 ,$44.45 ,$44.45 ,$46.02 ,$44.45 ,$46.02 ,$46.02 ,$45.49 ,$44.45 ,$44.45 ,$44.45 ,$39.95 ,$47.06
Carle Richland Memorial Hospital,8980250,glycopyrrolate 0.2 mg/mL injection solution,143968101,J3490,250,$101.18 ,$101.18 ,$77.30 ,$91.06 ,$86.00 ,$86.00 ,$86.00 ,$89.04 ,$86.00 ,$89.04 ,$89.04 ,$88.03 ,$86.00 ,$86.00 ,$86.00 ,$77.30 ,$91.06
Carle Richland Memorial Hospital,8980250,glycopyrrolate 0.2 mg/mL injection solution,143968001,J3490,250,$212.92 ,$212.92 ,$162.67 ,$191.63 ,$180.98 ,$180.98 ,$180.98 ,$187.37 ,$180.98 ,$187.37 ,$187.37 ,$185.24 ,$180.98 ,$180.98 ,$180.98 ,$162.67 ,$191.63
Carle Richland Memorial Hospital,8980250,glycopyrrolate 0.2 mg/mL injection solution,143967901,J3490,250,$841.48 ,$841.48 ,$642.89 ,$757.33 ,$715.26 ,$715.26 ,$715.26 ,$740.50 ,$715.26 ,$740.50 ,$740.50 ,$732.09 ,$715.26 ,$715.26 ,$715.26 ,$642.89 ,$757.33
Carle Richland Memorial Hospital,8980250,glycopyrrolate 9 mcg-formoteroL 4.8 mcg HFA aerosol inhaler,310460039,,250,$57.86 ,$57.86 ,$44.21 ,$52.07 ,$49.18 ,$49.18 ,$49.18 ,$50.92 ,$49.18 ,$50.92 ,$50.92 ,$50.34 ,$49.18 ,$49.18 ,$49.18 ,$44.21 ,$52.07
Carle Richland Memorial Hospital,8980250,guaiFENesin 100 mg/5 mL oral liquid,121148810,,250,$0.90 ,$0.90 ,$0.69 ,$0.81 ,$0.77 ,$0.77 ,$0.77 ,$0.79 ,$0.77 ,$0.79 ,$0.79 ,$0.78 ,$0.77 ,$0.77 ,$0.77 ,$0.69 ,$0.81
Carle Richland Memorial Hospital,8980250,"guaiFENesin ER 600 mg tablet, extended release 12 hr",68084057201,,250,$1.40 ,$1.40 ,$1.07 ,$1.26 ,$1.19 ,$1.19 ,$1.19 ,$1.23 ,$1.19 ,$1.23 ,$1.23 ,$1.22 ,$1.19 ,$1.19 ,$1.19 ,$1.07 ,$1.26
Carle Richland Memorial Hospital,8980250,"guaiFENesin ER 600 mg tablet, extended release 12 hr",68084057211,,250,$1.40 ,$1.40 ,$1.07 ,$1.26 ,$1.19 ,$1.19 ,$1.19 ,$1.23 ,$1.19 ,$1.23 ,$1.23 ,$1.22 ,$1.19 ,$1.19 ,$1.19 ,$1.07 ,$1.26
Carle Richland Memorial Hospital,8980250,guar gum oral packet,43900097647,,250,$0.68 ,$0.68 ,$0.52 ,$0.61 ,$0.58 ,$0.58 ,$0.58 ,$0.60 ,$0.58 ,$0.60 ,$0.60 ,$0.59 ,$0.58 ,$0.58 ,$0.58 ,$0.52 ,$0.61
Carle Richland Memorial Hospital,8980250,haloperidoL 1 mg tablet,832152011,,250,$7.32 ,$7.32 ,$5.59 ,$6.59 ,$6.22 ,$6.22 ,$6.22 ,$6.44 ,$6.22 ,$6.44 ,$6.44 ,$6.37 ,$6.22 ,$6.22 ,$6.22 ,$5.59 ,$6.59
Carle Richland Memorial Hospital,8980250,haloperidoL 5 mg tablet,60687016101,,250,$7.42 ,$7.42 ,$5.67 ,$6.68 ,$6.31 ,$6.31 ,$6.31 ,$6.53 ,$6.31 ,$6.53 ,$6.53 ,$6.46 ,$6.31 ,$6.31 ,$6.31 ,$5.67 ,$6.68
Carle Richland Memorial Hospital,8980250,haloperidoL 5 mg tablet,60687016111,,250,$7.42 ,$7.42 ,$5.67 ,$6.68 ,$6.31 ,$6.31 ,$6.31 ,$6.53 ,$6.31 ,$6.53 ,$6.53 ,$6.46 ,$6.31 ,$6.31 ,$6.31 ,$5.67 ,$6.68
Carle Richland Memorial Hospital,8980250,haloperidol lactate 2 mg/mL oral concentrate,121058104,,250,$9.62 ,$9.62 ,$7.35 ,$8.66 ,$8.18 ,$8.18 ,$8.18 ,$8.47 ,$8.18 ,$8.47 ,$8.47 ,$8.37 ,$8.18 ,$8.18 ,$8.18 ,$7.35 ,$8.66
Carle Richland Memorial Hospital,8980250,hetastarch 6 % in 0.9 % sodium chloride intravenous solution,409724803,,250,$116.41 ,$116.41 ,$88.94 ,$104.77 ,$98.95 ,$98.95 ,$98.95 ,$102.44 ,$98.95 ,$102.44 ,$102.44 ,$101.28 ,$98.95 ,$98.95 ,$98.95 ,$88.94 ,$104.77
Carle Richland Memorial Hospital,8980250,hydrALAZINE 10 mg tablet,51079007420,,250,$4.26 ,$4.26 ,$3.25 ,$3.83 ,$3.62 ,$3.62 ,$3.62 ,$3.75 ,$3.62 ,$3.75 ,$3.75 ,$3.71 ,$3.62 ,$3.62 ,$3.62 ,$3.25 ,$3.83
Carle Richland Memorial Hospital,8980250,hydrALAZINE 25 mg tablet,904644161,,250,$3.02 ,$3.02 ,$2.31 ,$2.72 ,$2.57 ,$2.57 ,$2.57 ,$2.66 ,$2.57 ,$2.66 ,$2.66 ,$2.63 ,$2.57 ,$2.57 ,$2.57 ,$2.31 ,$2.72
Carle Richland Memorial Hospital,8980250,hydrALAZINE 25 mg tablet,62584073311,,250,$3.51 ,$3.51 ,$2.68 ,$3.16 ,$2.98 ,$2.98 ,$2.98 ,$3.09 ,$2.98 ,$3.09 ,$3.09 ,$3.05 ,$2.98 ,$2.98 ,$2.98 ,$2.68 ,$3.16
Carle Richland Memorial Hospital,8980250,hydroCHLOROthiazide 25 mg tablet,63739012810,,250,$2.92 ,$2.92 ,$2.23 ,$2.63 ,$2.48 ,$2.48 ,$2.48 ,$2.57 ,$2.48 ,$2.57 ,$2.57 ,$2.54 ,$2.48 ,$2.48 ,$2.48 ,$2.23 ,$2.63
Carle Richland Memorial Hospital,8980250,HYDROcodone 10 mg-acetaminophen 325 mg tablet,50268040211,,250,$11.95 ,$11.95 ,$9.13 ,$10.76 ,$10.16 ,$10.16 ,$10.16 ,$10.52 ,$10.16 ,$10.52 ,$10.52 ,$10.40 ,$10.16 ,$10.16 ,$10.16 ,$9.13 ,$10.76
Carle Richland Memorial Hospital,8980250,HYDROcodone 5 mg-acetaminophen 325 mg tablet,406012362,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,HYDROcodone 7.5 mg-acetaminophen 325 mg tablet,68084086311,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,HYDROcodone 7.5 mg-acetaminophen 325 mg/15 mL oral solution,60687041744,,250,$27.59 ,$27.59 ,$21.08 ,$24.83 ,$23.45 ,$23.45 ,$23.45 ,$24.28 ,$23.45 ,$24.28 ,$24.28 ,$24.00 ,$23.45 ,$23.45 ,$23.45 ,$21.08 ,$24.83
Carle Richland Memorial Hospital,8980250,HYDROcodone 7.5 mg-acetaminophen 325 mg/15 mL oral solution,60687041771,,250,$27.59 ,$27.59 ,$21.08 ,$24.83 ,$23.45 ,$23.45 ,$23.45 ,$24.28 ,$23.45 ,$24.28 ,$24.28 ,$24.00 ,$23.45 ,$23.45 ,$23.45 ,$21.08 ,$24.83
Carle Richland Memorial Hospital,8980250,HYDROcodone 7.5 mg-ibuprofen 200 mg tablet,68084084101,,250,$10.52 ,$10.52 ,$8.04 ,$9.47 ,$8.94 ,$8.94 ,$8.94 ,$9.26 ,$8.94 ,$9.26 ,$9.26 ,$9.15 ,$8.94 ,$8.94 ,$8.94 ,$8.04 ,$9.47
Carle Richland Memorial Hospital,8980250,hydrocortisone 1 % topical cream,24385002103,,250,$24.99 ,$24.99 ,$19.09 ,$22.49 ,$21.24 ,$21.24 ,$21.24 ,$21.99 ,$21.24 ,$21.99 ,$21.99 ,$21.74 ,$21.24 ,$21.24 ,$21.24 ,$19.09 ,$22.49
Carle Richland Memorial Hospital,8980250,hydrocortisone 1 % topical cream,87701098111,,250,$25.48 ,$25.48 ,$19.47 ,$22.93 ,$21.66 ,$21.66 ,$21.66 ,$22.42 ,$21.66 ,$22.42 ,$22.42 ,$22.17 ,$21.66 ,$21.66 ,$21.66 ,$19.47 ,$22.93
Carle Richland Memorial Hospital,8980250,hydrocortisone 2.5 % topical cream with perineal applicator,62559043130,,250,$408.50 ,$408.50 ,$312.09 ,$367.65 ,$347.23 ,$347.23 ,$347.23 ,$359.48 ,$347.23 ,$359.48 ,$359.48 ,$355.40 ,$347.23 ,$347.23 ,$347.23 ,$312.09 ,$367.65
Carle Richland Memorial Hospital,8980250,hydrocortisone 5 mg tablet,42543014050,,250,$3.91 ,$3.91 ,$2.99 ,$3.52 ,$3.32 ,$3.32 ,$3.32 ,$3.44 ,$3.32 ,$3.44 ,$3.44 ,$3.40 ,$3.32 ,$3.32 ,$3.32 ,$2.99 ,$3.52
Carle Richland Memorial Hospital,8980250,hydrocortisone acetate 25 mg rectal suppository,713050306,,250,$87.41 ,$87.41 ,$66.78 ,$78.67 ,$74.30 ,$74.30 ,$74.30 ,$76.92 ,$74.30 ,$76.92 ,$76.92 ,$76.05 ,$74.30 ,$74.30 ,$74.30 ,$66.78 ,$78.67
Carle Richland Memorial Hospital,8980250,hydrogen peroxide 3 % solution,21599034563,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,HYDROmorphone 2 mg tablet,42858030125,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,hydroxocobalamin 5 gram intravenous solution,11704037001,,250,"$3,571.67 ","$3,571.67 ","$2,728.76 ","$3,214.50 ","$3,035.92 ","$3,035.92 ","$3,035.92 ","$3,143.07 ","$3,035.92 ","$3,143.07 ","$3,143.07 ","$3,107.35 ","$3,035.92 ","$3,035.92 ","$3,035.92 ","$2,728.76 ","$3,214.50 "
Carle Richland Memorial Hospital,8980250,hydrOXYchloroQUINE 200 mg tablet,68084026911,,250,$22.79 ,$22.79 ,$17.41 ,$20.51 ,$19.37 ,$19.37 ,$19.37 ,$20.06 ,$19.37 ,$20.06 ,$20.06 ,$19.83 ,$19.37 ,$19.37 ,$19.37 ,$17.41 ,$20.51
Carle Richland Memorial Hospital,8980250,hydrOXYzine HCL 10 mg tablet,68084025301,,250,$3.62 ,$3.62 ,$2.77 ,$3.26 ,$3.08 ,$3.08 ,$3.08 ,$3.19 ,$3.08 ,$3.19 ,$3.19 ,$3.15 ,$3.08 ,$3.08 ,$3.08 ,$2.77 ,$3.26
Carle Richland Memorial Hospital,8980250,hydrOXYzine HCL 10 mg tablet,68084025311,,250,$3.62 ,$3.62 ,$2.77 ,$3.26 ,$3.08 ,$3.08 ,$3.08 ,$3.19 ,$3.08 ,$3.19 ,$3.19 ,$3.15 ,$3.08 ,$3.08 ,$3.08 ,$2.77 ,$3.26
Carle Richland Memorial Hospital,8980250,hydrOXYzine HCL 10 mg/5 mL oral solution,60432015004,,250,$11.82 ,$11.82 ,$9.03 ,$10.64 ,$10.05 ,$10.05 ,$10.05 ,$10.40 ,$10.05 ,$10.40 ,$10.40 ,$10.28 ,$10.05 ,$10.05 ,$10.05 ,$9.03 ,$10.64
Carle Richland Memorial Hospital,8980250,hydrOXYzine HCL 25 mg tablet,68084025411,,250,$4.17 ,$4.17 ,$3.19 ,$3.75 ,$3.54 ,$3.54 ,$3.54 ,$3.67 ,$3.54 ,$3.67 ,$3.67 ,$3.63 ,$3.54 ,$3.54 ,$3.54 ,$3.19 ,$3.75
Carle Richland Memorial Hospital,8980250,hyoscyamine 0.125 mg sublingual tablet,43199001101,,250,$6.29 ,$6.29 ,$4.81 ,$5.66 ,$5.35 ,$5.35 ,$5.35 ,$5.54 ,$5.35 ,$5.54 ,$5.54 ,$5.47 ,$5.35 ,$5.35 ,$5.35 ,$4.81 ,$5.66
Carle Richland Memorial Hospital,8980250,ibuprofen 100 mg/5 mL oral suspension,68094050359,,250,$1.50 ,$1.50 ,$1.15 ,$1.35 ,$1.28 ,$1.28 ,$1.28 ,$1.32 ,$1.28 ,$1.32 ,$1.32 ,$1.31 ,$1.28 ,$1.28 ,$1.28 ,$1.15 ,$1.35
Carle Richland Memorial Hospital,8980250,ibuprofen 100 mg/5 mL oral suspension,68094060059,,250,$2.62 ,$2.62 ,$2.00 ,$2.36 ,$2.23 ,$2.23 ,$2.23 ,$2.31 ,$2.23 ,$2.31 ,$2.31 ,$2.28 ,$2.23 ,$2.23 ,$2.23 ,$2.00 ,$2.36
Carle Richland Memorial Hospital,8980250,ibuprofen 100 mg/5 mL oral suspension,45802095226,,250,$11.36 ,$11.36 ,$8.68 ,$10.22 ,$9.66 ,$9.66 ,$9.66 ,$10.00 ,$9.66 ,$10.00 ,$10.00 ,$9.88 ,$9.66 ,$9.66 ,$9.66 ,$8.68 ,$10.22
Carle Richland Memorial Hospital,8980250,ibuprofen 200 mg tablet,904791461,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,ibuprofen 600 mg tablet,60687045701,,250,$4.02 ,$4.02 ,$3.07 ,$3.62 ,$3.42 ,$3.42 ,$3.42 ,$3.54 ,$3.42 ,$3.54 ,$3.54 ,$3.50 ,$3.42 ,$3.42 ,$3.42 ,$3.07 ,$3.62
Carle Richland Memorial Hospital,8980250,ibuprofen 600 mg tablet,60687045711,,250,$4.02 ,$4.02 ,$3.07 ,$3.62 ,$3.42 ,$3.42 ,$3.42 ,$3.54 ,$3.42 ,$3.54 ,$3.54 ,$3.50 ,$3.42 ,$3.42 ,$3.42 ,$3.07 ,$3.62
Carle Richland Memorial Hospital,8980250,ibuprofen 800 mg tablet,68084077201,,250,$4.32 ,$4.32 ,$3.30 ,$3.89 ,$3.67 ,$3.67 ,$3.67 ,$3.80 ,$3.67 ,$3.80 ,$3.80 ,$3.76 ,$3.67 ,$3.67 ,$3.67 ,$3.30 ,$3.89
Carle Richland Memorial Hospital,8980250,ibuprofen 800 mg tablet,68084077211,,250,$4.32 ,$4.32 ,$3.30 ,$3.89 ,$3.67 ,$3.67 ,$3.67 ,$3.80 ,$3.67 ,$3.80 ,$3.80 ,$3.76 ,$3.67 ,$3.67 ,$3.67 ,$3.30 ,$3.89
Carle Richland Memorial Hospital,8980250,imipenem-cilastatin 500 mg intravenous solution,63323032294,J0743,250,$122.25 ,$122.25 ,$93.40 ,$110.03 ,$103.91 ,$103.91 ,$103.91 ,$107.58 ,$103.91 ,$107.58 ,$107.58 ,$106.36 ,$103.91 ,$103.91 ,$103.91 ,$93.40 ,$110.03
Carle Richland Memorial Hospital,8980250,imipramine 25 mg tablet,781176413,,250,$6.40 ,$6.40 ,$4.89 ,$5.76 ,$5.44 ,$5.44 ,$5.44 ,$5.63 ,$5.44 ,$5.63 ,$5.63 ,$5.57 ,$5.44 ,$5.44 ,$5.44 ,$4.89 ,$5.76
Carle Richland Memorial Hospital,8980250,indacateroL 27.5 mcg-glycopyrrolate 15.6 mcg capsule inhalation device,63402068106,,250,$277.42 ,$277.42 ,$211.95 ,$249.68 ,$235.81 ,$235.81 ,$235.81 ,$244.13 ,$235.81 ,$244.13 ,$244.13 ,$241.36 ,$235.81 ,$235.81 ,$235.81 ,$211.95 ,$249.68
Carle Richland Memorial Hospital,8980250,indapamide 2.5 mg tablet,51079086801,,250,$9.55 ,$9.55 ,$7.30 ,$8.60 ,$8.12 ,$8.12 ,$8.12 ,$8.40 ,$8.12 ,$8.40 ,$8.40 ,$8.31 ,$8.12 ,$8.12 ,$8.12 ,$7.30 ,$8.60
Carle Richland Memorial Hospital,8980250,indomethacin 25 mg capsule,50268043015,,250,$4.33 ,$4.33 ,$3.31 ,$3.90 ,$3.68 ,$3.68 ,$3.68 ,$3.81 ,$3.68 ,$3.81 ,$3.81 ,$3.77 ,$3.68 ,$3.68 ,$3.68 ,$3.31 ,$3.90
Carle Richland Memorial Hospital,8980250,insulin aspart U-100 100 unit/mL subcutaneous solution,169750111,J1815,250,"$1,655.42 ","$1,655.42 ","$1,264.74 ","$1,489.88 ","$1,407.11 ","$1,407.11 ","$1,407.11 ","$1,456.77 ","$1,407.11 ","$1,456.77 ","$1,456.77 ","$1,440.22 ","$1,407.11 ","$1,407.11 ","$1,407.11 ","$1,264.74 ","$1,489.88 "
Carle Richland Memorial Hospital,8980250,insulin human U-100 NPH-regulr 70-30 mix 100 unit/mL subcutaneous susp,169183711,J1815,250,$965.10 ,$965.10 ,$737.34 ,$868.59 ,$820.34 ,$820.34 ,$820.34 ,$849.29 ,$820.34 ,$849.29 ,$849.29 ,$839.64 ,$820.34 ,$820.34 ,$820.34 ,$737.34 ,$868.59
Carle Richland Memorial Hospital,8980250,ipratropium 0.5 mg-albuteroL 3 mg (2.5 mg base)/3 mL nebulization soln,60687040579,,250,$5.20 ,$5.20 ,$3.97 ,$4.68 ,$4.42 ,$4.42 ,$4.42 ,$4.58 ,$4.42 ,$4.58 ,$4.58 ,$4.52 ,$4.42 ,$4.42 ,$4.42 ,$3.97 ,$4.68
Carle Richland Memorial Hospital,8980250,ipratropium 0.5 mg-albuteroL 3 mg (2.5 mg base)/3 mL nebulization soln,60687040583,,250,$5.20 ,$5.20 ,$3.97 ,$4.68 ,$4.42 ,$4.42 ,$4.42 ,$4.58 ,$4.42 ,$4.58 ,$4.58 ,$4.52 ,$4.42 ,$4.42 ,$4.42 ,$3.97 ,$4.68
Carle Richland Memorial Hospital,8980250,ipratropium 20 mcg-albuteroL 100 mcg/actuation mist for inhalation,597002402,,250,"$2,501.08 ","$2,501.08 ","$1,910.83 ","$2,250.97 ","$2,125.92 ","$2,125.92 ","$2,125.92 ","$2,200.95 ","$2,125.92 ","$2,200.95 ","$2,200.95 ","$2,175.94 ","$2,125.92 ","$2,125.92 ","$2,125.92 ","$1,910.83 ","$2,250.97 "
Carle Richland Memorial Hospital,8980250,ipratropium bromide 17 mcg/actuation HFA aerosol inhaler,597008717,,250,"$2,413.51 ","$2,413.51 ","$1,843.92 ","$2,172.16 ","$2,051.48 ","$2,051.48 ","$2,051.48 ","$2,123.89 ","$2,051.48 ","$2,123.89 ","$2,123.89 ","$2,099.75 ","$2,051.48 ","$2,051.48 ","$2,051.48 ","$1,843.92 ","$2,172.16 "
Carle Richland Memorial Hospital,8980250,ipratropium bromide 21 mcg (0.03 %) nasal spray,54004544,,250,$541.31 ,$541.31 ,$413.56 ,$487.18 ,$460.11 ,$460.11 ,$460.11 ,$476.35 ,$460.11 ,$476.35 ,$476.35 ,$470.94 ,$460.11 ,$460.11 ,$460.11 ,$413.56 ,$487.18
Carle Richland Memorial Hospital,8980250,isoflurane 99.9 % inhalation liquid,66794001725,,250,$202.71 ,$202.71 ,$154.87 ,$182.44 ,$172.30 ,$172.30 ,$172.30 ,$178.38 ,$172.30 ,$178.38 ,$178.38 ,$176.36 ,$172.30 ,$172.30 ,$172.30 ,$154.87 ,$182.44
Carle Richland Memorial Hospital,8980250,isopropyl alcohoL 70 % solution,869081043,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,isosorbide dinitrate 10 mg tablet,68084008211,,250,$8.16 ,$8.16 ,$6.23 ,$7.34 ,$6.94 ,$6.94 ,$6.94 ,$7.18 ,$6.94 ,$7.18 ,$7.18 ,$7.10 ,$6.94 ,$6.94 ,$6.94 ,$6.23 ,$7.34
Carle Richland Memorial Hospital,8980250,isosorbide mononitrate 20 mg tablet,228262011,,250,$6.50 ,$6.50 ,$4.97 ,$5.85 ,$5.53 ,$5.53 ,$5.53 ,$5.72 ,$5.53 ,$5.72 ,$5.72 ,$5.66 ,$5.53 ,$5.53 ,$5.53 ,$4.97 ,$5.85
Carle Richland Memorial Hospital,8980250,"isosorbide mononitrate ER 30 mg tablet,extended release 24 hr",68084059101,,250,$10.14 ,$10.14 ,$7.75 ,$9.13 ,$8.62 ,$8.62 ,$8.62 ,$8.92 ,$8.62 ,$8.92 ,$8.92 ,$8.82 ,$8.62 ,$8.62 ,$8.62 ,$7.75 ,$9.13
Carle Richland Memorial Hospital,8980250,"isosorbide mononitrate ER 30 mg tablet,extended release 24 hr",68084059111,,250,$10.14 ,$10.14 ,$7.75 ,$9.13 ,$8.62 ,$8.62 ,$8.62 ,$8.92 ,$8.62 ,$8.92 ,$8.92 ,$8.82 ,$8.62 ,$8.62 ,$8.62 ,$7.75 ,$9.13
Carle Richland Memorial Hospital,8980250,"isosorbide mononitrate ER 60 mg tablet,extended release 24 hr",68084059201,,250,$11.92 ,$11.92 ,$9.11 ,$10.73 ,$10.13 ,$10.13 ,$10.13 ,$10.49 ,$10.13 ,$10.49 ,$10.49 ,$10.37 ,$10.13 ,$10.13 ,$10.13 ,$9.11 ,$10.73
Carle Richland Memorial Hospital,8980250,"isosorbide mononitrate ER 60 mg tablet,extended release 24 hr",68084059211,,250,$11.92 ,$11.92 ,$9.11 ,$10.73 ,$10.13 ,$10.13 ,$10.13 ,$10.49 ,$10.13 ,$10.49 ,$10.49 ,$10.37 ,$10.13 ,$10.13 ,$10.13 ,$9.11 ,$10.73
Carle Richland Memorial Hospital,8980250,ivermectin 3 mg tablet,42799080601,,250,$25.49 ,$25.49 ,$19.47 ,$22.94 ,$21.67 ,$21.67 ,$21.67 ,$22.43 ,$21.67 ,$22.43 ,$22.43 ,$22.18 ,$21.67 ,$21.67 ,$21.67 ,$19.47 ,$22.94
Carle Richland Memorial Hospital,8980250,ketamine 100 mg/mL injection solution,143950910,,250,$86.81 ,$86.81 ,$66.32 ,$78.13 ,$73.79 ,$73.79 ,$73.79 ,$76.39 ,$73.79 ,$76.39 ,$76.39 ,$75.52 ,$73.79 ,$73.79 ,$73.79 ,$66.32 ,$78.13
Carle Richland Memorial Hospital,8980250,ketamine 50 mg/mL injection solution,143950801,,250,$145.61 ,$145.61 ,$111.25 ,$131.05 ,$123.77 ,$123.77 ,$123.77 ,$128.14 ,$123.77 ,$128.14 ,$128.14 ,$126.68 ,$123.77 ,$123.77 ,$123.77 ,$111.25 ,$131.05
Carle Richland Memorial Hospital,8980250,ketorolac (PF) 0.45 % eye drops in a dropperette,23350730,,250,$54.94 ,$54.94 ,$41.97 ,$49.45 ,$46.70 ,$46.70 ,$46.70 ,$48.35 ,$46.70 ,$48.35 ,$48.35 ,$47.80 ,$46.70 ,$46.70 ,$46.70 ,$41.97 ,$49.45
Carle Richland Memorial Hospital,8980250,ketorolac 10 mg tablet,93031401,,250,$12.38 ,$12.38 ,$9.46 ,$11.14 ,$10.52 ,$10.52 ,$10.52 ,$10.89 ,$10.52 ,$10.89 ,$10.89 ,$10.77 ,$10.52 ,$10.52 ,$10.52 ,$9.46 ,$11.14
Carle Richland Memorial Hospital,8980250,labetaloL 100 mg tablet,60687043901,,250,$4.87 ,$4.87 ,$3.72 ,$4.38 ,$4.14 ,$4.14 ,$4.14 ,$4.29 ,$4.14 ,$4.29 ,$4.29 ,$4.24 ,$4.14 ,$4.14 ,$4.14 ,$3.72 ,$4.38
Carle Richland Memorial Hospital,8980250,labetaloL 100 mg tablet,60687043911,,250,$4.87 ,$4.87 ,$3.72 ,$4.38 ,$4.14 ,$4.14 ,$4.14 ,$4.29 ,$4.14 ,$4.29 ,$4.29 ,$4.24 ,$4.14 ,$4.14 ,$4.14 ,$3.72 ,$4.38
Carle Richland Memorial Hospital,8980250,labetaloL 20 mg/4 mL (5 mg/mL) intravenous syringe,409233924,,250,$55.31 ,$55.31 ,$42.26 ,$49.78 ,$47.01 ,$47.01 ,$47.01 ,$48.67 ,$47.01 ,$48.67 ,$48.67 ,$48.12 ,$47.01 ,$47.01 ,$47.01 ,$42.26 ,$49.78
Carle Richland Memorial Hospital,8980250,labetaloL 20 mg/4 mL (5 mg/mL) intravenous syringe,409233934,,250,$55.31 ,$55.31 ,$42.26 ,$49.78 ,$47.01 ,$47.01 ,$47.01 ,$48.67 ,$47.01 ,$48.67 ,$48.67 ,$48.12 ,$47.01 ,$47.01 ,$47.01 ,$42.26 ,$49.78
Carle Richland Memorial Hospital,8980250,labetaloL 5 mg/mL intravenous solution,409226720,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,Lactobacillus acidophilus 75 million cell-pectin 100 mg capsule,904660861,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,Lactobacillus rhamnosus GG 5 billion cell oral powder packet,49100040008,,250,$1.56 ,$1.56 ,$1.19 ,$1.40 ,$1.33 ,$1.33 ,$1.33 ,$1.37 ,$1.33 ,$1.37 ,$1.37 ,$1.36 ,$1.33 ,$1.33 ,$1.33 ,$1.19 ,$1.40
Carle Richland Memorial Hospital,8980250,lactose-reduced food with fiber 0.06 gram-1.5 kcal/mL oral liquid,70074064626,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,lactulose 10 gram/15 mL oral solution,50383077916,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,lactulose 20 gram/30 mL oral solution,121115440,,250,$6.80 ,$6.80 ,$5.20 ,$6.12 ,$5.78 ,$5.78 ,$5.78 ,$5.98 ,$5.78 ,$5.98 ,$5.98 ,$5.92 ,$5.78 ,$5.78 ,$5.78 ,$5.20 ,$6.12
Carle Richland Memorial Hospital,8980250,lamoTRIgine 100 mg tablet,51079049901,,250,$24.47 ,$24.47 ,$18.70 ,$22.02 ,$20.80 ,$20.80 ,$20.80 ,$21.53 ,$20.80 ,$21.53 ,$21.53 ,$21.29 ,$20.80 ,$20.80 ,$20.80 ,$18.70 ,$22.02
Carle Richland Memorial Hospital,8980250,lamoTRIgine 100 mg tablet,51079049920,,250,$24.47 ,$24.47 ,$18.70 ,$22.02 ,$20.80 ,$20.80 ,$20.80 ,$21.53 ,$20.80 ,$21.53 ,$21.53 ,$21.29 ,$20.80 ,$20.80 ,$20.80 ,$18.70 ,$22.02
Carle Richland Memorial Hospital,8980250,lamoTRIgine 25 mg tablet,68084031801,,250,$3.37 ,$3.37 ,$2.57 ,$3.03 ,$2.86 ,$2.86 ,$2.86 ,$2.97 ,$2.86 ,$2.97 ,$2.97 ,$2.93 ,$2.86 ,$2.86 ,$2.86 ,$2.57 ,$3.03
Carle Richland Memorial Hospital,8980250,lamoTRIgine 25 mg tablet,68084031811,,250,$3.37 ,$3.37 ,$2.57 ,$3.03 ,$2.86 ,$2.86 ,$2.86 ,$2.97 ,$2.86 ,$2.97 ,$2.97 ,$2.93 ,$2.86 ,$2.86 ,$2.86 ,$2.57 ,$3.03
Carle Richland Memorial Hospital,8980250,"lamoTRIgine ER 300 mg tablet,extended release 24 hr",55111042830,,250,$62.60 ,$62.60 ,$47.83 ,$56.34 ,$53.21 ,$53.21 ,$53.21 ,$55.09 ,$53.21 ,$55.09 ,$55.09 ,$54.46 ,$53.21 ,$53.21 ,$53.21 ,$47.83 ,$56.34
Carle Richland Memorial Hospital,8980250,lanolin topical cream,20451087121,,250,$2.18 ,$2.18 ,$1.67 ,$1.96 ,$1.85 ,$1.85 ,$1.85 ,$1.92 ,$1.85 ,$1.92 ,$1.92 ,$1.90 ,$1.85 ,$1.85 ,$1.85 ,$1.67 ,$1.96
Carle Richland Memorial Hospital,8980250,latanoprost 0.005 % eye drops,61314054701,,250,$463.67 ,$463.67 ,$354.24 ,$417.30 ,$394.12 ,$394.12 ,$394.12 ,$408.03 ,$394.12 ,$408.03 ,$408.03 ,$403.39 ,$394.12 ,$394.12 ,$394.12 ,$354.24 ,$417.30
Carle Richland Memorial Hospital,8980250,levETIRAcetam 100 mg/mL oral solution,31722057447,,250,$10.72 ,$10.72 ,$8.19 ,$9.65 ,$9.11 ,$9.11 ,$9.11 ,$9.43 ,$9.11 ,$9.43 ,$9.43 ,$9.33 ,$9.11 ,$9.11 ,$9.11 ,$8.19 ,$9.65
Carle Richland Memorial Hospital,8980250,levETIRAcetam 500 mg/5 mL (5 mL) oral solution,60687024940,,250,$34.76 ,$34.76 ,$26.56 ,$31.28 ,$29.55 ,$29.55 ,$29.55 ,$30.59 ,$29.55 ,$30.59 ,$30.59 ,$30.24 ,$29.55 ,$29.55 ,$29.55 ,$26.56 ,$31.28
Carle Richland Memorial Hospital,8980250,levETIRAcetam 500 mg/5 mL (5 mL) oral solution,60687024967,,250,$34.76 ,$34.76 ,$26.56 ,$31.28 ,$29.55 ,$29.55 ,$29.55 ,$30.59 ,$29.55 ,$30.59 ,$30.59 ,$30.24 ,$29.55 ,$29.55 ,$29.55 ,$26.56 ,$31.28
Carle Richland Memorial Hospital,8980250,levobunoloL 0.5 % eye drops,60758006005,,250,$35.98 ,$35.98 ,$27.49 ,$32.38 ,$30.58 ,$30.58 ,$30.58 ,$31.66 ,$30.58 ,$31.66 ,$31.66 ,$31.30 ,$30.58 ,$30.58 ,$30.58 ,$27.49 ,$32.38
Carle Richland Memorial Hospital,8980250,levoFLOXacin 250 mg tablet,904635161,,250,$59.69 ,$59.69 ,$45.60 ,$53.72 ,$50.74 ,$50.74 ,$50.74 ,$52.53 ,$50.74 ,$52.53 ,$52.53 ,$51.93 ,$50.74 ,$50.74 ,$50.74 ,$45.60 ,$53.72
Carle Richland Memorial Hospital,8980250,levoFLOXacin 500 mg tablet,904635261,,250,$67.02 ,$67.02 ,$51.20 ,$60.32 ,$56.97 ,$56.97 ,$56.97 ,$58.98 ,$56.97 ,$58.98 ,$58.98 ,$58.31 ,$56.97 ,$56.97 ,$56.97 ,$51.20 ,$60.32
Carle Richland Memorial Hospital,8980250,levothyroxine 100 mcg intravenous powder for solution,63323064994,,250,$507.74 ,$507.74 ,$387.91 ,$456.97 ,$431.58 ,$431.58 ,$431.58 ,$446.81 ,$431.58 ,$446.81 ,$446.81 ,$441.73 ,$431.58 ,$431.58 ,$431.58 ,$387.91 ,$456.97
Carle Richland Memorial Hospital,8980250,levothyroxine 100 mcg tablet,51079044220,,250,$5.18 ,$5.18 ,$3.96 ,$4.66 ,$4.40 ,$4.40 ,$4.40 ,$4.56 ,$4.40 ,$4.56 ,$4.56 ,$4.51 ,$4.40 ,$4.40 ,$4.40 ,$3.96 ,$4.66
Carle Richland Memorial Hospital,8980250,levothyroxine 112 mcg tablet,69238183501,,250,$5.36 ,$5.36 ,$4.10 ,$4.82 ,$4.56 ,$4.56 ,$4.56 ,$4.72 ,$4.56 ,$4.72 ,$4.72 ,$4.66 ,$4.56 ,$4.56 ,$4.56 ,$4.10 ,$4.82
Carle Richland Memorial Hospital,8980250,levothyroxine 112 mcg tablet,42292003901,,250,$5.62 ,$5.62 ,$4.29 ,$5.06 ,$4.78 ,$4.78 ,$4.78 ,$4.95 ,$4.78 ,$4.95 ,$4.95 ,$4.89 ,$4.78 ,$4.78 ,$4.78 ,$4.29 ,$5.06
Carle Richland Memorial Hospital,8980250,levothyroxine 112 mcg tablet,42292003920,,250,$5.62 ,$5.62 ,$4.29 ,$5.06 ,$4.78 ,$4.78 ,$4.78 ,$4.95 ,$4.78 ,$4.95 ,$4.95 ,$4.89 ,$4.78 ,$4.78 ,$4.78 ,$4.29 ,$5.06
Carle Richland Memorial Hospital,8980250,levothyroxine 125 mcg tablet,51079044301,,250,$5.67 ,$5.67 ,$4.33 ,$5.10 ,$4.82 ,$4.82 ,$4.82 ,$4.99 ,$4.82 ,$4.99 ,$4.99 ,$4.93 ,$4.82 ,$4.82 ,$4.82 ,$4.33 ,$5.10
Carle Richland Memorial Hospital,8980250,levothyroxine 150 mcg tablet,51079044520,,250,$5.77 ,$5.77 ,$4.41 ,$5.19 ,$4.90 ,$4.90 ,$4.90 ,$5.08 ,$4.90 ,$5.08 ,$5.08 ,$5.02 ,$4.90 ,$4.90 ,$4.90 ,$4.41 ,$5.19
Carle Richland Memorial Hospital,8980250,levothyroxine 25 mcg tablet,51079044420,,250,$4.54 ,$4.54 ,$3.47 ,$4.09 ,$3.86 ,$3.86 ,$3.86 ,$4.00 ,$3.86 ,$4.00 ,$4.00 ,$3.95 ,$3.86 ,$3.86 ,$3.86 ,$3.47 ,$4.09
Carle Richland Memorial Hospital,8980250,levothyroxine 50 mcg tablet,51079044020,,250,$4.85 ,$4.85 ,$3.71 ,$4.37 ,$4.12 ,$4.12 ,$4.12 ,$4.27 ,$4.12 ,$4.27 ,$4.27 ,$4.22 ,$4.12 ,$4.12 ,$4.12 ,$3.71 ,$4.37
Carle Richland Memorial Hospital,8980250,levothyroxine 75 mcg tablet,51079044120,,250,$5.11 ,$5.11 ,$3.90 ,$4.60 ,$4.34 ,$4.34 ,$4.34 ,$4.50 ,$4.34 ,$4.50 ,$4.50 ,$4.45 ,$4.34 ,$4.34 ,$4.34 ,$3.90 ,$4.60
Carle Richland Memorial Hospital,8980250,levothyroxine 88 mcg tablet,42292003801,,250,$5.16 ,$5.16 ,$3.94 ,$4.64 ,$4.39 ,$4.39 ,$4.39 ,$4.54 ,$4.39 ,$4.54 ,$4.54 ,$4.49 ,$4.39 ,$4.39 ,$4.39 ,$3.94 ,$4.64
Carle Richland Memorial Hospital,8980250,levothyroxine 88 mcg tablet,42292003820,,250,$5.16 ,$5.16 ,$3.94 ,$4.64 ,$4.39 ,$4.39 ,$4.39 ,$4.54 ,$4.39 ,$4.54 ,$4.54 ,$4.49 ,$4.39 ,$4.39 ,$4.39 ,$3.94 ,$4.64
Carle Richland Memorial Hospital,8980250,"lidocaine 1 %-epinephrine 1:100,000 injection solution",409317802,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"lidocaine 1 %-epinephrine 1:100,000 injection solution",409317803,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"lidocaine 1 %-epinephrine 1:100,000 injection solution",63323048227,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,lidocaine 2 % mucosal jelly in applicator,76329301305,,250,$38.17 ,$38.17 ,$29.16 ,$34.35 ,$32.44 ,$32.44 ,$32.44 ,$33.59 ,$32.44 ,$33.59 ,$33.59 ,$33.21 ,$32.44 ,$32.44 ,$32.44 ,$29.16 ,$34.35
Carle Richland Memorial Hospital,8980250,Lidocaine 2.5 % Ointment,9999040070,,250,$57.77 ,$57.77 ,$44.14 ,$51.99 ,$49.10 ,$49.10 ,$49.10 ,$50.84 ,$49.10 ,$50.84 ,$50.84 ,$50.26 ,$49.10 ,$49.10 ,$49.10 ,$44.14 ,$51.99
Carle Richland Memorial Hospital,8980250,metOLazone 2.5 mg tablet,51079002301,,250,$17.64 ,$17.64 ,$13.48 ,$15.88 ,$14.99 ,$14.99 ,$14.99 ,$15.52 ,$14.99 ,$15.52 ,$15.52 ,$15.35 ,$14.99 ,$14.99 ,$14.99 ,$13.48 ,$15.88
Carle Richland Memorial Hospital,8980250,metOLazone 2.5 mg tablet,51079002320,,250,$17.64 ,$17.64 ,$13.48 ,$15.88 ,$14.99 ,$14.99 ,$14.99 ,$15.52 ,$14.99 ,$15.52 ,$15.52 ,$15.35 ,$14.99 ,$14.99 ,$14.99 ,$13.48 ,$15.88
Carle Richland Memorial Hospital,8980250,"metoprolol succinate ER 100 mg tablet,extended release 24 hr",50268054211,,250,$10.13 ,$10.13 ,$7.74 ,$9.12 ,$8.61 ,$8.61 ,$8.61 ,$8.91 ,$8.61 ,$8.91 ,$8.91 ,$8.81 ,$8.61 ,$8.61 ,$8.61 ,$7.74 ,$9.12
Carle Richland Memorial Hospital,8980250,"metoprolol succinate ER 100 mg tablet,extended release 24 hr",50268054215,,250,$10.13 ,$10.13 ,$7.74 ,$9.12 ,$8.61 ,$8.61 ,$8.61 ,$8.91 ,$8.61 ,$8.91 ,$8.91 ,$8.81 ,$8.61 ,$8.61 ,$8.61 ,$7.74 ,$9.12
Carle Richland Memorial Hospital,8980250,"metoprolol succinate ER 25 mg tablet,extended release 24 hr",60687039001,,250,$7.53 ,$7.53 ,$5.75 ,$6.78 ,$6.40 ,$6.40 ,$6.40 ,$6.63 ,$6.40 ,$6.63 ,$6.63 ,$6.55 ,$6.40 ,$6.40 ,$6.40 ,$5.75 ,$6.78
Carle Richland Memorial Hospital,8980250,"metoprolol succinate ER 25 mg tablet,extended release 24 hr",60687039011,,250,$7.53 ,$7.53 ,$5.75 ,$6.78 ,$6.40 ,$6.40 ,$6.40 ,$6.63 ,$6.40 ,$6.63 ,$6.63 ,$6.55 ,$6.40 ,$6.40 ,$6.40 ,$5.75 ,$6.78
Carle Richland Memorial Hospital,8980250,"metoprolol succinate ER 50 mg tablet,extended release 24 hr",60687040201,,250,$7.53 ,$7.53 ,$5.75 ,$6.78 ,$6.40 ,$6.40 ,$6.40 ,$6.63 ,$6.40 ,$6.63 ,$6.63 ,$6.55 ,$6.40 ,$6.40 ,$6.40 ,$5.75 ,$6.78
Carle Richland Memorial Hospital,8980250,"metoprolol succinate ER 50 mg tablet,extended release 24 hr",60687040211,,250,$7.53 ,$7.53 ,$5.75 ,$6.78 ,$6.40 ,$6.40 ,$6.40 ,$6.63 ,$6.40 ,$6.63 ,$6.63 ,$6.55 ,$6.40 ,$6.40 ,$6.40 ,$5.75 ,$6.78
Carle Richland Memorial Hospital,8980250,metoprolol tartrate 100 mg tablet,62584026701,,250,$3.16 ,$3.16 ,$2.41 ,$2.84 ,$2.69 ,$2.69 ,$2.69 ,$2.78 ,$2.69 ,$2.78 ,$2.78 ,$2.75 ,$2.69 ,$2.69 ,$2.69 ,$2.41 ,$2.84
Carle Richland Memorial Hospital,8980250,metoprolol tartrate 100 mg tablet,62584026711,,250,$3.16 ,$3.16 ,$2.41 ,$2.84 ,$2.69 ,$2.69 ,$2.69 ,$2.78 ,$2.69 ,$2.78 ,$2.78 ,$2.75 ,$2.69 ,$2.69 ,$2.69 ,$2.41 ,$2.84
Carle Richland Memorial Hospital,8980250,metoprolol tartrate 25 mg tablet,51079025501,,250,$3.46 ,$3.46 ,$2.64 ,$3.11 ,$2.94 ,$2.94 ,$2.94 ,$3.04 ,$2.94 ,$3.04 ,$3.04 ,$3.01 ,$2.94 ,$2.94 ,$2.94 ,$2.64 ,$3.11
Carle Richland Memorial Hospital,8980250,metoprolol tartrate 25 mg tablet,51079025520,,250,$3.46 ,$3.46 ,$2.64 ,$3.11 ,$2.94 ,$2.94 ,$2.94 ,$3.04 ,$2.94 ,$3.04 ,$3.04 ,$3.01 ,$2.94 ,$2.94 ,$2.94 ,$2.64 ,$3.11
Carle Richland Memorial Hospital,8980250,metoprolol tartrate 5 mg/5 mL intravenous solution,36000003310,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,metoprolol tartrate 50 mg tablet,51079080101,,250,$5.00 ,$5.00 ,$3.82 ,$4.50 ,$4.25 ,$4.25 ,$4.25 ,$4.40 ,$4.25 ,$4.40 ,$4.40 ,$4.35 ,$4.25 ,$4.25 ,$4.25 ,$3.82 ,$4.50
Carle Richland Memorial Hospital,8980250,metroNIDAZOLE 250 mg tablet,904145361,,250,$5.02 ,$5.02 ,$3.84 ,$4.52 ,$4.27 ,$4.27 ,$4.27 ,$4.42 ,$4.27 ,$4.42 ,$4.42 ,$4.37 ,$4.27 ,$4.27 ,$4.27 ,$3.84 ,$4.52
Carle Richland Memorial Hospital,8980250,metroNIDAZOLE 500 mg/100 mL-sodium chloride(iso) intravenous piggyback,25021013182,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,miconazole nitrate 2 % topical cream,51672200102,,250,$45.40 ,$45.40 ,$34.69 ,$40.86 ,$38.59 ,$38.59 ,$38.59 ,$39.95 ,$38.59 ,$39.95 ,$39.95 ,$39.50 ,$38.59 ,$38.59 ,$38.59 ,$34.69 ,$40.86
Carle Richland Memorial Hospital,8980250,midazolam (PF) 1 mg/mL injection solution,409230517,J2250,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,midodrine 5 mg tablet,245021211,,250,$21.70 ,$21.70 ,$16.58 ,$19.53 ,$18.45 ,$18.45 ,$18.45 ,$19.10 ,$18.45 ,$19.10 ,$19.10 ,$18.88 ,$18.45 ,$18.45 ,$18.45 ,$16.58 ,$19.53
Carle Richland Memorial Hospital,8980250,"mineral oil, light sterile",63323025410,,250,$106.20 ,$106.20 ,$81.14 ,$95.58 ,$90.27 ,$90.27 ,$90.27 ,$93.46 ,$90.27 ,$93.46 ,$93.46 ,$92.39 ,$90.27 ,$90.27 ,$90.27 ,$81.14 ,$95.58
Carle Richland Memorial Hospital,8980250,minoxidiL 10 mg tablet,49884025701,,250,$10.20 ,$10.20 ,$7.79 ,$9.18 ,$8.67 ,$8.67 ,$8.67 ,$8.98 ,$8.67 ,$8.98 ,$8.98 ,$8.87 ,$8.67 ,$8.67 ,$8.67 ,$7.79 ,$9.18
Carle Richland Memorial Hospital,8980250,minoxidiL 2.5 mg tablet,68084020411,,250,$10.23 ,$10.23 ,$7.82 ,$9.21 ,$8.70 ,$8.70 ,$8.70 ,$9.00 ,$8.70 ,$9.00 ,$9.00 ,$8.90 ,$8.70 ,$8.70 ,$8.70 ,$7.82 ,$9.21
Carle Richland Memorial Hospital,8980250,mirtazapine 15 mg tablet,68084011911,,250,$7.20 ,$7.20 ,$5.50 ,$6.48 ,$6.12 ,$6.12 ,$6.12 ,$6.34 ,$6.12 ,$6.34 ,$6.34 ,$6.26 ,$6.12 ,$6.12 ,$6.12 ,$5.50 ,$6.48
Carle Richland Memorial Hospital,8980250,miSOPROStoL 100 mcg tablet,68084004001,,250,$5.22 ,$5.22 ,$3.99 ,$4.70 ,$4.44 ,$4.44 ,$4.44 ,$4.59 ,$4.44 ,$4.59 ,$4.59 ,$4.54 ,$4.44 ,$4.44 ,$4.44 ,$3.99 ,$4.70
Carle Richland Memorial Hospital,8980250,miSOPROStoL 100 mcg tablet,68084004011,,250,$5.22 ,$5.22 ,$3.99 ,$4.70 ,$4.44 ,$4.44 ,$4.44 ,$4.59 ,$4.44 ,$4.59 ,$4.59 ,$4.54 ,$4.44 ,$4.44 ,$4.44 ,$3.99 ,$4.70
Carle Richland Memorial Hospital,8980250,mometasone 110 mcg/actuation(30 doses) breath activated powder inhaler,85146102,,250,"$1,012.94 ","$1,012.94 ",$773.89 ,$911.65 ,$861.00 ,$861.00 ,$861.00 ,$891.39 ,$861.00 ,$891.39 ,$891.39 ,$881.26 ,$861.00 ,$861.00 ,$861.00 ,$773.89 ,$911.65
Carle Richland Memorial Hospital,8980250,mometasone 220 mcg/actuation(14 doses) breath activated powder inhaler,85134106,,250,$434.55 ,$434.55 ,$332.00 ,$391.10 ,$369.37 ,$369.37 ,$369.37 ,$382.40 ,$369.37 ,$382.40 ,$382.40 ,$378.06 ,$369.37 ,$369.37 ,$369.37 ,$332.00 ,$391.10
Carle Richland Memorial Hospital,8980250,montelukast 10 mg tablet,68084087511,,250,$27.42 ,$27.42 ,$20.95 ,$24.68 ,$23.31 ,$23.31 ,$23.31 ,$24.13 ,$23.31 ,$24.13 ,$24.13 ,$23.86 ,$23.31 ,$23.31 ,$23.31 ,$20.95 ,$24.68
Carle Richland Memorial Hospital,8980250,montelukast 4 mg chewable tablet,50268057311,,250,$19.38 ,$19.38 ,$14.81 ,$17.44 ,$16.47 ,$16.47 ,$16.47 ,$17.05 ,$16.47 ,$17.05 ,$17.05 ,$16.86 ,$16.47 ,$16.47 ,$16.47 ,$14.81 ,$17.44
Carle Richland Memorial Hospital,8980250,montelukast 4 mg chewable tablet,50268057315,,250,$19.38 ,$19.38 ,$14.81 ,$17.44 ,$16.47 ,$16.47 ,$16.47 ,$17.05 ,$16.47 ,$17.05 ,$17.05 ,$16.86 ,$16.47 ,$16.47 ,$16.47 ,$14.81 ,$17.44
Carle Richland Memorial Hospital,8980250,morphine 15 mg immediate release tablet,54023524,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,morphine concentrate 10 mg/0.5 mL oral syringe (FOR ORAL USE ONLY),68094075401,,250,$16.38 ,$16.38 ,$12.51 ,$14.74 ,$13.92 ,$13.92 ,$13.92 ,$14.41 ,$13.92 ,$14.41 ,$14.41 ,$14.25 ,$13.92 ,$13.92 ,$13.92 ,$12.51 ,$14.74
Carle Richland Memorial Hospital,8980250,morphine concentrate 10 mg/0.5 mL oral syringe (FOR ORAL USE ONLY),68094075458,,250,$16.38 ,$16.38 ,$12.51 ,$14.74 ,$13.92 ,$13.92 ,$13.92 ,$14.41 ,$13.92 ,$14.41 ,$14.41 ,$14.25 ,$13.92 ,$13.92 ,$13.92 ,$12.51 ,$14.74
Carle Richland Memorial Hospital,8980250,morphine concentrate 100 mg/5 mL (20 mg/mL) oral solution,54051744,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,"morphine ER 100 mg tablet,extended release",406839062,,250,$37.22 ,$37.22 ,$28.44 ,$33.50 ,$31.64 ,$31.64 ,$31.64 ,$32.75 ,$31.64 ,$32.75 ,$32.75 ,$32.38 ,$31.64 ,$31.64 ,$31.64 ,$28.44 ,$33.50
Carle Richland Memorial Hospital,8980250,"morphine ER 15 mg tablet,extended release",68084015711,,250,$13.25 ,$13.25 ,$10.12 ,$11.93 ,$11.26 ,$11.26 ,$11.26 ,$11.66 ,$11.26 ,$11.66 ,$11.66 ,$11.53 ,$11.26 ,$11.26 ,$11.26 ,$10.12 ,$11.93
Carle Richland Memorial Hospital,8980250,moxifloxacin 0.5 % eye drops,65401303,,250,$994.64 ,$994.64 ,$759.90 ,$895.18 ,$845.44 ,$845.44 ,$845.44 ,$875.28 ,$845.44 ,$875.28 ,$875.28 ,$865.34 ,$845.44 ,$845.44 ,$845.44 ,$759.90 ,$895.18
Carle Richland Memorial Hospital,8980250,multivitamin-minerals-iron fumarate 7.5 mg-folic acid 400 mcg tablet,79854040050,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,mupirocin 2 % topical ointment,68462018022,,250,$220.17 ,$220.17 ,$168.21 ,$198.15 ,$187.14 ,$187.14 ,$187.14 ,$193.75 ,$187.14 ,$193.75 ,$193.75 ,$191.55 ,$187.14 ,$187.14 ,$187.14 ,$168.21 ,$198.15
Carle Richland Memorial Hospital,8980250,"mvi,adult no.4 with vit K 3300 unit-150 mcg/10 mL intravenous solution",54643564901,,250,$111.95 ,$111.95 ,$85.53 ,$100.76 ,$95.16 ,$95.16 ,$95.16 ,$98.52 ,$95.16 ,$98.52 ,$98.52 ,$97.40 ,$95.16 ,$95.16 ,$95.16 ,$85.53 ,$100.76
Carle Richland Memorial Hospital,8980250,nabumetone 500 mg tablet,591367001,,250,$8.37 ,$8.37 ,$6.39 ,$7.53 ,$7.11 ,$7.11 ,$7.11 ,$7.37 ,$7.11 ,$7.37 ,$7.37 ,$7.28 ,$7.11 ,$7.11 ,$7.11 ,$6.39 ,$7.53
Carle Richland Memorial Hospital,8980250,nadoloL 40 mg tablet,60687031395,,250,$20.83 ,$20.83 ,$15.91 ,$18.75 ,$17.71 ,$17.71 ,$17.71 ,$18.33 ,$17.71 ,$18.33 ,$18.33 ,$18.12 ,$17.71 ,$17.71 ,$17.71 ,$15.91 ,$18.75
Carle Richland Memorial Hospital,8980250,nafcillin 1 gram solution for injection,44567022110,,250,$111.77 ,$111.77 ,$85.39 ,$100.59 ,$95.00 ,$95.00 ,$95.00 ,$98.36 ,$95.00 ,$98.36 ,$98.36 ,$97.24 ,$95.00 ,$95.00 ,$95.00 ,$85.39 ,$100.59
Carle Richland Memorial Hospital,8980250,nafcillin 2 gram solution for injection,70860011726,,250,$185.42 ,$185.42 ,$141.66 ,$166.88 ,$157.61 ,$157.61 ,$157.61 ,$163.17 ,$157.61 ,$163.17 ,$163.17 ,$161.32 ,$157.61 ,$157.61 ,$157.61 ,$141.66 ,$166.88
Carle Richland Memorial Hospital,8980250,naproxen sodium 275 mg tablet,43598049401,,250,$3.21 ,$3.21 ,$2.45 ,$2.89 ,$2.73 ,$2.73 ,$2.73 ,$2.82 ,$2.73 ,$2.82 ,$2.82 ,$2.79 ,$2.73 ,$2.73 ,$2.73 ,$2.45 ,$2.89
Carle Richland Memorial Hospital,8980250,"neomy-bacit-polymyx-pramoxine 3.5 mg-500 unit-10,000 unit/g top oint",24385014303,,250,$48.62 ,$48.62 ,$37.15 ,$43.76 ,$41.33 ,$41.33 ,$41.33 ,$42.79 ,$41.33 ,$42.79 ,$42.79 ,$42.30 ,$41.33 ,$41.33 ,$41.33 ,$37.15 ,$43.76
Carle Richland Memorial Hospital,8980250,"neomycin 1.75 mg-polymyxin 10,000 unit-gramicidin 0.025mg/mL eye drops",24208079062,,250,$306.44 ,$306.44 ,$234.12 ,$275.80 ,$260.47 ,$260.47 ,$260.47 ,$269.67 ,$260.47 ,$269.67 ,$269.67 ,$266.60 ,$260.47 ,$260.47 ,$260.47 ,$234.12 ,$275.80
Carle Richland Memorial Hospital,8980250,"neomycin 3.5 mg/g-polymyxin B 10,000 unit/g-dexameth 0.1 % eye oint",24208079535,,250,$101.95 ,$101.95 ,$77.89 ,$91.76 ,$86.66 ,$86.66 ,$86.66 ,$89.72 ,$86.66 ,$89.72 ,$89.72 ,$88.70 ,$86.66 ,$86.66 ,$86.66 ,$77.89 ,$91.76
Carle Richland Memorial Hospital,8980250,"neomycin 40 mg-polymyxin B 200,000 unit/mL GU irrigation solution",39822122001,,250,$905.50 ,$905.50 ,$691.80 ,$814.95 ,$769.68 ,$769.68 ,$769.68 ,$796.84 ,$769.68 ,$796.84 ,$796.84 ,$787.79 ,$769.68 ,$769.68 ,$769.68 ,$691.80 ,$814.95
Carle Richland Memorial Hospital,8980250,neomycin 500 mg tablet,93117701,,250,$8.69 ,$8.69 ,$6.64 ,$7.82 ,$7.39 ,$7.39 ,$7.39 ,$7.65 ,$7.39 ,$7.65 ,$7.65 ,$7.56 ,$7.39 ,$7.39 ,$7.39 ,$6.64 ,$7.82
Carle Richland Memorial Hospital,8980250,neomycin 500 mg tablet,39822031005,,250,$10.23 ,$10.23 ,$7.82 ,$9.21 ,$8.70 ,$8.70 ,$8.70 ,$9.00 ,$8.70 ,$9.00 ,$9.00 ,$8.90 ,$8.70 ,$8.70 ,$8.70 ,$7.82 ,$9.21
Carle Richland Memorial Hospital,8980250,"neomycin-bacitracin-poly-HC 3.5 mg-400-10,000 unit/g-1 % eye ointment",24208078555,,250,$286.22 ,$286.22 ,$218.67 ,$257.60 ,$243.29 ,$243.29 ,$243.29 ,$251.87 ,$243.29 ,$251.87 ,$251.87 ,$249.01 ,$243.29 ,$243.29 ,$243.29 ,$218.67 ,$257.60
Carle Richland Memorial Hospital,8980250,"neomycin-bacitracin-polymyxn 3.5 mg-400 unit-10,000 unit/gram eye oint",24208078055,,250,$253.19 ,$253.19 ,$193.44 ,$227.87 ,$215.21 ,$215.21 ,$215.21 ,$222.81 ,$215.21 ,$222.81 ,$222.81 ,$220.28 ,$215.21 ,$215.21 ,$215.21 ,$193.44 ,$227.87
Carle Richland Memorial Hospital,8980250,"neomycin-bacitracn Zn-polymyx 3.5 mg-400 unit-5,000 unit/gram top oint",45802014301,,250,$26.56 ,$26.56 ,$20.29 ,$23.90 ,$22.58 ,$22.58 ,$22.58 ,$23.37 ,$22.58 ,$23.37 ,$23.37 ,$23.11 ,$22.58 ,$22.58 ,$22.58 ,$20.29 ,$23.90
Carle Richland Memorial Hospital,8980250,"neomycin-bacitracn Zn-polymyxn 3.5 mg-400 unit-5,000 unit top oint pkt",45802014370,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"neomycin-polymyxin-dexameth 3.5 mg/mL-10,000 unit/mL-0.1% eye drops",24208083060,,250,$113.52 ,$113.52 ,$86.73 ,$102.17 ,$96.49 ,$96.49 ,$96.49 ,$99.90 ,$96.49 ,$99.90 ,$99.90 ,$98.76 ,$96.49 ,$96.49 ,$96.49 ,$86.73 ,$102.17
Carle Richland Memorial Hospital,8980250,"neomycin-polymyxin-hydrocort 3.5 mg/mL-10,000 unit/mL-1 % ear solution",61314064610,,250,$509.71 ,$509.71 ,$389.42 ,$458.74 ,$433.25 ,$433.25 ,$433.25 ,$448.54 ,$433.25 ,$448.54 ,$448.54 ,$443.45 ,$433.25 ,$433.25 ,$433.25 ,$389.42 ,$458.74
Carle Richland Memorial Hospital,8980250,"nepafenac 0.1 % eye drops,suspension",65000203,,250,"$1,539.94 ","$1,539.94 ","$1,176.51 ","$1,385.95 ","$1,308.95 ","$1,308.95 ","$1,308.95 ","$1,355.15 ","$1,308.95 ","$1,355.15 ","$1,355.15 ","$1,339.75 ","$1,308.95 ","$1,308.95 ","$1,308.95 ","$1,176.51 ","$1,385.95 "
Carle Richland Memorial Hospital,8980250,niCARdipine 25 mg/10 mL intravenous solution,143954201,,250,$175.62 ,$175.62 ,$134.17 ,$158.06 ,$149.28 ,$149.28 ,$149.28 ,$154.55 ,$149.28 ,$154.55 ,$154.55 ,$152.79 ,$149.28 ,$149.28 ,$149.28 ,$134.17 ,$158.06
Carle Richland Memorial Hospital,8980250,nicotine 14 mg/24 hr daily transdermal patch,43598044771,,250,$12.31 ,$12.31 ,$9.40 ,$11.08 ,$10.46 ,$10.46 ,$10.46 ,$10.83 ,$10.46 ,$10.83 ,$10.83 ,$10.71 ,$10.46 ,$10.46 ,$10.46 ,$9.40 ,$11.08
Carle Richland Memorial Hospital,8980250,nicotine 21 mg/24 hr daily transdermal patch,43598044871,,250,$3.00 ,$3.00 ,$2.29 ,$2.70 ,$2.55 ,$2.55 ,$2.55 ,$2.64 ,$2.55 ,$2.64 ,$2.64 ,$2.61 ,$2.55 ,$2.55 ,$2.55 ,$2.29 ,$2.70
Carle Richland Memorial Hospital,8980250,nicotine 7 mg/24 hr daily transdermal patch,135019602,,250,$5.20 ,$5.20 ,$3.97 ,$4.68 ,$4.42 ,$4.42 ,$4.42 ,$4.58 ,$4.42 ,$4.58 ,$4.58 ,$4.52 ,$4.42 ,$4.42 ,$4.42 ,$3.97 ,$4.68
Carle Richland Memorial Hospital,8980250,nicotine 7 mg/24 hr daily transdermal patch,135019608,,250,$5.20 ,$5.20 ,$3.97 ,$4.68 ,$4.42 ,$4.42 ,$4.42 ,$4.58 ,$4.42 ,$4.58 ,$4.58 ,$4.52 ,$4.42 ,$4.42 ,$4.42 ,$3.97 ,$4.68
Carle Richland Memorial Hospital,8980250,NIFEdipine 10 mg capsule,69315021101,,250,$7.31 ,$7.31 ,$5.58 ,$6.58 ,$6.21 ,$6.21 ,$6.21 ,$6.43 ,$6.21 ,$6.43 ,$6.43 ,$6.36 ,$6.21 ,$6.21 ,$6.21 ,$5.58 ,$6.58
Carle Richland Memorial Hospital,8980250,"NIFEdipine ER 30 mg tablet,extended release 24 hr",50268059715,,250,$8.44 ,$8.44 ,$6.45 ,$7.60 ,$7.17 ,$7.17 ,$7.17 ,$7.43 ,$7.17 ,$7.43 ,$7.43 ,$7.34 ,$7.17 ,$7.17 ,$7.17 ,$6.45 ,$7.60
Carle Richland Memorial Hospital,8980250,nitrofurantoin monohydrate/macrocrystals 100 mg capsule,185012210,,250,$17.28 ,$17.28 ,$13.20 ,$15.55 ,$14.69 ,$14.69 ,$14.69 ,$15.21 ,$14.69 ,$15.21 ,$15.21 ,$15.03 ,$14.69 ,$14.69 ,$14.69 ,$13.20 ,$15.55
Carle Richland Memorial Hospital,8980250,nitroglycerin 0.1 mg/hr transdermal 24 hour patch,378910216,,250,$10.99 ,$10.99 ,$8.40 ,$9.89 ,$9.34 ,$9.34 ,$9.34 ,$9.67 ,$9.34 ,$9.67 ,$9.67 ,$9.56 ,$9.34 ,$9.34 ,$9.34 ,$8.40 ,$9.89
Carle Richland Memorial Hospital,8980250,nitroglycerin 0.2 mg/hr transdermal 24 hour patch,68382030901,,250,$11.19 ,$11.19 ,$8.55 ,$10.07 ,$9.51 ,$9.51 ,$9.51 ,$9.85 ,$9.51 ,$9.85 ,$9.85 ,$9.74 ,$9.51 ,$9.51 ,$9.51 ,$8.55 ,$10.07
Carle Richland Memorial Hospital,8980250,nitroglycerin 0.4 mg sublingual tablet,43598043611,,250,$7.06 ,$7.06 ,$5.39 ,$6.35 ,$6.00 ,$6.00 ,$6.00 ,$6.21 ,$6.00 ,$6.21 ,$6.21 ,$6.14 ,$6.00 ,$6.00 ,$6.00 ,$5.39 ,$6.35
Carle Richland Memorial Hospital,8980250,nitroglycerin 0.4 mg/hr transdermal 24 hour patch,68382031030,,250,$12.46 ,$12.46 ,$9.52 ,$11.21 ,$10.59 ,$10.59 ,$10.59 ,$10.96 ,$10.59 ,$10.96 ,$10.96 ,$10.84 ,$10.59 ,$10.59 ,$10.59 ,$9.52 ,$11.21
Carle Richland Memorial Hospital,8980250,nitroglycerin 2 % transdermal ointment,281032608,,250,$15.17 ,$15.17 ,$11.59 ,$13.65 ,$12.89 ,$12.89 ,$12.89 ,$13.35 ,$12.89 ,$13.35 ,$13.35 ,$13.20 ,$12.89 ,$12.89 ,$12.89 ,$11.59 ,$13.65
Carle Richland Memorial Hospital,8980250,nitroglycerin 50 mg/250 mL (200 mcg/mL) in 5 % dextrose intravenous,338104902,,250,$153.27 ,$153.27 ,$117.10 ,$137.94 ,$130.28 ,$130.28 ,$130.28 ,$134.88 ,$130.28 ,$134.88 ,$134.88 ,$133.34 ,$130.28 ,$130.28 ,$130.28 ,$117.10 ,$137.94
Carle Richland Memorial Hospital,8980250,norepinephrine bitartrate 1 mg/mL intravenous solution,703115301,,250,$160.80 ,$160.80 ,$122.85 ,$144.72 ,$136.68 ,$136.68 ,$136.68 ,$141.50 ,$136.68 ,$141.50 ,$141.50 ,$139.90 ,$136.68 ,$136.68 ,$136.68 ,$122.85 ,$144.72
Carle Richland Memorial Hospital,8980250,nortriptyline 25 mg capsule,50268060411,,250,$5.08 ,$5.08 ,$3.88 ,$4.57 ,$4.32 ,$4.32 ,$4.32 ,$4.47 ,$4.32 ,$4.47 ,$4.47 ,$4.42 ,$4.32 ,$4.32 ,$4.32 ,$3.88 ,$4.57
Carle Richland Memorial Hospital,8980250,nortriptyline 25 mg capsule,50268060415,,250,$5.08 ,$5.08 ,$3.88 ,$4.57 ,$4.32 ,$4.32 ,$4.32 ,$4.47 ,$4.32 ,$4.47 ,$4.47 ,$4.42 ,$4.32 ,$4.32 ,$4.32 ,$3.88 ,$4.57
Carle Richland Memorial Hospital,8980250,nut.tx impaired digestive fxn 0.035 gram-1 kcal/mL oral liquid,70074064899,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,nut.tx impaired digestive fxn 0.035 gram-1 kcal/mL oral liquid,70074064901,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,"nut.tx pulmonary disorder soy, lac-free oral liquid",70074064810,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,"nutritional therapy glucose intolerance,lactose-free,soy oral liquid",70074064921,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,"nutritional therapy glucose intolerance,lactose-free,soy oral liquid",70074064924,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,"nutritional therapy glucose intolerance,lactose-free,soy oral liquid",70074064928,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,"nystatin 100,000 unit/gram topical cream",713067815,,250,$102.54 ,$102.54 ,$78.34 ,$92.29 ,$87.16 ,$87.16 ,$87.16 ,$90.24 ,$87.16 ,$90.24 ,$90.24 ,$89.21 ,$87.16 ,$87.16 ,$87.16 ,$78.34 ,$92.29
Carle Richland Memorial Hospital,8980250,"nystatin 100,000 unit/gram topical powder",574200815,,250,$148.96 ,$148.96 ,$113.81 ,$134.06 ,$126.62 ,$126.62 ,$126.62 ,$131.08 ,$126.62 ,$131.08 ,$131.08 ,$129.60 ,$126.62 ,$126.62 ,$126.62 ,$113.81 ,$134.06
Carle Richland Memorial Hospital,8980250,"nystatin 100,000 unit/mL oral suspension",66689003799,,250,$7.04 ,$7.04 ,$5.38 ,$6.34 ,$5.98 ,$5.98 ,$5.98 ,$6.20 ,$5.98 ,$6.20 ,$6.20 ,$6.12 ,$5.98 ,$5.98 ,$5.98 ,$5.38 ,$6.34
Carle Richland Memorial Hospital,8980250,"nystatin 100,000 unit/mL oral suspension",121081016,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,"nystatin 100,000 unit/mL oral suspension",66689003701,,250,$9.51 ,$9.51 ,$7.27 ,$8.56 ,$8.08 ,$8.08 ,$8.08 ,$8.37 ,$8.08 ,$8.37 ,$8.37 ,$8.27 ,$8.08 ,$8.08 ,$8.08 ,$7.27 ,$8.56
Carle Richland Memorial Hospital,8980250,ofloxacin 0.3 % ear drops,50383002505,,250,$820.21 ,$820.21 ,$626.64 ,$738.19 ,$697.18 ,$697.18 ,$697.18 ,$721.78 ,$697.18 ,$721.78 ,$721.78 ,$713.58 ,$697.18 ,$697.18 ,$697.18 ,$626.64 ,$738.19
Carle Richland Memorial Hospital,8980250,ofloxacin 0.3 % eye drops,24208043405,,250,$135.28 ,$135.28 ,$103.35 ,$121.75 ,$114.99 ,$114.99 ,$114.99 ,$119.05 ,$114.99 ,$119.05 ,$119.05 ,$117.69 ,$114.99 ,$114.99 ,$114.99 ,$103.35 ,$121.75
Carle Richland Memorial Hospital,8980250,OLANZapine 5 mg disintegrating tablet,59746030612,,250,$58.11 ,$58.11 ,$44.40 ,$52.30 ,$49.39 ,$49.39 ,$49.39 ,$51.14 ,$49.39 ,$51.14 ,$51.14 ,$50.56 ,$49.39 ,$49.39 ,$49.39 ,$44.40 ,$52.30
Carle Richland Memorial Hospital,8980250,OLANZapine 5 mg disintegrating tablet,59746030632,,250,$58.11 ,$58.11 ,$44.40 ,$52.30 ,$49.39 ,$49.39 ,$49.39 ,$51.14 ,$49.39 ,$51.14 ,$51.14 ,$50.56 ,$49.39 ,$49.39 ,$49.39 ,$44.40 ,$52.30
Carle Richland Memorial Hospital,8980250,OLANZapine 5 mg tablet,68084072311,,250,$46.27 ,$46.27 ,$35.35 ,$41.64 ,$39.33 ,$39.33 ,$39.33 ,$40.72 ,$39.33 ,$40.72 ,$40.72 ,$40.25 ,$39.33 ,$39.33 ,$39.33 ,$35.35 ,$41.64
Carle Richland Memorial Hospital,8980250,olive oil,395206311,,250,$43.13 ,$43.13 ,$32.95 ,$38.82 ,$36.66 ,$36.66 ,$36.66 ,$37.95 ,$36.66 ,$37.95 ,$37.95 ,$37.52 ,$36.66 ,$36.66 ,$36.66 ,$32.95 ,$38.82
Carle Richland Memorial Hospital,8980250,"omega 3-dha-epa-fish oil 300 mg-1,000 mg capsule,delayed release",68094010959,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"omega 3-dha-epa-fish oil 300 mg-1,000 mg capsule,delayed release",68094010961,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"omega 3-dha-epa-fish oil 300 mg-1,000 mg capsule,delayed release,omega 3-dha-epa-fish oil 1,000 mg (120 mg-180 mg) capsule",68094010961,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"omega 3-dha-epa-fish oil 300 mg-1,000 mg capsule,delayed release,omega 3-dha-epa-fish oil 1,000 mg (120 mg-180 mg) capsule",77333030810,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"omeprazole 20 mg capsule,delayed release",50268061915,,250,$33.41 ,$33.41 ,$25.53 ,$30.07 ,$28.40 ,$28.40 ,$28.40 ,$29.40 ,$28.40 ,$29.40 ,$29.40 ,$29.07 ,$28.40 ,$28.40 ,$28.40 ,$25.53 ,$30.07
Carle Richland Memorial Hospital,8980250,oseltamivir 30 mg capsule,64380079701,,250,$157.04 ,$157.04 ,$119.98 ,$141.34 ,$133.48 ,$133.48 ,$133.48 ,$138.20 ,$133.48 ,$138.20 ,$138.20 ,$136.62 ,$133.48 ,$133.48 ,$133.48 ,$119.98 ,$141.34
Carle Richland Memorial Hospital,8980250,oseltamivir 6 mg/mL oral suspension,70710116506,,250,$86.55 ,$86.55 ,$66.12 ,$77.90 ,$73.57 ,$73.57 ,$73.57 ,$76.16 ,$73.57 ,$76.16 ,$76.16 ,$75.30 ,$73.57 ,$73.57 ,$73.57 ,$66.12 ,$77.90
Carle Richland Memorial Hospital,8980250,oseltamivir 75 mg capsule,69238126601,,250,$62.25 ,$62.25 ,$47.56 ,$56.03 ,$52.91 ,$52.91 ,$52.91 ,$54.78 ,$52.91 ,$54.78 ,$54.78 ,$54.16 ,$52.91 ,$52.91 ,$52.91 ,$47.56 ,$56.03
Carle Richland Memorial Hospital,8980250,oxybutynin chloride 5 mg tablet,68084040011,,250,$4.67 ,$4.67 ,$3.57 ,$4.20 ,$3.97 ,$3.97 ,$3.97 ,$4.11 ,$3.97 ,$4.11 ,$4.11 ,$4.06 ,$3.97 ,$3.97 ,$3.97 ,$3.57 ,$4.20
Carle Richland Memorial Hospital,8980250,oxyCODONE 10 mg tablet,42858000201,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,oxyCODONE 5 mg tablet,68084035401,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,"oxyCODONE ER 10 mg tablet,crush resistant,extended release 12 hr",59011041020,,250,$29.62 ,$29.62 ,$22.63 ,$26.66 ,$25.18 ,$25.18 ,$25.18 ,$26.07 ,$25.18 ,$26.07 ,$26.07 ,$25.77 ,$25.18 ,$25.18 ,$25.18 ,$22.63 ,$26.66
Carle Richland Memorial Hospital,8980250,"oxyCODONE ER 40 mg tablet,crush resistant,extended release 12 hr",59011044020,,250,$71.52 ,$71.52 ,$54.64 ,$64.37 ,$60.79 ,$60.79 ,$60.79 ,$62.94 ,$60.79 ,$62.94 ,$62.94 ,$62.22 ,$60.79 ,$60.79 ,$60.79 ,$54.64 ,$64.37
Carle Richland Memorial Hospital,8980250,oxyCODONE-acetaminophen 10 mg-325 mg tablet,42858010401,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,oxyCODONE-acetaminophen 5 mg-325 mg tablet,68084035511,,250,$11.11 ,$11.11 ,$8.49 ,$10.00 ,$9.44 ,$9.44 ,$9.44 ,$9.78 ,$9.44 ,$9.78 ,$9.78 ,$9.67 ,$9.44 ,$9.44 ,$9.44 ,$8.49 ,$10.00
Carle Richland Memorial Hospital,8980250,oxymetazoline 0.05 % nasal spray,45802041059,,250,$26.72 ,$26.72 ,$20.41 ,$24.05 ,$22.71 ,$22.71 ,$22.71 ,$23.51 ,$22.71 ,$23.51 ,$23.51 ,$23.25 ,$22.71 ,$22.71 ,$22.71 ,$20.41 ,$24.05
Carle Richland Memorial Hospital,8980250,oxytocin in lactated ringers 30 unit/500 mL intravenous solution,9999501525,,250,$177.54 ,$177.54 ,$135.64 ,$159.79 ,$150.91 ,$150.91 ,$150.91 ,$156.24 ,$150.91 ,$156.24 ,$156.24 ,$154.46 ,$150.91 ,$150.91 ,$150.91 ,$135.64 ,$159.79
Carle Richland Memorial Hospital,8980250,"paliperidone ER 3 mg tablet,extended release 24 hr",47335076583,,250,$115.12 ,$115.12 ,$87.95 ,$103.61 ,$97.85 ,$97.85 ,$97.85 ,$101.31 ,$97.85 ,$101.31 ,$101.31 ,$100.15 ,$97.85 ,$97.85 ,$97.85 ,$87.95 ,$103.61
Carle Richland Memorial Hospital,8980250,"pantoprazole 20 mg tablet,delayed release",50268063611,,250,$20.90 ,$20.90 ,$15.97 ,$18.81 ,$17.77 ,$17.77 ,$17.77 ,$18.39 ,$17.77 ,$18.39 ,$18.39 ,$18.18 ,$17.77 ,$17.77 ,$17.77 ,$15.97 ,$18.81
Carle Richland Memorial Hospital,8980250,"pantoprazole 20 mg tablet,delayed release",50268063615,,250,$20.90 ,$20.90 ,$15.97 ,$18.81 ,$17.77 ,$17.77 ,$17.77 ,$18.39 ,$17.77 ,$18.39 ,$18.39 ,$18.18 ,$17.77 ,$17.77 ,$17.77 ,$15.97 ,$18.81
Carle Richland Memorial Hospital,8980250,"pantoprazole 40 mg tablet,delayed release",68084081309,,250,$4.47 ,$4.47 ,$3.42 ,$4.02 ,$3.80 ,$3.80 ,$3.80 ,$3.93 ,$3.80 ,$3.93 ,$3.93 ,$3.89 ,$3.80 ,$3.80 ,$3.80 ,$3.42 ,$4.02
Carle Richland Memorial Hospital,8980250,"pantoprazole 40 mg tablet,delayed release",68084081311,,250,$4.47 ,$4.47 ,$3.42 ,$4.02 ,$3.80 ,$3.80 ,$3.80 ,$3.93 ,$3.80 ,$3.93 ,$3.93 ,$3.89 ,$3.80 ,$3.80 ,$3.80 ,$3.42 ,$4.02
Carle Richland Memorial Hospital,8980250,PARoxetine 20 mg tablet,68084004501,,250,$15.33 ,$15.33 ,$11.71 ,$13.80 ,$13.03 ,$13.03 ,$13.03 ,$13.49 ,$13.03 ,$13.49 ,$13.49 ,$13.34 ,$13.03 ,$13.03 ,$13.03 ,$11.71 ,$13.80
Carle Richland Memorial Hospital,8980250,PARoxetine 20 mg tablet,68084004511,,250,$15.33 ,$15.33 ,$11.71 ,$13.80 ,$13.03 ,$13.03 ,$13.03 ,$13.49 ,$13.03 ,$13.49 ,$13.49 ,$13.34 ,$13.03 ,$13.03 ,$13.03 ,$11.71 ,$13.80
Carle Richland Memorial Hospital,8980250,peg 3350-electrolytes 236 gram-22.74 gram-6.74 gram-5.86 gram solution,52268010001,,250,$76.89 ,$76.89 ,$58.74 ,$69.20 ,$65.36 ,$65.36 ,$65.36 ,$67.66 ,$65.36 ,$67.66 ,$67.66 ,$66.89 ,$65.36 ,$65.36 ,$65.36 ,$58.74 ,$69.20
Carle Richland Memorial Hospital,8980250,"peg 400-hypromellose-glycerin 1 %-0.2 %-0.2 % eye drops,dextran 70-hypromellose 0.1 %-0.3 % eye drops,polyvinyl alcohol-povidone 0.5 %-0.6 % eye drops,polyvinyl alcohol 1.4 % eye drops,peg 400-propylene glycol 0.4 %-0.3 % eye drops",57896018105,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,peg 400-propylene glycol (PF) 0.4 %-0.3 % eye drops in a dropperette,65043133,,250,$4.14 ,$4.14 ,$3.16 ,$3.73 ,$3.52 ,$3.52 ,$3.52 ,$3.64 ,$3.52 ,$3.64 ,$3.64 ,$3.60 ,$3.52 ,$3.52 ,$3.52 ,$3.16 ,$3.73
Carle Richland Memorial Hospital,8980250,penicillin V potassium 250 mg tablet,781120501,,250,$5.53 ,$5.53 ,$4.22 ,$4.98 ,$4.70 ,$4.70 ,$4.70 ,$4.87 ,$4.70 ,$4.87 ,$4.87 ,$4.81 ,$4.70 ,$4.70 ,$4.70 ,$4.22 ,$4.98
Carle Richland Memorial Hospital,8980250,permethrin 0.5 % spray,74300000421,,250,$33.21 ,$33.21 ,$25.37 ,$29.89 ,$28.23 ,$28.23 ,$28.23 ,$29.22 ,$28.23 ,$29.22 ,$29.22 ,$28.89 ,$28.23 ,$28.23 ,$28.23 ,$25.37 ,$29.89
Carle Richland Memorial Hospital,8980250,permethrin 1 % topical liquid,87701041115,,250,$60.84 ,$60.84 ,$46.48 ,$54.76 ,$51.71 ,$51.71 ,$51.71 ,$53.54 ,$51.71 ,$53.54 ,$53.54 ,$52.93 ,$51.71 ,$51.71 ,$51.71 ,$46.48 ,$54.76
Carle Richland Memorial Hospital,8980250,permethrin 5 % topical cream,45802026937,,250,$574.58 ,$574.58 ,$438.98 ,$517.12 ,$488.39 ,$488.39 ,$488.39 ,$505.63 ,$488.39 ,$505.63 ,$505.63 ,$499.88 ,$488.39 ,$488.39 ,$488.39 ,$438.98 ,$517.12
Carle Richland Memorial Hospital,8980250,PHENobarbitaL 30 mg tablet,51293069201,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,phenoL 1.4 % mucosal aerosol spray,536122858,,250,$21.01 ,$21.01 ,$16.05 ,$18.91 ,$17.86 ,$17.86 ,$17.86 ,$18.49 ,$17.86 ,$18.49 ,$18.49 ,$18.28 ,$17.86 ,$17.86 ,$17.86 ,$16.05 ,$18.91
Carle Richland Memorial Hospital,8980250,phenoL 89 % topical swab,884629730,,250,$27.25 ,$27.25 ,$20.82 ,$24.53 ,$23.16 ,$23.16 ,$23.16 ,$23.98 ,$23.16 ,$23.98 ,$23.98 ,$23.71 ,$23.16 ,$23.16 ,$23.16 ,$20.82 ,$24.53
Carle Richland Memorial Hospital,8980250,phenylephrine 0.5 % nasal spray,50323000603,,250,$25.59 ,$25.59 ,$19.55 ,$23.03 ,$21.75 ,$21.75 ,$21.75 ,$22.52 ,$21.75 ,$22.52 ,$22.52 ,$22.26 ,$21.75 ,$21.75 ,$21.75 ,$19.55 ,$23.03
Carle Richland Memorial Hospital,8980250,phenylephrine 1 % nasal spray,50323000604,,250,$28.38 ,$28.38 ,$21.68 ,$25.54 ,$24.12 ,$24.12 ,$24.12 ,$24.97 ,$24.12 ,$24.97 ,$24.97 ,$24.69 ,$24.12 ,$24.12 ,$24.12 ,$21.68 ,$25.54
Carle Richland Memorial Hospital,8980250,phenylephrine 10 % eye drops,17478020605,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,phenytoin 100 mg/4 mL oral suspension,60687027562,,250,$39.80 ,$39.80 ,$30.41 ,$35.82 ,$33.83 ,$33.83 ,$33.83 ,$35.02 ,$33.83 ,$35.02 ,$35.02 ,$34.63 ,$33.83 ,$33.83 ,$33.83 ,$30.41 ,$35.82
Carle Richland Memorial Hospital,8980250,phenytoin 100 mg/4 mL oral suspension,60687027566,,250,$39.80 ,$39.80 ,$30.41 ,$35.82 ,$33.83 ,$33.83 ,$33.83 ,$35.02 ,$33.83 ,$35.02 ,$35.02 ,$34.63 ,$33.83 ,$33.83 ,$33.83 ,$30.41 ,$35.82
Carle Richland Memorial Hospital,8980250,phenytoin 50 mg chewable tablet,60687015695,,250,$4.01 ,$4.01 ,$3.06 ,$3.61 ,$3.41 ,$3.41 ,$3.41 ,$3.53 ,$3.41 ,$3.53 ,$3.53 ,$3.49 ,$3.41 ,$3.41 ,$3.41 ,$3.06 ,$3.61
Carle Richland Memorial Hospital,8980250,phenytoin sodium extended 100 mg capsule,68084037601,,250,$5.32 ,$5.32 ,$4.06 ,$4.79 ,$4.52 ,$4.52 ,$4.52 ,$4.68 ,$4.52 ,$4.68 ,$4.68 ,$4.63 ,$4.52 ,$4.52 ,$4.52 ,$4.06 ,$4.79
Carle Richland Memorial Hospital,8980250,phenytoin sodium extended 100 mg capsule,68084037611,,250,$5.32 ,$5.32 ,$4.06 ,$4.79 ,$4.52 ,$4.52 ,$4.52 ,$4.68 ,$4.52 ,$4.68 ,$4.68 ,$4.63 ,$4.52 ,$4.52 ,$4.52 ,$4.06 ,$4.79
Carle Richland Memorial Hospital,8980250,physostigmine 1 mg/mL injection solution,17478051002,,250,$475.11 ,$475.11 ,$362.98 ,$427.60 ,$403.84 ,$403.84 ,$403.84 ,$418.10 ,$403.84 ,$418.10 ,$418.10 ,$413.35 ,$403.84 ,$403.84 ,$403.84 ,$362.98 ,$427.60
Carle Richland Memorial Hospital,8980250,pilocarpine 2 % eye drops,17478022412,,250,$472.87 ,$472.87 ,$361.27 ,$425.58 ,$401.94 ,$401.94 ,$401.94 ,$416.13 ,$401.94 ,$416.13 ,$416.13 ,$411.40 ,$401.94 ,$401.94 ,$401.94 ,$361.27 ,$425.58
Carle Richland Memorial Hospital,8980250,polyethylene glycol 3350 17 gram oral powder packet,904642286,,250,$2.62 ,$2.62 ,$2.00 ,$2.36 ,$2.23 ,$2.23 ,$2.23 ,$2.31 ,$2.23 ,$2.31 ,$2.31 ,$2.28 ,$2.23 ,$2.23 ,$2.23 ,$2.00 ,$2.36
Carle Richland Memorial Hospital,8980250,polyethylene glycol 3350 17 gram/dose oral powder,45802086801,,250,$33.28 ,$33.28 ,$25.43 ,$29.95 ,$28.29 ,$28.29 ,$28.29 ,$29.29 ,$28.29 ,$29.29 ,$29.29 ,$28.95 ,$28.29 ,$28.29 ,$28.29 ,$25.43 ,$29.95
Carle Richland Memorial Hospital,8980250,"polymyxin B sulfate 10,000 unit-trimethoprim 1 mg/mL eye drops",17478070311,,250,$78.40 ,$78.40 ,$59.90 ,$70.56 ,$66.64 ,$66.64 ,$66.64 ,$68.99 ,$66.64 ,$68.99 ,$68.99 ,$68.21 ,$66.64 ,$66.64 ,$66.64 ,$59.90 ,$70.56
Carle Richland Memorial Hospital,8980250,"polymyxin B sulfate 500,000 unit solution for injection",63323036711,,250,$111.77 ,$111.77 ,$85.39 ,$100.59 ,$95.00 ,$95.00 ,$95.00 ,$98.36 ,$95.00 ,$98.36 ,$98.36 ,$97.24 ,$95.00 ,$95.00 ,$95.00 ,$85.39 ,$100.59
Carle Richland Memorial Hospital,8980250,poractant alfa 240 mg/3 mL intratracheal suspension,10122051003,,250,"$4,098.46 ","$4,098.46 ","$3,131.22 ","$3,688.61 ","$3,483.69 ","$3,483.69 ","$3,483.69 ","$3,606.64 ","$3,483.69 ","$3,606.64 ","$3,606.64 ","$3,565.66 ","$3,483.69 ","$3,483.69 ","$3,483.69 ","$3,131.22 ","$3,688.61 "
Carle Richland Memorial Hospital,8980250,potassium bicarbonate-citric acid 25 mEq effervescent tablet,51801000130,,250,$4.15 ,$4.15 ,$3.17 ,$3.74 ,$3.53 ,$3.53 ,$3.53 ,$3.65 ,$3.53 ,$3.65 ,$3.65 ,$3.61 ,$3.53 ,$3.53 ,$3.53 ,$3.17 ,$3.74
Carle Richland Memorial Hospital,8980250,potassium chloride 20 mEq oral packet,69238161701,,250,$45.74 ,$45.74 ,$34.95 ,$41.17 ,$38.88 ,$38.88 ,$38.88 ,$40.25 ,$38.88 ,$40.25 ,$40.25 ,$39.79 ,$38.88 ,$38.88 ,$38.88 ,$34.95 ,$41.17
Carle Richland Memorial Hospital,8980250,"potassium chloride ER 10 mEq tablet,extended release(part/cryst),potassium chloride ER 10 mEq tablet,extended release",574027511,,250,$4.15 ,$4.15 ,$3.17 ,$3.74 ,$3.53 ,$3.53 ,$3.53 ,$3.65 ,$3.53 ,$3.65 ,$3.65 ,$3.61 ,$3.53 ,$3.53 ,$3.53 ,$3.17 ,$3.74
Carle Richland Memorial Hospital,8980250,"potassium chloride ER 10 mEq tablet,extended release(part/cryst),potassium chloride ER 10 mEq tablet,extended release",245531701,,250,$5.21 ,$5.21 ,$3.98 ,$4.69 ,$4.43 ,$4.43 ,$4.43 ,$4.58 ,$4.43 ,$4.58 ,$4.58 ,$4.53 ,$4.43 ,$4.43 ,$4.43 ,$3.98 ,$4.69
Carle Richland Memorial Hospital,8980250,"potassium chloride ER 20 mEq tablet,extended release(part/cryst)",245531989,,250,$5.50 ,$5.50 ,$4.20 ,$4.95 ,$4.68 ,$4.68 ,$4.68 ,$4.84 ,$4.68 ,$4.84 ,$4.84 ,$4.79 ,$4.68 ,$4.68 ,$4.68 ,$4.20 ,$4.95
Carle Richland Memorial Hospital,8980250,"potassium citrate ER 10 mEq (1,080 mg) tablet,extended release",68084085032,,250,$15.82 ,$15.82 ,$12.09 ,$14.24 ,$13.45 ,$13.45 ,$13.45 ,$13.92 ,$13.45 ,$13.92 ,$13.92 ,$13.76 ,$13.45 ,$13.45 ,$13.45 ,$12.09 ,$14.24
Carle Richland Memorial Hospital,8980250,"potassium citrate ER 10 mEq (1,080 mg) tablet,extended release",68084085033,,250,$15.82 ,$15.82 ,$12.09 ,$14.24 ,$13.45 ,$13.45 ,$13.45 ,$13.92 ,$13.45 ,$13.92 ,$13.92 ,$13.76 ,$13.45 ,$13.45 ,$13.45 ,$12.09 ,$14.24
Carle Richland Memorial Hospital,8980250,potassium phosphates-mbasic and dibasic 3 mmol/mL intravenous solution,409729511,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,povidone-iodine 10 % topical solution,67618015005,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,povidone-iodine 10 % topical solution,67618015009,,250,$22.81 ,$22.81 ,$17.43 ,$20.53 ,$19.39 ,$19.39 ,$19.39 ,$20.07 ,$19.39 ,$20.07 ,$20.07 ,$19.84 ,$19.39 ,$19.39 ,$19.39 ,$17.43 ,$20.53
Carle Richland Memorial Hospital,8980250,povidone-iodine 10 % topical swab,67618015303,,250,$3.00 ,$3.00 ,$2.29 ,$2.70 ,$2.55 ,$2.55 ,$2.55 ,$2.64 ,$2.55 ,$2.64 ,$2.64 ,$2.61 ,$2.55 ,$2.55 ,$2.55 ,$2.29 ,$2.70
Carle Richland Memorial Hospital,8980250,povidone-iodine 5 % eye solution,65041130,,250,$93.95 ,$93.95 ,$71.78 ,$84.56 ,$79.86 ,$79.86 ,$79.86 ,$82.68 ,$79.86 ,$82.68 ,$82.68 ,$81.74 ,$79.86 ,$79.86 ,$79.86 ,$71.78 ,$84.56
Carle Richland Memorial Hospital,8980250,pramipexole 0.25 mg tablet,13668009290,,250,$16.03 ,$16.03 ,$12.25 ,$14.43 ,$13.63 ,$13.63 ,$13.63 ,$14.11 ,$13.63 ,$14.11 ,$14.11 ,$13.95 ,$13.63 ,$13.63 ,$13.63 ,$12.25 ,$14.43
Carle Richland Memorial Hospital,8980250,pravastatin 20 mg tablet,60687017801,,250,$17.48 ,$17.48 ,$13.35 ,$15.73 ,$14.86 ,$14.86 ,$14.86 ,$15.38 ,$14.86 ,$15.38 ,$15.38 ,$15.21 ,$14.86 ,$14.86 ,$14.86 ,$13.35 ,$15.73
Carle Richland Memorial Hospital,8980250,prazosin 1 mg capsule,70954001910,,250,$6.50 ,$6.50 ,$4.97 ,$5.85 ,$5.53 ,$5.53 ,$5.53 ,$5.72 ,$5.53 ,$5.72 ,$5.72 ,$5.66 ,$5.53 ,$5.53 ,$5.53 ,$4.97 ,$5.85
Carle Richland Memorial Hospital,8980250,"prednisoLONE 1 %-moxifloxacin 0.5 %-nepafenac 0.1 % eye drops,susp",71384032005,,250,$255.83 ,$255.83 ,$195.45 ,$230.25 ,$217.46 ,$217.46 ,$217.46 ,$225.13 ,$217.46 ,$225.13 ,$225.13 ,$222.57 ,$217.46 ,$217.46 ,$217.46 ,$195.45 ,$230.25
Carle Richland Memorial Hospital,8980250,"prednisoLONE acetate 1 % eye drops,suspension",60758011905,,250,$267.02 ,$267.02 ,$204.00 ,$240.32 ,$226.97 ,$226.97 ,$226.97 ,$234.98 ,$226.97 ,$234.98 ,$234.98 ,$232.31 ,$226.97 ,$226.97 ,$226.97 ,$204.00 ,$240.32
Carle Richland Memorial Hospital,8980250,pregabalin 25 mg capsule,71101268,,250,$46.55 ,$46.55 ,$35.56 ,$41.90 ,$39.57 ,$39.57 ,$39.57 ,$40.96 ,$39.57 ,$40.96 ,$40.96 ,$40.50 ,$39.57 ,$39.57 ,$39.57 ,$35.56 ,$41.90
Carle Richland Memorial Hospital,8980250,pregabalin 75 mg capsule,60687049501,,250,$12.20 ,$12.20 ,$9.32 ,$10.98 ,$10.37 ,$10.37 ,$10.37 ,$10.74 ,$10.37 ,$10.74 ,$10.74 ,$10.61 ,$10.37 ,$10.37 ,$10.37 ,$9.32 ,$10.98
Carle Richland Memorial Hospital,8980250,pregabalin 75 mg capsule,60687049511,,250,$12.20 ,$12.20 ,$9.32 ,$10.98 ,$10.37 ,$10.37 ,$10.37 ,$10.74 ,$10.37 ,$10.74 ,$10.74 ,$10.61 ,$10.37 ,$10.37 ,$10.37 ,$9.32 ,$10.98
Carle Richland Memorial Hospital,8980250,prenatal vit no.95-ferrous fumarate 28 mg-folic acid 800 mcg tablet,46122009878,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,primidone 50 mg tablet,50268068611,,250,$6.78 ,$6.78 ,$5.18 ,$6.10 ,$5.76 ,$5.76 ,$5.76 ,$5.97 ,$5.76 ,$5.97 ,$5.97 ,$5.90 ,$5.76 ,$5.76 ,$5.76 ,$5.18 ,$6.10
Carle Richland Memorial Hospital,8980250,primidone 50 mg tablet,50268068615,,250,$6.78 ,$6.78 ,$5.18 ,$6.10 ,$5.76 ,$5.76 ,$5.76 ,$5.97 ,$5.76 ,$5.97 ,$5.97 ,$5.90 ,$5.76 ,$5.76 ,$5.76 ,$5.18 ,$6.10
Carle Richland Memorial Hospital,8980250,prochlorperazine 25 mg rectal suppository,574722612,,250,$52.19 ,$52.19 ,$39.87 ,$46.97 ,$44.36 ,$44.36 ,$44.36 ,$45.93 ,$44.36 ,$45.93 ,$45.93 ,$45.41 ,$44.36 ,$44.36 ,$44.36 ,$39.87 ,$46.97
Carle Richland Memorial Hospital,8980250,promethazine 12.5 mg rectal suppository,51672529601,,250,$70.12 ,$70.12 ,$53.57 ,$63.11 ,$59.60 ,$59.60 ,$59.60 ,$61.71 ,$59.60 ,$61.71 ,$61.71 ,$61.00 ,$59.60 ,$59.60 ,$59.60 ,$53.57 ,$63.11
Carle Richland Memorial Hospital,8980250,promethazine 12.5 mg rectal suppository,51672529605,,250,$70.12 ,$70.12 ,$53.57 ,$63.11 ,$59.60 ,$59.60 ,$59.60 ,$61.71 ,$59.60 ,$61.71 ,$61.71 ,$61.00 ,$59.60 ,$59.60 ,$59.60 ,$53.57 ,$63.11
Carle Richland Memorial Hospital,8980250,promethazine 25 mg rectal suppository,591299239,,250,$70.12 ,$70.12 ,$53.57 ,$63.11 ,$59.60 ,$59.60 ,$59.60 ,$61.71 ,$59.60 ,$61.71 ,$61.71 ,$61.00 ,$59.60 ,$59.60 ,$59.60 ,$53.57 ,$63.11
Carle Richland Memorial Hospital,8980250,promethazine 25 mg tablet,68084015511,,250,$4.86 ,$4.86 ,$3.71 ,$4.37 ,$4.13 ,$4.13 ,$4.13 ,$4.28 ,$4.13 ,$4.28 ,$4.28 ,$4.23 ,$4.13 ,$4.13 ,$4.13 ,$3.71 ,$4.37
Carle Richland Memorial Hospital,8980250,promethazine-phenylephrine 6.25 mg-5 mg/5 mL oral syrup,9999037717,,250,$16.74 ,$16.74 ,$12.79 ,$15.07 ,$14.23 ,$14.23 ,$14.23 ,$14.73 ,$14.23 ,$14.73 ,$14.73 ,$14.56 ,$14.23 ,$14.23 ,$14.23 ,$12.79 ,$15.07
Carle Richland Memorial Hospital,8980250,promethazine-phenylephrine-codeine 6.25 mg-5 mg-10 mg/5 mL oral syrup,50383080504,,250,$22.21 ,$22.21 ,$16.97 ,$19.99 ,$18.88 ,$18.88 ,$18.88 ,$19.54 ,$18.88 ,$19.54 ,$19.54 ,$19.32 ,$18.88 ,$18.88 ,$18.88 ,$16.97 ,$19.99
Carle Richland Memorial Hospital,8980250,proparacaine 0.5 % eye drops,24208073006,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,propranoloL 10 mg tablet,904655061,,250,$3.97 ,$3.97 ,$3.03 ,$3.57 ,$3.37 ,$3.37 ,$3.37 ,$3.49 ,$3.37 ,$3.49 ,$3.49 ,$3.45 ,$3.37 ,$3.37 ,$3.37 ,$3.03 ,$3.57
Carle Richland Memorial Hospital,8980250,propranoloL 40 mg tablet,60687029501,,250,$8.41 ,$8.41 ,$6.43 ,$7.57 ,$7.15 ,$7.15 ,$7.15 ,$7.40 ,$7.15 ,$7.40 ,$7.40 ,$7.32 ,$7.15 ,$7.15 ,$7.15 ,$6.43 ,$7.57
Carle Richland Memorial Hospital,8980250,propranoloL 40 mg tablet,60687029511,,250,$8.41 ,$8.41 ,$6.43 ,$7.57 ,$7.15 ,$7.15 ,$7.15 ,$7.40 ,$7.15 ,$7.40 ,$7.40 ,$7.32 ,$7.15 ,$7.15 ,$7.15 ,$6.43 ,$7.57
Carle Richland Memorial Hospital,8980250,"propranoloL ER 60 mg capsule,24 hr,extended release",60687021501,,250,$12.49 ,$12.49 ,$9.54 ,$11.24 ,$10.62 ,$10.62 ,$10.62 ,$10.99 ,$10.62 ,$10.99 ,$10.99 ,$10.87 ,$10.62 ,$10.62 ,$10.62 ,$9.54 ,$11.24
Carle Richland Memorial Hospital,8980250,"propranoloL ER 60 mg capsule,24 hr,extended release",60687021511,,250,$12.49 ,$12.49 ,$9.54 ,$11.24 ,$10.62 ,$10.62 ,$10.62 ,$10.99 ,$10.62 ,$10.99 ,$10.99 ,$10.87 ,$10.62 ,$10.62 ,$10.62 ,$9.54 ,$11.24
Carle Richland Memorial Hospital,8980250,"propranoloL ER 80 mg capsule,24 hr,extended release",62559053101,,250,$13.44 ,$13.44 ,$10.27 ,$12.10 ,$11.42 ,$11.42 ,$11.42 ,$11.83 ,$11.42 ,$11.83 ,$11.83 ,$11.69 ,$11.42 ,$11.42 ,$11.42 ,$10.27 ,$12.10
Carle Richland Memorial Hospital,8980250,propylthiouraciL 50 mg tablet,68084096425,,250,$17.99 ,$17.99 ,$13.74 ,$16.19 ,$15.29 ,$15.29 ,$15.29 ,$15.83 ,$15.29 ,$15.83 ,$15.83 ,$15.65 ,$15.29 ,$15.29 ,$15.29 ,$13.74 ,$16.19
Carle Richland Memorial Hospital,8980250,propylthiouraciL 50 mg tablet,68084096495,,250,$17.99 ,$17.99 ,$13.74 ,$16.19 ,$15.29 ,$15.29 ,$15.29 ,$15.83 ,$15.29 ,$15.83 ,$15.83 ,$15.65 ,$15.29 ,$15.29 ,$15.29 ,$13.74 ,$16.19
Carle Richland Memorial Hospital,8980250,psyllium husk (with sugar) 3.4 gram oral powder packet,37000002304,,250,$0.62 ,$0.62 ,$0.47 ,$0.56 ,$0.53 ,$0.53 ,$0.53 ,$0.55 ,$0.53 ,$0.55 ,$0.55 ,$0.54 ,$0.53 ,$0.53 ,$0.53 ,$0.47 ,$0.56
Carle Richland Memorial Hospital,8980250,psyllium husk (with sugar) 3.4 gram oral powder packet,37000002310,,250,$0.62 ,$0.62 ,$0.47 ,$0.56 ,$0.53 ,$0.53 ,$0.53 ,$0.55 ,$0.53 ,$0.55 ,$0.55 ,$0.54 ,$0.53 ,$0.53 ,$0.53 ,$0.47 ,$0.56
Carle Richland Memorial Hospital,8980250,pyridostigmine bromide 60 mg tablet,68084049401,,250,$9.24 ,$9.24 ,$7.06 ,$8.32 ,$7.85 ,$7.85 ,$7.85 ,$8.13 ,$7.85 ,$8.13 ,$8.13 ,$8.04 ,$7.85 ,$7.85 ,$7.85 ,$7.06 ,$8.32
Carle Richland Memorial Hospital,8980250,pyridostigmine bromide 60 mg tablet,68084049411,,250,$9.24 ,$9.24 ,$7.06 ,$8.32 ,$7.85 ,$7.85 ,$7.85 ,$8.13 ,$7.85 ,$8.13 ,$8.13 ,$8.04 ,$7.85 ,$7.85 ,$7.85 ,$7.06 ,$8.32
Carle Richland Memorial Hospital,8980250,QUEtiapine 25 mg tablet,60687032711,,250,$19.93 ,$19.93 ,$15.23 ,$17.94 ,$16.94 ,$16.94 ,$16.94 ,$17.54 ,$16.94 ,$17.54 ,$17.54 ,$17.34 ,$16.94 ,$16.94 ,$16.94 ,$15.23 ,$17.94
Carle Richland Memorial Hospital,8980250,"QUEtiapine ER 200 mg tablet,extended release 24 hr",50742063760,,250,$67.39 ,$67.39 ,$51.49 ,$60.65 ,$57.28 ,$57.28 ,$57.28 ,$59.30 ,$57.28 ,$59.30 ,$59.30 ,$58.63 ,$57.28 ,$57.28 ,$57.28 ,$51.49 ,$60.65
Carle Richland Memorial Hospital,8980250,"QUEtiapine ER 50 mg tablet,extended release 24 hr",71093013502,,250,$60.65 ,$60.65 ,$46.34 ,$54.59 ,$51.55 ,$51.55 ,$51.55 ,$53.37 ,$51.55 ,$53.37 ,$53.37 ,$52.77 ,$51.55 ,$51.55 ,$51.55 ,$46.34 ,$54.59
Carle Richland Memorial Hospital,8980250,raltegravir 400 mg tablet,6022761,,250,$129.61 ,$129.61 ,$99.02 ,$116.65 ,$110.17 ,$110.17 ,$110.17 ,$114.06 ,$110.17 ,$114.06 ,$114.06 ,$112.76 ,$110.17 ,$110.17 ,$110.17 ,$99.02 ,$116.65
Carle Richland Memorial Hospital,8980250,ramipriL 2.5 mg capsule,68001014200,,250,$10.32 ,$10.32 ,$7.88 ,$9.29 ,$8.77 ,$8.77 ,$8.77 ,$9.08 ,$8.77 ,$9.08 ,$9.08 ,$8.98 ,$8.77 ,$8.77 ,$8.77 ,$7.88 ,$9.29
Carle Richland Memorial Hospital,8980250,"ranolazine ER 500 mg tablet,extended release,12 hr",68180035407,,250,$30.63 ,$30.63 ,$23.40 ,$27.57 ,$26.04 ,$26.04 ,$26.04 ,$26.95 ,$26.04 ,$26.95 ,$26.95 ,$26.65 ,$26.04 ,$26.04 ,$26.04 ,$23.40 ,$27.57
Carle Richland Memorial Hospital,8980250,remdesivir 100 mg intravenous powder for solution,61958290101,,250,"$2,971.91 ","$2,971.91 ","$2,270.54 ","$2,674.72 ","$2,526.12 ","$2,526.12 ","$2,526.12 ","$2,615.28 ","$2,526.12 ","$2,615.28 ","$2,615.28 ","$2,585.56 ","$2,526.12 ","$2,526.12 ","$2,526.12 ","$2,270.54 ","$2,674.72 "
Carle Richland Memorial Hospital,8980250,remdesivir 100 mg/20 mL (5 mg/mL) IV soln (for pts 40 kg or more),61958290201,,250,"$2,971.91 ","$2,971.91 ","$2,270.54 ","$2,674.72 ","$2,526.12 ","$2,526.12 ","$2,526.12 ","$2,615.28 ","$2,526.12 ","$2,615.28 ","$2,615.28 ","$2,585.56 ","$2,526.12 ","$2,526.12 ","$2,526.12 ","$2,270.54 ","$2,674.72 "
Carle Richland Memorial Hospital,8980250,rifAMPin 300 mg capsule,527131530,,250,$23.73 ,$23.73 ,$18.13 ,$21.36 ,$20.17 ,$20.17 ,$20.17 ,$20.88 ,$20.17 ,$20.88 ,$20.88 ,$20.65 ,$20.17 ,$20.17 ,$20.17 ,$18.13 ,$21.36
Carle Richland Memorial Hospital,8980250,rifAMPin 600 mg intravenous solution,68059701,,250,"$1,062.57 ","$1,062.57 ",$811.80 ,$956.31 ,$903.18 ,$903.18 ,$903.18 ,$935.06 ,$903.18 ,$935.06 ,$935.06 ,$924.44 ,$903.18 ,$903.18 ,$903.18 ,$811.80 ,$956.31
Carle Richland Memorial Hospital,8980250,rifAXIMin 550 mg tablet,65649030303,,250,$201.18 ,$201.18 ,$153.70 ,$181.06 ,$171.00 ,$171.00 ,$171.00 ,$177.04 ,$171.00 ,$177.04 ,$177.04 ,$175.03 ,$171.00 ,$171.00 ,$171.00 ,$153.70 ,$181.06
Carle Richland Memorial Hospital,8980250,risperiDONE 0.5 mg tablet,68084027101,,250,$22.23 ,$22.23 ,$16.98 ,$20.01 ,$18.90 ,$18.90 ,$18.90 ,$19.56 ,$18.90 ,$19.56 ,$19.56 ,$19.34 ,$18.90 ,$18.90 ,$18.90 ,$16.98 ,$20.01
Carle Richland Memorial Hospital,8980250,risperiDONE 0.5 mg tablet,68084027111,,250,$22.23 ,$22.23 ,$16.98 ,$20.01 ,$18.90 ,$18.90 ,$18.90 ,$19.56 ,$18.90 ,$19.56 ,$19.56 ,$19.34 ,$18.90 ,$18.90 ,$18.90 ,$16.98 ,$20.01
Carle Richland Memorial Hospital,8980250,risperiDONE 1 mg tablet,68084027211,,250,$23.49 ,$23.49 ,$17.95 ,$21.14 ,$19.97 ,$19.97 ,$19.97 ,$20.67 ,$19.97 ,$20.67 ,$20.67 ,$20.44 ,$19.97 ,$19.97 ,$19.97 ,$17.95 ,$21.14
Carle Richland Memorial Hospital,8980250,risperiDONE 2 mg tablet,68084027301,,250,$34.72 ,$34.72 ,$26.53 ,$31.25 ,$29.51 ,$29.51 ,$29.51 ,$30.55 ,$29.51 ,$30.55 ,$30.55 ,$30.21 ,$29.51 ,$29.51 ,$29.51 ,$26.53 ,$31.25
Carle Richland Memorial Hospital,8980250,risperiDONE 2 mg tablet,68084027311,,250,$34.72 ,$34.72 ,$26.53 ,$31.25 ,$29.51 ,$29.51 ,$29.51 ,$30.55 ,$29.51 ,$30.55 ,$30.55 ,$30.21 ,$29.51 ,$29.51 ,$29.51 ,$26.53 ,$31.25
Carle Richland Memorial Hospital,8980250,rivaroxaban 10 mg tablet,50458058010,,250,$77.10 ,$77.10 ,$58.90 ,$69.39 ,$65.54 ,$65.54 ,$65.54 ,$67.85 ,$65.54 ,$67.85 ,$67.85 ,$67.08 ,$65.54 ,$65.54 ,$65.54 ,$58.90 ,$69.39
Carle Richland Memorial Hospital,8980250,rivaroxaban 2.5 mg tablet,50458057710,,250,$42.63 ,$42.63 ,$32.57 ,$38.37 ,$36.24 ,$36.24 ,$36.24 ,$37.51 ,$36.24 ,$37.51 ,$37.51 ,$37.09 ,$36.24 ,$36.24 ,$36.24 ,$32.57 ,$38.37
Carle Richland Memorial Hospital,8980250,rivastigmine 1.5 mg capsule,60687057401,,250,$21.71 ,$21.71 ,$16.59 ,$19.54 ,$18.45 ,$18.45 ,$18.45 ,$19.10 ,$18.45 ,$19.10 ,$19.10 ,$18.89 ,$18.45 ,$18.45 ,$18.45 ,$16.59 ,$19.54
Carle Richland Memorial Hospital,8980250,rizatriptan 5 mg disintegrating tablet,51991036299,,250,$124.48 ,$124.48 ,$95.10 ,$112.03 ,$105.81 ,$105.81 ,$105.81 ,$109.54 ,$105.81 ,$109.54 ,$109.54 ,$108.30 ,$105.81 ,$105.81 ,$105.81 ,$95.10 ,$112.03
Carle Richland Memorial Hospital,8980250,rocuronium 10 mg/mL intravenous solution,39822420002,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,rocuronium 10 mg/mL intravenous solution,703239503,,250,$55.20 ,$55.20 ,$42.17 ,$49.68 ,$46.92 ,$46.92 ,$46.92 ,$48.58 ,$46.92 ,$48.58 ,$48.58 ,$48.02 ,$46.92 ,$46.92 ,$46.92 ,$42.17 ,$49.68
Carle Richland Memorial Hospital,8980250,roflumilast 500 mcg tablet,310009530,,250,$65.01 ,$65.01 ,$49.67 ,$58.51 ,$55.26 ,$55.26 ,$55.26 ,$57.21 ,$55.26 ,$57.21 ,$57.21 ,$56.56 ,$55.26 ,$55.26 ,$55.26 ,$49.67 ,$58.51
Carle Richland Memorial Hospital,8980250,rOPINIRole 0.5 mg tablet,62332003131,,250,$13.98 ,$13.98 ,$10.68 ,$12.58 ,$11.88 ,$11.88 ,$11.88 ,$12.30 ,$11.88 ,$12.30 ,$12.30 ,$12.16 ,$11.88 ,$11.88 ,$11.88 ,$10.68 ,$12.58
Carle Richland Memorial Hospital,8980250,rOPINIRole 3 mg tablet,68462025701,,250,$14.44 ,$14.44 ,$11.03 ,$13.00 ,$12.27 ,$12.27 ,$12.27 ,$12.71 ,$12.27 ,$12.71 ,$12.71 ,$12.56 ,$12.27 ,$12.27 ,$12.27 ,$11.03 ,$13.00
Carle Richland Memorial Hospital,8980250,sacubitriL 24 mg-valsartan 26 mg tablet,78065920,,250,$48.95 ,$48.95 ,$37.40 ,$44.06 ,$41.61 ,$41.61 ,$41.61 ,$43.08 ,$41.61 ,$43.08 ,$43.08 ,$42.59 ,$41.61 ,$41.61 ,$41.61 ,$37.40 ,$44.06
Carle Richland Memorial Hospital,8980250,saliva stimulant combination no.3 oral mucosal spray,48582000155,,250,$34.70 ,$34.70 ,$26.51 ,$31.23 ,$29.50 ,$29.50 ,$29.50 ,$30.54 ,$29.50 ,$30.54 ,$30.54 ,$30.19 ,$29.50 ,$29.50 ,$29.50 ,$26.51 ,$31.23
Carle Richland Memorial Hospital,8980250,scopolamine 1 mg over 3 days transdermal patch,10019055303,,250,$97.59 ,$97.59 ,$74.56 ,$87.83 ,$82.95 ,$82.95 ,$82.95 ,$85.88 ,$82.95 ,$85.88 ,$85.88 ,$84.90 ,$82.95 ,$82.95 ,$82.95 ,$74.56 ,$87.83
Carle Richland Memorial Hospital,8980250,sennosides 8.6 mg tablet,904652261,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,sennosides 8.6 mg-docusate sodium 50 mg tablet,63739043210,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,sertraline 50 mg tablet,60687024201,,250,$4.20 ,$4.20 ,$3.21 ,$3.78 ,$3.57 ,$3.57 ,$3.57 ,$3.70 ,$3.57 ,$3.70 ,$3.70 ,$3.65 ,$3.57 ,$3.57 ,$3.57 ,$3.21 ,$3.78
Carle Richland Memorial Hospital,8980250,sertraline 50 mg tablet,60687024211,,250,$4.20 ,$4.20 ,$3.21 ,$3.78 ,$3.57 ,$3.57 ,$3.57 ,$3.70 ,$3.57 ,$3.70 ,$3.70 ,$3.65 ,$3.57 ,$3.57 ,$3.57 ,$3.21 ,$3.78
Carle Richland Memorial Hospital,8980250,sevoflurane inhalation liquid,10019065164,,250,$813.24 ,$813.24 ,$621.32 ,$731.92 ,$691.25 ,$691.25 ,$691.25 ,$715.65 ,$691.25 ,$715.65 ,$715.65 ,$707.52 ,$691.25 ,$691.25 ,$691.25 ,$621.32 ,$731.92
Carle Richland Memorial Hospital,8980250,silver nitrate applicators 75 %-25 % topical stick,12870000101,,250,$5.88 ,$5.88 ,$4.49 ,$5.29 ,$5.00 ,$5.00 ,$5.00 ,$5.17 ,$5.00 ,$5.17 ,$5.17 ,$5.12 ,$5.00 ,$5.00 ,$5.00 ,$4.49 ,$5.29
Carle Richland Memorial Hospital,8980250,silver sulfADIAZINE 1 % topical cream,67877012440,,250,$322.94 ,$322.94 ,$246.73 ,$290.65 ,$274.50 ,$274.50 ,$274.50 ,$284.19 ,$274.50 ,$284.19 ,$284.19 ,$280.96 ,$274.50 ,$274.50 ,$274.50 ,$246.73 ,$290.65
Carle Richland Memorial Hospital,8980250,silver sulfADIAZINE 1 % topical cream,67877012425,J3490,250,$56.32 ,$56.32 ,$43.03 ,$50.69 ,$47.87 ,$47.87 ,$47.87 ,$49.56 ,$47.87 ,$49.56 ,$49.56 ,$49.00 ,$47.87 ,$47.87 ,$47.87 ,$43.03 ,$50.69
Carle Richland Memorial Hospital,8980250,"simethicone 40 mg/0.6 mL oral drops,suspension",904589430,,250,$23.93 ,$23.93 ,$18.28 ,$21.54 ,$20.34 ,$20.34 ,$20.34 ,$21.06 ,$20.34 ,$21.06 ,$21.06 ,$20.82 ,$20.34 ,$20.34 ,$20.34 ,$18.28 ,$21.54
Carle Richland Memorial Hospital,8980250,simethicone 80 mg chewable tablet,63739022510,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,simvastatin 10 mg tablet,68084051111,,250,$15.33 ,$15.33 ,$11.71 ,$13.80 ,$13.03 ,$13.03 ,$13.03 ,$13.49 ,$13.03 ,$13.49 ,$13.49 ,$13.34 ,$13.03 ,$13.03 ,$13.03 ,$11.71 ,$13.80
Carle Richland Memorial Hospital,8980250,simvastatin 20 mg tablet,68084051211,,250,$25.26 ,$25.26 ,$19.30 ,$22.73 ,$21.47 ,$21.47 ,$21.47 ,$22.23 ,$21.47 ,$22.23 ,$22.23 ,$21.98 ,$21.47 ,$21.47 ,$21.47 ,$19.30 ,$22.73
Carle Richland Memorial Hospital,8980250,sod polystyrene sulfonate 30 gram-sorbitoL 40 gram/120 mL enema,46287000604,,250,$503.37 ,$503.37 ,$384.57 ,$453.03 ,$427.86 ,$427.86 ,$427.86 ,$442.97 ,$427.86 ,$442.97 ,$442.97 ,$437.93 ,$427.86 ,$427.86 ,$427.86 ,$384.57 ,$453.03
Carle Richland Memorial Hospital,8980250,sodium bicarbonate 1 mEq/mL (8.4 %) intravenous solution,63323008950,,250,$174.05 ,$174.05 ,$132.97 ,$156.65 ,$147.94 ,$147.94 ,$147.94 ,$153.16 ,$147.94 ,$153.16 ,$153.16 ,$151.42 ,$147.94 ,$147.94 ,$147.94 ,$132.97 ,$156.65
Carle Richland Memorial Hospital,8980250,sodium bicarbonate 10 mEq/10 mL (8.4 %) intravenous syringe,409490034,,250,$101.53 ,$101.53 ,$77.57 ,$91.38 ,$86.30 ,$86.30 ,$86.30 ,$89.35 ,$86.30 ,$89.35 ,$89.35 ,$88.33 ,$86.30 ,$86.30 ,$86.30 ,$77.57 ,$91.38
Carle Richland Memorial Hospital,8980250,sodium bicarbonate 4.2 % (0.5 mEq/mL) intravenous syringe,409553434,,250,$78.89 ,$78.89 ,$60.27 ,$71.00 ,$67.06 ,$67.06 ,$67.06 ,$69.42 ,$67.06 ,$69.42 ,$69.42 ,$68.63 ,$67.06 ,$67.06 ,$67.06 ,$60.27 ,$71.00
Carle Richland Memorial Hospital,8980250,sodium bicarbonate 650 mg tablet,66553000801,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,sodium bicarbonate 8.4 % (1 mEq/mL) intravenous syringe,76329335201,,250,$97.68 ,$97.68 ,$74.63 ,$87.91 ,$83.03 ,$83.03 ,$83.03 ,$85.96 ,$83.03 ,$85.96 ,$85.96 ,$84.98 ,$83.03 ,$83.03 ,$83.03 ,$74.63 ,$87.91
Carle Richland Memorial Hospital,8980250,sodium bicarbonate-sodium chloride 0.9 % nasal spray aerosol,5928005075,,250,$23.58 ,$23.58 ,$18.02 ,$21.22 ,$20.04 ,$20.04 ,$20.04 ,$20.75 ,$20.04 ,$20.75 ,$20.75 ,$20.51 ,$20.04 ,$20.04 ,$20.04 ,$18.02 ,$21.22
Carle Richland Memorial Hospital,8980250,sodium chloride 0.65 % nasal spray aerosol,904386575,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,sodium chloride 0.9 % for nebulization,487930133,,250,$3.03 ,$3.03 ,$2.31 ,$2.73 ,$2.58 ,$2.58 ,$2.58 ,$2.67 ,$2.58 ,$2.67 ,$2.67 ,$2.64 ,$2.58 ,$2.58 ,$2.58 ,$2.31 ,$2.73
Carle Richland Memorial Hospital,8980250,sodium chloride 0.9 % for nebulization,378698789,,250,$6.73 ,$6.73 ,$5.14 ,$6.06 ,$5.72 ,$5.72 ,$5.72 ,$5.92 ,$5.72 ,$5.92 ,$5.92 ,$5.86 ,$5.72 ,$5.72 ,$5.72 ,$5.14 ,$6.06
Carle Richland Memorial Hospital,8980250,"sodium chloride 0.9 %, bacteriostatic injection solution",409196602,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"sodium chloride 0.9 %, bacteriostatic injection solution",409196606,,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,sodium chloride 1 gram tablet,223176001,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,sodium chloride 1 gram tablet,223176002,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,sodium chloride 4 mEq/mL intravenous solution,409114102,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,sodium chloride 4 mEq/mL intravenous solution,409114112,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,sodium chloride 4 mEq/mL intravenous solution,63323018730,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,sodium chloride 4 mEq/mL intravenous solution,63323008861,,250,$117.01 ,$117.01 ,$89.40 ,$105.31 ,$99.46 ,$99.46 ,$99.46 ,$102.97 ,$99.46 ,$102.97 ,$102.97 ,$101.80 ,$99.46 ,$99.46 ,$99.46 ,$89.40 ,$105.31
Carle Richland Memorial Hospital,8980250,sodium chloride 4 mEq/mL intravenous solution,63323008863,,250,$228.17 ,$228.17 ,$174.32 ,$205.35 ,$193.94 ,$193.94 ,$193.94 ,$200.79 ,$193.94 ,$200.79 ,$200.79 ,$198.51 ,$193.94 ,$193.94 ,$193.94 ,$174.32 ,$205.35
Carle Richland Memorial Hospital,8980250,sodium chloride 7 % for nebulization,83490030760,J3490,250,$3.73 ,$3.73 ,$2.85 ,$3.36 ,$3.17 ,$3.17 ,$3.17 ,$3.28 ,$3.17 ,$3.28 ,$3.28 ,$3.25 ,$3.17 ,$3.17 ,$3.17 ,$2.85 ,$3.36
Carle Richland Memorial Hospital,8980250,sodium chloride-potassium chloride 287 mg-180 mg-15 mg tablet,38485086335,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,sodium citrate-citric acid 500 mg-334 mg/5 mL oral solution,121059530,,250,$12.40 ,$12.40 ,$9.47 ,$11.16 ,$10.54 ,$10.54 ,$10.54 ,$10.91 ,$10.54 ,$10.91 ,$10.91 ,$10.79 ,$10.54 ,$10.54 ,$10.54 ,$9.47 ,$11.16
Carle Richland Memorial Hospital,8980250,sodium hyaluronate 10 mg/mL(mw 2.4-3.6 million)intra-articular syringe,55566410001,J7323,250,"$1,549.84 ","$1,549.84 ","$1,184.08 ","$1,394.86 ","$1,317.36 ","$1,317.36 ","$1,317.36 ","$1,363.86 ","$1,317.36 ","$1,363.86 ","$1,363.86 ","$1,348.36 ","$1,317.36 ","$1,317.36 ","$1,317.36 ","$1,184.08 ","$1,394.86 "
Carle Richland Memorial Hospital,8980250,sodium nitroprusside 25 mg/mL intravenous solution,67457083902,J3490,250,"$1,572.23 ","$1,572.23 ","$1,201.18 ","$1,415.01 ","$1,336.40 ","$1,336.40 ","$1,336.40 ","$1,383.56 ","$1,336.40 ","$1,383.56 ","$1,383.56 ","$1,367.84 ","$1,336.40 ","$1,336.40 ","$1,336.40 ","$1,201.18 ","$1,415.01 "
Carle Richland Memorial Hospital,8980250,sodium phosphate 3 mmol/mL intravenous solution,63323017005,,250,$147.68 ,$147.68 ,$112.83 ,$132.91 ,$125.53 ,$125.53 ,$125.53 ,$129.96 ,$125.53 ,$129.96 ,$129.96 ,$128.48 ,$125.53 ,$125.53 ,$125.53 ,$112.83 ,$132.91
Carle Richland Memorial Hospital,8980250,sodium polystyrene sulfonate 15 gram-sorbitoL 20 gram/60 mL oral susp,46287000660,,250,$113.61 ,$113.61 ,$86.80 ,$102.25 ,$96.57 ,$96.57 ,$96.57 ,$99.98 ,$96.57 ,$99.98 ,$99.98 ,$98.84 ,$96.57 ,$96.57 ,$96.57 ,$86.80 ,$102.25
Carle Richland Memorial Hospital,8980250,sotaloL 80 mg tablet,68084065411,,250,$13.14 ,$13.14 ,$10.04 ,$11.83 ,$11.17 ,$11.17 ,$11.17 ,$11.56 ,$11.17 ,$11.56 ,$11.56 ,$11.43 ,$11.17 ,$11.17 ,$11.17 ,$10.04 ,$11.83
Carle Richland Memorial Hospital,8980250,spironolactone 100 mg tablet,59746021801,,250,$3.66 ,$3.66 ,$2.80 ,$3.29 ,$3.11 ,$3.11 ,$3.11 ,$3.22 ,$3.11 ,$3.22 ,$3.22 ,$3.18 ,$3.11 ,$3.11 ,$3.11 ,$2.80 ,$3.29
Carle Richland Memorial Hospital,8980250,spironolactone 25 mg tablet,60687046501,,250,$3.39 ,$3.39 ,$2.59 ,$3.05 ,$2.88 ,$2.88 ,$2.88 ,$2.98 ,$2.88 ,$2.98 ,$2.98 ,$2.95 ,$2.88 ,$2.88 ,$2.88 ,$2.59 ,$3.05
Carle Richland Memorial Hospital,8980250,spironolactone 25 mg tablet,60687046511,,250,$3.39 ,$3.39 ,$2.59 ,$3.05 ,$2.88 ,$2.88 ,$2.88 ,$2.98 ,$2.88 ,$2.98 ,$2.98 ,$2.95 ,$2.88 ,$2.88 ,$2.88 ,$2.59 ,$3.05
Carle Richland Memorial Hospital,8980250,sucralfate 100 mg/mL oral suspension,68094017159,,250,$17.48 ,$17.48 ,$13.35 ,$15.73 ,$14.86 ,$14.86 ,$14.86 ,$15.38 ,$14.86 ,$15.38 ,$15.38 ,$15.21 ,$14.86 ,$14.86 ,$14.86 ,$13.35 ,$15.73
Carle Richland Memorial Hospital,8980250,sugammadex 100 mg/mL intravenous solution,6542505,,250,"$1,163.28 ","$1,163.28 ",$888.75 ,"$1,046.95 ",$988.79 ,$988.79 ,$988.79 ,"$1,023.69 ",$988.79 ,"$1,023.69 ","$1,023.69 ","$1,012.05 ",$988.79 ,$988.79 ,$988.79 ,$888.75 ,"$1,046.95 "
Carle Richland Memorial Hospital,8980250,sulfacetamide sodium 10 % eye drops,61314070101,,250,$280.30 ,$280.30 ,$214.15 ,$252.27 ,$238.26 ,$238.26 ,$238.26 ,$246.66 ,$238.26 ,$246.66 ,$246.66 ,$243.86 ,$238.26 ,$238.26 ,$238.26 ,$214.15 ,$252.27
Carle Richland Memorial Hospital,8980250,sulfamethoxazole 200 mg-trimethoprim 40 mg/5 mL oral suspension,121085416,,250,$20.67 ,$20.67 ,$15.79 ,$18.60 ,$17.57 ,$17.57 ,$17.57 ,$18.19 ,$17.57 ,$18.19 ,$18.19 ,$17.98 ,$17.57 ,$17.57 ,$17.57 ,$15.79 ,$18.60
Carle Richland Memorial Hospital,8980250,sulfamethoxazole 200 mg-trimethoprim 40 mg/5 mL oral suspension,121085320,,250,$45.11 ,$45.11 ,$34.46 ,$40.60 ,$38.34 ,$38.34 ,$38.34 ,$39.70 ,$38.34 ,$39.70 ,$39.70 ,$39.25 ,$38.34 ,$38.34 ,$38.34 ,$34.46 ,$40.60
Carle Richland Memorial Hospital,8980250,sulfamethoxazole 400 mg-trimethoprim 80 mg/5 mL intravenous solution,703951401,,250,$122.54 ,$122.54 ,$93.62 ,$110.29 ,$104.16 ,$104.16 ,$104.16 ,$107.84 ,$104.16 ,$107.84 ,$107.84 ,$106.61 ,$104.16 ,$104.16 ,$104.16 ,$93.62 ,$110.29
Carle Richland Memorial Hospital,8980250,sulfamethoxazole 800 mg-trimethoprim 160 mg tablet,68084023011,,250,$3.70 ,$3.70 ,$2.83 ,$3.33 ,$3.15 ,$3.15 ,$3.15 ,$3.26 ,$3.15 ,$3.26 ,$3.26 ,$3.22 ,$3.15 ,$3.15 ,$3.15 ,$2.83 ,$3.33
Carle Richland Memorial Hospital,8980250,sulfamethoxazole 800 mg-trimethoprim 160 mg tablet,904272561,,250,$4.07 ,$4.07 ,$3.11 ,$3.66 ,$3.46 ,$3.46 ,$3.46 ,$3.58 ,$3.46 ,$3.58 ,$3.58 ,$3.54 ,$3.46 ,$3.46 ,$3.46 ,$3.11 ,$3.66
Carle Richland Memorial Hospital,8980250,sulfaSALAzine 500 mg tablet,50268073011,,250,$4.93 ,$4.93 ,$3.77 ,$4.44 ,$4.19 ,$4.19 ,$4.19 ,$4.34 ,$4.19 ,$4.34 ,$4.34 ,$4.29 ,$4.19 ,$4.19 ,$4.19 ,$3.77 ,$4.44
Carle Richland Memorial Hospital,8980250,sulfaSALAzine 500 mg tablet,50268073015,,250,$4.93 ,$4.93 ,$3.77 ,$4.44 ,$4.19 ,$4.19 ,$4.19 ,$4.34 ,$4.19 ,$4.34 ,$4.34 ,$4.29 ,$4.19 ,$4.19 ,$4.19 ,$3.77 ,$4.44
Carle Richland Memorial Hospital,8980250,surgical lubricant jelly topical,281020537,,250,$31.15 ,$31.15 ,$23.80 ,$28.04 ,$26.48 ,$26.48 ,$26.48 ,$27.41 ,$26.48 ,$27.41 ,$27.41 ,$27.10 ,$26.48 ,$26.48 ,$26.48 ,$23.80 ,$28.04
Carle Richland Memorial Hospital,8980250,tamsulosin 0.4 mg capsule,68084029901,,250,$21.97 ,$21.97 ,$16.79 ,$19.77 ,$18.67 ,$18.67 ,$18.67 ,$19.33 ,$18.67 ,$19.33 ,$19.33 ,$19.11 ,$18.67 ,$18.67 ,$18.67 ,$16.79 ,$19.77
Carle Richland Memorial Hospital,8980250,tamsulosin 0.4 mg capsule,68084029911,,250,$21.97 ,$21.97 ,$16.79 ,$19.77 ,$18.67 ,$18.67 ,$18.67 ,$19.33 ,$18.67 ,$19.33 ,$19.33 ,$19.11 ,$18.67 ,$18.67 ,$18.67 ,$16.79 ,$19.77
Carle Richland Memorial Hospital,8980250,terazosin 1 mg capsule,51079093601,,250,$9.81 ,$9.81 ,$7.49 ,$8.83 ,$8.34 ,$8.34 ,$8.34 ,$8.63 ,$8.34 ,$8.63 ,$8.63 ,$8.53 ,$8.34 ,$8.34 ,$8.34 ,$7.49 ,$8.83
Carle Richland Memorial Hospital,8980250,terazosin 1 mg capsule,51079093620,,250,$9.81 ,$9.81 ,$7.49 ,$8.83 ,$8.34 ,$8.34 ,$8.34 ,$8.63 ,$8.34 ,$8.63 ,$8.63 ,$8.53 ,$8.34 ,$8.34 ,$8.34 ,$7.49 ,$8.83
Carle Richland Memorial Hospital,8980250,terazosin 5 mg capsule,50268076615,,250,$9.81 ,$9.81 ,$7.49 ,$8.83 ,$8.34 ,$8.34 ,$8.34 ,$8.63 ,$8.34 ,$8.63 ,$8.63 ,$8.53 ,$8.34 ,$8.34 ,$8.34 ,$7.49 ,$8.83
Carle Richland Memorial Hospital,8980250,terbinafine HCL 1 % topical cream,51672208002,,250,$73.51 ,$73.51 ,$56.16 ,$66.16 ,$62.48 ,$62.48 ,$62.48 ,$64.69 ,$62.48 ,$64.69 ,$64.69 ,$63.95 ,$62.48 ,$62.48 ,$62.48 ,$56.16 ,$66.16
Carle Richland Memorial Hospital,8980250,tetracaine HCl (bulk) powder,38779056604,,250,$982.42 ,$982.42 ,$750.57 ,$884.18 ,$835.06 ,$835.06 ,$835.06 ,$864.53 ,$835.06 ,$864.53 ,$864.53 ,$854.71 ,$835.06 ,$835.06 ,$835.06 ,$750.57 ,$884.18
Carle Richland Memorial Hospital,8980250,tetracaine HCl (PF) 0.5 % eye drops,65074114,,250,$77.46 ,$77.46 ,$59.18 ,$69.71 ,$65.84 ,$65.84 ,$65.84 ,$68.16 ,$65.84 ,$68.16 ,$68.16 ,$67.39 ,$65.84 ,$65.84 ,$65.84 ,$59.18 ,$69.71
Carle Richland Memorial Hospital,8980250,tetracaine HCl (PF) 1 % (10 mg/mL) injection solution,17478004532,,250,$462.00 ,$462.00 ,$352.97 ,$415.80 ,$392.70 ,$392.70 ,$392.70 ,$406.56 ,$392.70 ,$406.56 ,$406.56 ,$401.94 ,$392.70 ,$392.70 ,$392.70 ,$352.97 ,$415.80
Carle Richland Memorial Hospital,8980250,tetrahydrozoline 0.05 % eye drops,536100294,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,theophylline 80 mg/15 mL oral solution,60687025844,,250,$67.76 ,$67.76 ,$51.77 ,$60.98 ,$57.60 ,$57.60 ,$57.60 ,$59.63 ,$57.60 ,$59.63 ,$59.63 ,$58.95 ,$57.60 ,$57.60 ,$57.60 ,$51.77 ,$60.98
Carle Richland Memorial Hospital,8980250,theophylline 80 mg/15 mL oral solution,60687025871,,250,$67.76 ,$67.76 ,$51.77 ,$60.98 ,$57.60 ,$57.60 ,$57.60 ,$59.63 ,$57.60 ,$59.63 ,$59.63 ,$58.95 ,$57.60 ,$57.60 ,$57.60 ,$51.77 ,$60.98
Carle Richland Memorial Hospital,8980250,"theophylline ER 100 mg capsule,extended release 24 hr",52244010010,,250,$17.16 ,$17.16 ,$13.11 ,$15.44 ,$14.59 ,$14.59 ,$14.59 ,$15.10 ,$14.59 ,$15.10 ,$15.10 ,$14.93 ,$14.59 ,$14.59 ,$14.59 ,$13.11 ,$15.44
Carle Richland Memorial Hospital,8980250,"theophylline ER 300 mg tablet,extended release,12 hr",62332002531,,250,$22.35 ,$22.35 ,$17.08 ,$20.12 ,$19.00 ,$19.00 ,$19.00 ,$19.67 ,$19.00 ,$19.67 ,$19.67 ,$19.44 ,$19.00 ,$19.00 ,$19.00 ,$17.08 ,$20.12
Carle Richland Memorial Hospital,8980250,"theophylline ER 400 mg tablet,extended release 24 hr",42858070101,,250,$8.66 ,$8.66 ,$6.62 ,$7.79 ,$7.36 ,$7.36 ,$7.36 ,$7.62 ,$7.36 ,$7.62 ,$7.62 ,$7.53 ,$7.36 ,$7.36 ,$7.36 ,$6.62 ,$7.79
Carle Richland Memorial Hospital,8980250,"thiamine mononitrate 100 mg tablet,thiamine HCL 100 mg tablet",87701040729,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,"thrombin (bovine) 20,000 unit topical solution",60793021720,,250,"$1,202.88 ","$1,202.88 ",$919.00 ,"$1,082.59 ","$1,022.45 ","$1,022.45 ","$1,022.45 ","$1,058.53 ","$1,022.45 ","$1,058.53 ","$1,058.53 ","$1,046.51 ","$1,022.45 ","$1,022.45 ","$1,022.45 ",$919.00 ,"$1,082.59 "
Carle Richland Memorial Hospital,8980250,"thrombin (bovine) 20,000 unit topical spray",60793021721,,250,"$1,262.66 ","$1,262.66 ",$964.67 ,"$1,136.39 ","$1,073.26 ","$1,073.26 ","$1,073.26 ","$1,111.14 ","$1,073.26 ","$1,111.14 ","$1,111.14 ","$1,098.51 ","$1,073.26 ","$1,073.26 ","$1,073.26 ",$964.67 ,"$1,136.39 "
Carle Richland Memorial Hospital,8980250,timoloL maleate 0.25 % eye drops,60758080205,,250,$24.34 ,$24.34 ,$18.60 ,$21.91 ,$20.69 ,$20.69 ,$20.69 ,$21.42 ,$20.69 ,$21.42 ,$21.42 ,$21.18 ,$20.69 ,$20.69 ,$20.69 ,$18.60 ,$21.91
Carle Richland Memorial Hospital,8980250,timoloL maleate 0.5 % eye drops,17478028810,,250,$100.19 ,$100.19 ,$76.55 ,$90.17 ,$85.16 ,$85.16 ,$85.16 ,$88.17 ,$85.16 ,$88.17 ,$88.17 ,$87.17 ,$85.16 ,$85.16 ,$85.16 ,$76.55 ,$90.17
Carle Richland Memorial Hospital,8980250,timoloL maleate 0.5 % eye drops,64980051405,,250,$100.19 ,$100.19 ,$76.55 ,$90.17 ,$85.16 ,$85.16 ,$85.16 ,$88.17 ,$85.16 ,$88.17 ,$88.17 ,$87.17 ,$85.16 ,$85.16 ,$85.16 ,$76.55 ,$90.17
Carle Richland Memorial Hospital,8980250,tiotropium bromide 2.5 mcg/actuation mist for inhalation,597010051,,250,$440.37 ,$440.37 ,$336.44 ,$396.33 ,$374.31 ,$374.31 ,$374.31 ,$387.53 ,$374.31 ,$387.53 ,$387.53 ,$383.12 ,$374.31 ,$374.31 ,$374.31 ,$336.44 ,$396.33
Carle Richland Memorial Hospital,8980250,tiZANidine 4 mg tablet,68084064511,,250,$9.39 ,$9.39 ,$7.17 ,$8.45 ,$7.98 ,$7.98 ,$7.98 ,$8.26 ,$7.98 ,$8.26 ,$8.26 ,$8.17 ,$7.98 ,$7.98 ,$7.98 ,$7.17 ,$8.45
Carle Richland Memorial Hospital,8980250,tobramycin 0.3 % eye drops,65064305,,250,$591.73 ,$591.73 ,$452.08 ,$532.56 ,$502.97 ,$502.97 ,$502.97 ,$520.72 ,$502.97 ,$520.72 ,$520.72 ,$514.81 ,$502.97 ,$502.97 ,$502.97 ,$452.08 ,$532.56
Carle Richland Memorial Hospital,8980250,tobramycin 0.3 % eye ointment,65064435,,250,"$1,069.83 ","$1,069.83 ",$817.35 ,$962.85 ,$909.36 ,$909.36 ,$909.36 ,$941.45 ,$909.36 ,$941.45 ,$941.45 ,$930.75 ,$909.36 ,$909.36 ,$909.36 ,$817.35 ,$962.85
Carle Richland Memorial Hospital,8980250,"tobramycin 0.3 %-dexamethasone 0.1 % eye drops,suspension",61314064725,,250,$359.10 ,$359.10 ,$274.35 ,$323.19 ,$305.24 ,$305.24 ,$305.24 ,$316.01 ,$305.24 ,$316.01 ,$316.01 ,$312.42 ,$305.24 ,$305.24 ,$305.24 ,$274.35 ,$323.19
Carle Richland Memorial Hospital,8980250,"tolterodine ER 2 mg capsule,extended release 24 hr",60687031911,,250,$50.33 ,$50.33 ,$38.45 ,$45.30 ,$42.78 ,$42.78 ,$42.78 ,$44.29 ,$42.78 ,$44.29 ,$44.29 ,$43.79 ,$42.78 ,$42.78 ,$42.78 ,$38.45 ,$45.30
Carle Richland Memorial Hospital,8980250,topiramate 25 mg tablet,68084034201,,250,$12.12 ,$12.12 ,$9.26 ,$10.91 ,$10.30 ,$10.30 ,$10.30 ,$10.67 ,$10.30 ,$10.67 ,$10.67 ,$10.54 ,$10.30 ,$10.30 ,$10.30 ,$9.26 ,$10.91
Carle Richland Memorial Hospital,8980250,topiramate 25 mg tablet,68084034211,,250,$12.12 ,$12.12 ,$9.26 ,$10.91 ,$10.30 ,$10.30 ,$10.30 ,$10.67 ,$10.30 ,$10.67 ,$10.67 ,$10.54 ,$10.30 ,$10.30 ,$10.30 ,$9.26 ,$10.91
Carle Richland Memorial Hospital,8980250,torsemide 10 mg tablet,50268075511,,250,$5.65 ,$5.65 ,$4.32 ,$5.09 ,$4.80 ,$4.80 ,$4.80 ,$4.97 ,$4.80 ,$4.97 ,$4.97 ,$4.92 ,$4.80 ,$4.80 ,$4.80 ,$4.32 ,$5.09
Carle Richland Memorial Hospital,8980250,torsemide 10 mg tablet,50268075515,,250,$5.65 ,$5.65 ,$4.32 ,$5.09 ,$4.80 ,$4.80 ,$4.80 ,$4.97 ,$4.80 ,$4.97 ,$4.97 ,$4.92 ,$4.80 ,$4.80 ,$4.80 ,$4.32 ,$5.09
Carle Richland Memorial Hospital,8980250,torsemide 100 mg tablet,50268075711,,250,$15.82 ,$15.82 ,$12.09 ,$14.24 ,$13.45 ,$13.45 ,$13.45 ,$13.92 ,$13.45 ,$13.92 ,$13.92 ,$13.76 ,$13.45 ,$13.45 ,$13.45 ,$12.09 ,$14.24
Carle Richland Memorial Hospital,8980250,torsemide 100 mg tablet,50268075715,,250,$15.82 ,$15.82 ,$12.09 ,$14.24 ,$13.45 ,$13.45 ,$13.45 ,$13.92 ,$13.45 ,$13.92 ,$13.92 ,$13.76 ,$13.45 ,$13.45 ,$13.45 ,$12.09 ,$14.24
Carle Richland Memorial Hospital,8980250,traMADoL 50 mg tablet,68084080801,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,"tranexamic acid 1,000 mg/10 mL (100 mg/mL) intravenous solution",23155052441,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,traZODone 100 mg tablet,60687045411,,250,$3.36 ,$3.36 ,$2.57 ,$3.02 ,$2.86 ,$2.86 ,$2.86 ,$2.96 ,$2.86 ,$2.96 ,$2.96 ,$2.92 ,$2.86 ,$2.86 ,$2.86 ,$2.57 ,$3.02
Carle Richland Memorial Hospital,8980250,traZODone 50 mg tablet,60687044301,,250,$3.06 ,$3.06 ,$2.34 ,$2.75 ,$2.60 ,$2.60 ,$2.60 ,$2.69 ,$2.60 ,$2.69 ,$2.69 ,$2.66 ,$2.60 ,$2.60 ,$2.60 ,$2.34 ,$2.75
Carle Richland Memorial Hospital,8980250,traZODone 50 mg tablet,60687044311,,250,$3.06 ,$3.06 ,$2.34 ,$2.75 ,$2.60 ,$2.60 ,$2.60 ,$2.69 ,$2.60 ,$2.69 ,$2.69 ,$2.66 ,$2.60 ,$2.60 ,$2.60 ,$2.34 ,$2.75
Carle Richland Memorial Hospital,8980250,triamcinolone 9 mg-moxiflox 0.6 mg/0.6 mL in water(PF)intraocular susp,71384051001,,250,"$1,180.46 ","$1,180.46 ",$901.87 ,"$1,062.41 ","$1,003.39 ","$1,003.39 ","$1,003.39 ","$1,038.80 ","$1,003.39 ","$1,038.80 ","$1,038.80 ","$1,027.00 ","$1,003.39 ","$1,003.39 ","$1,003.39 ",$901.87 ,"$1,062.41 "
Carle Richland Memorial Hospital,8980250,triamcinolone acetonide 0.1 % topical cream,45802006435,J3490,250,$26.11 ,$26.11 ,$19.95 ,$23.50 ,$22.19 ,$22.19 ,$22.19 ,$22.98 ,$22.19 ,$22.98 ,$22.98 ,$22.72 ,$22.19 ,$22.19 ,$22.19 ,$19.95 ,$23.50
Carle Richland Memorial Hospital,8980250,triamcinolone acetonide 0.1 % topical ointment,45802005535,,250,$35.89 ,$35.89 ,$27.42 ,$32.30 ,$30.51 ,$30.51 ,$30.51 ,$31.58 ,$30.51 ,$31.58 ,$31.58 ,$31.22 ,$30.51 ,$30.51 ,$30.51 ,$27.42 ,$32.30
Carle Richland Memorial Hospital,8980250,triamcinolone acetonide 0.5 % topical cream,168000215,,250,$68.10 ,$68.10 ,$52.03 ,$61.29 ,$57.89 ,$57.89 ,$57.89 ,$59.93 ,$57.89 ,$59.93 ,$59.93 ,$59.25 ,$57.89 ,$57.89 ,$57.89 ,$52.03 ,$61.29
Carle Richland Memorial Hospital,8980250,triamterene 37.5 mg-hydrochlorothiazide 25 mg capsule,527163201,,250,$4.26 ,$4.26 ,$3.25 ,$3.83 ,$3.62 ,$3.62 ,$3.62 ,$3.75 ,$3.62 ,$3.75 ,$3.75 ,$3.71 ,$3.62 ,$3.62 ,$3.62 ,$3.25 ,$3.83
Carle Richland Memorial Hospital,8980250,tropicamide 1 % eye drops,61314035502,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,trypan blue 0.06 % intraocular syringe,68803061210,,250,$415.30 ,$415.30 ,$317.29 ,$373.77 ,$353.01 ,$353.01 ,$353.01 ,$365.46 ,$353.01 ,$365.46 ,$365.46 ,$361.31 ,$353.01 ,$353.01 ,$353.01 ,$317.29 ,$373.77
Carle Richland Memorial Hospital,8980250,umeclidinium 62.5 mcg-vilanteroL 25 mcg/actuation powdr for inhalation,173086906,,250,$778.41 ,$778.41 ,$594.71 ,$700.57 ,$661.65 ,$661.65 ,$661.65 ,$685.00 ,$661.65 ,$685.00 ,$685.00 ,$677.22 ,$661.65 ,$661.65 ,$661.65 ,$594.71 ,$700.57
Carle Richland Memorial Hospital,8980250,valACYclovir 500 mg tablet,68084021511,,250,$20.84 ,$20.84 ,$15.92 ,$18.76 ,$17.71 ,$17.71 ,$17.71 ,$18.34 ,$17.71 ,$18.34 ,$18.34 ,$18.13 ,$17.71 ,$17.71 ,$17.71 ,$15.92 ,$18.76
Carle Richland Memorial Hospital,8980250,valproate sodium 500 mg/5 mL (100 mg/mL) intravenous solution,63323049416,J3490,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,valproic acid (as sodium salt) 250 mg/5 mL (5 mL) oral solution,68094019362,,250,$5.80 ,$5.80 ,$4.43 ,$5.22 ,$4.93 ,$4.93 ,$4.93 ,$5.10 ,$4.93 ,$5.10 ,$5.10 ,$5.05 ,$4.93 ,$4.93 ,$4.93 ,$4.43 ,$5.22
Carle Richland Memorial Hospital,8980250,vancomycin 125 mg capsule,121086720,,250,$117.72 ,$117.72 ,$89.94 ,$105.95 ,$100.06 ,$100.06 ,$100.06 ,$103.59 ,$100.06 ,$103.59 ,$103.59 ,$102.42 ,$100.06 ,$100.06 ,$100.06 ,$89.94 ,$105.95
Carle Richland Memorial Hospital,8980250,vasopressin 20 unit/mL intravenous solution,42023016401,J3490,250,"$1,251.68 ","$1,251.68 ",$956.28 ,"$1,126.51 ","$1,063.93 ","$1,063.93 ","$1,063.93 ","$1,101.48 ","$1,063.93 ","$1,101.48 ","$1,101.48 ","$1,088.96 ","$1,063.93 ","$1,063.93 ","$1,063.93 ",$956.28 ,"$1,126.51 "
Carle Richland Memorial Hospital,8980250,vasopressin 20 unit/mL intravenous solution,42023016425,J3490,250,"$1,251.68 ","$1,251.68 ",$956.28 ,"$1,126.51 ","$1,063.93 ","$1,063.93 ","$1,063.93 ","$1,101.48 ","$1,063.93 ","$1,101.48 ","$1,101.48 ","$1,088.96 ","$1,063.93 ","$1,063.93 ","$1,063.93 ",$956.28 ,"$1,126.51 "
Carle Richland Memorial Hospital,8980250,venlafaxine 37.5 mg tablet,68084084401,,250,$11.65 ,$11.65 ,$8.90 ,$10.49 ,$9.90 ,$9.90 ,$9.90 ,$10.25 ,$9.90 ,$10.25 ,$10.25 ,$10.14 ,$9.90 ,$9.90 ,$9.90 ,$8.90 ,$10.49
Carle Richland Memorial Hospital,8980250,venlafaxine 50 mg tablet,65162030609,,250,$11.93 ,$11.93 ,$9.11 ,$10.74 ,$10.14 ,$10.14 ,$10.14 ,$10.50 ,$10.14 ,$10.50 ,$10.50 ,$10.38 ,$10.14 ,$10.14 ,$10.14 ,$9.11 ,$10.74
Carle Richland Memorial Hospital,8980250,"venlafaxine ER 37.5 mg capsule,extended release 24 hr",68084069811,,250,$19.77 ,$19.77 ,$15.10 ,$17.79 ,$16.80 ,$16.80 ,$16.80 ,$17.40 ,$16.80 ,$17.40 ,$17.40 ,$17.20 ,$16.80 ,$16.80 ,$16.80 ,$15.10 ,$17.79
Carle Richland Memorial Hospital,8980250,"venlafaxine ER 75 mg capsule,extended release 24 hr",68084070911,,250,$21.89 ,$21.89 ,$16.72 ,$19.70 ,$18.61 ,$18.61 ,$18.61 ,$19.26 ,$18.61 ,$19.26 ,$19.26 ,$19.04 ,$18.61 ,$18.61 ,$18.61 ,$16.72 ,$19.70
Carle Richland Memorial Hospital,8980250,verapamiL 120 mg tablet,904292461,,250,$5.83 ,$5.83 ,$4.45 ,$5.25 ,$4.96 ,$4.96 ,$4.96 ,$5.13 ,$4.96 ,$5.13 ,$5.13 ,$5.07 ,$4.96 ,$4.96 ,$4.96 ,$4.45 ,$5.25
Carle Richland Memorial Hospital,8980250,verapamiL 2.5 mg/mL intravenous solution,51754020404,J3490,250,$227.94 ,$227.94 ,$174.15 ,$205.15 ,$193.75 ,$193.75 ,$193.75 ,$200.59 ,$193.75 ,$200.59 ,$200.59 ,$198.31 ,$193.75 ,$193.75 ,$193.75 ,$174.15 ,$205.15
Carle Richland Memorial Hospital,8980250,verapamiL 80 mg tablet,904292061,,250,$4.99 ,$4.99 ,$3.81 ,$4.49 ,$4.24 ,$4.24 ,$4.24 ,$4.39 ,$4.24 ,$4.39 ,$4.39 ,$4.34 ,$4.24 ,$4.24 ,$4.24 ,$3.81 ,$4.49
Carle Richland Memorial Hospital,8980250,"verapamiL ER 180 mg 24 hr capsule,extended release",591288201,,250,$10.85 ,$10.85 ,$8.29 ,$9.77 ,$9.22 ,$9.22 ,$9.22 ,$9.55 ,$9.22 ,$9.55 ,$9.55 ,$9.44 ,$9.22 ,$9.22 ,$9.22 ,$8.29 ,$9.77
Carle Richland Memorial Hospital,8980250,"vitA-B2-C-E-lutein-zeaxant-min 3,300 unit-5 mg-200mg-75 unit tablet ER",65804053,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,vitamin B comp no.3-folic acid 1 mg-vit C 60 mg-biotin 300 mcg tablet,60258016101,,250,$3.40 ,$3.40 ,$2.60 ,$3.06 ,$2.89 ,$2.89 ,$2.89 ,$2.99 ,$2.89 ,$2.99 ,$2.99 ,$2.96 ,$2.89 ,$2.89 ,$2.89 ,$2.60 ,$3.06
Carle Richland Memorial Hospital,8980250,vitamin B complex-folic acid 0.4 mg tablet,50268085715,,250,$0.60 ,$0.60 ,$0.46 ,$0.54 ,$0.51 ,$0.51 ,$0.51 ,$0.53 ,$0.51 ,$0.53 ,$0.53 ,$0.52 ,$0.51 ,$0.51 ,$0.51 ,$0.46 ,$0.54
Carle Richland Memorial Hospital,8980250,warfarin 1 mg tablet,56016901,,250,$13.86 ,$13.86 ,$10.59 ,$12.47 ,$11.78 ,$11.78 ,$11.78 ,$12.20 ,$11.78 ,$12.20 ,$12.20 ,$12.06 ,$11.78 ,$11.78 ,$11.78 ,$10.59 ,$12.47
Carle Richland Memorial Hospital,8980250,warfarin 10 mg tablet,832121901,,250,$6.76 ,$6.76 ,$5.16 ,$6.08 ,$5.75 ,$5.75 ,$5.75 ,$5.95 ,$5.75 ,$5.95 ,$5.95 ,$5.88 ,$5.75 ,$5.75 ,$5.75 ,$5.16 ,$6.08
Carle Richland Memorial Hospital,8980250,warfarin 2 mg tablet,56017001,,250,$14.36 ,$14.36 ,$10.97 ,$12.92 ,$12.21 ,$12.21 ,$12.21 ,$12.64 ,$12.21 ,$12.64 ,$12.64 ,$12.49 ,$12.21 ,$12.21 ,$12.21 ,$10.97 ,$12.92
Carle Richland Memorial Hospital,8980250,warfarin 2.5 mg tablet,56017601,,250,$14.74 ,$14.74 ,$11.26 ,$13.27 ,$12.53 ,$12.53 ,$12.53 ,$12.97 ,$12.53 ,$12.97 ,$12.97 ,$12.82 ,$12.53 ,$12.53 ,$12.53 ,$11.26 ,$13.27
Carle Richland Memorial Hospital,8980250,warfarin 3 mg tablet,65162076410,,250,$5.39 ,$5.39 ,$4.12 ,$4.85 ,$4.58 ,$4.58 ,$4.58 ,$4.74 ,$4.58 ,$4.74 ,$4.74 ,$4.69 ,$4.58 ,$4.58 ,$4.58 ,$4.12 ,$4.85
Carle Richland Memorial Hospital,8980250,warfarin 4 mg tablet,56016801,,250,$14.82 ,$14.82 ,$11.32 ,$13.34 ,$12.60 ,$12.60 ,$12.60 ,$13.04 ,$12.60 ,$13.04 ,$13.04 ,$12.89 ,$12.60 ,$12.60 ,$12.60 ,$11.32 ,$13.34
Carle Richland Memorial Hospital,8980250,warfarin 5 mg tablet,56017201,,250,$15.27 ,$15.27 ,$11.67 ,$13.74 ,$12.98 ,$12.98 ,$12.98 ,$13.44 ,$12.98 ,$13.44 ,$13.44 ,$13.28 ,$12.98 ,$12.98 ,$12.98 ,$11.67 ,$13.74
Carle Richland Memorial Hospital,8980250,warfarin 7.5 mg tablet,56017301,,250,$19.57 ,$19.57 ,$14.95 ,$17.61 ,$16.63 ,$16.63 ,$16.63 ,$17.22 ,$16.63 ,$17.22 ,$17.22 ,$17.03 ,$16.63 ,$16.63 ,$16.63 ,$14.95 ,$17.61
Carle Richland Memorial Hospital,8980250,"water for injection, bacteriostatic injection solution",409397701,J3490,250,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980250,"water for injection, sterile intravenous solution",264785000,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,"water for injection, sterile intravenous solution",409799009,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,"water for irrigation, sterile solution",409613903,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,"water for irrigation, sterile solution",409713909,,250,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980250,"water for irrigation, sterile solution",338000402,,250,$122.23 ,$122.23 ,$93.38 ,$110.01 ,$103.90 ,$103.90 ,$103.90 ,$107.56 ,$103.90 ,$107.56 ,$107.56 ,$106.34 ,$103.90 ,$103.90 ,$103.90 ,$93.38 ,$110.01
Carle Richland Memorial Hospital,8980250,whey protein isolate 6 gram-25 kcal/7 gram oral powder packet,43900028430,,250,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980250,white petrolatum 41 % topical ointment,72140045231,,250,$8.12 ,$8.12 ,$6.20 ,$7.31 ,$6.90 ,$6.90 ,$6.90 ,$7.15 ,$6.90 ,$7.15 ,$7.15 ,$7.06 ,$6.90 ,$6.90 ,$6.90 ,$6.20 ,$7.31
Carle Richland Memorial Hospital,8980250,white petrolatum topical ointment,168005321,,250,$17.69 ,$17.69 ,$13.52 ,$15.92 ,$15.04 ,$15.04 ,$15.04 ,$15.57 ,$15.04 ,$15.57 ,$15.57 ,$15.39 ,$15.04 ,$15.04 ,$15.04 ,$13.52 ,$15.92
Carle Richland Memorial Hospital,8980250,"white petrolatum-mineral oil 83 %-15 % eye ointment,white petrolatum 57.7 %-mineral oil 31.9 % eye ointment,white petrolatum-mineral oil 94 %-3 % eye ointment",23031204,,250,$63.18 ,$63.18 ,$48.27 ,$56.86 ,$53.70 ,$53.70 ,$53.70 ,$55.60 ,$53.70 ,$55.60 ,$55.60 ,$54.97 ,$53.70 ,$53.70 ,$53.70 ,$48.27 ,$56.86
Carle Richland Memorial Hospital,8980250,"witch hazel 50 % topical pads,glycerin-witch hazel 12.5 %-50 % topical pads",50289325001,,250,$155.13 ,$155.13 ,$118.52 ,$139.62 ,$131.86 ,$131.86 ,$131.86 ,$136.51 ,$131.86 ,$136.51 ,$136.51 ,$134.96 ,$131.86 ,$131.86 ,$131.86 ,$118.52 ,$139.62
Carle Richland Memorial Hospital,8980250,zafirlukast 20 mg tablet,68084005911,,250,$16.27 ,$16.27 ,$12.43 ,$14.64 ,$13.83 ,$13.83 ,$13.83 ,$14.32 ,$13.83 ,$14.32 ,$14.32 ,$14.15 ,$13.83 ,$13.83 ,$13.83 ,$12.43 ,$14.64
Carle Richland Memorial Hospital,8980250,zidovudine 10 mg/mL oral syrup,65862004824,,250,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980250,zinc acetate-meadowsweet extract-oak extract topical gel,61470101401,,250,$106.95 ,$106.95 ,$81.71 ,$96.26 ,$90.91 ,$90.91 ,$90.91 ,$94.12 ,$90.91 ,$94.12 ,$94.12 ,$93.05 ,$90.91 ,$90.91 ,$90.91 ,$81.71 ,$96.26
Carle Richland Memorial Hospital,8980250,zinc oxide 13 % topical cream,74300000300,,250,$23.74 ,$23.74 ,$18.14 ,$21.37 ,$20.18 ,$20.18 ,$20.18 ,$20.89 ,$20.18 ,$20.89 ,$20.89 ,$20.65 ,$20.18 ,$20.18 ,$20.18 ,$18.14 ,$21.37
Carle Richland Memorial Hospital,8980250,zinc oxide 20 % topical ointment,75834017001,,250,$39.70 ,$39.70 ,$30.33 ,$35.73 ,$33.75 ,$33.75 ,$33.75 ,$34.94 ,$33.75 ,$34.94 ,$34.94 ,$34.54 ,$33.75 ,$33.75 ,$33.75 ,$30.33 ,$35.73
Carle Richland Memorial Hospital,8980250,zinc sulfate 50 mg zinc (220 mg) capsule,77333098325,,250,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980250,ziprasidone 20 mg capsule,904626908,,250,$39.52 ,$39.52 ,$30.19 ,$35.57 ,$33.59 ,$33.59 ,$33.59 ,$34.78 ,$33.59 ,$34.78 ,$34.78 ,$34.38 ,$33.59 ,$33.59 ,$33.59 ,$30.19 ,$35.57
Carle Richland Memorial Hospital,8980250,zolpidem 5 mg tablet,781531701,,250,$26.21 ,$26.21 ,$20.02 ,$23.59 ,$22.28 ,$22.28 ,$22.28 ,$23.06 ,$22.28 ,$23.06 ,$23.06 ,$22.80 ,$22.28 ,$22.28 ,$22.28 ,$20.02 ,$23.59
Carle Richland Memorial Hospital,8980250,zonisamide 100 mg capsule,60687023001,,250,$6.54 ,$6.54 ,$5.00 ,$5.89 ,$5.56 ,$5.56 ,$5.56 ,$5.76 ,$5.56 ,$5.76 ,$5.76 ,$5.69 ,$5.56 ,$5.56 ,$5.56 ,$5.00 ,$5.89
Carle Richland Memorial Hospital,8980250,zonisamide 100 mg capsule,60687023011,,250,$6.54 ,$6.54 ,$5.00 ,$5.89 ,$5.56 ,$5.56 ,$5.56 ,$5.76 ,$5.56 ,$5.76 ,$5.76 ,$5.69 ,$5.56 ,$5.56 ,$5.56 ,$5.00 ,$5.89
Carle Richland Memorial Hospital,8980255,barium sulfate 98 % oral powder for suspension,32909076401,,255,$33.42 ,$33.42 ,$25.53 ,$30.08 ,$28.41 ,$28.41 ,$28.41 ,$29.41 ,$28.41 ,$29.41 ,$29.41 ,$29.08 ,$28.41 ,$28.41 ,$28.41 ,$25.53 ,$30.08
Carle Richland Memorial Hospital,8980255,gadobutroL 7.5 mmol/7.5 mL (1 mmol/mL) intravenous solution,50419032511,A9585,255,$438.15 ,$438.15 ,$334.75 ,$394.34 ,$372.43 ,$372.43 ,$372.43 ,$385.57 ,$372.43 ,$385.57 ,$385.57 ,$381.19 ,$372.43 ,$372.43 ,$372.43 ,$334.75 ,$394.34
Carle Richland Memorial Hospital,8980255,iopamidoL 61 % intravenous solution,270131530,Q9967,255,$160.83 ,$160.83 ,$122.87 ,$144.75 ,$136.71 ,$136.71 ,$136.71 ,$141.53 ,$136.71 ,$141.53 ,$141.53 ,$139.92 ,$136.71 ,$136.71 ,$136.71 ,$122.87 ,$144.75
Carle Richland Memorial Hospital,8980255,iopamidol 61 % intravenous solution,270131530,Q9967,255,$318.26 ,$318.26 ,$243.15 ,$286.43 ,$270.52 ,$270.52 ,$270.52 ,$280.07 ,$270.52 ,$280.07 ,$280.07 ,$276.89 ,$270.52 ,$270.52 ,$270.52 ,$243.15 ,$286.43
Carle Richland Memorial Hospital,8980255,iopamidol 61 % intravenous solution,270131535,Q9967,255,$618.57 ,$618.57 ,$472.59 ,$556.71 ,$525.78 ,$525.78 ,$525.78 ,$544.34 ,$525.78 ,$544.34 ,$544.34 ,$538.16 ,$525.78 ,$525.78 ,$525.78 ,$472.59 ,$556.71
Carle Richland Memorial Hospital,8980255,perflutren lipid microspheres 1.1 mg/mL intravenous suspension,11994001101,,255,$679.96 ,$679.96 ,$519.49 ,$611.96 ,$577.97 ,$577.97 ,$577.97 ,$598.36 ,$577.97 ,$598.36 ,$598.36 ,$591.57 ,$577.97 ,$577.97 ,$577.97 ,$519.49 ,$611.96
Carle Richland Memorial Hospital,8980258,dextrose 5 %-0.45 % sodium chloride IV,338008503,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,dextrose 5 %-0.45 % sodium chloride IV,338008504,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,dextrose 5 %-0.9 % sodium chloride IV,338008904,J7042,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,dextrose 5%-1/4 normal saline IV,338007703,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,dextrose 5%-1/4 normal saline IV,338007704,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 10 mEq/L in dextrose 5 %-0.45 % sodium chloride IV,338066904,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 20 mEq/L in D5-0.9 % sodium chloride intravenous,409710709,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 20 mEq/L in dextrose 5 %-0.2 % sodium chloride IV,409790109,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 20 mEq/L in dextrose 5 %-0.45 % sodium chloride IV,409790209,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 20 mEq/L-lactated ringers-5 % dextrose intravenous,409711109,J7120,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 30 mEq/L in dextrose 5 %-0.45 % sodium chloride IV,338067304,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 40 mEq/L in D5-0.9 % sodium chloride intravenous,338080704,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,potassium chloride 40 mEq/L in dextrose 5 %-0.45 % sodium chloride IV,264763800,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980258,sodium chloride 0.9 % irrigation solution,990797208,,258,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980259,acyclovir 5 % topical ointment,63646030015,,259,$365.15 ,$365.15 ,$278.97 ,$328.64 ,$310.38 ,$310.38 ,$310.38 ,$321.33 ,$310.38 ,$321.33 ,$321.33 ,$317.68 ,$310.38 ,$310.38 ,$310.38 ,$278.97 ,$328.64
Carle Richland Memorial Hospital,8980259,acyclovir 5 % topical ointment,72578008201,,259,"$1,879.40 ","$1,879.40 ","$1,435.86 ","$1,691.46 ","$1,597.49 ","$1,597.49 ","$1,597.49 ","$1,653.87 ","$1,597.49 ","$1,653.87 ","$1,653.87 ","$1,635.08 ","$1,597.49 ","$1,597.49 ","$1,597.49 ","$1,435.86 ","$1,691.46 "
Carle Richland Memorial Hospital,8980259,albuterol sulfate 2 mg tablet,68084094925,,259,$34.30 ,$34.30 ,$26.21 ,$30.87 ,$29.16 ,$29.16 ,$29.16 ,$30.18 ,$29.16 ,$30.18 ,$30.18 ,$29.84 ,$29.16 ,$29.16 ,$29.16 ,$26.21 ,$30.87
Carle Richland Memorial Hospital,8980259,"alfuzosin ER 10 mg tablet,extended release 24 hr",29300015501,,259,$21.97 ,$21.97 ,$16.79 ,$19.77 ,$18.67 ,$18.67 ,$18.67 ,$19.33 ,$18.67 ,$19.33 ,$19.33 ,$19.11 ,$18.67 ,$18.67 ,$18.67 ,$16.79 ,$19.77
Carle Richland Memorial Hospital,8980259,aliskiren 150 mg tablet,66993014130,,259,$35.50 ,$35.50 ,$27.12 ,$31.95 ,$30.18 ,$30.18 ,$30.18 ,$31.24 ,$30.18 ,$31.24 ,$31.24 ,$30.89 ,$30.18 ,$30.18 ,$30.18 ,$27.12 ,$31.95
Carle Richland Memorial Hospital,8980259,aluminum hydrox-magnesium carb 95 mg-358 mg/15 mL oral suspension,904772714,,259,$38.62 ,$38.62 ,$29.51 ,$34.76 ,$32.83 ,$32.83 ,$32.83 ,$33.99 ,$32.83 ,$33.99 ,$33.99 ,$33.60 ,$32.83 ,$32.83 ,$32.83 ,$29.51 ,$34.76
Carle Richland Memorial Hospital,8980259,amoxicillin 250 mg/5 mL oral suspension,143988915,,259,$44.53 ,$44.53 ,$34.02 ,$40.08 ,$37.85 ,$37.85 ,$37.85 ,$39.19 ,$37.85 ,$39.19 ,$39.19 ,$38.74 ,$37.85 ,$37.85 ,$37.85 ,$34.02 ,$40.08
Carle Richland Memorial Hospital,8980259,amoxicillin 250 mg-potassium clavulanate 125 mg tablet,781187431,,259,$28.86 ,$28.86 ,$22.05 ,$25.97 ,$24.53 ,$24.53 ,$24.53 ,$25.40 ,$24.53 ,$25.40 ,$25.40 ,$25.11 ,$24.53 ,$24.53 ,$24.53 ,$22.05 ,$25.97
Carle Richland Memorial Hospital,8980259,amoxicillin 875 mg tablet,65862001501,,259,$6.38 ,$6.38 ,$4.87 ,$5.74 ,$5.42 ,$5.42 ,$5.42 ,$5.61 ,$5.42 ,$5.61 ,$5.61 ,$5.55 ,$5.42 ,$5.42 ,$5.42 ,$4.87 ,$5.74
Carle Richland Memorial Hospital,8980259,"aspirin 325 mg tablet,delayed release",57896092101,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,aspirin 600 mg rectal suppository,574703612,,259,$2.11 ,$2.11 ,$1.61 ,$1.90 ,$1.79 ,$1.79 ,$1.79 ,$1.86 ,$1.79 ,$1.86 ,$1.86 ,$1.84 ,$1.79 ,$1.79 ,$1.79 ,$1.61 ,$1.90
Carle Richland Memorial Hospital,8980259,azelastine 0.05 % eye drops,60505057804,,259,$505.94 ,$505.94 ,$386.54 ,$455.35 ,$430.05 ,$430.05 ,$430.05 ,$445.23 ,$430.05 ,$445.23 ,$445.23 ,$440.17 ,$430.05 ,$430.05 ,$430.05 ,$386.54 ,$455.35
Carle Richland Memorial Hospital,8980259,bacitracin 500 unit/gram eye ointment,574402235,,259,$503.91 ,$503.91 ,$384.99 ,$453.52 ,$428.32 ,$428.32 ,$428.32 ,$443.44 ,$428.32 ,$443.44 ,$443.44 ,$438.40 ,$428.32 ,$428.32 ,$428.32 ,$384.99 ,$453.52
Carle Richland Memorial Hospital,8980259,benzocaine 6 mg-menthoL 10 mg lozenges,78112001106,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,benztropine 1 mg tablet,60687036801,,259,$5.07 ,$5.07 ,$3.87 ,$4.56 ,$4.31 ,$4.31 ,$4.31 ,$4.46 ,$4.31 ,$4.46 ,$4.46 ,$4.41 ,$4.31 ,$4.31 ,$4.31 ,$3.87 ,$4.56
Carle Richland Memorial Hospital,8980259,benztropine 1 mg tablet,60687036811,,259,$5.07 ,$5.07 ,$3.87 ,$4.56 ,$4.31 ,$4.31 ,$4.31 ,$4.46 ,$4.31 ,$4.46 ,$4.46 ,$4.41 ,$4.31 ,$4.31 ,$4.31 ,$3.87 ,$4.56
Carle Richland Memorial Hospital,8980259,betaxoloL 0.5 % eye drops,61314024501,,259,$329.79 ,$329.79 ,$251.96 ,$296.81 ,$280.32 ,$280.32 ,$280.32 ,$290.22 ,$280.32 ,$290.22 ,$290.22 ,$286.92 ,$280.32 ,$280.32 ,$280.32 ,$251.96 ,$296.81
Carle Richland Memorial Hospital,8980259,"budesonide DR - ER 3 mg capsule,delayed,extended release",574985010,J3490,259,$104.81 ,$104.81 ,$80.07 ,$94.33 ,$89.09 ,$89.09 ,$89.09 ,$92.23 ,$89.09 ,$92.23 ,$92.23 ,$91.18 ,$89.09 ,$89.09 ,$89.09 ,$80.07 ,$94.33
Carle Richland Memorial Hospital,8980259,"buPROPion HCL SR 150 mg tablet,12 hr sustained-release",68084070825,,259,$5.75 ,$5.75 ,$4.39 ,$5.18 ,$4.89 ,$4.89 ,$4.89 ,$5.06 ,$4.89 ,$5.06 ,$5.06 ,$5.00 ,$4.89 ,$4.89 ,$4.89 ,$4.39 ,$5.18
Carle Richland Memorial Hospital,8980259,"buPROPion HCL SR 150 mg tablet,12 hr sustained-release",68084070895,,259,$5.75 ,$5.75 ,$4.39 ,$5.18 ,$4.89 ,$4.89 ,$4.89 ,$5.06 ,$4.89 ,$5.06 ,$5.06 ,$5.00 ,$4.89 ,$4.89 ,$4.89 ,$4.39 ,$5.18
Carle Richland Memorial Hospital,8980259,calcitonin (salmon) 200 unit/actuation nasal spray,60505082306,,259,$573.37 ,$573.37 ,$438.05 ,$516.03 ,$487.36 ,$487.36 ,$487.36 ,$504.57 ,$487.36 ,$504.57 ,$504.57 ,$498.83 ,$487.36 ,$487.36 ,$487.36 ,$438.05 ,$516.03
Carle Richland Memorial Hospital,8980259,"calcium carbonate 500 mg calcium (1,250 mg) tablet",904188361,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,calcium carbonate 500 mg-vitamin D3 5 mcg (200 unit) tablet,10006070038,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,calcium polycarbophiL 625 mg tablet,5250002,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,carboxymethylcellulose sodium 1 % eye liquid gel drops,23920515,,259,$58.59 ,$58.59 ,$44.76 ,$52.73 ,$49.80 ,$49.80 ,$49.80 ,$51.56 ,$49.80 ,$51.56 ,$51.56 ,$50.97 ,$49.80 ,$49.80 ,$49.80 ,$44.76 ,$52.73
Carle Richland Memorial Hospital,8980259,cefproziL 125 mg/5 mL oral suspension,68180040101,,259,$12.14 ,$12.14 ,$9.27 ,$10.93 ,$10.32 ,$10.32 ,$10.32 ,$10.68 ,$10.32 ,$10.68 ,$10.68 ,$10.56 ,$10.32 ,$10.32 ,$10.32 ,$9.27 ,$10.93
Carle Richland Memorial Hospital,8980259,cefproziL 250 mg/5 mL oral suspension,68180040201,,259,$29.75 ,$29.75 ,$22.73 ,$26.78 ,$25.29 ,$25.29 ,$25.29 ,$26.18 ,$25.29 ,$26.18 ,$26.18 ,$25.88 ,$25.29 ,$25.29 ,$25.29 ,$22.73 ,$26.78
Carle Richland Memorial Hospital,8980259,cephalexin 250 mg/5 mL oral suspension,93417773,,259,$174.61 ,$174.61 ,$133.40 ,$157.15 ,$148.42 ,$148.42 ,$148.42 ,$153.66 ,$148.42 ,$153.66 ,$153.66 ,$151.91 ,$148.42 ,$148.42 ,$148.42 ,$133.40 ,$157.15
Carle Richland Memorial Hospital,8980259,cetirizine 10 mg tablet,24385099874,,259,$1.10 ,$1.10 ,$0.84 ,$0.99 ,$0.94 ,$0.94 ,$0.94 ,$0.97 ,$0.94 ,$0.97 ,$0.97 ,$0.96 ,$0.94 ,$0.94 ,$0.94 ,$0.84 ,$0.99
Carle Richland Memorial Hospital,8980259,clotrimazole 1 % topical cream,904782231,,259,$49.04 ,$49.04 ,$37.47 ,$44.14 ,$41.68 ,$41.68 ,$41.68 ,$43.16 ,$41.68 ,$43.16 ,$43.16 ,$42.66 ,$41.68 ,$41.68 ,$41.68 ,$37.47 ,$44.14
Carle Richland Memorial Hospital,8980259,clotrimazole 1 % topical cream,51672200202,,259,$67.58 ,$67.58 ,$51.63 ,$60.82 ,$57.44 ,$57.44 ,$57.44 ,$59.47 ,$57.44 ,$59.47 ,$59.47 ,$58.79 ,$57.44 ,$57.44 ,$57.44 ,$51.63 ,$60.82
Carle Richland Memorial Hospital,8980259,clotrimazole-betamethasone 1 %-0.05 % topical cream,168025815,,259,$28.33 ,$28.33 ,$21.64 ,$25.50 ,$24.08 ,$24.08 ,$24.08 ,$24.93 ,$24.08 ,$24.93 ,$24.93 ,$24.65 ,$24.08 ,$24.08 ,$24.08 ,$21.64 ,$25.50
Carle Richland Memorial Hospital,8980259,cloZAPine 100 mg tablet,60687041501,,259,$18.44 ,$18.44 ,$14.09 ,$16.60 ,$15.67 ,$15.67 ,$15.67 ,$16.23 ,$15.67 ,$16.23 ,$16.23 ,$16.04 ,$15.67 ,$15.67 ,$15.67 ,$14.09 ,$16.60
Carle Richland Memorial Hospital,8980259,cloZAPine 100 mg tablet,60687041511,,259,$18.44 ,$18.44 ,$14.09 ,$16.60 ,$15.67 ,$15.67 ,$15.67 ,$16.23 ,$15.67 ,$16.23 ,$16.23 ,$16.04 ,$15.67 ,$15.67 ,$15.67 ,$14.09 ,$16.60
Carle Richland Memorial Hospital,8980259,coenzyme Q10 100 mg capsule,87701040816,,259,$0.66 ,$0.66 ,$0.50 ,$0.59 ,$0.56 ,$0.56 ,$0.56 ,$0.58 ,$0.56 ,$0.58 ,$0.58 ,$0.57 ,$0.56 ,$0.56 ,$0.56 ,$0.50 ,$0.59
Carle Richland Memorial Hospital,8980259,colesevelam 625 mg tablet,65597070118,,259,$64.74 ,$64.74 ,$49.46 ,$58.27 ,$55.03 ,$55.03 ,$55.03 ,$56.97 ,$55.03 ,$56.97 ,$56.97 ,$56.32 ,$55.03 ,$55.03 ,$55.03 ,$49.46 ,$58.27
Carle Richland Memorial Hospital,8980259,dexAMETHasone 1 mg/mL drops (concentrate),54317644,,259,$194.16 ,$194.16 ,$148.34 ,$174.74 ,$165.04 ,$165.04 ,$165.04 ,$170.86 ,$165.04 ,$170.86 ,$170.86 ,$168.92 ,$165.04 ,$165.04 ,$165.04 ,$148.34 ,$174.74
Carle Richland Memorial Hospital,8980259,diazePAM 5 mg-7.5 mg-10 mg rectal kit,68682065220,,259,"$1,284.70 ","$1,284.70 ",$981.51 ,"$1,156.23 ","$1,092.00 ","$1,092.00 ","$1,092.00 ","$1,130.54 ","$1,092.00 ","$1,130.54 ","$1,130.54 ","$1,117.69 ","$1,092.00 ","$1,092.00 ","$1,092.00 ",$981.51 ,"$1,156.23 "
Carle Richland Memorial Hospital,8980259,"diclofenac sodium 75 mg tablet,delayed release",68084033301,,259,$6.08 ,$6.08 ,$4.65 ,$5.47 ,$5.17 ,$5.17 ,$5.17 ,$5.35 ,$5.17 ,$5.35 ,$5.35 ,$5.29 ,$5.17 ,$5.17 ,$5.17 ,$4.65 ,$5.47
Carle Richland Memorial Hospital,8980259,digoxin 250 mcg (0.25 mg) tablet,68084068001,,259,$14.26 ,$14.26 ,$10.89 ,$12.83 ,$12.12 ,$12.12 ,$12.12 ,$12.55 ,$12.12 ,$12.55 ,$12.55 ,$12.41 ,$12.12 ,$12.12 ,$12.12 ,$10.89 ,$12.83
Carle Richland Memorial Hospital,8980259,digoxin 250 mcg (0.25 mg) tablet,68084068011,,259,$14.26 ,$14.26 ,$10.89 ,$12.83 ,$12.12 ,$12.12 ,$12.12 ,$12.55 ,$12.12 ,$12.55 ,$12.55 ,$12.41 ,$12.12 ,$12.12 ,$12.12 ,$10.89 ,$12.83
Carle Richland Memorial Hospital,8980259,digoxin 50 mcg/mL (0.05 mg/mL) oral solution,54005746,,259,$55.88 ,$55.88 ,$42.69 ,$50.29 ,$47.50 ,$47.50 ,$47.50 ,$49.17 ,$47.50 ,$49.17 ,$49.17 ,$48.62 ,$47.50 ,$47.50 ,$47.50 ,$42.69 ,$50.29
Carle Richland Memorial Hospital,8980259,"dinoprostone ER 10 mg vaginal insert,controlled release",55566280001,,259,"$1,927.52 ","$1,927.52 ","$1,472.63 ","$1,734.77 ","$1,638.39 ","$1,638.39 ","$1,638.39 ","$1,696.22 ","$1,638.39 ","$1,696.22 ","$1,696.22 ","$1,676.94 ","$1,638.39 ","$1,638.39 ","$1,638.39 ","$1,472.63 ","$1,734.77 "
Carle Richland Memorial Hospital,8980259,"divalproex 250 mg tablet,delayed release",68084077601,,259,$10.54 ,$10.54 ,$8.05 ,$9.49 ,$8.96 ,$8.96 ,$8.96 ,$9.28 ,$8.96 ,$9.28 ,$9.28 ,$9.17 ,$8.96 ,$8.96 ,$8.96 ,$8.05 ,$9.49
Carle Richland Memorial Hospital,8980259,"divalproex 500 mg tablet,delayed release",904686190,,259,$4.14 ,$4.14 ,$3.16 ,$3.73 ,$3.52 ,$3.52 ,$3.52 ,$3.64 ,$3.52 ,$3.64 ,$3.64 ,$3.60 ,$3.52 ,$3.52 ,$3.52 ,$3.16 ,$3.73
Carle Richland Memorial Hospital,8980259,docusate calcium 240 mg capsule,50268026611,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,docusate calcium 240 mg capsule,50268026615,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,donepeziL 23 mg tablet,43547038203,,259,$47.90 ,$47.90 ,$36.60 ,$43.11 ,$40.72 ,$40.72 ,$40.72 ,$42.15 ,$40.72 ,$42.15 ,$42.15 ,$41.67 ,$40.72 ,$40.72 ,$40.72 ,$36.60 ,$43.11
Carle Richland Memorial Hospital,8980259,dorzolamide 22.3 mg-timoloL 6.8 mg/mL eye drops,50383023310,,259,$592.29 ,$592.29 ,$452.51 ,$533.06 ,$503.45 ,$503.45 ,$503.45 ,$521.22 ,$503.45 ,$521.22 ,$521.22 ,$515.29 ,$503.45 ,$503.45 ,$503.45 ,$452.51 ,$533.06
Carle Richland Memorial Hospital,8980259,doxepin 10 mg capsule,51079043601,,259,$5.31 ,$5.31 ,$4.06 ,$4.78 ,$4.51 ,$4.51 ,$4.51 ,$4.67 ,$4.51 ,$4.67 ,$4.67 ,$4.62 ,$4.51 ,$4.51 ,$4.51 ,$4.06 ,$4.78
Carle Richland Memorial Hospital,8980259,"ergocalciferol (vitamin D2) 1,250 mcg (50,000 unit) capsule",60687050001,,259,$11.28 ,$11.28 ,$8.62 ,$10.15 ,$9.59 ,$9.59 ,$9.59 ,$9.93 ,$9.59 ,$9.93 ,$9.93 ,$9.81 ,$9.59 ,$9.59 ,$9.59 ,$8.62 ,$10.15
Carle Richland Memorial Hospital,8980259,"ergocalciferol (vitamin D2) 1,250 mcg (50,000 unit) capsule",60687050011,,259,$11.28 ,$11.28 ,$8.62 ,$10.15 ,$9.59 ,$9.59 ,$9.59 ,$9.93 ,$9.59 ,$9.93 ,$9.93 ,$9.81 ,$9.59 ,$9.59 ,$9.59 ,$8.62 ,$10.15
Carle Richland Memorial Hospital,8980259,"erythromycin 250 mg tablet,delayed release",24338012203,,259,$39.06 ,$39.06 ,$29.84 ,$35.15 ,$33.20 ,$33.20 ,$33.20 ,$34.37 ,$33.20 ,$34.37 ,$34.37 ,$33.98 ,$33.20 ,$33.20 ,$33.20 ,$29.84 ,$35.15
Carle Richland Memorial Hospital,8980259,escitalopram 10 mg tablet,904642661,,259,$22.75 ,$22.75 ,$17.38 ,$20.48 ,$19.34 ,$19.34 ,$19.34 ,$20.02 ,$19.34 ,$20.02 ,$20.02 ,$19.79 ,$19.34 ,$19.34 ,$19.34 ,$17.38 ,$20.48
Carle Richland Memorial Hospital,8980259,eszopiclone 1 mg tablet,42043032003,,259,$51.35 ,$51.35 ,$39.23 ,$46.22 ,$43.65 ,$43.65 ,$43.65 ,$45.19 ,$43.65 ,$45.19 ,$45.19 ,$44.67 ,$43.65 ,$43.65 ,$43.65 ,$39.23 ,$46.22
Carle Richland Memorial Hospital,8980259,famciclovir 500 mg tablet,31722070830,,259,$52.58 ,$52.58 ,$40.17 ,$47.32 ,$44.69 ,$44.69 ,$44.69 ,$46.27 ,$44.69 ,$46.27 ,$46.27 ,$45.74 ,$44.69 ,$44.69 ,$44.69 ,$40.17 ,$47.32
Carle Richland Memorial Hospital,8980259,famotidine 40 mg/5 mL (8 mg/mL) oral suspension,68180015001,,259,$68.78 ,$68.78 ,$52.55 ,$61.90 ,$58.46 ,$58.46 ,$58.46 ,$60.53 ,$58.46 ,$60.53 ,$60.53 ,$59.84 ,$58.46 ,$58.46 ,$58.46 ,$52.55 ,$61.90
Carle Richland Memorial Hospital,8980259,fentaNYL 12 mcg/hr transdermal patch,47781042347,,259,$123.98 ,$123.98 ,$94.72 ,$111.58 ,$105.38 ,$105.38 ,$105.38 ,$109.10 ,$105.38 ,$109.10 ,$109.10 ,$107.86 ,$105.38 ,$105.38 ,$105.38 ,$94.72 ,$111.58
Carle Richland Memorial Hospital,8980259,fentaNYL 25 mcg/hr transdermal patch,60505700600,,259,$84.92 ,$84.92 ,$64.88 ,$76.43 ,$72.18 ,$72.18 ,$72.18 ,$74.73 ,$72.18 ,$74.73 ,$74.73 ,$73.88 ,$72.18 ,$72.18 ,$72.18 ,$64.88 ,$76.43
Carle Richland Memorial Hospital,8980259,fexofenadine 60 mg tablet,45802042578,,259,$1.01 ,$1.01 ,$0.77 ,$0.91 ,$0.86 ,$0.86 ,$0.86 ,$0.89 ,$0.86 ,$0.89 ,$0.89 ,$0.88 ,$0.86 ,$0.86 ,$0.86 ,$0.77 ,$0.91
Carle Richland Memorial Hospital,8980259,"fluorometholone 0.1 % eye drops,suspension",60758088005,,259,$418.28 ,$418.28 ,$319.57 ,$376.45 ,$355.54 ,$355.54 ,$355.54 ,$368.09 ,$355.54 ,$368.09 ,$368.09 ,$363.90 ,$355.54 ,$355.54 ,$355.54 ,$319.57 ,$376.45
Carle Richland Memorial Hospital,8980259,glimepiride 2 mg tablet,68084032611,,259,$6.44 ,$6.44 ,$4.92 ,$5.80 ,$5.47 ,$5.47 ,$5.47 ,$5.67 ,$5.47 ,$5.67 ,$5.67 ,$5.60 ,$5.47 ,$5.47 ,$5.47 ,$4.92 ,$5.80
Carle Richland Memorial Hospital,8980259,"glipiZIDE ER 2.5 mg tablet, extended release 24 hr",68084029511,,259,$8.67 ,$8.67 ,$6.62 ,$7.80 ,$7.37 ,$7.37 ,$7.37 ,$7.63 ,$7.37 ,$7.63 ,$7.63 ,$7.54 ,$7.37 ,$7.37 ,$7.37 ,$6.62 ,$7.80
Carle Richland Memorial Hospital,8980259,"glipiZIDE ER 2.5 mg tablet, extended release 24 hr",68084029521,,259,$8.67 ,$8.67 ,$6.62 ,$7.80 ,$7.37 ,$7.37 ,$7.37 ,$7.63 ,$7.37 ,$7.63 ,$7.63 ,$7.54 ,$7.37 ,$7.37 ,$7.37 ,$6.62 ,$7.80
Carle Richland Memorial Hospital,8980259,"glipiZIDE ER 5 mg tablet, extended release 24 hr",64980028001,,259,$4.23 ,$4.23 ,$3.23 ,$3.81 ,$3.60 ,$3.60 ,$3.60 ,$3.72 ,$3.60 ,$3.72 ,$3.72 ,$3.68 ,$3.60 ,$3.60 ,$3.60 ,$3.23 ,$3.81
Carle Richland Memorial Hospital,8980259,glyBURIDE 5 mg tablet,51079087301,,259,$4.78 ,$4.78 ,$3.65 ,$4.30 ,$4.06 ,$4.06 ,$4.06 ,$4.21 ,$4.06 ,$4.21 ,$4.21 ,$4.16 ,$4.06 ,$4.06 ,$4.06 ,$3.65 ,$4.30
Carle Richland Memorial Hospital,8980259,glyBURIDE micronized 3 mg tablet,143991901,,259,$5.15 ,$5.15 ,$3.93 ,$4.64 ,$4.38 ,$4.38 ,$4.38 ,$4.53 ,$4.38 ,$4.53 ,$4.53 ,$4.48 ,$4.38 ,$4.38 ,$4.38 ,$3.93 ,$4.64
Carle Richland Memorial Hospital,8980259,glycerin (adult) rectal suppository,132007924,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,glycerin (child) rectal suppository,58980040912,,259,$1.18 ,$1.18 ,$0.90 ,$1.06 ,$1.00 ,$1.00 ,$1.00 ,$1.04 ,$1.00 ,$1.04 ,$1.04 ,$1.03 ,$1.00 ,$1.00 ,$1.00 ,$0.90 ,$1.06
Carle Richland Memorial Hospital,8980259,glycopyrrolate 15.6 mcg capsule with inhalation device,63402081506,,259,$296.27 ,$296.27 ,$226.35 ,$266.64 ,$251.83 ,$251.83 ,$251.83 ,$260.72 ,$251.83 ,$260.72 ,$260.72 ,$257.75 ,$251.83 ,$251.83 ,$251.83 ,$226.35 ,$266.64
Carle Richland Memorial Hospital,8980259,hydrocortisone (bulk) powder,574042025,,259,$533.12 ,$533.12 ,$407.30 ,$479.81 ,$453.15 ,$453.15 ,$453.15 ,$469.15 ,$453.15 ,$469.15 ,$469.15 ,$463.81 ,$453.15 ,$453.15 ,$453.15 ,$407.30 ,$479.81
Carle Richland Memorial Hospital,8980259,hydrocortisone (bulk) powder,38779000904,,259,"$3,119.38 ","$3,119.38 ","$2,383.21 ","$2,807.44 ","$2,651.47 ","$2,651.47 ","$2,651.47 ","$2,745.05 ","$2,651.47 ","$2,745.05 ","$2,745.05 ","$2,713.86 ","$2,651.47 ","$2,651.47 ","$2,651.47 ","$2,383.21 ","$2,807.44 "
Carle Richland Memorial Hospital,8980259,hydrocortisone 0.5 % topical cream,51672201002,,259,$33.75 ,$33.75 ,$25.79 ,$30.38 ,$28.69 ,$28.69 ,$28.69 ,$29.70 ,$28.69 ,$29.70 ,$29.70 ,$29.36 ,$28.69 ,$28.69 ,$28.69 ,$25.79 ,$30.38
Carle Richland Memorial Hospital,8980259,hydrocortisone 1 % topical ointment,472034556,,259,$22.40 ,$22.40 ,$17.11 ,$20.16 ,$19.04 ,$19.04 ,$19.04 ,$19.71 ,$19.04 ,$19.71 ,$19.71 ,$19.49 ,$19.04 ,$19.04 ,$19.04 ,$17.11 ,$20.16
Carle Richland Memorial Hospital,8980259,hydrocortisone 2.5 % topical cream,49999016230,,259,$258.77 ,$258.77 ,$197.70 ,$232.89 ,$219.95 ,$219.95 ,$219.95 ,$227.72 ,$219.95 ,$227.72 ,$227.72 ,$225.13 ,$219.95 ,$219.95 ,$219.95 ,$197.70 ,$232.89
Carle Richland Memorial Hospital,8980259,hydrocortisone valerate 0.2 % topical cream,45802045535,,259,$221.23 ,$221.23 ,$169.02 ,$199.11 ,$188.05 ,$188.05 ,$188.05 ,$194.68 ,$188.05 ,$194.68 ,$194.68 ,$192.47 ,$188.05 ,$188.05 ,$188.05 ,$169.02 ,$199.11
Carle Richland Memorial Hospital,8980259,HYDROmorphone 3 mg rectal suppository,574722406,,259,$53.42 ,$53.42 ,$40.81 ,$48.08 ,$45.41 ,$45.41 ,$45.41 ,$47.01 ,$45.41 ,$47.01 ,$47.01 ,$46.48 ,$45.41 ,$45.41 ,$45.41 ,$40.81 ,$48.08
Carle Richland Memorial Hospital,8980259,insulin aspar prt-insulin aspart 100 unit/mL (70-30) subcutaneous soln,169368512,J1815,259,"$1,715.58 ","$1,715.58 ","$1,310.70 ","$1,544.02 ","$1,458.24 ","$1,458.24 ","$1,458.24 ","$1,509.71 ","$1,458.24 ","$1,509.71 ","$1,509.71 ","$1,492.55 ","$1,458.24 ","$1,458.24 ","$1,458.24 ","$1,310.70 ","$1,544.02 "
Carle Richland Memorial Hospital,8980259,iodine-potassium iodide 5 %-10 % topical solution,59365606400,,259,$47.17 ,$47.17 ,$36.04 ,$42.45 ,$40.09 ,$40.09 ,$40.09 ,$41.51 ,$40.09 ,$41.51 ,$41.51 ,$41.04 ,$40.09 ,$40.09 ,$40.09 ,$36.04 ,$42.45
Carle Richland Memorial Hospital,8980259,iodine-potassium iodide 5 %-10 % topical solution,10481011108,,259,$67.15 ,$67.15 ,$51.30 ,$60.44 ,$57.08 ,$57.08 ,$57.08 ,$59.09 ,$57.08 ,$59.09 ,$59.09 ,$58.42 ,$57.08 ,$57.08 ,$57.08 ,$51.30 ,$60.44
Carle Richland Memorial Hospital,8980259,ipratropium bromide 42 mcg (0.06 %) nasal spray,54004641,,259,$467.00 ,$467.00 ,$356.79 ,$420.30 ,$396.95 ,$396.95 ,$396.95 ,$410.96 ,$396.95 ,$410.96 ,$410.96 ,$406.29 ,$396.95 ,$396.95 ,$396.95 ,$356.79 ,$420.30
Carle Richland Memorial Hospital,8980259,ketoconazole 2 % topical cream,168009930,,259,$263.80 ,$263.80 ,$201.54 ,$237.42 ,$224.23 ,$224.23 ,$224.23 ,$232.14 ,$224.23 ,$232.14 ,$232.14 ,$229.51 ,$224.23 ,$224.23 ,$224.23 ,$201.54 ,$237.42
Carle Richland Memorial Hospital,8980259,Lactobacillus rhamnosus GG 10 billion cell capsule,49100040007,,259,$1.60 ,$1.60 ,$1.22 ,$1.44 ,$1.36 ,$1.36 ,$1.36 ,$1.41 ,$1.36 ,$1.41 ,$1.41 ,$1.39 ,$1.36 ,$1.36 ,$1.36 ,$1.22 ,$1.44
Carle Richland Memorial Hospital,8980259,lamiVUDine 150 mg-zidovudine 300 mg tablet,31722050660,,259,$62.49 ,$62.49 ,$47.74 ,$56.24 ,$53.12 ,$53.12 ,$53.12 ,$54.99 ,$53.12 ,$54.99 ,$54.99 ,$54.37 ,$53.12 ,$53.12 ,$53.12 ,$47.74 ,$56.24
Carle Richland Memorial Hospital,8980259,lanolin alcohols-mineral oil-w.petrolatum-ceresin topical cream,92771060002,,259,$29.81 ,$29.81 ,$22.77 ,$26.83 ,$25.34 ,$25.34 ,$25.34 ,$26.23 ,$25.34 ,$26.23 ,$26.23 ,$25.93 ,$25.34 ,$25.34 ,$25.34 ,$22.77 ,$26.83
Carle Richland Memorial Hospital,8980259,lidocaine-prilocaine 2.5 %-2.5 % topical cream,168035705,,259,$61.21 ,$61.21 ,$46.76 ,$55.09 ,$52.03 ,$52.03 ,$52.03 ,$53.86 ,$52.03 ,$53.86 ,$53.86 ,$53.25 ,$52.03 ,$52.03 ,$52.03 ,$46.76 ,$55.09
Carle Richland Memorial Hospital,8980259,lithium carbonate 300 mg capsule,54852725,,259,$3.31 ,$3.31 ,$2.53 ,$2.98 ,$2.81 ,$2.81 ,$2.81 ,$2.91 ,$2.81 ,$2.91 ,$2.91 ,$2.88 ,$2.81 ,$2.81 ,$2.81 ,$2.53 ,$2.98
Carle Richland Memorial Hospital,8980259,magnesium oxide 400 mg (241.3 mg magnesium) tablet,10006070028,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,megestroL 40 mg tablet,63739016510,,259,$9.53 ,$9.53 ,$7.28 ,$8.58 ,$8.10 ,$8.10 ,$8.10 ,$8.39 ,$8.10 ,$8.39 ,$8.39 ,$8.29 ,$8.10 ,$8.10 ,$8.10 ,$7.28 ,$8.58
Carle Richland Memorial Hospital,8980259,meloxicam 7.5 mg tablet,50268052511,,259,$16.77 ,$16.77 ,$12.81 ,$15.09 ,$14.25 ,$14.25 ,$14.25 ,$14.76 ,$14.25 ,$14.76 ,$14.76 ,$14.59 ,$14.25 ,$14.25 ,$14.25 ,$12.81 ,$15.09
Carle Richland Memorial Hospital,8980259,meloxicam 7.5 mg tablet,50268052515,,259,$16.77 ,$16.77 ,$12.81 ,$15.09 ,$14.25 ,$14.25 ,$14.25 ,$14.76 ,$14.25 ,$14.76 ,$14.76 ,$14.59 ,$14.25 ,$14.25 ,$14.25 ,$12.81 ,$15.09
Carle Richland Memorial Hospital,8980259,menthol 0.44 %-zinc oxide 20.6 % topical ointment,799000102,J3490,259,$26.64 ,$26.64 ,$20.35 ,$23.98 ,$22.64 ,$22.64 ,$22.64 ,$23.44 ,$22.64 ,$23.44 ,$23.44 ,$23.18 ,$22.64 ,$22.64 ,$22.64 ,$20.35 ,$23.98
Carle Richland Memorial Hospital,8980259,metaxalone 800 mg tablet,68084013511,,259,$28.77 ,$28.77 ,$21.98 ,$25.89 ,$24.45 ,$24.45 ,$24.45 ,$25.32 ,$24.45 ,$25.32 ,$25.32 ,$25.03 ,$24.45 ,$24.45 ,$24.45 ,$21.98 ,$25.89
Carle Richland Memorial Hospital,8980259,metaxalone 800 mg tablet,68084013521,,259,$28.77 ,$28.77 ,$21.98 ,$25.89 ,$24.45 ,$24.45 ,$24.45 ,$25.32 ,$24.45 ,$25.32 ,$25.32 ,$25.03 ,$24.45 ,$24.45 ,$24.45 ,$21.98 ,$25.89
Carle Richland Memorial Hospital,8980259,metFORMIN 850 mg tablet,60687014301,,259,$7.94 ,$7.94 ,$6.07 ,$7.15 ,$6.75 ,$6.75 ,$6.75 ,$6.99 ,$6.75 ,$6.99 ,$6.99 ,$6.91 ,$6.75 ,$6.75 ,$6.75 ,$6.07 ,$7.15
Carle Richland Memorial Hospital,8980259,metFORMIN 850 mg tablet,60687014311,,259,$7.94 ,$7.94 ,$6.07 ,$7.15 ,$6.75 ,$6.75 ,$6.75 ,$6.99 ,$6.75 ,$6.99 ,$6.99 ,$6.91 ,$6.75 ,$6.75 ,$6.75 ,$6.07 ,$7.15
Carle Richland Memorial Hospital,8980259,"metFORMIN ER 500 mg tablet,extended release 24 hr",50268053111,,259,$8.57 ,$8.57 ,$6.55 ,$7.71 ,$7.28 ,$7.28 ,$7.28 ,$7.54 ,$7.28 ,$7.54 ,$7.54 ,$7.46 ,$7.28 ,$7.28 ,$7.28 ,$6.55 ,$7.71
Carle Richland Memorial Hospital,8980259,"metFORMIN ER 500 mg tablet,extended release 24 hr",50268053115,,259,$8.57 ,$8.57 ,$6.55 ,$7.71 ,$7.28 ,$7.28 ,$7.28 ,$7.54 ,$7.28 ,$7.54 ,$7.54 ,$7.46 ,$7.28 ,$7.28 ,$7.28 ,$6.55 ,$7.71
Carle Richland Memorial Hospital,8980259,methyl salicylate 15 %-menthol 10 % topical cream,74300008186,,259,$25.39 ,$25.39 ,$19.40 ,$22.85 ,$21.58 ,$21.58 ,$21.58 ,$22.34 ,$21.58 ,$22.34 ,$22.34 ,$22.09 ,$21.58 ,$21.58 ,$21.58 ,$19.40 ,$22.85
Carle Richland Memorial Hospital,8980259,metoclopramide 5 mg tablet,63739010310,,259,$2.96 ,$2.96 ,$2.26 ,$2.66 ,$2.52 ,$2.52 ,$2.52 ,$2.60 ,$2.52 ,$2.60 ,$2.60 ,$2.58 ,$2.52 ,$2.52 ,$2.52 ,$2.26 ,$2.66
Carle Richland Memorial Hospital,8980259,metroNIDAZOLE 0.75 % vaginal gel,245086070,,259,$780.69 ,$780.69 ,$596.45 ,$702.62 ,$663.59 ,$663.59 ,$663.59 ,$687.01 ,$663.59 ,$687.01 ,$687.01 ,$679.20 ,$663.59 ,$663.59 ,$663.59 ,$596.45 ,$702.62
Carle Richland Memorial Hospital,8980259,mineral oil oral,48433020230,,259,$1.39 ,$1.39 ,$1.06 ,$1.25 ,$1.18 ,$1.18 ,$1.18 ,$1.22 ,$1.18 ,$1.22 ,$1.22 ,$1.21 ,$1.18 ,$1.18 ,$1.18 ,$1.06 ,$1.25
Carle Richland Memorial Hospital,8980259,minocycline 50 mg capsule,55289020230,,259,$11.76 ,$11.76 ,$8.98 ,$10.58 ,$10.00 ,$10.00 ,$10.00 ,$10.35 ,$10.00 ,$10.35 ,$10.35 ,$10.23 ,$10.00 ,$10.00 ,$10.00 ,$8.98 ,$10.58
Carle Richland Memorial Hospital,8980259,modafiniL 200 mg tablet,60505252703,,259,$150.16 ,$150.16 ,$114.72 ,$135.14 ,$127.64 ,$127.64 ,$127.64 ,$132.14 ,$127.64 ,$132.14 ,$132.14 ,$130.64 ,$127.64 ,$127.64 ,$127.64 ,$114.72 ,$135.14
Carle Richland Memorial Hospital,8980259,moexipriL 7.5 mg tablet,93001701,,259,$8.80 ,$8.80 ,$6.72 ,$7.92 ,$7.48 ,$7.48 ,$7.48 ,$7.74 ,$7.48 ,$7.74 ,$7.74 ,$7.66 ,$7.48 ,$7.48 ,$7.48 ,$6.72 ,$7.92
Carle Richland Memorial Hospital,8980259,multivitamin-minerals-lutein tablet,536344508,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,naphazoline 0.025 %-pheniramine 0.3 % eye drops,65008515,,259,$55.97 ,$55.97 ,$42.76 ,$50.37 ,$47.57 ,$47.57 ,$47.57 ,$49.25 ,$47.57 ,$49.25 ,$49.25 ,$48.69 ,$47.57 ,$47.57 ,$47.57 ,$42.76 ,$50.37
Carle Richland Memorial Hospital,8980259,nebivoloL 5 mg tablet,456140511,,259,$30.68 ,$30.68 ,$23.44 ,$27.61 ,$26.08 ,$26.08 ,$26.08 ,$27.00 ,$26.08 ,$27.00 ,$27.00 ,$26.69 ,$26.08 ,$26.08 ,$26.08 ,$23.44 ,$27.61
Carle Richland Memorial Hospital,8980259,nebivoloL 5 mg tablet,456140563,,259,$30.68 ,$30.68 ,$23.44 ,$27.61 ,$26.08 ,$26.08 ,$26.08 ,$27.00 ,$26.08 ,$27.00 ,$27.00 ,$26.69 ,$26.08 ,$26.08 ,$26.08 ,$23.44 ,$27.61
Carle Richland Memorial Hospital,8980259,"neomycin 3.5 mg-polymyxin 10,000 unit-hydrocort 10 mg/mL eye drop,susp",61314064175,,259,$814.34 ,$814.34 ,$622.16 ,$732.91 ,$692.19 ,$692.19 ,$692.19 ,$716.62 ,$692.19 ,$716.62 ,$716.62 ,$708.48 ,$692.19 ,$692.19 ,$692.19 ,$622.16 ,$732.91
Carle Richland Memorial Hospital,8980259,"neomycin-polymyxin-hydrocort 3.5 mg-10,000 unit/mL-1 % ear drops,susp",61314064511,,259,$509.71 ,$509.71 ,$389.42 ,$458.74 ,$433.25 ,$433.25 ,$433.25 ,$448.54 ,$433.25 ,$448.54 ,$448.54 ,$443.45 ,$433.25 ,$433.25 ,$433.25 ,$389.42 ,$458.74
Carle Richland Memorial Hospital,8980259,nitrofurantoin macrocrystaL 100 mg capsule,115164501,,259,$18.77 ,$18.77 ,$14.34 ,$16.89 ,$15.95 ,$15.95 ,$15.95 ,$16.52 ,$15.95 ,$16.52 ,$16.52 ,$16.33 ,$15.95 ,$15.95 ,$15.95 ,$14.34 ,$16.89
Carle Richland Memorial Hospital,8980259,"nystatin 100,000 unit/gram topical ointment",713068615,,259,$102.54 ,$102.54 ,$78.34 ,$92.29 ,$87.16 ,$87.16 ,$87.16 ,$90.24 ,$87.16 ,$90.24 ,$90.24 ,$89.21 ,$87.16 ,$87.16 ,$87.16 ,$78.34 ,$92.29
Carle Richland Memorial Hospital,8980259,"nystatin-triamcinolone 100,000 unit/g-0.1 % topical cream",45802088014,,259,$138.12 ,$138.12 ,$105.52 ,$124.31 ,$117.40 ,$117.40 ,$117.40 ,$121.55 ,$117.40 ,$121.55 ,$121.55 ,$120.16 ,$117.40 ,$117.40 ,$117.40 ,$105.52 ,$124.31
Carle Richland Memorial Hospital,8980259,OLANZapine 2.5 mg tablet,68084052511,,259,$47.25 ,$47.25 ,$36.10 ,$42.53 ,$40.16 ,$40.16 ,$40.16 ,$41.58 ,$40.16 ,$41.58 ,$41.58 ,$41.11 ,$40.16 ,$40.16 ,$40.16 ,$36.10 ,$42.53
Carle Richland Memorial Hospital,8980259,oxazepam 15 mg capsule,62584081301,,259,$16.89 ,$16.89 ,$12.90 ,$15.20 ,$14.36 ,$14.36 ,$14.36 ,$14.86 ,$14.36 ,$14.86 ,$14.86 ,$14.69 ,$14.36 ,$14.36 ,$14.36 ,$12.90 ,$15.20
Carle Richland Memorial Hospital,8980259,oxazepam 15 mg capsule,62584081311,,259,$16.89 ,$16.89 ,$12.90 ,$15.20 ,$14.36 ,$14.36 ,$14.36 ,$14.86 ,$14.36 ,$14.86 ,$14.86 ,$14.69 ,$14.36 ,$14.36 ,$14.36 ,$12.90 ,$15.20
Carle Richland Memorial Hospital,8980259,OXcarbazepine 150 mg tablet,68084084501,,259,$9.36 ,$9.36 ,$7.15 ,$8.42 ,$7.96 ,$7.96 ,$7.96 ,$8.24 ,$7.96 ,$8.24 ,$8.24 ,$8.14 ,$7.96 ,$7.96 ,$7.96 ,$7.15 ,$8.42
Carle Richland Memorial Hospital,8980259,OXcarbazepine 150 mg tablet,68084084511,,259,$9.36 ,$9.36 ,$7.15 ,$8.42 ,$7.96 ,$7.96 ,$7.96 ,$8.24 ,$7.96 ,$8.24 ,$8.24 ,$8.14 ,$7.96 ,$7.96 ,$7.96 ,$7.15 ,$8.42
Carle Richland Memorial Hospital,8980259,OXcarbazepine 300 mg tablet,68084085301,,259,$15.17 ,$15.17 ,$11.59 ,$13.65 ,$12.89 ,$12.89 ,$12.89 ,$13.35 ,$12.89 ,$13.35 ,$13.35 ,$13.20 ,$12.89 ,$12.89 ,$12.89 ,$11.59 ,$13.65
Carle Richland Memorial Hospital,8980259,OXcarbazepine 300 mg tablet,68084085311,,259,$15.17 ,$15.17 ,$11.59 ,$13.65 ,$12.89 ,$12.89 ,$12.89 ,$13.35 ,$12.89 ,$13.35 ,$13.35 ,$13.20 ,$12.89 ,$12.89 ,$12.89 ,$11.59 ,$13.65
Carle Richland Memorial Hospital,8980259,"oxybutynin chloride ER 5 mg tablet,extended release 24 hr",68084048001,,259,$16.35 ,$16.35 ,$12.49 ,$14.72 ,$13.90 ,$13.90 ,$13.90 ,$14.39 ,$13.90 ,$14.39 ,$14.39 ,$14.22 ,$13.90 ,$13.90 ,$13.90 ,$12.49 ,$14.72
Carle Richland Memorial Hospital,8980259,"oxybutynin chloride ER 5 mg tablet,extended release 24 hr",68084048011,,259,$16.35 ,$16.35 ,$12.49 ,$14.72 ,$13.90 ,$13.90 ,$13.90 ,$14.39 ,$13.90 ,$14.39 ,$14.39 ,$14.22 ,$13.90 ,$13.90 ,$13.90 ,$12.49 ,$14.72
Carle Richland Memorial Hospital,8980259,penicillin V potassium 125 mg/5 mL oral solution,93412573,,259,$9.64 ,$9.64 ,$7.36 ,$8.68 ,$8.19 ,$8.19 ,$8.19 ,$8.48 ,$8.19 ,$8.48 ,$8.48 ,$8.39 ,$8.19 ,$8.19 ,$8.19 ,$7.36 ,$8.68
Carle Richland Memorial Hospital,8980259,penicillin V potassium 250 mg/5 mL oral solution,93412773,,259,$9.96 ,$9.96 ,$7.61 ,$8.96 ,$8.47 ,$8.47 ,$8.47 ,$8.76 ,$8.47 ,$8.76 ,$8.76 ,$8.67 ,$8.47 ,$8.47 ,$8.47 ,$7.61 ,$8.96
Carle Richland Memorial Hospital,8980259,phenazopyridine 100 mg tablet,69367016204,,259,$14.91 ,$14.91 ,$11.39 ,$13.42 ,$12.67 ,$12.67 ,$12.67 ,$13.12 ,$12.67 ,$13.12 ,$13.12 ,$12.97 ,$12.67 ,$12.67 ,$12.67 ,$11.39 ,$13.42
Carle Richland Memorial Hospital,8980259,PHENobarbitaL 32.4 mg tablet,63739020110,,259,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980259,phenylephrine 2.5 % eye drops,17478020115,,259,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980259,pioglitazone 15 mg tablet,51079051301,,259,$28.04 ,$28.04 ,$21.42 ,$25.24 ,$23.83 ,$23.83 ,$23.83 ,$24.68 ,$23.83 ,$24.68 ,$24.68 ,$24.39 ,$23.83 ,$23.83 ,$23.83 ,$21.42 ,$25.24
Carle Richland Memorial Hospital,8980259,potassium chloride 20 mEq/15 mL oral liquid,60687034172,,259,$122.00 ,$122.00 ,$93.21 ,$109.80 ,$103.70 ,$103.70 ,$103.70 ,$107.36 ,$103.70 ,$107.36 ,$107.36 ,$106.14 ,$103.70 ,$103.70 ,$103.70 ,$93.21 ,$109.80
Carle Richland Memorial Hospital,8980259,potassium chloride 20 mEq/15 mL oral liquid,60687034114,,259,$151.36 ,$151.36 ,$115.64 ,$136.22 ,$128.66 ,$128.66 ,$128.66 ,$133.20 ,$128.66 ,$133.20 ,$133.20 ,$131.68 ,$128.66 ,$128.66 ,$128.66 ,$115.64 ,$136.22
Carle Richland Memorial Hospital,8980259,potassium chloride 20 mEq/15 mL oral liquid,60687034145,,259,$151.36 ,$151.36 ,$115.64 ,$136.22 ,$128.66 ,$128.66 ,$128.66 ,$133.20 ,$128.66 ,$133.20 ,$133.20 ,$131.68 ,$128.66 ,$128.66 ,$128.66 ,$115.64 ,$136.22
Carle Richland Memorial Hospital,8980259,povidone-iodine 10 % topical ointment,904110231,,259,$20.66 ,$20.66 ,$15.78 ,$18.59 ,$17.56 ,$17.56 ,$17.56 ,$18.18 ,$17.56 ,$18.18 ,$18.18 ,$17.97 ,$17.56 ,$17.56 ,$17.56 ,$15.78 ,$18.59
Carle Richland Memorial Hospital,8980259,pseudoephedrine 30 mg tablet,45802043262,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,psyllium husk 0.52 gram capsule,37000040514,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,quinapriL 10 mg tablet,68001018805,,259,$8.03 ,$8.03 ,$6.13 ,$7.23 ,$6.83 ,$6.83 ,$6.83 ,$7.07 ,$6.83 ,$7.07 ,$7.07 ,$6.99 ,$6.83 ,$6.83 ,$6.83 ,$6.13 ,$7.23
Carle Richland Memorial Hospital,8980259,raNITIdine 150 mg tablet,60687032201,,259,$4.01 ,$4.01 ,$3.06 ,$3.61 ,$3.41 ,$3.41 ,$3.41 ,$3.53 ,$3.41 ,$3.53 ,$3.53 ,$3.49 ,$3.41 ,$3.41 ,$3.41 ,$3.06 ,$3.61
Carle Richland Memorial Hospital,8980259,raNITIdine 150 mg tablet,60687032211,,259,$4.01 ,$4.01 ,$3.06 ,$3.61 ,$3.41 ,$3.41 ,$3.41 ,$3.53 ,$3.41 ,$3.53 ,$3.53 ,$3.49 ,$3.41 ,$3.41 ,$3.41 ,$3.06 ,$3.61
Carle Richland Memorial Hospital,8980259,simple syrup,395266116,,259,$13.98 ,$13.98 ,$10.68 ,$12.58 ,$11.88 ,$11.88 ,$11.88 ,$12.30 ,$11.88 ,$12.30 ,$12.30 ,$12.16 ,$11.88 ,$11.88 ,$11.88 ,$10.68 ,$12.58
Carle Richland Memorial Hospital,8980259,sodium chloride 3 % for nebulization,487900360,J3490,259,$6.06 ,$6.06 ,$4.63 ,$5.45 ,$5.15 ,$5.15 ,$5.15 ,$5.33 ,$5.15 ,$5.33 ,$5.33 ,$5.27 ,$5.15 ,$5.15 ,$5.15 ,$4.63 ,$5.45
Carle Richland Memorial Hospital,8980259,sodium chloride 5 % eye drops,17478062312,,259,$89.32 ,$89.32 ,$68.24 ,$80.39 ,$75.92 ,$75.92 ,$75.92 ,$78.60 ,$75.92 ,$78.60 ,$78.60 ,$77.71 ,$75.92 ,$75.92 ,$75.92 ,$68.24 ,$80.39
Carle Richland Memorial Hospital,8980259,sodium chloride-aloe vera nasal gel,225052547,,259,$20.32 ,$20.32 ,$15.52 ,$18.29 ,$17.27 ,$17.27 ,$17.27 ,$17.88 ,$17.27 ,$17.88 ,$17.88 ,$17.68 ,$17.27 ,$17.27 ,$17.27 ,$15.52 ,$18.29
Carle Richland Memorial Hospital,8980259,sodium di- and monophosphate-potassium phos monobasic 250 mg tablet,68084076425,,259,$9.79 ,$9.79 ,$7.48 ,$8.81 ,$8.32 ,$8.32 ,$8.32 ,$8.62 ,$8.32 ,$8.62 ,$8.62 ,$8.52 ,$8.32 ,$8.32 ,$8.32 ,$7.48 ,$8.81
Carle Richland Memorial Hospital,8980259,sodium di- and monophosphate-potassium phos monobasic 250 mg tablet,68084076495,,259,$9.79 ,$9.79 ,$7.48 ,$8.81 ,$8.32 ,$8.32 ,$8.32 ,$8.62 ,$8.32 ,$8.62 ,$8.62 ,$8.52 ,$8.32 ,$8.32 ,$8.32 ,$7.48 ,$8.81
Carle Richland Memorial Hospital,8980259,sodium hypochlorite 0.25 % solution,39328006325,,259,$83.33 ,$83.33 ,$63.66 ,$75.00 ,$70.83 ,$70.83 ,$70.83 ,$73.33 ,$70.83 ,$73.33 ,$73.33 ,$72.50 ,$70.83 ,$70.83 ,$70.83 ,$63.66 ,$75.00
Carle Richland Memorial Hospital,8980259,sucralfate 1 gram tablet,51079075301,,259,$4.10 ,$4.10 ,$3.13 ,$3.69 ,$3.49 ,$3.49 ,$3.49 ,$3.61 ,$3.49 ,$3.61 ,$3.61 ,$3.57 ,$3.49 ,$3.49 ,$3.49 ,$3.13 ,$3.69
Carle Richland Memorial Hospital,8980259,sucralfate 1 gram tablet,51079075320,,259,$4.10 ,$4.10 ,$3.13 ,$3.69 ,$3.49 ,$3.49 ,$3.49 ,$3.61 ,$3.49 ,$3.61 ,$3.61 ,$3.57 ,$3.49 ,$3.49 ,$3.49 ,$3.13 ,$3.69
Carle Richland Memorial Hospital,8980259,sulfacetamide-prednisolone 10 %-0.23 % (0.25 %) eye drops,24208031705,,259,$108.35 ,$108.35 ,$82.78 ,$97.52 ,$92.10 ,$92.10 ,$92.10 ,$95.35 ,$92.10 ,$95.35 ,$95.35 ,$94.26 ,$92.10 ,$92.10 ,$92.10 ,$82.78 ,$97.52
Carle Richland Memorial Hospital,8980259,SUMAtriptan 25 mg tablet,65862014636,,259,$102.83 ,$102.83 ,$78.56 ,$92.55 ,$87.41 ,$87.41 ,$87.41 ,$90.49 ,$87.41 ,$90.49 ,$90.49 ,$89.46 ,$87.41 ,$87.41 ,$87.41 ,$78.56 ,$92.55
Carle Richland Memorial Hospital,8980259,temazepam 15 mg capsule,63739087710,,259,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980259,temazepam 7.5 mg capsule,68084054911,,259,$39.72 ,$39.72 ,$30.35 ,$35.75 ,$33.76 ,$33.76 ,$33.76 ,$34.95 ,$33.76 ,$34.95 ,$34.95 ,$34.56 ,$33.76 ,$33.76 ,$33.76 ,$30.35 ,$35.75
Carle Richland Memorial Hospital,8980259,temazepam 7.5 mg capsule,68084054921,,259,$39.72 ,$39.72 ,$30.35 ,$35.75 ,$33.76 ,$33.76 ,$33.76 ,$34.95 ,$33.76 ,$34.95 ,$34.95 ,$34.56 ,$33.76 ,$33.76 ,$33.76 ,$30.35 ,$35.75
Carle Richland Memorial Hospital,8980259,thyroid (pork) 30 mg tablet,42192032901,,259,$6.69 ,$6.69 ,$5.11 ,$6.02 ,$5.69 ,$5.69 ,$5.69 ,$5.89 ,$5.69 ,$5.89 ,$5.89 ,$5.82 ,$5.69 ,$5.69 ,$5.69 ,$5.11 ,$6.02
Carle Richland Memorial Hospital,8980259,tobramycin-dexamethasone 0.3 %-0.1 % eye ointment,65064835,,259,"$1,137.60 ","$1,137.60 ",$869.13 ,"$1,023.84 ",$966.96 ,$966.96 ,$966.96 ,"$1,001.09 ",$966.96 ,"$1,001.09 ","$1,001.09 ",$989.71 ,$966.96 ,$966.96 ,$966.96 ,$869.13 ,"$1,023.84 "
Carle Richland Memorial Hospital,8980259,tolnaftate 1 % topical cream,51672202001,,259,$33.18 ,$33.18 ,$25.35 ,$29.86 ,$28.20 ,$28.20 ,$28.20 ,$29.20 ,$28.20 ,$29.20 ,$29.20 ,$28.87 ,$28.20 ,$28.20 ,$28.20 ,$25.35 ,$29.86
Carle Richland Memorial Hospital,8980259,topiramate 100 mg tablet,68084034401,,259,$29.85 ,$29.85 ,$22.81 ,$26.87 ,$25.37 ,$25.37 ,$25.37 ,$26.27 ,$25.37 ,$26.27 ,$26.27 ,$25.97 ,$25.37 ,$25.37 ,$25.37 ,$22.81 ,$26.87
Carle Richland Memorial Hospital,8980259,trandolapriL 2 mg tablet,68180056701,,259,$8.10 ,$8.10 ,$6.19 ,$7.29 ,$6.89 ,$6.89 ,$6.89 ,$7.13 ,$6.89 ,$7.13 ,$7.13 ,$7.05 ,$6.89 ,$6.89 ,$6.89 ,$6.19 ,$7.29
Carle Richland Memorial Hospital,8980259,triamterene 75 mg-hydrochlorothiazide 50 mg tablet,51079043301,,259,$6.59 ,$6.59 ,$5.03 ,$5.93 ,$5.60 ,$5.60 ,$5.60 ,$5.80 ,$5.60 ,$5.80 ,$5.80 ,$5.73 ,$5.60 ,$5.60 ,$5.60 ,$5.03 ,$5.93
Carle Richland Memorial Hospital,8980259,triamterene 75 mg-hydrochlorothiazide 50 mg tablet,51079043320,,259,$6.59 ,$6.59 ,$5.03 ,$5.93 ,$5.60 ,$5.60 ,$5.60 ,$5.80 ,$5.60 ,$5.80 ,$5.80 ,$5.73 ,$5.60 ,$5.60 ,$5.60 ,$5.03 ,$5.93
Carle Richland Memorial Hospital,8980259,"verapamiL ER (SR) 120 mg tablet,extended release",68462029201,,259,$7.33 ,$7.33 ,$5.60 ,$6.60 ,$6.23 ,$6.23 ,$6.23 ,$6.45 ,$6.23 ,$6.45 ,$6.45 ,$6.38 ,$6.23 ,$6.23 ,$6.23 ,$5.60 ,$6.60
Carle Richland Memorial Hospital,8980259,"verapamiL ER (SR) 180 mg tablet,extended release",68462029301,,259,$9.04 ,$9.04 ,$6.91 ,$8.14 ,$7.68 ,$7.68 ,$7.68 ,$7.96 ,$7.68 ,$7.96 ,$7.96 ,$7.86 ,$7.68 ,$7.68 ,$7.68 ,$6.91 ,$8.14
Carle Richland Memorial Hospital,8980259,"verapamiL ER (SR) 240 mg tablet,extended release",68462026001,,259,$9.95 ,$9.95 ,$7.60 ,$8.96 ,$8.46 ,$8.46 ,$8.46 ,$8.76 ,$8.46 ,$8.76 ,$8.76 ,$8.66 ,$8.46 ,$8.46 ,$8.46 ,$7.60 ,$8.96
Carle Richland Memorial Hospital,8980259,"vitamin E (dl, acetate) 180 mg (400 unit) capsule",536479901,,259,$0.59 ,$0.59 ,$0.45 ,$0.53 ,$0.50 ,$0.50 ,$0.50 ,$0.52 ,$0.50 ,$0.52 ,$0.52 ,$0.51 ,$0.50 ,$0.50 ,$0.50 ,$0.45 ,$0.53
Carle Richland Memorial Hospital,8980259,zinc oxide 16 % topical ointment,62103033302,,259,$27.08 ,$27.08 ,$20.69 ,$24.37 ,$23.02 ,$23.02 ,$23.02 ,$23.83 ,$23.02 ,$23.83 ,$23.83 ,$23.56 ,$23.02 ,$23.02 ,$23.02 ,$20.69 ,$24.37
Carle Richland Memorial Hospital,8980259,ZOLMitriptan 2.5 mg tablet,27241002168,,259,$185.37 ,$185.37 ,$141.62 ,$166.83 ,$157.56 ,$157.56 ,$157.56 ,$163.13 ,$157.56 ,$163.13 ,$163.13 ,$161.27 ,$157.56 ,$157.56 ,$157.56 ,$141.62 ,$166.83
Carle Richland Memorial Hospital,8980259,zolpidem 10 mg tablet,13668000801,,259,$26.21 ,$26.21 ,$20.02 ,$23.59 ,$22.28 ,$22.28 ,$22.28 ,$23.06 ,$22.28 ,$23.06 ,$23.06 ,$22.80 ,$22.28 ,$22.28 ,$22.28 ,$20.02 ,$23.59
Carle Richland Memorial Hospital,96360,"IV INFUSION, HYDRATION, 31-60 MIN",,96360,260,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,96361,"IV INFUSION, HYDRATION, EA ADD HOUR",,96361,260,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,96365,"IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",,96365,260,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,96366,"IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR",,96366,260,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8140060,OXYGEN,,,270,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8670003,14 FRENCH STYLET,,,270,$31.00 ,$31.00 ,$23.68 ,$27.90 ,$26.35 ,$26.35 ,$26.35 ,$27.28 ,$26.35 ,$27.28 ,$27.28 ,$26.97 ,$26.35 ,$26.35 ,$26.35 ,$23.68 ,$27.90
Carle Richland Memorial Hospital,8670068,ET TUBE,,,270,$20.00 ,$20.00 ,$15.28 ,$18.00 ,$17.00 ,$17.00 ,$17.00 ,$17.60 ,$17.00 ,$17.60 ,$17.60 ,$17.40 ,$17.00 ,$17.00 ,$17.00 ,$15.28 ,$18.00
Carle Richland Memorial Hospital,8670075,FLEX PROBE,,,270,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8670077,FOOT DROP SPLINT,,,270,$536.24 ,$536.24 ,$409.69 ,$482.62 ,$455.80 ,$455.80 ,$455.80 ,$471.89 ,$455.80 ,$471.89 ,$471.89 ,$466.53 ,$455.80 ,$455.80 ,$455.80 ,$409.69 ,$482.62
Carle Richland Memorial Hospital,8670103,INCENTIVE SPIROMETER,,,270,$30.00 ,$30.00 ,$22.92 ,$27.00 ,$25.50 ,$25.50 ,$25.50 ,$26.40 ,$25.50 ,$26.40 ,$26.40 ,$26.10 ,$25.50 ,$25.50 ,$25.50 ,$22.92 ,$27.00
Carle Richland Memorial Hospital,8670131,PEAK FLOWMETER-ONLY,,,270,$92.00 ,$92.00 ,$70.29 ,$82.80 ,$78.20 ,$78.20 ,$78.20 ,$80.96 ,$78.20 ,$80.96 ,$80.96 ,$80.04 ,$78.20 ,$78.20 ,$78.20 ,$70.29 ,$82.80
Carle Richland Memorial Hospital,8140070,OR ANESTHESIA SUPPLIES 2,,,270,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8140071,OR ANESTHESIA SUPPLIES 3,,,270,$29.00 ,$29.00 ,$22.16 ,$26.10 ,$24.65 ,$24.65 ,$24.65 ,$25.52 ,$24.65 ,$25.52 ,$25.52 ,$25.23 ,$24.65 ,$24.65 ,$24.65 ,$22.16 ,$26.10
Carle Richland Memorial Hospital,8130006,PERIPHERAL NERVE BLOCK TRAY BRAUN,,,270,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8130007,OR ANES SUPPLIES ART LINE ARROW,,,270,$194.00 ,$194.00 ,$148.22 ,$174.60 ,$164.90 ,$164.90 ,$164.90 ,$170.72 ,$164.90 ,$170.72 ,$170.72 ,$168.78 ,$164.90 ,$164.90 ,$164.90 ,$148.22 ,$174.60
Carle Richland Memorial Hospital,8130008,OR ANES SUPPLIES ART LINE ANGIOCATH,,,270,$159.00 ,$159.00 ,$121.48 ,$143.10 ,$135.15 ,$135.15 ,$135.15 ,$139.92 ,$135.15 ,$139.92 ,$139.92 ,$138.33 ,$135.15 ,$135.15 ,$135.15 ,$121.48 ,$143.10
Carle Richland Memorial Hospital,8130013,OR ANES GLIDESCOPE 0 - 2.5,,,270,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8130014,OR ANES GLIDESCOPE 3 -4,,,270,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8130015,KING VIDEO LARYNGOSCOPE CHANNELED BLADE,,,270,$232.11 ,$232.11 ,$177.33 ,$208.90 ,$197.29 ,$197.29 ,$197.29 ,$204.26 ,$197.29 ,$204.26 ,$204.26 ,$201.94 ,$197.29 ,$197.29 ,$197.29 ,$177.33 ,$208.90
Carle Richland Memorial Hospital,8130016,LUMBAR DRAINAGE SET,,,270,$922.06 ,$922.06 ,$704.45 ,$829.85 ,$783.75 ,$783.75 ,$783.75 ,$811.41 ,$783.75 ,$811.41 ,$811.41 ,$802.19 ,$783.75 ,$783.75 ,$783.75 ,$704.45 ,$829.85
Carle Richland Memorial Hospital,8030030,L&D TRIAGE SUPPLY,,,270,$14.00 ,$14.00 ,$10.70 ,$12.60 ,$11.90 ,$11.90 ,$11.90 ,$12.32 ,$11.90 ,$12.32 ,$12.32 ,$12.18 ,$11.90 ,$11.90 ,$11.90 ,$10.70 ,$12.60
Carle Richland Memorial Hospital,8030063,SENSATION PLUS 40CC BALLOON CATHETER KIT (618707),,,270,"$4,702.00 ","$4,702.00 ","$3,592.33 ","$4,231.80 ","$3,996.70 ","$3,996.70 ","$3,996.70 ","$4,137.76 ","$3,996.70 ","$4,137.76 ","$4,137.76 ","$4,090.74 ","$3,996.70 ","$3,996.70 ","$3,996.70 ","$3,592.33 ","$4,231.80 "
Carle Richland Memorial Hospital,8030064,SENSATION PLUS 50CC BALLOON CATHETER KIT (619270),,,270,"$4,702.00 ","$4,702.00 ","$3,592.33 ","$4,231.80 ","$3,996.70 ","$3,996.70 ","$3,996.70 ","$4,137.76 ","$3,996.70 ","$4,137.76 ","$4,137.76 ","$4,090.74 ","$3,996.70 ","$3,996.70 ","$3,996.70 ","$3,592.33 ","$4,231.80 "
Carle Richland Memorial Hospital,8030066,ICY CATHETER (626268),,,270,"$3,909.00 ","$3,909.00 ","$2,986.48 ","$3,518.10 ","$3,322.65 ","$3,322.65 ","$3,322.65 ","$3,439.92 ","$3,322.65 ","$3,439.92 ","$3,439.92 ","$3,400.83 ","$3,322.65 ","$3,322.65 ","$3,322.65 ","$2,986.48 ","$3,518.10 "
Carle Richland Memorial Hospital,8030067,QUATRO CATHETER (626269),,,270,"$4,376.00 ","$4,376.00 ","$3,343.26 ","$3,938.40 ","$3,719.60 ","$3,719.60 ","$3,719.60 ","$3,850.88 ","$3,719.60 ","$3,850.88 ","$3,850.88 ","$3,807.12 ","$3,719.60 ","$3,719.60 ","$3,719.60 ","$3,343.26 ","$3,938.40 "
Carle Richland Memorial Hospital,8030072,CODMAN EDS3 CSF DRAINAGE KIT (306327),,,270,$924.00 ,$924.00 ,$705.94 ,$831.60 ,$785.40 ,$785.40 ,$785.40 ,$813.12 ,$785.40 ,$813.12 ,$813.12 ,$803.88 ,$785.40 ,$785.40 ,$785.40 ,$705.94 ,$831.60
Carle Richland Memorial Hospital,8030073,LUMBAR PUNCTURE TRAY (226925),,,270,$30.00 ,$30.00 ,$22.92 ,$27.00 ,$25.50 ,$25.50 ,$25.50 ,$26.40 ,$25.50 ,$26.40 ,$26.40 ,$26.10 ,$25.50 ,$25.50 ,$25.50 ,$22.92 ,$27.00
Carle Richland Memorial Hospital,8670209,TRACH INNER CANNULA,,A4623,270,$50.96 ,$50.96 ,$38.93 ,$45.86 ,$43.32 ,$43.32 ,$43.32 ,$44.84 ,$43.32 ,$44.84 ,$44.84 ,$44.34 ,$43.32 ,$43.32 ,$43.32 ,$38.93 ,$45.86
Carle Richland Memorial Hospital,8030092,WOUND VAC (EACH DAY),,,270,$328.00 ,$328.00 ,$250.59 ,$295.20 ,$278.80 ,$278.80 ,$278.80 ,$288.64 ,$278.80 ,$288.64 ,$288.64 ,$285.36 ,$278.80 ,$278.80 ,$278.80 ,$250.59 ,$295.20
Carle Richland Memorial Hospital,8030093,WOUND VAC DRESSING (EACH),,,270,$222.54 ,$222.54 ,$170.02 ,$200.29 ,$189.16 ,$189.16 ,$189.16 ,$195.84 ,$189.16 ,$195.84 ,$195.84 ,$193.61 ,$189.16 ,$189.16 ,$189.16 ,$170.02 ,$200.29
Carle Richland Memorial Hospital,8030094,WOUND VAC CANISTER (EACH),,,270,$226.13 ,$226.13 ,$172.76 ,$203.52 ,$192.21 ,$192.21 ,$192.21 ,$198.99 ,$192.21 ,$198.99 ,$198.99 ,$196.73 ,$192.21 ,$192.21 ,$192.21 ,$172.76 ,$203.52
Carle Richland Memorial Hospital,8030095,WOUND VAC TRAC PAD,,,270,$87.58 ,$87.58 ,$66.91 ,$78.82 ,$74.44 ,$74.44 ,$74.44 ,$77.07 ,$74.44 ,$77.07 ,$77.07 ,$76.19 ,$74.44 ,$74.44 ,$74.44 ,$66.91 ,$78.82
Carle Richland Memorial Hospital,8030096,WOUND VAC DRAPE,,,270,$18.76 ,$18.76 ,$14.33 ,$16.88 ,$15.95 ,$15.95 ,$15.95 ,$16.51 ,$15.95 ,$16.51 ,$16.51 ,$16.32 ,$15.95 ,$15.95 ,$15.95 ,$14.33 ,$16.88
Carle Richland Memorial Hospital,8030097,CASSETTE IRRIGATION WOUND VAC,,,270,$175.81 ,$175.81 ,$134.32 ,$158.23 ,$149.44 ,$149.44 ,$149.44 ,$154.71 ,$149.44 ,$154.71 ,$154.71 ,$152.95 ,$149.44 ,$149.44 ,$149.44 ,$134.32 ,$158.23
Carle Richland Memorial Hospital,8030098,DRESSING IRRIGATION MEDIUM WOUND VAC,,,270,$367.63 ,$367.63 ,$280.87 ,$330.87 ,$312.49 ,$312.49 ,$312.49 ,$323.51 ,$312.49 ,$323.51 ,$323.51 ,$319.84 ,$312.49 ,$312.49 ,$312.49 ,$280.87 ,$330.87
Carle Richland Memorial Hospital,8670255,OXYGEN (E. ROOM ONLY),,,270,$216.29 ,$216.29 ,$165.25 ,$194.66 ,$183.85 ,$183.85 ,$183.85 ,$190.34 ,$183.85 ,$190.34 ,$190.34 ,$188.17 ,$183.85 ,$183.85 ,$183.85 ,$165.25 ,$194.66
Carle Richland Memorial Hospital,8670292,MONITOR DEFIB PER HOUR,,,270,$41.11 ,$41.11 ,$31.41 ,$37.00 ,$34.94 ,$34.94 ,$34.94 ,$36.18 ,$34.94 ,$36.18 ,$36.18 ,$35.77 ,$34.94 ,$34.94 ,$34.94 ,$31.41 ,$37.00
Carle Richland Memorial Hospital,8030099,CATH ARROW 4 LUMEN CY,,C1751,270,$492.54 ,$492.54 ,$376.30 ,$443.29 ,$418.66 ,$418.66 ,$418.66 ,$433.44 ,$418.66 ,$433.44 ,$433.44 ,$428.51 ,$418.66 ,$418.66 ,$418.66 ,$376.30 ,$443.29
Carle Richland Memorial Hospital,8940025,CATH PICC 5 FR DUAL LUMEN KIT,,C1751,270,$620.00 ,$620.00 ,$473.68 ,$558.00 ,$527.00 ,$527.00 ,$527.00 ,$545.60 ,$527.00 ,$545.60 ,$545.60 ,$539.40 ,$527.00 ,$527.00 ,$527.00 ,$473.68 ,$558.00
Carle Richland Memorial Hospital,8940024,CATH PICC 4 FR SINGLE LUMEN KIT,,C1751,270,$620.00 ,$620.00 ,$473.68 ,$558.00 ,$527.00 ,$527.00 ,$527.00 ,$545.60 ,$527.00 ,$545.60 ,$545.60 ,$539.40 ,$527.00 ,$527.00 ,$527.00 ,$473.68 ,$558.00
Carle Richland Memorial Hospital,8940026,4 FR INTRO PICC KIT,,,270,$97.00 ,$97.00 ,$74.11 ,$87.30 ,$82.45 ,$82.45 ,$82.45 ,$85.36 ,$82.45 ,$85.36 ,$85.36 ,$84.39 ,$82.45 ,$82.45 ,$82.45 ,$74.11 ,$87.30
Carle Richland Memorial Hospital,8940027,5 FR INTRO PICC KIT,,,270,$97.00 ,$97.00 ,$74.11 ,$87.30 ,$82.45 ,$82.45 ,$82.45 ,$85.36 ,$82.45 ,$85.36 ,$85.36 ,$84.39 ,$82.45 ,$82.45 ,$82.45 ,$74.11 ,$87.30
Carle Richland Memorial Hospital,8940028,CATH MIDLINE 4 FR SINGLE LUMEN KIT,,,270,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,8940029,CATH MIDLINE 5 FR DUAL LUMEN KIT,,,270,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8940030,VALVE PORT,,,270,$37.00 ,$37.00 ,$28.27 ,$33.30 ,$31.45 ,$31.45 ,$31.45 ,$32.56 ,$31.45 ,$32.56 ,$32.56 ,$32.19 ,$31.45 ,$31.45 ,$31.45 ,$28.27 ,$33.30
Carle Richland Memorial Hospital,8940031,PROBE COVER/C-ARM MINI,,,270,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8940032,BIOPATCH,,,270,$25.00 ,$25.00 ,$19.10 ,$22.50 ,$21.25 ,$21.25 ,$21.25 ,$22.00 ,$21.25 ,$22.00 ,$22.00 ,$21.75 ,$21.25 ,$21.25 ,$21.25 ,$19.10 ,$22.50
Carle Richland Memorial Hospital,8030101,FOLEY,,,270,$30.00 ,$30.00 ,$22.92 ,$27.00 ,$25.50 ,$25.50 ,$25.50 ,$26.40 ,$25.50 ,$26.40 ,$26.40 ,$26.10 ,$25.50 ,$25.50 ,$25.50 ,$22.92 ,$27.00
Carle Richland Memorial Hospital,8030102,DELEE,,,270,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8030103,BREASTPUMP KIT,,,270,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8030104,KIWI,,,270,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8030105,BINDER,,,270,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8030106,INTRAN,,,270,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8030107,CHG WIPE,,,270,$24.00 ,$24.00 ,$18.34 ,$21.60 ,$20.40 ,$20.40 ,$20.40 ,$21.12 ,$20.40 ,$21.12 ,$21.12 ,$20.88 ,$20.40 ,$20.40 ,$20.40 ,$18.34 ,$21.60
Carle Richland Memorial Hospital,8030108,ALP SLEEVES,,,270,$59.00 ,$59.00 ,$45.08 ,$53.10 ,$50.15 ,$50.15 ,$50.15 ,$51.92 ,$50.15 ,$51.92 ,$51.92 ,$51.33 ,$50.15 ,$50.15 ,$50.15 ,$45.08 ,$53.10
Carle Richland Memorial Hospital,8030109,GAYMAR PAD,,,270,$20.00 ,$20.00 ,$15.28 ,$18.00 ,$17.00 ,$17.00 ,$17.00 ,$17.60 ,$17.00 ,$17.60 ,$17.60 ,$17.40 ,$17.00 ,$17.00 ,$17.00 ,$15.28 ,$18.00
Carle Richland Memorial Hospital,8030110,CLEARSIGHT CUFF,,,270,"$1,328.00 ","$1,328.00 ","$1,014.59 ","$1,195.20 ","$1,128.80 ","$1,128.80 ","$1,128.80 ","$1,168.64 ","$1,128.80 ","$1,168.64 ","$1,168.64 ","$1,155.36 ","$1,128.80 ","$1,128.80 ","$1,128.80 ","$1,014.59 ","$1,195.20 "
Carle Richland Memorial Hospital,8030111,FLOTRAC ARTERIAL LINE (MHD85),,,270,"$1,328.00 ","$1,328.00 ","$1,014.59 ","$1,195.20 ","$1,128.80 ","$1,128.80 ","$1,128.80 ","$1,168.64 ","$1,128.80 ","$1,168.64 ","$1,168.64 ","$1,155.36 ","$1,128.80 ","$1,128.80 ","$1,128.80 ","$1,014.59 ","$1,195.20 "
Carle Richland Memorial Hospital,8030112,ASCOPE 4FLEX REGULAR,,,270,"$1,211.00 ","$1,211.00 ",$925.20 ,"$1,089.90 ","$1,029.35 ","$1,029.35 ","$1,029.35 ","$1,065.68 ","$1,029.35 ","$1,065.68 ","$1,065.68 ","$1,053.57 ","$1,029.35 ","$1,029.35 ","$1,029.35 ",$925.20 ,"$1,089.90 "
Carle Richland Memorial Hospital,8030113,ASCOPE 4FLEX LARGE,,,270,"$1,400.00 ","$1,400.00 ","$1,069.60 ","$1,260.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,232.00 ","$1,190.00 ","$1,232.00 ","$1,232.00 ","$1,218.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,069.60 ","$1,260.00 "
Carle Richland Memorial Hospital,8030114,CATH CU 7FR 3 LUMEN RADIO BLUE FLEX TIP,,,270,$141.00 ,$141.00 ,$107.72 ,$126.90 ,$119.85 ,$119.85 ,$119.85 ,$124.08 ,$119.85 ,$124.08 ,$124.08 ,$122.67 ,$119.85 ,$119.85 ,$119.85 ,$107.72 ,$126.90
Carle Richland Memorial Hospital,8030115,THICK WHITE MEPLEX 4X4 DRESSING,,,270,$14.00 ,$14.00 ,$10.70 ,$12.60 ,$11.90 ,$11.90 ,$11.90 ,$12.32 ,$11.90 ,$12.32 ,$12.32 ,$12.18 ,$11.90 ,$11.90 ,$11.90 ,$10.70 ,$12.60
Carle Richland Memorial Hospital,8030116,OBTURATOR SHEATH 8FR,,,270,$6.00 ,$6.00 ,$4.58 ,$5.40 ,$5.10 ,$5.10 ,$5.10 ,$5.28 ,$5.10 ,$5.28 ,$5.28 ,$5.22 ,$5.10 ,$5.10 ,$5.10 ,$4.58 ,$5.40
Carle Richland Memorial Hospital,8030117,SYSTEM EXTERNAL CSF DRAIN W/ ANTI REFLUX VALVE,,,270,$881.00 ,$881.00 ,$673.08 ,$792.90 ,$748.85 ,$748.85 ,$748.85 ,$775.28 ,$748.85 ,$775.28 ,$775.28 ,$766.47 ,$748.85 ,$748.85 ,$748.85 ,$673.08 ,$792.90
Carle Richland Memorial Hospital,8030118,GUIDEWARE COPE MANDRIL,,,270,$149.00 ,$149.00 ,$113.84 ,$134.10 ,$126.65 ,$126.65 ,$126.65 ,$131.12 ,$126.65 ,$131.12 ,$131.12 ,$129.63 ,$126.65 ,$126.65 ,$126.65 ,$113.84 ,$134.10
Carle Richland Memorial Hospital,8030119,GUIDEWIRE CHOICE PT FLOPPY,,,270,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8030120,16 CM CENTRAL LINE (CDC-42703-P1A),,,270,$483.00 ,$483.00 ,$369.01 ,$434.70 ,$410.55 ,$410.55 ,$410.55 ,$425.04 ,$410.55 ,$425.04 ,$425.04 ,$420.21 ,$410.55 ,$410.55 ,$410.55 ,$369.01 ,$434.70
Carle Richland Memorial Hospital,8030121,PURGE CASSETTS FOR IMPELLA (0043-003),,,270,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,8030122,FORESIGHT SENSORS FOR ECMO (01-07-2103),,,270,$383.00 ,$383.00 ,$292.61 ,$344.70 ,$325.55 ,$325.55 ,$325.55 ,$337.04 ,$325.55 ,$337.04 ,$337.04 ,$333.21 ,$325.55 ,$325.55 ,$325.55 ,$292.61 ,$344.70
Carle Richland Memorial Hospital,8030123,SURGICELL .5 X 2IN,,,270,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,8030124,DRESSING MEPITELONE WOUND CONTACT LAYER,,,270,$38.00 ,$38.00 ,$29.03 ,$34.20 ,$32.30 ,$32.30 ,$32.30 ,$33.44 ,$32.30 ,$33.44 ,$33.44 ,$33.06 ,$32.30 ,$32.30 ,$32.30 ,$29.03 ,$34.20
Carle Richland Memorial Hospital,8030125,TRANSDUCER NO FLUSH,,,270,$371.00 ,$371.00 ,$283.44 ,$333.90 ,$315.35 ,$315.35 ,$315.35 ,$326.48 ,$315.35 ,$326.48 ,$326.48 ,$322.77 ,$315.35 ,$315.35 ,$315.35 ,$283.44 ,$333.90
Carle Richland Memorial Hospital,8030126,TEMP PACER (520007P),,,270,$792.00 ,$792.00 ,$605.09 ,$712.80 ,$673.20 ,$673.20 ,$673.20 ,$696.96 ,$673.20 ,$696.96 ,$696.96 ,$689.04 ,$673.20 ,$673.20 ,$673.20 ,$605.09 ,$712.80
Carle Richland Memorial Hospital,8030127,TEMP PACER CABLE (ADAP-2000),,,270,$90.00 ,$90.00 ,$68.76 ,$81.00 ,$76.50 ,$76.50 ,$76.50 ,$79.20 ,$76.50 ,$79.20 ,$79.20 ,$78.30 ,$76.50 ,$76.50 ,$76.50 ,$68.76 ,$81.00
Carle Richland Memorial Hospital,8030128,TEMP PACER CONTAMINATION SLEEVE (COM-006-02),,,270,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8940035,MIDLINE 3 FRENCH SINGLE LUMEN,,,270,"$3,647.00 ","$3,647.00 ","$2,786.31 ","$3,282.30 ","$3,099.95 ","$3,099.95 ","$3,099.95 ","$3,209.36 ","$3,099.95 ","$3,209.36 ","$3,209.36 ","$3,172.89 ","$3,099.95 ","$3,099.95 ","$3,099.95 ","$2,786.31 ","$3,282.30 "
Carle Richland Memorial Hospital,8940036,MIDLINE 4 FRENCH DUAL LUMEN,,,270,"$2,282.00 ","$2,282.00 ","$1,743.45 ","$2,053.80 ","$1,939.70 ","$1,939.70 ","$1,939.70 ","$2,008.16 ","$1,939.70 ","$2,008.16 ","$2,008.16 ","$1,985.34 ","$1,939.70 ","$1,939.70 ","$1,939.70 ","$1,743.45 ","$2,053.80 "
Carle Richland Memorial Hospital,8030157,ARTIC SUN PADS UNIVERSAL,,,270,"$1,565.00 ","$1,565.00 ","$1,195.66 ","$1,408.50 ","$1,330.25 ","$1,330.25 ","$1,330.25 ","$1,377.20 ","$1,330.25 ","$1,377.20 ","$1,377.20 ","$1,361.55 ","$1,330.25 ","$1,330.25 ","$1,330.25 ","$1,195.66 ","$1,408.50 "
Carle Richland Memorial Hospital,8130026,EPIDURAL STEROID INJECTION SUPPLY,,,270,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,8030184,5.0MM AMBU BRONCH,,,270,"$1,211.00 ","$1,211.00 ",$925.20 ,"$1,089.90 ","$1,029.35 ","$1,029.35 ","$1,029.35 ","$1,065.68 ","$1,029.35 ","$1,065.68 ","$1,065.68 ","$1,053.57 ","$1,029.35 ","$1,029.35 ","$1,029.35 ",$925.20 ,"$1,089.90 "
Carle Richland Memorial Hospital,8030185,5.8MM AMBU BRONCH,,,270,"$1,400.00 ","$1,400.00 ","$1,069.60 ","$1,260.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,232.00 ","$1,190.00 ","$1,232.00 ","$1,232.00 ","$1,218.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,069.60 ","$1,260.00 "
Carle Richland Memorial Hospital,8030186,5.0MM GLIDESCOPE,,,270,$606.00 ,$606.00 ,$462.98 ,$545.40 ,$515.10 ,$515.10 ,$515.10 ,$533.28 ,$515.10 ,$533.28 ,$533.28 ,$527.22 ,$515.10 ,$515.10 ,$515.10 ,$462.98 ,$545.40
Carle Richland Memorial Hospital,8030187,5.8MM GLIDESCOPE,,,270,"$1,404.00 ","$1,404.00 ","$1,072.66 ","$1,263.60 ","$1,193.40 ","$1,193.40 ","$1,193.40 ","$1,235.52 ","$1,193.40 ","$1,235.52 ","$1,235.52 ","$1,221.48 ","$1,193.40 ","$1,193.40 ","$1,193.40 ","$1,072.66 ","$1,263.60 "
Carle Richland Memorial Hospital,8030188,PERCUTANEOUS TRACH,,,270,"$1,958.00 ","$1,958.00 ","$1,495.91 ","$1,762.20 ","$1,664.30 ","$1,664.30 ","$1,664.30 ","$1,723.04 ","$1,664.30 ","$1,723.04 ","$1,723.04 ","$1,703.46 ","$1,664.30 ","$1,664.30 ","$1,664.30 ","$1,495.91 ","$1,762.20 "
Carle Richland Memorial Hospital,8030189,CRANIAL ACCESS KIT,,,270,"$1,465.00 ","$1,465.00 ","$1,119.26 ","$1,318.50 ","$1,245.25 ","$1,245.25 ","$1,245.25 ","$1,289.20 ","$1,245.25 ","$1,289.20 ","$1,289.20 ","$1,274.55 ","$1,245.25 ","$1,245.25 ","$1,245.25 ","$1,119.26 ","$1,318.50 "
Carle Richland Memorial Hospital,8130027,LARYNGOSCOPE BLADE,,,270,$45.00 ,$45.00 ,$34.38 ,$40.50 ,$38.25 ,$38.25 ,$38.25 ,$39.60 ,$38.25 ,$39.60 ,$39.60 ,$39.15 ,$38.25 ,$38.25 ,$38.25 ,$34.38 ,$40.50
Carle Richland Memorial Hospital,8130028,DISPOSABLE LARYNGOSCOPE BLADE,,,270,$61.00 ,$61.00 ,$46.60 ,$54.90 ,$51.85 ,$51.85 ,$51.85 ,$53.68 ,$51.85 ,$53.68 ,$53.68 ,$53.07 ,$51.85 ,$51.85 ,$51.85 ,$46.60 ,$54.90
Carle Richland Memorial Hospital,8130029,CARDIAC OUTPUT A-LINE TRANSDUCER,,,270,"$1,395.00 ","$1,395.00 ","$1,065.78 ","$1,255.50 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,227.60 ","$1,185.75 ","$1,227.60 ","$1,227.60 ","$1,213.65 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,065.78 ","$1,255.50 "
Carle Richland Memorial Hospital,8130030,CEREBRAL/TISSUE OXIMETRY PATCHES,,,270,$383.00 ,$383.00 ,$292.61 ,$344.70 ,$325.55 ,$325.55 ,$325.55 ,$337.04 ,$325.55 ,$337.04 ,$337.04 ,$333.21 ,$325.55 ,$325.55 ,$325.55 ,$292.61 ,$344.70
Carle Richland Memorial Hospital,8030190,VENTRICULAR CATHETER BACTISEAL 35CM,,,270,"$2,030.00 ","$2,030.00 ","$1,550.92 ","$1,827.00 ","$1,725.50 ","$1,725.50 ","$1,725.50 ","$1,786.40 ","$1,725.50 ","$1,786.40 ","$1,786.40 ","$1,766.10 ","$1,725.50 ","$1,725.50 ","$1,725.50 ","$1,550.92 ","$1,827.00 "
Carle Richland Memorial Hospital,8030191,METABOLT KIT CODMAN,,,270,"$4,820.00 ","$4,820.00 ","$3,682.48 ","$4,338.00 ","$4,097.00 ","$4,097.00 ","$4,097.00 ","$4,241.60 ","$4,097.00 ","$4,241.60 ","$4,241.60 ","$4,193.40 ","$4,097.00 ","$4,097.00 ","$4,097.00 ","$3,682.48 ","$4,338.00 "
Carle Richland Memorial Hospital,8030192,FLOTRAC ART LINE,,,270,"$1,395.00 ","$1,395.00 ","$1,065.78 ","$1,255.50 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,227.60 ","$1,185.75 ","$1,227.60 ","$1,227.60 ","$1,213.65 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,065.78 ","$1,255.50 "
Carle Richland Memorial Hospital,8030193,CLEAR SIGHT CUFF SMALL,,,270,"$1,395.00 ","$1,395.00 ","$1,065.78 ","$1,255.50 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,227.60 ","$1,185.75 ","$1,227.60 ","$1,227.60 ","$1,213.65 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,065.78 ","$1,255.50 "
Carle Richland Memorial Hospital,8030194,CLEARSIGHT CUFF MEDIUM,,,270,"$1,395.00 ","$1,395.00 ","$1,065.78 ","$1,255.50 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,227.60 ","$1,185.75 ","$1,227.60 ","$1,227.60 ","$1,213.65 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,065.78 ","$1,255.50 "
Carle Richland Memorial Hospital,8030195,CLEARSIGHT CUFF LARGE,,,270,"$1,395.00 ","$1,395.00 ","$1,065.78 ","$1,255.50 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,227.60 ","$1,185.75 ","$1,227.60 ","$1,227.60 ","$1,213.65 ","$1,185.75 ","$1,185.75 ","$1,185.75 ","$1,065.78 ","$1,255.50 "
Carle Richland Memorial Hospital,8030197,ARCTIC SUN (SM),,,270,"$5,202.00 ","$5,202.00 ","$3,974.33 ","$4,681.80 ","$4,421.70 ","$4,421.70 ","$4,421.70 ","$4,577.76 ","$4,421.70 ","$4,577.76 ","$4,577.76 ","$4,525.74 ","$4,421.70 ","$4,421.70 ","$4,421.70 ","$3,974.33 ","$4,681.80 "
Carle Richland Memorial Hospital,8030198,ARCTIC SUN (LG),,,270,"$5,202.00 ","$5,202.00 ","$3,974.33 ","$4,681.80 ","$4,421.70 ","$4,421.70 ","$4,421.70 ","$4,577.76 ","$4,421.70 ","$4,577.76 ","$4,577.76 ","$4,525.74 ","$4,421.70 ","$4,421.70 ","$4,421.70 ","$3,974.33 ","$4,681.80 "
Carle Richland Memorial Hospital,8030199,TRIALYSIS CATHETER,,,270,$668.00 ,$668.00 ,$510.35 ,$601.20 ,$567.80 ,$567.80 ,$567.80 ,$587.84 ,$567.80 ,$587.84 ,$587.84 ,$581.16 ,$567.80 ,$567.80 ,$567.80 ,$510.35 ,$601.20
Carle Richland Memorial Hospital,8030200,16CM CENTRAL LINE,,,270,$584.00 ,$584.00 ,$446.18 ,$525.60 ,$496.40 ,$496.40 ,$496.40 ,$513.92 ,$496.40 ,$513.92 ,$513.92 ,$508.08 ,$496.40 ,$496.40 ,$496.40 ,$446.18 ,$525.60
Carle Richland Memorial Hospital,8030201,BELMONT TUBING,,,270,$679.00 ,$679.00 ,$518.76 ,$611.10 ,$577.15 ,$577.15 ,$577.15 ,$597.52 ,$577.15 ,$597.52 ,$597.52 ,$590.73 ,$577.15 ,$577.15 ,$577.15 ,$518.76 ,$611.10
Carle Richland Memorial Hospital,8030202,PRISMAX DISPOSABLE FILTER,,,270,"$1,093.00 ","$1,093.00 ",$835.05 ,$983.70 ,$929.05 ,$929.05 ,$929.05 ,$961.84 ,$929.05 ,$961.84 ,$961.84 ,$950.91 ,$929.05 ,$929.05 ,$929.05 ,$835.05 ,$983.70
Carle Richland Memorial Hospital,8030203,THERMAX BLOOD WARMER,,,270,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,8030204,COMFORT GLIDE SHEET,,,270,$507.00 ,$507.00 ,$387.35 ,$456.30 ,$430.95 ,$430.95 ,$430.95 ,$446.16 ,$430.95 ,$446.16 ,$446.16 ,$441.09 ,$430.95 ,$430.95 ,$430.95 ,$387.35 ,$456.30
Carle Richland Memorial Hospital,8030205,PUPILLOMETER SMARTGUARD,,,270,$122.00 ,$122.00 ,$93.21 ,$109.80 ,$103.70 ,$103.70 ,$103.70 ,$107.36 ,$103.70 ,$107.36 ,$107.36 ,$106.14 ,$103.70 ,$103.70 ,$103.70 ,$93.21 ,$109.80
Carle Richland Memorial Hospital,8030003,ANTEPARTUM SUPPLY CHARGE,,,270,$9.00 ,$9.00 ,$6.88 ,$8.10 ,$7.65 ,$7.65 ,$7.65 ,$7.92 ,$7.65 ,$7.92 ,$7.92 ,$7.83 ,$7.65 ,$7.65 ,$7.65 ,$6.88 ,$8.10
Carle Richland Memorial Hospital,8030007,C-SECTION SUPPLY CHARGE,,,270,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8031013,NEWBORN NURSERY CARE SUPPLY,,,270,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,8031014,NEWBORN RESUSCITATION SUPPLY,,,270,$153.00 ,$153.00 ,$116.89 ,$137.70 ,$130.05 ,$130.05 ,$130.05 ,$134.64 ,$130.05 ,$134.64 ,$134.64 ,$133.11 ,$130.05 ,$130.05 ,$130.05 ,$116.89 ,$137.70
Carle Richland Memorial Hospital,8031015,IV SUPPLY CHARGE,,,270,$49.00 ,$49.00 ,$37.44 ,$44.10 ,$41.65 ,$41.65 ,$41.65 ,$43.12 ,$41.65 ,$43.12 ,$43.12 ,$42.63 ,$41.65 ,$41.65 ,$41.65 ,$37.44 ,$44.10
Carle Richland Memorial Hospital,8030016,PHOTOTHERAPY,,,270,$38.00 ,$38.00 ,$29.03 ,$34.20 ,$32.30 ,$32.30 ,$32.30 ,$33.44 ,$32.30 ,$33.44 ,$33.44 ,$33.06 ,$32.30 ,$32.30 ,$32.30 ,$29.03 ,$34.20
Carle Richland Memorial Hospital,8030019,SPINAL ANESTHESIA SUPPLIES,,,270,$80.00 ,$80.00 ,$61.12 ,$72.00 ,$68.00 ,$68.00 ,$68.00 ,$70.40 ,$68.00 ,$70.40 ,$70.40 ,$69.60 ,$68.00 ,$68.00 ,$68.00 ,$61.12 ,$72.00
Carle Richland Memorial Hospital,8030022,GYN SUPPLY,,,270,$142.00 ,$142.00 ,$108.49 ,$127.80 ,$120.70 ,$120.70 ,$120.70 ,$124.96 ,$120.70 ,$124.96 ,$124.96 ,$123.54 ,$120.70 ,$120.70 ,$120.70 ,$108.49 ,$127.80
Carle Richland Memorial Hospital,7624997,Cebatrol,,99070,270,$55.00 ,$55.00 ,$42.02 ,$49.50 ,$46.75 ,$46.75 ,$46.75 ,$48.40 ,$46.75 ,$48.40 ,$48.40 ,$47.85 ,$46.75 ,$46.75 ,$46.75 ,$42.02 ,$49.50
Carle Richland Memorial Hospital,7624996,Melamix,,99070,270,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,7624995,Melamin,,99070,270,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,7624994,Glycogent,,99070,270,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,7624993,Balatone,,99070,270,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,7624992,Foamacleanse,,99070,270,$43.00 ,$43.00 ,$32.85 ,$38.70 ,$36.55 ,$36.55 ,$36.55 ,$37.84 ,$36.55 ,$37.84 ,$37.84 ,$37.41 ,$36.55 ,$36.55 ,$36.55 ,$32.85 ,$38.70
Carle Richland Memorial Hospital,7624991,Normacleanse,,99070,270,$43.00 ,$43.00 ,$32.85 ,$38.70 ,$36.55 ,$36.55 ,$36.55 ,$37.84 ,$36.55 ,$37.84 ,$37.84 ,$37.41 ,$36.55 ,$36.55 ,$36.55 ,$32.85 ,$38.70
Carle Richland Memorial Hospital,7624990,Skincare Biocorneum 50g,,99070,270,$96.00 ,$96.00 ,$73.34 ,$86.40 ,$81.60 ,$81.60 ,$81.60 ,$84.48 ,$81.60 ,$84.48 ,$84.48 ,$83.52 ,$81.60 ,$81.60 ,$81.60 ,$73.34 ,$86.40
Carle Richland Memorial Hospital,7624989,Skincare Biocorneum 20g,,99070,270,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,7550009,Vaginal Dilator Large,,99070,270,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,7550010,Vaginal Dilator Med,,99070,270,$16.00 ,$16.00 ,$12.22 ,$14.40 ,$13.60 ,$13.60 ,$13.60 ,$14.08 ,$13.60 ,$14.08 ,$14.08 ,$13.92 ,$13.60 ,$13.60 ,$13.60 ,$12.22 ,$14.40
Carle Richland Memorial Hospital,7550770,Vaginal Dilator Sm,,99070,270,$14.00 ,$14.00 ,$10.70 ,$12.60 ,$11.90 ,$11.90 ,$11.90 ,$12.32 ,$11.90 ,$12.32 ,$12.32 ,$12.18 ,$11.90 ,$11.90 ,$11.90 ,$10.70 ,$12.60
Carle Richland Memorial Hospital,7550771,Vaginal Dilator Xs,,99070,270,$14.00 ,$14.00 ,$10.70 ,$12.60 ,$11.90 ,$11.90 ,$11.90 ,$12.32 ,$11.90 ,$12.32 ,$12.32 ,$12.18 ,$11.90 ,$11.90 ,$11.90 ,$10.70 ,$12.60
Carle Richland Memorial Hospital,8030014,CLIP TUBAL FILSHIE,69654,,270,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM MAX FILM ISLE 2.,233217,,270,$7.43 ,$7.43 ,$5.68 ,$6.69 ,$6.32 ,$6.32 ,$6.32 ,$6.54 ,$6.32 ,$6.54 ,$6.54 ,$6.46 ,$6.32 ,$6.32 ,$6.32 ,$5.68 ,$6.69
Carle Richland Memorial Hospital,8140054,DRAPE BACK TABLE COVER 50X90,136,,270,$7.44 ,$7.44 ,$5.68 ,$6.70 ,$6.32 ,$6.32 ,$6.32 ,$6.55 ,$6.32 ,$6.55 ,$6.55 ,$6.47 ,$6.32 ,$6.32 ,$6.32 ,$5.68 ,$6.70
Carle Richland Memorial Hospital,8140054,DRAPE THREE QUARTER 60X76IN,156,,270,$7.45 ,$7.45 ,$5.69 ,$6.71 ,$6.33 ,$6.33 ,$6.33 ,$6.56 ,$6.33 ,$6.56 ,$6.56 ,$6.48 ,$6.33 ,$6.33 ,$6.33 ,$5.69 ,$6.71
Carle Richland Memorial Hospital,8140054,ADHESIVE MASTISOL 0.225OZ,228984,,270,$7.45 ,$7.45 ,$5.69 ,$6.71 ,$6.33 ,$6.33 ,$6.33 ,$6.56 ,$6.33 ,$6.56 ,$6.56 ,$6.48 ,$6.33 ,$6.33 ,$6.33 ,$5.69 ,$6.71
Carle Richland Memorial Hospital,8140054,DRESSING TEGADERM 8X12,165,,270,$7.59 ,$7.59 ,$5.80 ,$6.83 ,$6.45 ,$6.45 ,$6.45 ,$6.68 ,$6.45 ,$6.68 ,$6.68 ,$6.60 ,$6.45 ,$6.45 ,$6.45 ,$5.80 ,$6.83
Carle Richland Memorial Hospital,8140054,GOWN ASTOUND SURG LARGE AAMI 3,203,,270,$7.68 ,$7.68 ,$5.87 ,$6.91 ,$6.53 ,$6.53 ,$6.53 ,$6.76 ,$6.53 ,$6.76 ,$6.76 ,$6.68 ,$6.53 ,$6.53 ,$6.53 ,$5.87 ,$6.91
Carle Richland Memorial Hospital,8140054,BANDAGE STRETCH 2IN KLING NS,9502,,270,$7.74 ,$7.74 ,$5.91 ,$6.97 ,$6.58 ,$6.58 ,$6.58 ,$6.81 ,$6.58 ,$6.81 ,$6.81 ,$6.73 ,$6.58 ,$6.58 ,$6.58 ,$5.91 ,$6.97
Carle Richland Memorial Hospital,8140054,TRAP SPECIMEN MUCUS STR 80CC,234304,,270,$7.81 ,$7.81 ,$5.97 ,$7.03 ,$6.64 ,$6.64 ,$6.64 ,$6.87 ,$6.64 ,$6.87 ,$6.87 ,$6.79 ,$6.64 ,$6.64 ,$6.64 ,$5.97 ,$7.03
Carle Richland Memorial Hospital,8140054,STOCKING COMPR KNEE LARGE REG,426,,270,$7.90 ,$7.90 ,$6.04 ,$7.11 ,$6.72 ,$6.72 ,$6.72 ,$6.95 ,$6.72 ,$6.95 ,$6.95 ,$6.87 ,$6.72 ,$6.72 ,$6.72 ,$6.04 ,$7.11
Carle Richland Memorial Hospital,8140054,STOCKING COMPR KNEE MED REG,430,,270,$7.90 ,$7.90 ,$6.04 ,$7.11 ,$6.72 ,$6.72 ,$6.72 ,$6.95 ,$6.72 ,$6.95 ,$6.95 ,$6.87 ,$6.72 ,$6.72 ,$6.72 ,$6.04 ,$7.11
Carle Richland Memorial Hospital,8140054,STOCKING COMPR KNEE SMALL REG,431,,270,$7.90 ,$7.90 ,$6.04 ,$7.11 ,$6.72 ,$6.72 ,$6.72 ,$6.95 ,$6.72 ,$6.95 ,$6.95 ,$6.87 ,$6.72 ,$6.72 ,$6.72 ,$6.04 ,$7.11
Carle Richland Memorial Hospital,8140054,DRESSING GAUZE DERMACEA 3X8,232226,,270,$7.96 ,$7.96 ,$6.08 ,$7.16 ,$6.77 ,$6.77 ,$6.77 ,$7.00 ,$6.77 ,$7.00 ,$7.00 ,$6.93 ,$6.77 ,$6.77 ,$6.77 ,$6.08 ,$7.16
Carle Richland Memorial Hospital,8140054,CATH INSYTE AUTOGUARD 14GA,234457,,270,$7.97 ,$7.97 ,$6.09 ,$7.17 ,$6.77 ,$6.77 ,$6.77 ,$7.01 ,$6.77 ,$7.01 ,$7.01 ,$6.93 ,$6.77 ,$6.77 ,$6.77 ,$6.09 ,$7.17
Carle Richland Memorial Hospital,8140054,TUBE DSE,234449,,270,$8.01 ,$8.01 ,$6.12 ,$7.21 ,$6.81 ,$6.81 ,$6.81 ,$7.05 ,$6.81 ,$7.05 ,$7.05 ,$6.97 ,$6.81 ,$6.81 ,$6.81 ,$6.12 ,$7.21
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN ADHESIVE 3X3,232123,,270,$8.10 ,$8.10 ,$6.19 ,$7.29 ,$6.89 ,$6.89 ,$6.89 ,$7.13 ,$6.89 ,$7.13 ,$7.13 ,$7.05 ,$6.89 ,$6.89 ,$6.89 ,$6.19 ,$7.29
Carle Richland Memorial Hospital,8140054,WRAP COBAN 4IN STERILE TAN,1039,,270,$8.15 ,$8.15 ,$6.23 ,$7.34 ,$6.93 ,$6.93 ,$6.93 ,$7.17 ,$6.93 ,$7.17 ,$7.17 ,$7.09 ,$6.93 ,$6.93 ,$6.93 ,$6.23 ,$7.34
Carle Richland Memorial Hospital,8140054,GOWN ASTOUND XL AAMI 3,206,,270,$8.22 ,$8.22 ,$6.28 ,$7.40 ,$6.99 ,$6.99 ,$6.99 ,$7.23 ,$6.99 ,$7.23 ,$7.23 ,$7.15 ,$6.99 ,$6.99 ,$6.99 ,$6.28 ,$7.40
Carle Richland Memorial Hospital,8140054,STRIP PACKING IODOFORM 1IN,307,,270,$8.25 ,$8.25 ,$6.30 ,$7.43 ,$7.01 ,$7.01 ,$7.01 ,$7.26 ,$7.01 ,$7.26 ,$7.26 ,$7.18 ,$7.01 ,$7.01 ,$7.01 ,$6.30 ,$7.43
Carle Richland Memorial Hospital,8140054,GLOVE BIOGEL SZ 6.5,232165,,270,$8.41 ,$8.41 ,$6.43 ,$7.57 ,$7.15 ,$7.15 ,$7.15 ,$7.40 ,$7.15 ,$7.40 ,$7.40 ,$7.32 ,$7.15 ,$7.15 ,$7.15 ,$6.43 ,$7.57
Carle Richland Memorial Hospital,8140054,GLOVE BIOGEL SZ 7.5,232166,,270,$8.41 ,$8.41 ,$6.43 ,$7.57 ,$7.15 ,$7.15 ,$7.15 ,$7.40 ,$7.15 ,$7.40 ,$7.40 ,$7.32 ,$7.15 ,$7.15 ,$7.15 ,$6.43 ,$7.57
Carle Richland Memorial Hospital,8140054,GLOVE BIOGEL SZ 7,232167,,270,$8.41 ,$8.41 ,$6.43 ,$7.57 ,$7.15 ,$7.15 ,$7.15 ,$7.40 ,$7.15 ,$7.40 ,$7.40 ,$7.32 ,$7.15 ,$7.15 ,$7.15 ,$6.43 ,$7.57
Carle Richland Memorial Hospital,8140054,GLOVE BIOGEL SZ 8.0,234690,,270,$8.41 ,$8.41 ,$6.43 ,$7.57 ,$7.15 ,$7.15 ,$7.15 ,$7.40 ,$7.15 ,$7.40 ,$7.40 ,$7.32 ,$7.15 ,$7.15 ,$7.15 ,$6.43 ,$7.57
Carle Richland Memorial Hospital,8140054,GLOVE BIOGEL SZ 8.5,234691,,270,$8.41 ,$8.41 ,$6.43 ,$7.57 ,$7.15 ,$7.15 ,$7.15 ,$7.40 ,$7.15 ,$7.40 ,$7.40 ,$7.32 ,$7.15 ,$7.15 ,$7.15 ,$6.43 ,$7.57
Carle Richland Memorial Hospital,8140054,CATH TRAY A 15FR LATEX,233182,,270,$8.54 ,$8.54 ,$6.52 ,$7.69 ,$7.26 ,$7.26 ,$7.26 ,$7.52 ,$7.26 ,$7.52 ,$7.52 ,$7.43 ,$7.26 ,$7.26 ,$7.26 ,$6.52 ,$7.69
Carle Richland Memorial Hospital,8140054,GLOVE SENSICARE SZ 8.5 STERILE,232686,,270,$8.56 ,$8.56 ,$6.54 ,$7.70 ,$7.28 ,$7.28 ,$7.28 ,$7.53 ,$7.28 ,$7.53 ,$7.53 ,$7.45 ,$7.28 ,$7.28 ,$7.28 ,$6.54 ,$7.70
Carle Richland Memorial Hospital,8140054,DRESSING TEGASORB THIN OVAL,232117,,270,$8.74 ,$8.74 ,$6.68 ,$7.87 ,$7.43 ,$7.43 ,$7.43 ,$7.69 ,$7.43 ,$7.69 ,$7.69 ,$7.60 ,$7.43 ,$7.43 ,$7.43 ,$6.68 ,$7.87
Carle Richland Memorial Hospital,8140054,STOCKING ANTIEMBOLI LG/REG,232180,,270,$8.78 ,$8.78 ,$6.71 ,$7.90 ,$7.46 ,$7.46 ,$7.46 ,$7.73 ,$7.46 ,$7.73 ,$7.73 ,$7.64 ,$7.46 ,$7.46 ,$7.46 ,$6.71 ,$7.90
Carle Richland Memorial Hospital,8140054,STOCKING ANTIEMBOLI BK SM/REG,232182,,270,$8.78 ,$8.78 ,$6.71 ,$7.90 ,$7.46 ,$7.46 ,$7.46 ,$7.73 ,$7.46 ,$7.73 ,$7.73 ,$7.64 ,$7.46 ,$7.46 ,$7.46 ,$6.71 ,$7.90
Carle Richland Memorial Hospital,8140054,PADDING CAST WEBRIL 3IN STRL,585,,270,$8.78 ,$8.78 ,$6.71 ,$7.90 ,$7.46 ,$7.46 ,$7.46 ,$7.73 ,$7.46 ,$7.73 ,$7.73 ,$7.64 ,$7.46 ,$7.46 ,$7.46 ,$6.71 ,$7.90
Carle Richland Memorial Hospital,8140054,CLIPPER HEAD UNIVERSAL,122,,270,$8.86 ,$8.86 ,$6.77 ,$7.97 ,$7.53 ,$7.53 ,$7.53 ,$7.80 ,$7.53 ,$7.80 ,$7.80 ,$7.71 ,$7.53 ,$7.53 ,$7.53 ,$6.77 ,$7.97
Carle Richland Memorial Hospital,8140054,SOL D5 .45 NACL 500ML 24/CASE,110014,,270,$8.91 ,$8.91 ,$6.81 ,$8.02 ,$7.57 ,$7.57 ,$7.57 ,$7.84 ,$7.57 ,$7.84 ,$7.84 ,$7.75 ,$7.57 ,$7.57 ,$7.57 ,$6.81 ,$8.02
Carle Richland Memorial Hospital,8140054,BLADE BP SURGICAL #10 BLADES,232153,,270,$8.97 ,$8.97 ,$6.85 ,$8.07 ,$7.62 ,$7.62 ,$7.62 ,$7.89 ,$7.62 ,$7.89 ,$7.89 ,$7.80 ,$7.62 ,$7.62 ,$7.62 ,$6.85 ,$8.07
Carle Richland Memorial Hospital,8140054,BLADE BP SURGICAL #15 BLADES,232154,,270,$8.97 ,$8.97 ,$6.85 ,$8.07 ,$7.62 ,$7.62 ,$7.62 ,$7.89 ,$7.62 ,$7.89 ,$7.89 ,$7.80 ,$7.62 ,$7.62 ,$7.62 ,$6.85 ,$8.07
Carle Richland Memorial Hospital,8140054,BLADE BP SURGICAL #11 BLADES,232576,,270,$8.97 ,$8.97 ,$6.85 ,$8.07 ,$7.62 ,$7.62 ,$7.62 ,$7.89 ,$7.62 ,$7.89 ,$7.89 ,$7.80 ,$7.62 ,$7.62 ,$7.62 ,$6.85 ,$8.07
Carle Richland Memorial Hospital,8140054,OSTOMY EAKIN COHES STOMA WRAP COH,234426,,270,$9.00 ,$9.00 ,$6.88 ,$8.10 ,$7.65 ,$7.65 ,$7.65 ,$7.92 ,$7.65 ,$7.92 ,$7.92 ,$7.83 ,$7.65 ,$7.65 ,$7.65 ,$6.88 ,$8.10
Carle Richland Memorial Hospital,8140054,RMH CANNULA HYDRODISSECTION 27GA,235167,,270,$9.00 ,$9.00 ,$6.88 ,$8.10 ,$7.65 ,$7.65 ,$7.65 ,$7.92 ,$7.65 ,$7.92 ,$7.92 ,$7.83 ,$7.65 ,$7.65 ,$7.65 ,$6.88 ,$8.10
Carle Richland Memorial Hospital,8140054,RMH PSI CANNULA,235180,,270,$9.00 ,$9.00 ,$6.88 ,$8.10 ,$7.65 ,$7.65 ,$7.65 ,$7.92 ,$7.65 ,$7.92 ,$7.92 ,$7.83 ,$7.65 ,$7.65 ,$7.65 ,$6.88 ,$8.10
Carle Richland Memorial Hospital,8140054,DRESSING COVADERM 4X10,232104,,270,$9.09 ,$9.09 ,$6.94 ,$8.18 ,$7.73 ,$7.73 ,$7.73 ,$8.00 ,$7.73 ,$8.00 ,$8.00 ,$7.91 ,$7.73 ,$7.73 ,$7.73 ,$6.94 ,$8.18
Carle Richland Memorial Hospital,8140054,EXTRACTOR SKIN STAPLE DISP,232193,,270,$9.09 ,$9.09 ,$6.94 ,$8.18 ,$7.73 ,$7.73 ,$7.73 ,$8.00 ,$7.73 ,$8.00 ,$8.00 ,$7.91 ,$7.73 ,$7.73 ,$7.73 ,$6.94 ,$8.18
Carle Richland Memorial Hospital,8140054,MARKER BLACK W/MEDI LABELS,899,,270,$9.13 ,$9.13 ,$6.98 ,$8.22 ,$7.76 ,$7.76 ,$7.76 ,$8.03 ,$7.76 ,$8.03 ,$8.03 ,$7.94 ,$7.76 ,$7.76 ,$7.76 ,$6.98 ,$8.22
Carle Richland Memorial Hospital,8140054,SOL LR 500ML 24/CASE,110015,,270,$9.18 ,$9.18 ,$7.01 ,$8.26 ,$7.80 ,$7.80 ,$7.80 ,$8.08 ,$7.80 ,$8.08 ,$8.08 ,$7.99 ,$7.80 ,$7.80 ,$7.80 ,$7.01 ,$8.26
Carle Richland Memorial Hospital,8140054,OSTOMY NATURA MOLD 1.75IN,234407,,270,$9.25 ,$9.25 ,$7.07 ,$8.33 ,$7.86 ,$7.86 ,$7.86 ,$8.14 ,$7.86 ,$8.14 ,$8.14 ,$8.05 ,$7.86 ,$7.86 ,$7.86 ,$7.07 ,$8.33
Carle Richland Memorial Hospital,8140054,CATH FOLEY HOLDER,78,,270,$9.27 ,$9.27 ,$7.08 ,$8.34 ,$7.88 ,$7.88 ,$7.88 ,$8.16 ,$7.88 ,$8.16 ,$8.16 ,$8.06 ,$7.88 ,$7.88 ,$7.88 ,$7.08 ,$8.34
Carle Richland Memorial Hospital,8140054,BAG URINARY DRAIN 2000ML,152,,270,$9.45 ,$9.45 ,$7.22 ,$8.51 ,$8.03 ,$8.03 ,$8.03 ,$8.32 ,$8.03 ,$8.32 ,$8.32 ,$8.22 ,$8.03 ,$8.03 ,$8.03 ,$7.22 ,$8.51
Carle Richland Memorial Hospital,8140054,DRESSING MEPILEX BORDER 3X3IN,232108,,270,$9.49 ,$9.49 ,$7.25 ,$8.54 ,$8.07 ,$8.07 ,$8.07 ,$8.35 ,$8.07 ,$8.35 ,$8.35 ,$8.26 ,$8.07 ,$8.07 ,$8.07 ,$7.25 ,$8.54
Carle Richland Memorial Hospital,8140054,PADDING CAST WEBRIL 4IN STRL,586,,270,$9.62 ,$9.62 ,$7.35 ,$8.66 ,$8.18 ,$8.18 ,$8.18 ,$8.47 ,$8.18 ,$8.47 ,$8.47 ,$8.37 ,$8.18 ,$8.18 ,$8.18 ,$7.35 ,$8.66
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN GENTLE BORDER,232232,,270,$9.65 ,$9.65 ,$7.37 ,$8.69 ,$8.20 ,$8.20 ,$8.20 ,$8.49 ,$8.20 ,$8.49 ,$8.49 ,$8.40 ,$8.20 ,$8.20 ,$8.20 ,$7.37 ,$8.69
Carle Richland Memorial Hospital,8140054,STOCKINET COTTON 4 X 48IN,1012,,270,$10.04 ,$10.04 ,$7.67 ,$9.04 ,$8.53 ,$8.53 ,$8.53 ,$8.84 ,$8.53 ,$8.84 ,$8.84 ,$8.73 ,$8.53 ,$8.53 ,$8.53 ,$7.67 ,$9.04
Carle Richland Memorial Hospital,8140054,DRESSING ALGISITE M 4X4,232234,,270,$10.05 ,$10.05 ,$7.68 ,$9.05 ,$8.54 ,$8.54 ,$8.54 ,$8.84 ,$8.54 ,$8.84 ,$8.84 ,$8.74 ,$8.54 ,$8.54 ,$8.54 ,$7.68 ,$9.05
Carle Richland Memorial Hospital,8140054,SET EXT MICROBORE CLAVE 7IN,218,,270,$10.14 ,$10.14 ,$7.75 ,$9.13 ,$8.62 ,$8.62 ,$8.62 ,$8.92 ,$8.62 ,$8.92 ,$8.92 ,$8.82 ,$8.62 ,$8.62 ,$8.62 ,$7.75 ,$9.13
Carle Richland Memorial Hospital,8140054,SOL D10 500ML,232207,,270,$10.17 ,$10.17 ,$7.77 ,$9.15 ,$8.64 ,$8.64 ,$8.64 ,$8.95 ,$8.64 ,$8.95 ,$8.95 ,$8.85 ,$8.64 ,$8.64 ,$8.64 ,$7.77 ,$9.15
Carle Richland Memorial Hospital,8140054,DRESSING TEGADERM 4 X 4.75 50/BX,1056,,270,$10.60 ,$10.60 ,$8.10 ,$9.54 ,$9.01 ,$9.01 ,$9.01 ,$9.33 ,$9.01 ,$9.33 ,$9.33 ,$9.22 ,$9.01 ,$9.01 ,$9.01 ,$8.10 ,$9.54
Carle Richland Memorial Hospital,8140054,SCOTCHCAST 3IN ROLL,48,,270,$10.68 ,$10.68 ,$8.16 ,$9.61 ,$9.08 ,$9.08 ,$9.08 ,$9.40 ,$9.08 ,$9.40 ,$9.40 ,$9.29 ,$9.08 ,$9.08 ,$9.08 ,$8.16 ,$9.61
Carle Richland Memorial Hospital,8140054,WEBRIL 3IN STERILE SPECIALIST,9115,,270,$10.77 ,$10.77 ,$8.23 ,$9.69 ,$9.15 ,$9.15 ,$9.15 ,$9.48 ,$9.15 ,$9.48 ,$9.48 ,$9.37 ,$9.15 ,$9.15 ,$9.15 ,$8.23 ,$9.69
Carle Richland Memorial Hospital,8140054,GOWN ASTOUND XXL AAMI 3,856,,270,$10.80 ,$10.80 ,$8.25 ,$9.72 ,$9.18 ,$9.18 ,$9.18 ,$9.50 ,$9.18 ,$9.50 ,$9.50 ,$9.40 ,$9.18 ,$9.18 ,$9.18 ,$8.25 ,$9.72
Carle Richland Memorial Hospital,8140054,SLING ARM ENVELOPE SMALL,233195,,270,$10.84 ,$10.84 ,$8.28 ,$9.76 ,$9.21 ,$9.21 ,$9.21 ,$9.54 ,$9.21 ,$9.54 ,$9.54 ,$9.43 ,$9.21 ,$9.21 ,$9.21 ,$8.28 ,$9.76
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN BORDER 5X5,232105,,270,$10.88 ,$10.88 ,$8.31 ,$9.79 ,$9.25 ,$9.25 ,$9.25 ,$9.57 ,$9.25 ,$9.57 ,$9.57 ,$9.47 ,$9.25 ,$9.25 ,$9.25 ,$8.31 ,$9.79
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN ADHESIVE 5X5,232124,,270,$10.88 ,$10.88 ,$8.31 ,$9.79 ,$9.25 ,$9.25 ,$9.25 ,$9.57 ,$9.25 ,$9.57 ,$9.57 ,$9.47 ,$9.25 ,$9.25 ,$9.25 ,$8.31 ,$9.79
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM TUBE SITE,232242,,270,$10.91 ,$10.91 ,$8.34 ,$9.82 ,$9.27 ,$9.27 ,$9.27 ,$9.60 ,$9.27 ,$9.60 ,$9.60 ,$9.49 ,$9.27 ,$9.27 ,$9.27 ,$8.34 ,$9.82
Carle Richland Memorial Hospital,8140054,LUBRICANT SURGICAL 4 1/4 OZ STERI,227,,270,$10.95 ,$10.95 ,$8.37 ,$9.86 ,$9.31 ,$9.31 ,$9.31 ,$9.64 ,$9.31 ,$9.64 ,$9.64 ,$9.53 ,$9.31 ,$9.31 ,$9.31 ,$8.37 ,$9.86
Carle Richland Memorial Hospital,8140054,PUNCH BIOPSY DERMAL 4.0MM 25/BX A,226272,,270,$10.97 ,$10.97 ,$8.38 ,$9.87 ,$9.32 ,$9.32 ,$9.32 ,$9.65 ,$9.32 ,$9.65 ,$9.65 ,$9.54 ,$9.32 ,$9.32 ,$9.32 ,$8.38 ,$9.87
Carle Richland Memorial Hospital,8140054,PUNCH BIOPSY DERMAL 5.0MM 25/BOX,226273,,270,$10.97 ,$10.97 ,$8.38 ,$9.87 ,$9.32 ,$9.32 ,$9.32 ,$9.65 ,$9.32 ,$9.65 ,$9.65 ,$9.54 ,$9.32 ,$9.32 ,$9.32 ,$8.38 ,$9.87
Carle Richland Memorial Hospital,8140054,PUNCH BIOPSY DERMAL 6MM,235944,,270,$10.97 ,$10.97 ,$8.38 ,$9.87 ,$9.32 ,$9.32 ,$9.32 ,$9.65 ,$9.32 ,$9.65 ,$9.65 ,$9.54 ,$9.32 ,$9.32 ,$9.32 ,$8.38 ,$9.87
Carle Richland Memorial Hospital,8140054,PUNCH BIOPSY DERMAL 3.0MM ACUPUNC,243134,,270,$10.97 ,$10.97 ,$8.38 ,$9.87 ,$9.32 ,$9.32 ,$9.32 ,$9.65 ,$9.32 ,$9.65 ,$9.65 ,$9.54 ,$9.32 ,$9.32 ,$9.32 ,$8.38 ,$9.87
Carle Richland Memorial Hospital,8140054,RESERVOIR JACKSON-PRATT 100ML,150,,270,$11.39 ,$11.39 ,$8.70 ,$10.25 ,$9.68 ,$9.68 ,$9.68 ,$10.02 ,$9.68 ,$10.02 ,$10.02 ,$9.91 ,$9.68 ,$9.68 ,$9.68 ,$8.70 ,$10.25
Carle Richland Memorial Hospital,8140054,SLING ARM ENVELOPE MED,233194,,270,$11.61 ,$11.61 ,$8.87 ,$10.45 ,$9.87 ,$9.87 ,$9.87 ,$10.22 ,$9.87 ,$10.22 ,$10.22 ,$10.10 ,$9.87 ,$9.87 ,$9.87 ,$8.87 ,$10.45
Carle Richland Memorial Hospital,8140054,BANDAGE ESMARK 4IN STERILE,232094,,270,$11.65 ,$11.65 ,$8.90 ,$10.49 ,$9.90 ,$9.90 ,$9.90 ,$10.25 ,$9.90 ,$10.25 ,$10.25 ,$10.14 ,$9.90 ,$9.90 ,$9.90 ,$8.90 ,$10.49
Carle Richland Memorial Hospital,8140054,CONTAINER SPECIMEN GALLON,232163,,270,$11.65 ,$11.65 ,$8.90 ,$10.49 ,$9.90 ,$9.90 ,$9.90 ,$10.25 ,$9.90 ,$10.25 ,$10.25 ,$10.14 ,$9.90 ,$9.90 ,$9.90 ,$8.90 ,$10.49
Carle Richland Memorial Hospital,8140054,SET EXTENSION TWIN 32IN,9678,,270,$11.75 ,$11.75 ,$8.98 ,$10.58 ,$9.99 ,$9.99 ,$9.99 ,$10.34 ,$9.99 ,$10.34 ,$10.34 ,$10.22 ,$9.99 ,$9.99 ,$9.99 ,$8.98 ,$10.58
Carle Richland Memorial Hospital,8140054,DRESSING MEPILEX LT 4X4 BORDER,230084,,270,$11.81 ,$11.81 ,$9.02 ,$10.63 ,$10.04 ,$10.04 ,$10.04 ,$10.39 ,$10.04 ,$10.39 ,$10.39 ,$10.27 ,$10.04 ,$10.04 ,$10.04 ,$9.02 ,$10.63
Carle Richland Memorial Hospital,8140054,SUTURE 0 PDS CT2,64379,,270,$11.87 ,$11.87 ,$9.07 ,$10.68 ,$10.09 ,$10.09 ,$10.09 ,$10.45 ,$10.09 ,$10.45 ,$10.45 ,$10.33 ,$10.09 ,$10.09 ,$10.09 ,$9.07 ,$10.68
Carle Richland Memorial Hospital,8140054,PADDING CAST 3IN STERILE,671,,270,$11.94 ,$11.94 ,$9.12 ,$10.75 ,$10.15 ,$10.15 ,$10.15 ,$10.51 ,$10.15 ,$10.51 ,$10.51 ,$10.39 ,$10.15 ,$10.15 ,$10.15 ,$9.12 ,$10.75
Carle Richland Memorial Hospital,8140054,SLING ARM ENVELOPE LARGE,233193,,270,$12.00 ,$12.00 ,$9.17 ,$10.80 ,$10.20 ,$10.20 ,$10.20 ,$10.56 ,$10.20 ,$10.56 ,$10.56 ,$10.44 ,$10.20 ,$10.20 ,$10.20 ,$9.17 ,$10.80
Carle Richland Memorial Hospital,8140054,STOCKING ANTIEMBOLI MED/REG,232181,,270,$12.07 ,$12.07 ,$9.22 ,$10.86 ,$10.26 ,$10.26 ,$10.26 ,$10.62 ,$10.26 ,$10.62 ,$10.62 ,$10.50 ,$10.26 ,$10.26 ,$10.26 ,$9.22 ,$10.86
Carle Richland Memorial Hospital,8140054,BANDAGE ESMARK 6IN STERILE,232096,,270,$12.16 ,$12.16 ,$9.29 ,$10.94 ,$10.34 ,$10.34 ,$10.34 ,$10.70 ,$10.34 ,$10.70 ,$10.70 ,$10.58 ,$10.34 ,$10.34 ,$10.34 ,$9.29 ,$10.94
Carle Richland Memorial Hospital,8140054,DRAPE UNSTERILE U,235481,,270,$12.24 ,$12.24 ,$9.35 ,$11.02 ,$10.40 ,$10.40 ,$10.40 ,$10.77 ,$10.40 ,$10.77 ,$10.77 ,$10.65 ,$10.40 ,$10.40 ,$10.40 ,$9.35 ,$11.02
Carle Richland Memorial Hospital,8140054,DRESSING XEROFORM PETROLEUM RL US,830,,270,$12.48 ,$12.48 ,$9.53 ,$11.23 ,$10.61 ,$10.61 ,$10.61 ,$10.98 ,$10.61 ,$10.98 ,$10.98 ,$10.86 ,$10.61 ,$10.61 ,$10.61 ,$9.53 ,$11.23
Carle Richland Memorial Hospital,8140054,STRIP PACKING IODOFORM 2IN,9632,,270,$12.69 ,$12.69 ,$9.70 ,$11.42 ,$10.79 ,$10.79 ,$10.79 ,$11.17 ,$10.79 ,$11.17 ,$11.17 ,$11.04 ,$10.79 ,$10.79 ,$10.79 ,$9.70 ,$11.42
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 16FR 10CC,104,,270,$12.93 ,$12.93 ,$9.88 ,$11.64 ,$10.99 ,$10.99 ,$10.99 ,$11.38 ,$10.99 ,$11.38 ,$11.38 ,$11.25 ,$10.99 ,$10.99 ,$10.99 ,$9.88 ,$11.64
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 18FR 10CC,105,,270,$12.93 ,$12.93 ,$9.88 ,$11.64 ,$10.99 ,$10.99 ,$10.99 ,$11.38 ,$10.99 ,$11.38 ,$11.38 ,$11.25 ,$10.99 ,$10.99 ,$10.99 ,$9.88 ,$11.64
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 12FR 10CC,209056,,270,$12.93 ,$12.93 ,$9.88 ,$11.64 ,$10.99 ,$10.99 ,$10.99 ,$11.38 ,$10.99 ,$11.38 ,$11.38 ,$11.25 ,$10.99 ,$10.99 ,$10.99 ,$9.88 ,$11.64
Carle Richland Memorial Hospital,8140054,TRAY PRE-OP POVIDONE IODINE,954,,270,$12.96 ,$12.96 ,$9.90 ,$11.66 ,$11.02 ,$11.02 ,$11.02 ,$11.40 ,$11.02 ,$11.40 ,$11.40 ,$11.28 ,$11.02 ,$11.02 ,$11.02 ,$9.90 ,$11.66
Carle Richland Memorial Hospital,8140054,DRESSING MEPILEX BORDER 4X4IN,232109,,270,$13.11 ,$13.11 ,$10.02 ,$11.80 ,$11.14 ,$11.14 ,$11.14 ,$11.54 ,$11.14 ,$11.54 ,$11.54 ,$11.41 ,$11.14 ,$11.14 ,$11.14 ,$10.02 ,$11.80
Carle Richland Memorial Hospital,8140054,SOL .45 NACL 500ML,232210,,270,$13.50 ,$13.50 ,$10.31 ,$12.15 ,$11.48 ,$11.48 ,$11.48 ,$11.88 ,$11.48 ,$11.88 ,$11.88 ,$11.75 ,$11.48 ,$11.48 ,$11.48 ,$10.31 ,$12.15
Carle Richland Memorial Hospital,8140054,PADDING CAST WEBRIL 6IN STRL,587,,270,$13.51 ,$13.51 ,$10.32 ,$12.16 ,$11.48 ,$11.48 ,$11.48 ,$11.89 ,$11.48 ,$11.89 ,$11.89 ,$11.75 ,$11.48 ,$11.48 ,$11.48 ,$10.32 ,$12.16
Carle Richland Memorial Hospital,8140054,DRESSING ALGISITE M 3/4IN X 12 RO,232229,,270,$13.59 ,$13.59 ,$10.38 ,$12.23 ,$11.55 ,$11.55 ,$11.55 ,$11.96 ,$11.55 ,$11.96 ,$11.96 ,$11.82 ,$11.55 ,$11.55 ,$11.55 ,$10.38 ,$12.23
Carle Richland Memorial Hospital,8140054,ELECTRODE 1IN COAT EXT INS BLD,810,,270,$13.71 ,$13.71 ,$10.47 ,$12.34 ,$11.65 ,$11.65 ,$11.65 ,$12.06 ,$11.65 ,$12.06 ,$12.06 ,$11.93 ,$11.65 ,$11.65 ,$11.65 ,$10.47 ,$12.34
Carle Richland Memorial Hospital,8140054,BANDAGE STRETCH 4IN KLING NS,9504,,270,$13.73 ,$13.73 ,$10.49 ,$12.36 ,$11.67 ,$11.67 ,$11.67 ,$12.08 ,$11.67 ,$12.08 ,$12.08 ,$11.95 ,$11.67 ,$11.67 ,$11.67 ,$10.49 ,$12.36
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM FINGER/TOE 2,232243,,270,$13.74 ,$13.74 ,$10.50 ,$12.37 ,$11.68 ,$11.68 ,$11.68 ,$12.09 ,$11.68 ,$12.09 ,$12.09 ,$11.95 ,$11.68 ,$11.68 ,$11.68 ,$10.50 ,$12.37
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 20FR 5CC,232214,,270,$14.04 ,$14.04 ,$10.73 ,$12.64 ,$11.93 ,$11.93 ,$11.93 ,$12.36 ,$11.93 ,$12.36 ,$12.36 ,$12.21 ,$11.93 ,$11.93 ,$11.93 ,$10.73 ,$12.64
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 16FR 5CC,232215,,270,$14.04 ,$14.04 ,$10.73 ,$12.64 ,$11.93 ,$11.93 ,$11.93 ,$12.36 ,$11.93 ,$12.36 ,$12.36 ,$12.21 ,$11.93 ,$11.93 ,$11.93 ,$10.73 ,$12.64
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 18FR 5CC,233938,,270,$14.04 ,$14.04 ,$10.73 ,$12.64 ,$11.93 ,$11.93 ,$11.93 ,$12.36 ,$11.93 ,$12.36 ,$12.36 ,$12.21 ,$11.93 ,$11.93 ,$11.93 ,$10.73 ,$12.64
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 22FR 5CC,234378,,270,$14.04 ,$14.04 ,$10.73 ,$12.64 ,$11.93 ,$11.93 ,$11.93 ,$12.36 ,$11.93 ,$12.36 ,$12.36 ,$12.21 ,$11.93 ,$11.93 ,$11.93 ,$10.73 ,$12.64
Carle Richland Memorial Hospital,8140054,TOURNIQUET LARGE TOURNICOT,215240,,270,$14.16 ,$14.16 ,$10.82 ,$12.74 ,$12.04 ,$12.04 ,$12.04 ,$12.46 ,$12.04 ,$12.46 ,$12.46 ,$12.32 ,$12.04 ,$12.04 ,$12.04 ,$10.82 ,$12.74
Carle Richland Memorial Hospital,8140054,TAPE MEDIPORE 2IN,473,,270,$14.23 ,$14.23 ,$10.87 ,$12.81 ,$12.10 ,$12.10 ,$12.10 ,$12.52 ,$12.10 ,$12.52 ,$12.52 ,$12.38 ,$12.10 ,$12.10 ,$12.10 ,$10.87 ,$12.81
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY COATED 20FR 5CC LU,232134,,270,$14.32 ,$14.32 ,$10.94 ,$12.89 ,$12.17 ,$12.17 ,$12.17 ,$12.60 ,$12.17 ,$12.60 ,$12.60 ,$12.46 ,$12.17 ,$12.17 ,$12.17 ,$10.94 ,$12.89
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY COATED 22FR 5CC LU,232143,,270,$14.32 ,$14.32 ,$10.94 ,$12.89 ,$12.17 ,$12.17 ,$12.17 ,$12.60 ,$12.17 ,$12.60 ,$12.60 ,$12.46 ,$12.17 ,$12.17 ,$12.17 ,$10.94 ,$12.89
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 12FR 5CC 2-WAY LUB,233181,,270,$14.32 ,$14.32 ,$10.94 ,$12.89 ,$12.17 ,$12.17 ,$12.17 ,$12.60 ,$12.17 ,$12.60 ,$12.60 ,$12.46 ,$12.17 ,$12.17 ,$12.17 ,$10.94 ,$12.89
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 24FR 5CC 2-WAY LUB,234302,,270,$14.32 ,$14.32 ,$10.94 ,$12.89 ,$12.17 ,$12.17 ,$12.17 ,$12.60 ,$12.17 ,$12.60 ,$12.60 ,$12.46 ,$12.17 ,$12.17 ,$12.17 ,$10.94 ,$12.89
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY COATED 16FR 5CC LU,87939,,270,$14.32 ,$14.32 ,$10.94 ,$12.89 ,$12.17 ,$12.17 ,$12.17 ,$12.60 ,$12.17 ,$12.60 ,$12.60 ,$12.46 ,$12.17 ,$12.17 ,$12.17 ,$10.94 ,$12.89
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY COATED 18FR 5CC LU,87940,,270,$14.32 ,$14.32 ,$10.94 ,$12.89 ,$12.17 ,$12.17 ,$12.17 ,$12.60 ,$12.17 ,$12.60 ,$12.60 ,$12.46 ,$12.17 ,$12.17 ,$12.17 ,$10.94 ,$12.89
Carle Richland Memorial Hospital,8140054,STOCKINET COTTON 6 X 60IN,1013,,270,$14.34 ,$14.34 ,$10.96 ,$12.91 ,$12.19 ,$12.19 ,$12.19 ,$12.62 ,$12.19 ,$12.62 ,$12.62 ,$12.48 ,$12.19 ,$12.19 ,$12.19 ,$10.96 ,$12.91
Carle Richland Memorial Hospital,8140054,DRAPE IOBAN INCISE 13 X 13IN,1005,,270,$14.52 ,$14.52 ,$11.09 ,$13.07 ,$12.34 ,$12.34 ,$12.34 ,$12.78 ,$12.34 ,$12.78 ,$12.78 ,$12.63 ,$12.34 ,$12.34 ,$12.34 ,$11.09 ,$13.07
Carle Richland Memorial Hospital,8140054,ELECTRODE 1IN COAT NDL EXT INS,908,,270,$14.64 ,$14.64 ,$11.18 ,$13.18 ,$12.44 ,$12.44 ,$12.44 ,$12.88 ,$12.44 ,$12.88 ,$12.88 ,$12.74 ,$12.44 ,$12.44 ,$12.44 ,$11.18 ,$13.18
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM FILM 4X5,232241,,270,$15.29 ,$15.29 ,$11.68 ,$13.76 ,$13.00 ,$13.00 ,$13.00 ,$13.46 ,$13.00 ,$13.46 ,$13.46 ,$13.30 ,$13.00 ,$13.00 ,$13.00 ,$11.68 ,$13.76
Carle Richland Memorial Hospital,8140054,COVER MINI C ARM,235486,,270,$15.30 ,$15.30 ,$11.69 ,$13.77 ,$13.01 ,$13.01 ,$13.01 ,$13.46 ,$13.01 ,$13.46 ,$13.46 ,$13.31 ,$13.01 ,$13.01 ,$13.01 ,$11.69 ,$13.77
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM CLOTH 4X5,232237,,270,$15.36 ,$15.36 ,$11.74 ,$13.82 ,$13.06 ,$13.06 ,$13.06 ,$13.52 ,$13.06 ,$13.52 ,$13.52 ,$13.36 ,$13.06 ,$13.06 ,$13.06 ,$11.74 ,$13.82
Carle Richland Memorial Hospital,8140054,CATH SECURE,234294,,270,$15.57 ,$15.57 ,$11.90 ,$14.01 ,$13.23 ,$13.23 ,$13.23 ,$13.70 ,$13.23 ,$13.70 ,$13.70 ,$13.55 ,$13.23 ,$13.23 ,$13.23 ,$11.90 ,$14.01
Carle Richland Memorial Hospital,8140054,DEVICE ENDOMETRIAL CELL SAMPLE,234442,,270,$15.60 ,$15.60 ,$11.92 ,$14.04 ,$13.26 ,$13.26 ,$13.26 ,$13.73 ,$13.26 ,$13.73 ,$13.73 ,$13.57 ,$13.26 ,$13.26 ,$13.26 ,$11.92 ,$14.04
Carle Richland Memorial Hospital,8140054,OSTOMY BARRIER 4IN DURAHESIVE,234428,,270,$15.61 ,$15.61 ,$11.93 ,$14.05 ,$13.27 ,$13.27 ,$13.27 ,$13.74 ,$13.27 ,$13.74 ,$13.74 ,$13.58 ,$13.27 ,$13.27 ,$13.27 ,$11.93 ,$14.05
Carle Richland Memorial Hospital,8140054,DRAPE MINOR PROCEDURE,232130,,270,$16.52 ,$16.52 ,$12.62 ,$14.87 ,$14.04 ,$14.04 ,$14.04 ,$14.54 ,$14.04 ,$14.54 ,$14.54 ,$14.37 ,$14.04 ,$14.04 ,$14.04 ,$12.62 ,$14.87
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 20FR 30CC 2-WAY LU,232216,,270,$16.59 ,$16.59 ,$12.67 ,$14.93 ,$14.10 ,$14.10 ,$14.10 ,$14.60 ,$14.10 ,$14.60 ,$14.60 ,$14.43 ,$14.10 ,$14.10 ,$14.10 ,$12.67 ,$14.93
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 18FR 30CC 2-WAY LU,232217,,270,$16.59 ,$16.59 ,$12.67 ,$14.93 ,$14.10 ,$14.10 ,$14.10 ,$14.60 ,$14.10 ,$14.60 ,$14.60 ,$14.43 ,$14.10 ,$14.10 ,$14.10 ,$12.67 ,$14.93
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 24FR 30CC 2-WAY LU,233208,,270,$16.59 ,$16.59 ,$12.67 ,$14.93 ,$14.10 ,$14.10 ,$14.10 ,$14.60 ,$14.10 ,$14.60 ,$14.60 ,$14.43 ,$14.10 ,$14.10 ,$14.10 ,$12.67 ,$14.93
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 22FR 30CC 2-WAY LU,234301,,270,$16.59 ,$16.59 ,$12.67 ,$14.93 ,$14.10 ,$14.10 ,$14.10 ,$14.60 ,$14.10 ,$14.60 ,$14.60 ,$14.43 ,$14.10 ,$14.10 ,$14.10 ,$12.67 ,$14.93
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM WIC 3X3,232236,,270,$16.65 ,$16.65 ,$12.72 ,$14.99 ,$14.15 ,$14.15 ,$14.15 ,$14.65 ,$14.15 ,$14.65 ,$14.65 ,$14.49 ,$14.15 ,$14.15 ,$14.15 ,$12.72 ,$14.99
Carle Richland Memorial Hospital,8140054,CATH COUDE 22FR,232148,,270,$16.70 ,$16.70 ,$12.76 ,$15.03 ,$14.20 ,$14.20 ,$14.20 ,$14.70 ,$14.20 ,$14.70 ,$14.70 ,$14.53 ,$14.20 ,$14.20 ,$14.20 ,$12.76 ,$15.03
Carle Richland Memorial Hospital,8140054,PACK CYSTOSCOPY IV,232129,,270,$16.94 ,$16.94 ,$12.94 ,$15.25 ,$14.40 ,$14.40 ,$14.40 ,$14.91 ,$14.40 ,$14.91 ,$14.91 ,$14.74 ,$14.40 ,$14.40 ,$14.40 ,$12.94 ,$15.25
Carle Richland Memorial Hospital,8140054,ELECTRODE 6IN COAT ULTRACLEAN,800,,270,$17.01 ,$17.01 ,$13.00 ,$15.31 ,$14.46 ,$14.46 ,$14.46 ,$14.97 ,$14.46 ,$14.97 ,$14.97 ,$14.80 ,$14.46 ,$14.46 ,$14.46 ,$13.00 ,$15.31
Carle Richland Memorial Hospital,8140054,TUBE SPECIMEN ANAEROBIC,234420,,270,$17.46 ,$17.46 ,$13.34 ,$15.71 ,$14.84 ,$14.84 ,$14.84 ,$15.36 ,$14.84 ,$15.36 ,$15.36 ,$15.19 ,$14.84 ,$14.84 ,$14.84 ,$13.34 ,$15.71
Carle Richland Memorial Hospital,8140054,STOCKING COMPR THIGH MED SHORT,232183,,270,$17.55 ,$17.55 ,$13.41 ,$15.80 ,$14.92 ,$14.92 ,$14.92 ,$15.44 ,$14.92 ,$15.44 ,$15.44 ,$15.27 ,$14.92 ,$14.92 ,$14.92 ,$13.41 ,$15.80
Carle Richland Memorial Hospital,8140054,PUNCH BIOPSY DERMAL 4.0MM 25/BX A,235943,,270,$17.63 ,$17.63 ,$13.47 ,$15.87 ,$14.99 ,$14.99 ,$14.99 ,$15.51 ,$14.99 ,$15.51 ,$15.51 ,$15.34 ,$14.99 ,$14.99 ,$14.99 ,$13.47 ,$15.87
Carle Richland Memorial Hospital,8140054,CORD CAUTERY BIPOLAR,120,,270,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8140054,ISOVUE 300 50ML 10X5 10/CA,54641,,270,$18.02 ,$18.02 ,$13.77 ,$16.22 ,$15.32 ,$15.32 ,$15.32 ,$15.86 ,$15.32 ,$15.86 ,$15.86 ,$15.68 ,$15.32 ,$15.32 ,$15.32 ,$13.77 ,$16.22
Carle Richland Memorial Hospital,8140054,PADDING CAST 6IN STERILE,673,,270,$18.05 ,$18.05 ,$13.79 ,$16.25 ,$15.34 ,$15.34 ,$15.34 ,$15.88 ,$15.34 ,$15.88 ,$15.88 ,$15.70 ,$15.34 ,$15.34 ,$15.34 ,$13.79 ,$16.25
Carle Richland Memorial Hospital,8140054,SPLINT METACARPAL LEFT LARGE,233220,,270,$18.23 ,$18.23 ,$13.93 ,$16.41 ,$15.50 ,$15.50 ,$15.50 ,$16.04 ,$15.50 ,$16.04 ,$16.04 ,$15.86 ,$15.50 ,$15.50 ,$15.50 ,$13.93 ,$16.41
Carle Richland Memorial Hospital,8140054,SPLINT METACARPAL LEFT SMALL,233221,,270,$18.23 ,$18.23 ,$13.93 ,$16.41 ,$15.50 ,$15.50 ,$15.50 ,$16.04 ,$15.50 ,$16.04 ,$16.04 ,$15.86 ,$15.50 ,$15.50 ,$15.50 ,$13.93 ,$16.41
Carle Richland Memorial Hospital,8140054,STOCKINET IMPERVIOUS,232179,,270,$18.34 ,$18.34 ,$14.01 ,$16.51 ,$15.59 ,$15.59 ,$15.59 ,$16.14 ,$15.59 ,$16.14 ,$16.14 ,$15.96 ,$15.59 ,$15.59 ,$15.59 ,$14.01 ,$16.51
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 10FR 3CC,79,,270,$18.55 ,$18.55 ,$14.17 ,$16.70 ,$15.77 ,$15.77 ,$15.77 ,$16.32 ,$15.77 ,$16.32 ,$16.32 ,$16.14 ,$15.77 ,$15.77 ,$15.77 ,$14.17 ,$16.70
Carle Richland Memorial Hospital,8140054,CYSTO SETS,232184,,270,$18.59 ,$18.59 ,$14.20 ,$16.73 ,$15.80 ,$15.80 ,$15.80 ,$16.36 ,$15.80 ,$16.36 ,$16.36 ,$16.17 ,$15.80 ,$15.80 ,$15.80 ,$14.20 ,$16.73
Carle Richland Memorial Hospital,8140054,DRESSING SURGIFOAM 2X6 12-7 12 PE,240107,,270,$18.59 ,$18.59 ,$14.20 ,$16.73 ,$15.80 ,$15.80 ,$15.80 ,$16.36 ,$15.80 ,$16.36 ,$16.36 ,$16.17 ,$15.80 ,$15.80 ,$15.80 ,$14.20 ,$16.73
Carle Richland Memorial Hospital,8140054,CATH TRAY ADD A FOLEY,232136,,270,$19.32 ,$19.32 ,$14.76 ,$17.39 ,$16.42 ,$16.42 ,$16.42 ,$17.00 ,$16.42 ,$17.00 ,$17.00 ,$16.81 ,$16.42 ,$16.42 ,$16.42 ,$14.76 ,$17.39
Carle Richland Memorial Hospital,8140054,NEEDLE SPINAL 22GA 7IN QUINCK,11272,,270,$19.45 ,$19.45 ,$14.86 ,$17.51 ,$16.53 ,$16.53 ,$16.53 ,$17.12 ,$16.53 ,$17.12 ,$17.12 ,$16.92 ,$16.53 ,$16.53 ,$16.53 ,$14.86 ,$17.51
Carle Richland Memorial Hospital,8140054,VACURETTE D/C CURVED 8MM,234822,,270,$19.48 ,$19.48 ,$14.88 ,$17.53 ,$16.56 ,$16.56 ,$16.56 ,$17.14 ,$16.56 ,$17.14 ,$17.14 ,$16.95 ,$16.56 ,$16.56 ,$16.56 ,$14.88 ,$17.53
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 22FR 30CC,234536,,270,$19.98 ,$19.98 ,$15.26 ,$17.98 ,$16.98 ,$16.98 ,$16.98 ,$17.58 ,$16.98 ,$17.58 ,$17.58 ,$17.38 ,$16.98 ,$16.98 ,$16.98 ,$15.26 ,$17.98
Carle Richland Memorial Hospital,8140054,BLANKET WARMER FULL BODY 40/CA,109994,,270,$20.09 ,$20.09 ,$15.35 ,$18.08 ,$17.08 ,$17.08 ,$17.08 ,$17.68 ,$17.08 ,$17.68 ,$17.68 ,$17.48 ,$17.08 ,$17.08 ,$17.08 ,$15.35 ,$18.08
Carle Richland Memorial Hospital,8140054,BONE WAX 2.5GM BX/12,234729,,270,$20.17 ,$20.17 ,$15.41 ,$18.15 ,$17.14 ,$17.14 ,$17.14 ,$17.75 ,$17.14 ,$17.75 ,$17.75 ,$17.55 ,$17.14 ,$17.14 ,$17.14 ,$15.41 ,$18.15
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 18FR 30CC,234379,,270,$20.18 ,$20.18 ,$15.42 ,$18.16 ,$17.15 ,$17.15 ,$17.15 ,$17.76 ,$17.15 ,$17.76 ,$17.76 ,$17.56 ,$17.15 ,$17.15 ,$17.15 ,$15.42 ,$18.16
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM 5X5 NON ADH,232235,,270,$20.22 ,$20.22 ,$15.45 ,$18.20 ,$17.19 ,$17.19 ,$17.19 ,$17.79 ,$17.19 ,$17.79 ,$17.79 ,$17.59 ,$17.19 ,$17.19 ,$17.19 ,$15.45 ,$18.20
Carle Richland Memorial Hospital,8140054,CATH SUCT W/ MUCUS TRAP,232139,,270,$20.25 ,$20.25 ,$15.47 ,$18.23 ,$17.21 ,$17.21 ,$17.21 ,$17.82 ,$17.21 ,$17.82 ,$17.82 ,$17.62 ,$17.21 ,$17.21 ,$17.21 ,$15.47 ,$18.23
Carle Richland Memorial Hospital,8140054,DRAPE SPLIT SHEET,973,,270,$20.43 ,$20.43 ,$15.61 ,$18.39 ,$17.37 ,$17.37 ,$17.37 ,$17.98 ,$17.37 ,$17.98 ,$17.98 ,$17.77 ,$17.37 ,$17.37 ,$17.37 ,$15.61 ,$18.39
Carle Richland Memorial Hospital,8140054,COLLAR CERVIFORM SMALL XWIDE,233192,,270,$20.52 ,$20.52 ,$15.68 ,$18.47 ,$17.44 ,$17.44 ,$17.44 ,$18.06 ,$17.44 ,$18.06 ,$18.06 ,$17.85 ,$17.44 ,$17.44 ,$17.44 ,$15.68 ,$18.47
Carle Richland Memorial Hospital,8140054,DRAPE IOBAN 23X17,420,,270,$20.79 ,$20.79 ,$15.88 ,$18.71 ,$17.67 ,$17.67 ,$17.67 ,$18.30 ,$17.67 ,$18.30 ,$18.30 ,$18.09 ,$17.67 ,$17.67 ,$17.67 ,$15.88 ,$18.71
Carle Richland Memorial Hospital,8140054,SPLINT METACARPAL RIGHT LARGE,10062,,270,$20.91 ,$20.91 ,$15.98 ,$18.82 ,$17.77 ,$17.77 ,$17.77 ,$18.40 ,$17.77 ,$18.40 ,$18.40 ,$18.19 ,$17.77 ,$17.77 ,$17.77 ,$15.98 ,$18.82
Carle Richland Memorial Hospital,8140054,SPLINT METACARPAL LEFT MEDIUM,10063,,270,$20.93 ,$20.93 ,$15.99 ,$18.84 ,$17.79 ,$17.79 ,$17.79 ,$18.42 ,$17.79 ,$18.42 ,$18.42 ,$18.21 ,$17.79 ,$17.79 ,$17.79 ,$15.99 ,$18.84
Carle Richland Memorial Hospital,8140054,SPLINT METACARPAL RIGHT MEDIUM,10064,,270,$20.93 ,$20.93 ,$15.99 ,$18.84 ,$17.79 ,$17.79 ,$17.79 ,$18.42 ,$17.79 ,$18.42 ,$18.42 ,$18.21 ,$17.79 ,$17.79 ,$17.79 ,$15.99 ,$18.84
Carle Richland Memorial Hospital,8140054,SPLINT METACARPAL RIGHT SMALL,233222,,270,$20.93 ,$20.93 ,$15.99 ,$18.84 ,$17.79 ,$17.79 ,$17.79 ,$18.42 ,$17.79 ,$18.42 ,$18.42 ,$18.21 ,$17.79 ,$17.79 ,$17.79 ,$15.99 ,$18.84
Carle Richland Memorial Hospital,8140054,VACURETTE D/C CURVED 9MM,234827,,270,$21.35 ,$21.35 ,$16.31 ,$19.22 ,$18.15 ,$18.15 ,$18.15 ,$18.79 ,$18.15 ,$18.79 ,$18.79 ,$18.57 ,$18.15 ,$18.15 ,$18.15 ,$16.31 ,$19.22
Carle Richland Memorial Hospital,8140054,VACURETTE D/C CURVED 10MM,234828,,270,$21.35 ,$21.35 ,$16.31 ,$19.22 ,$18.15 ,$18.15 ,$18.15 ,$18.79 ,$18.15 ,$18.79 ,$18.79 ,$18.57 ,$18.15 ,$18.15 ,$18.15 ,$16.31 ,$19.22
Carle Richland Memorial Hospital,8140054,BLADE MYRINGOTOMY,232152,,270,$21.65 ,$21.65 ,$16.54 ,$19.49 ,$18.40 ,$18.40 ,$18.40 ,$19.05 ,$18.40 ,$19.05 ,$19.05 ,$18.84 ,$18.40 ,$18.40 ,$18.40 ,$16.54 ,$19.49
Carle Richland Memorial Hospital,8140054,BOOT POSTOP FEMALE MEDIUM,249417,,270,$21.95 ,$21.95 ,$16.77 ,$19.76 ,$18.66 ,$18.66 ,$18.66 ,$19.32 ,$18.66 ,$19.32 ,$19.32 ,$19.10 ,$18.66 ,$18.66 ,$18.66 ,$16.77 ,$19.76
Carle Richland Memorial Hospital,8140054,ADHESIVE PAD 25/BX,4190,,270,$22.06 ,$22.06 ,$16.85 ,$19.85 ,$18.75 ,$18.75 ,$18.75 ,$19.41 ,$18.75 ,$19.41 ,$19.41 ,$19.19 ,$18.75 ,$18.75 ,$18.75 ,$16.85 ,$19.85
Carle Richland Memorial Hospital,8140054,BLANKET WARMER LOWER BODY 40/CA,8267,,270,$22.68 ,$22.68 ,$17.33 ,$20.41 ,$19.28 ,$19.28 ,$19.28 ,$19.96 ,$19.28 ,$19.96 ,$19.96 ,$19.73 ,$19.28 ,$19.28 ,$19.28 ,$17.33 ,$20.41
Carle Richland Memorial Hospital,8140054,BLANKET WARMER SM UPPER BODY 40/C,8981,,270,$22.68 ,$22.68 ,$17.33 ,$20.41 ,$19.28 ,$19.28 ,$19.28 ,$19.96 ,$19.28 ,$19.96 ,$19.96 ,$19.73 ,$19.28 ,$19.28 ,$19.28 ,$17.33 ,$20.41
Carle Richland Memorial Hospital,8140054,COLLAR CERVIFOAM MEDIUM,233191,,270,$22.86 ,$22.86 ,$17.47 ,$20.57 ,$19.43 ,$19.43 ,$19.43 ,$20.12 ,$19.43 ,$20.12 ,$20.12 ,$19.89 ,$19.43 ,$19.43 ,$19.43 ,$17.47 ,$20.57
Carle Richland Memorial Hospital,8140054,COAGULATOR SUCTION,1025,,270,$22.91 ,$22.91 ,$17.50 ,$20.62 ,$19.47 ,$19.47 ,$19.47 ,$20.16 ,$19.47 ,$20.16 ,$20.16 ,$19.93 ,$19.47 ,$19.47 ,$19.47 ,$17.50 ,$20.62
Carle Richland Memorial Hospital,8140054,KIT CENTRAL LINE SUBCLAVIAN,232107,,270,$23.23 ,$23.23 ,$17.75 ,$20.91 ,$19.75 ,$19.75 ,$19.75 ,$20.44 ,$19.75 ,$20.44 ,$20.44 ,$20.21 ,$19.75 ,$19.75 ,$19.75 ,$17.75 ,$20.91
Carle Richland Memorial Hospital,8140054,PACK SET-UP,232110,,270,$24.08 ,$24.08 ,$18.40 ,$21.67 ,$20.47 ,$20.47 ,$20.47 ,$21.19 ,$20.47 ,$21.19 ,$21.19 ,$20.95 ,$20.47 ,$20.47 ,$20.47 ,$18.40 ,$21.67
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN SACRUM,232127,,270,$24.50 ,$24.50 ,$18.72 ,$22.05 ,$20.83 ,$20.83 ,$20.83 ,$21.56 ,$20.83 ,$21.56 ,$21.56 ,$21.32 ,$20.83 ,$20.83 ,$20.83 ,$18.72 ,$22.05
Carle Richland Memorial Hospital,8140054,DRESSING BIOPATCH 1IN,166,,270,$24.98 ,$24.98 ,$19.08 ,$22.48 ,$21.23 ,$21.23 ,$21.23 ,$21.98 ,$21.23 ,$21.98 ,$21.98 ,$21.73 ,$21.23 ,$21.23 ,$21.23 ,$19.08 ,$22.48
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN 6X6 HYDROCELLULA,232228,,270,$25.10 ,$25.10 ,$19.18 ,$22.59 ,$21.34 ,$21.34 ,$21.34 ,$22.09 ,$21.34 ,$22.09 ,$22.09 ,$21.84 ,$21.34 ,$21.34 ,$21.34 ,$19.18 ,$22.59
Carle Richland Memorial Hospital,8140054,SOL IRR WATER 3000ML BAG 4/CASE,399,,270,$25.20 ,$25.20 ,$19.25 ,$22.68 ,$21.42 ,$21.42 ,$21.42 ,$22.18 ,$21.42 ,$22.18 ,$22.18 ,$21.92 ,$21.42 ,$21.42 ,$21.42 ,$19.25 ,$22.68
Carle Richland Memorial Hospital,8140054,DRESSING GAUZE SPONGE N/S 4X4,232101,,270,$25.44 ,$25.44 ,$19.44 ,$22.90 ,$21.62 ,$21.62 ,$21.62 ,$22.39 ,$21.62 ,$22.39 ,$22.39 ,$22.13 ,$21.62 ,$21.62 ,$21.62 ,$19.44 ,$22.90
Carle Richland Memorial Hospital,8140054,SET IV PRIMARY PLUM 103IN,230088,,270,$25.70 ,$25.70 ,$19.63 ,$23.13 ,$21.85 ,$21.85 ,$21.85 ,$22.62 ,$21.85 ,$22.62 ,$22.62 ,$22.36 ,$21.85 ,$21.85 ,$21.85 ,$19.63 ,$23.13
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 14FR 5CC 2-WAY LUB,87937,,270,$26.39 ,$26.39 ,$20.16 ,$23.75 ,$22.43 ,$22.43 ,$22.43 ,$23.22 ,$22.43 ,$23.22 ,$23.22 ,$22.96 ,$22.43 ,$22.43 ,$22.43 ,$20.16 ,$23.75
Carle Richland Memorial Hospital,8140054,DRAPE TIBURON HAND 77X142IN,223699,,270,$27.32 ,$27.32 ,$20.87 ,$24.59 ,$23.22 ,$23.22 ,$23.22 ,$24.04 ,$23.22 ,$24.04 ,$24.04 ,$23.77 ,$23.22 ,$23.22 ,$23.22 ,$20.87 ,$24.59
Carle Richland Memorial Hospital,8140054,SLING ARM MEDIUM PROCARE,235478,,270,$27.36 ,$27.36 ,$20.90 ,$24.62 ,$23.26 ,$23.26 ,$23.26 ,$24.08 ,$23.26 ,$24.08 ,$24.08 ,$23.80 ,$23.26 ,$23.26 ,$23.26 ,$20.90 ,$24.62
Carle Richland Memorial Hospital,8140054,SLING ARM LARGE PROCARE,235479,,270,$27.36 ,$27.36 ,$20.90 ,$24.62 ,$23.26 ,$23.26 ,$23.26 ,$24.08 ,$23.26 ,$24.08 ,$24.08 ,$23.80 ,$23.26 ,$23.26 ,$23.26 ,$20.90 ,$24.62
Carle Richland Memorial Hospital,8140054,APPLICATOR CHLORAPREP ORG 26ML W/,316,,270,$27.50 ,$27.50 ,$21.01 ,$24.75 ,$23.38 ,$23.38 ,$23.38 ,$24.20 ,$23.38 ,$24.20 ,$24.20 ,$23.93 ,$23.38 ,$23.38 ,$23.38 ,$21.01 ,$24.75
Carle Richland Memorial Hospital,8140054,DRESSING TEGADERM CHG 4X6,9973,,270,$27.81 ,$27.81 ,$21.25 ,$25.03 ,$23.64 ,$23.64 ,$23.64 ,$24.47 ,$23.64 ,$24.47 ,$24.47 ,$24.19 ,$23.64 ,$23.64 ,$23.64 ,$21.25 ,$25.03
Carle Richland Memorial Hospital,8140054,CATHETER PEDIATRIC 3CC 8FR LATEX,232250,,270,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8140054,CATH FOLEY SILICONE 20FR 30CC,234380,,270,$28.36 ,$28.36 ,$21.67 ,$25.52 ,$24.11 ,$24.11 ,$24.11 ,$24.96 ,$24.11 ,$24.96 ,$24.96 ,$24.67 ,$24.11 ,$24.11 ,$24.11 ,$21.67 ,$25.52
Carle Richland Memorial Hospital,8140054,CATH TRAY LUBRICATH 16FR 5CC LATE,232137,,270,$28.41 ,$28.41 ,$21.71 ,$25.57 ,$24.15 ,$24.15 ,$24.15 ,$25.00 ,$24.15 ,$25.00 ,$25.00 ,$24.72 ,$24.15 ,$24.15 ,$24.15 ,$21.71 ,$25.57
Carle Richland Memorial Hospital,8140054,TAPE MEDIPORE 4IN,475,,270,$28.41 ,$28.41 ,$21.71 ,$25.57 ,$24.15 ,$24.15 ,$24.15 ,$25.00 ,$24.15 ,$25.00 ,$25.00 ,$24.72 ,$24.15 ,$24.15 ,$24.15 ,$21.71 ,$25.57
Carle Richland Memorial Hospital,8100027,TUBE VENT T-TUBE 6MM 1.14MM 1PR P,1831,,270,$70.07 ,$70.07 ,$53.53 ,$63.06 ,$59.56 ,$59.56 ,$59.56 ,$61.66 ,$59.56 ,$61.66 ,$61.66 ,$60.96 ,$59.56 ,$59.56 ,$59.56 ,$53.53 ,$63.06
Carle Richland Memorial Hospital,8140054,BANDAGE BANDAID 1INX3IN 50/BX,109995,,270,$0.07 ,$0.07 ,$0.05 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.06 ,$0.05 ,$0.06
Carle Richland Memorial Hospital,8140054,APPLICATOR COTTON TIP STRL 6IN,232090,,270,$0.10 ,$0.10 ,$0.08 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.08 ,$0.09
Carle Richland Memorial Hospital,8140054,SPONGE GAUZE 2 X 2 8-PLY STERILE,9753,,270,$0.10 ,$0.10 ,$0.08 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.09 ,$0.08 ,$0.09
Carle Richland Memorial Hospital,8140054,SPONGE GAUZE 2X2 2/PACK,839,,270,$0.11 ,$0.11 ,$0.08 ,$0.10 ,$0.09 ,$0.09 ,$0.09 ,$0.10 ,$0.09 ,$0.10 ,$0.10 ,$0.10 ,$0.09 ,$0.09 ,$0.09 ,$0.08 ,$0.10
Carle Richland Memorial Hospital,8140054,APPLICATOR OB/GYN 8IN,232573,,270,$0.12 ,$0.12 ,$0.09 ,$0.11 ,$0.10 ,$0.10 ,$0.10 ,$0.11 ,$0.10 ,$0.11 ,$0.11 ,$0.10 ,$0.10 ,$0.10 ,$0.10 ,$0.09 ,$0.11
Carle Richland Memorial Hospital,8140054,NEEDLE 18GA X 1IN NONSFTY,234347,,270,$0.12 ,$0.12 ,$0.09 ,$0.11 ,$0.10 ,$0.10 ,$0.10 ,$0.11 ,$0.10 ,$0.11 ,$0.11 ,$0.10 ,$0.10 ,$0.10 ,$0.10 ,$0.09 ,$0.11
Carle Richland Memorial Hospital,8140054,NEEDLE 25GA X 1 1/2 BD DISP,109649,,270,$0.14 ,$0.14 ,$0.11 ,$0.13 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.11 ,$0.13
Carle Richland Memorial Hospital,8140054,NEEDLE 25GA X 1 1/2 BD DISP,234265,,270,$0.14 ,$0.14 ,$0.11 ,$0.13 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.12 ,$0.11 ,$0.13
Carle Richland Memorial Hospital,8140054,APPLICATOR COTTON TIP 6IN 2PK 2/P,12056,,270,$0.18 ,$0.18 ,$0.14 ,$0.16 ,$0.15 ,$0.15 ,$0.15 ,$0.16 ,$0.15 ,$0.16 ,$0.16 ,$0.16 ,$0.15 ,$0.15 ,$0.15 ,$0.14 ,$0.16
Carle Richland Memorial Hospital,8140054,NEEDLE 27GA X 1.25IN PRECISION 10,233886,,270,$0.18 ,$0.18 ,$0.14 ,$0.16 ,$0.15 ,$0.15 ,$0.15 ,$0.16 ,$0.15 ,$0.16 ,$0.16 ,$0.16 ,$0.15 ,$0.15 ,$0.15 ,$0.14 ,$0.16
Carle Richland Memorial Hospital,8140054,SYRINGE 3ML LL,454,,270,$0.18 ,$0.18 ,$0.14 ,$0.16 ,$0.15 ,$0.15 ,$0.15 ,$0.16 ,$0.15 ,$0.16 ,$0.16 ,$0.16 ,$0.15 ,$0.15 ,$0.15 ,$0.14 ,$0.16
Carle Richland Memorial Hospital,8140054,DRESSING TELFA 2 X 3IN 100/BX LAT,10089,,270,$0.20 ,$0.20 ,$0.15 ,$0.18 ,$0.17 ,$0.17 ,$0.17 ,$0.18 ,$0.17 ,$0.18 ,$0.18 ,$0.17 ,$0.17 ,$0.17 ,$0.17 ,$0.15 ,$0.18
Carle Richland Memorial Hospital,8140054,DRESSING TELFA 3 X 8,171,,270,$0.24 ,$0.24 ,$0.18 ,$0.22 ,$0.20 ,$0.20 ,$0.20 ,$0.21 ,$0.20 ,$0.21 ,$0.21 ,$0.21 ,$0.20 ,$0.20 ,$0.20 ,$0.18 ,$0.22
Carle Richland Memorial Hospital,8140054,LUBRICANT FOIL PK SURGILUBE 5 GR,228,,270,$0.26 ,$0.26 ,$0.20 ,$0.23 ,$0.22 ,$0.22 ,$0.22 ,$0.23 ,$0.22 ,$0.23 ,$0.23 ,$0.23 ,$0.22 ,$0.22 ,$0.22 ,$0.20 ,$0.23
Carle Richland Memorial Hospital,8140054,SYRINGE 5ML LL,455,,270,$0.29 ,$0.29 ,$0.22 ,$0.26 ,$0.25 ,$0.25 ,$0.25 ,$0.26 ,$0.25 ,$0.26 ,$0.26 ,$0.25 ,$0.25 ,$0.25 ,$0.25 ,$0.22 ,$0.26
Carle Richland Memorial Hospital,8140054,SYRINGE TB W/ 3/8IN NDL 26GA,232172,,270,$0.30 ,$0.30 ,$0.23 ,$0.27 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.23 ,$0.27
Carle Richland Memorial Hospital,8140054,NEEDLE 30GA 1/2IN,2498,,270,$0.30 ,$0.30 ,$0.23 ,$0.27 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.23 ,$0.27
Carle Richland Memorial Hospital,8140054,NEEDLE BLUNT FILL 100/BX,251,,270,$0.30 ,$0.30 ,$0.23 ,$0.27 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.26 ,$0.23 ,$0.27
Carle Richland Memorial Hospital,8140054,SYRINGE 10ML LL 200/BOX,456,,270,$0.32 ,$0.32 ,$0.24 ,$0.29 ,$0.27 ,$0.27 ,$0.27 ,$0.28 ,$0.27 ,$0.28 ,$0.28 ,$0.28 ,$0.27 ,$0.27 ,$0.27 ,$0.24 ,$0.29
Carle Richland Memorial Hospital,8140054,BASIN EMESIS KIDNEY-SHAPED 500CC,133493,,270,$0.33 ,$0.33 ,$0.25 ,$0.30 ,$0.28 ,$0.28 ,$0.28 ,$0.29 ,$0.28 ,$0.29 ,$0.29 ,$0.29 ,$0.28 ,$0.28 ,$0.28 ,$0.25 ,$0.30
Carle Richland Memorial Hospital,8140054,PAD EYE OVAL,312,,270,$0.35 ,$0.35 ,$0.27 ,$0.32 ,$0.30 ,$0.30 ,$0.30 ,$0.31 ,$0.30 ,$0.31 ,$0.31 ,$0.30 ,$0.30 ,$0.30 ,$0.30 ,$0.27 ,$0.32
Carle Richland Memorial Hospital,8140054,APPLICATOR SNGL POVODONE IODNE 50,234430,,270,$0.43 ,$0.43 ,$0.33 ,$0.39 ,$0.37 ,$0.37 ,$0.37 ,$0.38 ,$0.37 ,$0.38 ,$0.38 ,$0.37 ,$0.37 ,$0.37 ,$0.37 ,$0.33 ,$0.39
Carle Richland Memorial Hospital,8140054,DRESSING COMBINE STERILE 8X7.5,232092,,270,$0.46 ,$0.46 ,$0.35 ,$0.41 ,$0.39 ,$0.39 ,$0.39 ,$0.40 ,$0.39 ,$0.40 ,$0.40 ,$0.40 ,$0.39 ,$0.39 ,$0.39 ,$0.35 ,$0.41
Carle Richland Memorial Hospital,8140054,DRESSING GAUZE COVR SPONGE 4X4,232114,,270,$0.46 ,$0.46 ,$0.35 ,$0.41 ,$0.39 ,$0.39 ,$0.39 ,$0.40 ,$0.39 ,$0.40 ,$0.40 ,$0.40 ,$0.39 ,$0.39 ,$0.39 ,$0.35 ,$0.41
Carle Richland Memorial Hospital,8140054,SWAB BETADINE STERILE,232135,,270,$0.47 ,$0.47 ,$0.36 ,$0.42 ,$0.40 ,$0.40 ,$0.40 ,$0.41 ,$0.40 ,$0.41 ,$0.41 ,$0.41 ,$0.40 ,$0.40 ,$0.40 ,$0.36 ,$0.42
Carle Richland Memorial Hospital,8140054,DRESSING TEGADERM 2X3 100/BX,169,,270,$0.49 ,$0.49 ,$0.37 ,$0.44 ,$0.42 ,$0.42 ,$0.42 ,$0.43 ,$0.42 ,$0.43 ,$0.43 ,$0.43 ,$0.42 ,$0.42 ,$0.42 ,$0.37 ,$0.44
Carle Richland Memorial Hospital,8140054,SPONGE DRAIN 6-PLY 4 X 4,418,,270,$0.58 ,$0.58 ,$0.44 ,$0.52 ,$0.49 ,$0.49 ,$0.49 ,$0.51 ,$0.49 ,$0.51 ,$0.51 ,$0.50 ,$0.49 ,$0.49 ,$0.49 ,$0.44 ,$0.52
Carle Richland Memorial Hospital,8140054,PAD ABDOMINAL SURGIPAD 8X7-1/2 ST,440,,270,$0.58 ,$0.58 ,$0.44 ,$0.52 ,$0.49 ,$0.49 ,$0.49 ,$0.51 ,$0.49 ,$0.51 ,$0.51 ,$0.50 ,$0.49 ,$0.49 ,$0.49 ,$0.44 ,$0.52
Carle Richland Memorial Hospital,8140054,DRESSING ADAPTIC 3 X 3 NON-ADHERI,157,,270,$0.73 ,$0.73 ,$0.56 ,$0.66 ,$0.62 ,$0.62 ,$0.62 ,$0.64 ,$0.62 ,$0.64 ,$0.64 ,$0.64 ,$0.62 ,$0.62 ,$0.62 ,$0.56 ,$0.66
Carle Richland Memorial Hospital,8140054,NEEDLE FILTER 19G X 1.5IN,243,,270,$0.73 ,$0.73 ,$0.56 ,$0.66 ,$0.62 ,$0.62 ,$0.62 ,$0.64 ,$0.62 ,$0.64 ,$0.64 ,$0.64 ,$0.62 ,$0.62 ,$0.62 ,$0.56 ,$0.66
Carle Richland Memorial Hospital,8140054,SYRINGE 20ML LL 48/BX,457,,270,$0.73 ,$0.73 ,$0.56 ,$0.66 ,$0.62 ,$0.62 ,$0.62 ,$0.64 ,$0.62 ,$0.64 ,$0.64 ,$0.64 ,$0.62 ,$0.62 ,$0.62 ,$0.56 ,$0.66
Carle Richland Memorial Hospital,8140054,NEEDLE FILTER 5MM 20GA X 1 1/2,232160,,270,$0.74 ,$0.74 ,$0.57 ,$0.67 ,$0.63 ,$0.63 ,$0.63 ,$0.65 ,$0.63 ,$0.65 ,$0.65 ,$0.64 ,$0.63 ,$0.63 ,$0.63 ,$0.57 ,$0.67
Carle Richland Memorial Hospital,8140054,CUP MEDICINE 2OZ,829,,270,$0.86 ,$0.86 ,$0.66 ,$0.77 ,$0.73 ,$0.73 ,$0.73 ,$0.76 ,$0.73 ,$0.76 ,$0.76 ,$0.75 ,$0.73 ,$0.73 ,$0.73 ,$0.66 ,$0.77
Carle Richland Memorial Hospital,8140054,BANDAGE CONFORM 2IN STRETCH GAUZE,826,,270,$0.89 ,$0.89 ,$0.68 ,$0.80 ,$0.76 ,$0.76 ,$0.76 ,$0.78 ,$0.76 ,$0.78 ,$0.78 ,$0.77 ,$0.76 ,$0.76 ,$0.76 ,$0.68 ,$0.80
Carle Richland Memorial Hospital,8140054,CONTAINER URINE SPECIMEN NONST NO,9419,,270,$0.89 ,$0.89 ,$0.68 ,$0.80 ,$0.76 ,$0.76 ,$0.76 ,$0.78 ,$0.76 ,$0.78 ,$0.78 ,$0.77 ,$0.76 ,$0.76 ,$0.76 ,$0.68 ,$0.80
Carle Richland Memorial Hospital,8140054,CONTAINER SPECIMEN 4OZ STERILE,232186,,270,$0.91 ,$0.91 ,$0.70 ,$0.82 ,$0.77 ,$0.77 ,$0.77 ,$0.80 ,$0.77 ,$0.80 ,$0.80 ,$0.79 ,$0.77 ,$0.77 ,$0.77 ,$0.70 ,$0.82
Carle Richland Memorial Hospital,8140054,SYRINGE 10ML NACL FLUSH 30/BX PRE,9991,,270,$0.91 ,$0.91 ,$0.70 ,$0.82 ,$0.77 ,$0.77 ,$0.77 ,$0.80 ,$0.77 ,$0.80 ,$0.80 ,$0.79 ,$0.77 ,$0.77 ,$0.77 ,$0.70 ,$0.82
Carle Richland Memorial Hospital,8140054,NEEDLE SAFETY 22GA X 1 1/2IN,232159,,270,$0.92 ,$0.92 ,$0.70 ,$0.83 ,$0.78 ,$0.78 ,$0.78 ,$0.81 ,$0.78 ,$0.81 ,$0.81 ,$0.80 ,$0.78 ,$0.78 ,$0.78 ,$0.70 ,$0.83
Carle Richland Memorial Hospital,8140054,NEEDLE SAFETY 18GX1.5IN 50/BX,232247,,270,$0.92 ,$0.92 ,$0.70 ,$0.83 ,$0.78 ,$0.78 ,$0.78 ,$0.81 ,$0.78 ,$0.81 ,$0.81 ,$0.80 ,$0.78 ,$0.78 ,$0.78 ,$0.70 ,$0.83
Carle Richland Memorial Hospital,8140054,NEEDLE SAFETY 25GAX5/8IN SAGL SAF,232249,,270,$0.92 ,$0.92 ,$0.70 ,$0.83 ,$0.78 ,$0.78 ,$0.78 ,$0.81 ,$0.78 ,$0.81 ,$0.81 ,$0.80 ,$0.78 ,$0.78 ,$0.78 ,$0.70 ,$0.83
Carle Richland Memorial Hospital,8140054,DRESSING OPSITE FLEXIGRID 2X3,232125,,270,$0.94 ,$0.94 ,$0.72 ,$0.85 ,$0.80 ,$0.80 ,$0.80 ,$0.83 ,$0.80 ,$0.83 ,$0.83 ,$0.82 ,$0.80 ,$0.80 ,$0.80 ,$0.72 ,$0.85
Carle Richland Memorial Hospital,8140054,OSTOMY ESTEEM ONE PC SYSTEM,234427,,270,$0.95 ,$0.95 ,$0.73 ,$0.86 ,$0.81 ,$0.81 ,$0.81 ,$0.84 ,$0.81 ,$0.84 ,$0.84 ,$0.83 ,$0.81 ,$0.81 ,$0.81 ,$0.73 ,$0.86
Carle Richland Memorial Hospital,8140054,BANDAGE CONFORM STRETCH 3 STRL,206586,,270,$0.96 ,$0.96 ,$0.73 ,$0.86 ,$0.82 ,$0.82 ,$0.82 ,$0.84 ,$0.82 ,$0.84 ,$0.84 ,$0.84 ,$0.82 ,$0.82 ,$0.82 ,$0.73 ,$0.86
Carle Richland Memorial Hospital,8140054,CONTAINER SPECIMEN URINE N-STR,232188,,270,$0.98 ,$0.98 ,$0.75 ,$0.88 ,$0.83 ,$0.83 ,$0.83 ,$0.86 ,$0.83 ,$0.86 ,$0.86 ,$0.85 ,$0.83 ,$0.83 ,$0.83 ,$0.75 ,$0.88
Carle Richland Memorial Hospital,8140054,PAD ABD STL LF 8X10IN,244106,,270,$0.99 ,$0.99 ,$0.76 ,$0.89 ,$0.84 ,$0.84 ,$0.84 ,$0.87 ,$0.84 ,$0.87 ,$0.87 ,$0.86 ,$0.84 ,$0.84 ,$0.84 ,$0.76 ,$0.89
Carle Richland Memorial Hospital,8140054,CATH SUCTION W/CONTROL 14FR,232142,,270,$1.02 ,$1.02 ,$0.78 ,$0.92 ,$0.87 ,$0.87 ,$0.87 ,$0.90 ,$0.87 ,$0.90 ,$0.90 ,$0.89 ,$0.87 ,$0.87 ,$0.87 ,$0.78 ,$0.92
Carle Richland Memorial Hospital,8140054,WIPE BARRIER NO STING SKINPREP,232122,,270,$1.03 ,$1.03 ,$0.79 ,$0.93 ,$0.88 ,$0.88 ,$0.88 ,$0.91 ,$0.88 ,$0.91 ,$0.91 ,$0.90 ,$0.88 ,$0.88 ,$0.88 ,$0.79 ,$0.93
Carle Richland Memorial Hospital,8140054,CATH SUCTION TRI FLO 10FR,232141,,270,$1.05 ,$1.05 ,$0.80 ,$0.95 ,$0.89 ,$0.89 ,$0.89 ,$0.92 ,$0.89 ,$0.92 ,$0.92 ,$0.91 ,$0.89 ,$0.89 ,$0.89 ,$0.80 ,$0.95
Carle Richland Memorial Hospital,8140054,BANDAGE CONFORM 4IN STRETCH GAUZE,827,,270,$1.06 ,$1.06 ,$0.81 ,$0.95 ,$0.90 ,$0.90 ,$0.90 ,$0.93 ,$0.90 ,$0.93 ,$0.93 ,$0.92 ,$0.90 ,$0.90 ,$0.90 ,$0.81 ,$0.95
Carle Richland Memorial Hospital,8140054,BLADE ONLY SCALPEL #10 DISPOSABLE,58,,270,$1.12 ,$1.12 ,$0.86 ,$1.01 ,$0.95 ,$0.95 ,$0.95 ,$0.99 ,$0.95 ,$0.99 ,$0.99 ,$0.97 ,$0.95 ,$0.95 ,$0.95 ,$0.86 ,$1.01
Carle Richland Memorial Hospital,8140054,CATH SUCTION TRI FLO 18FR,232140,,270,$1.18 ,$1.18 ,$0.90 ,$1.06 ,$1.00 ,$1.00 ,$1.00 ,$1.04 ,$1.00 ,$1.04 ,$1.04 ,$1.03 ,$1.00 ,$1.00 ,$1.00 ,$0.90 ,$1.06
Carle Richland Memorial Hospital,8140054,DRESSING ADAPTIC 3X3,232227,,270,$1.20 ,$1.20 ,$0.92 ,$1.08 ,$1.02 ,$1.02 ,$1.02 ,$1.06 ,$1.02 ,$1.06 ,$1.06 ,$1.04 ,$1.02 ,$1.02 ,$1.02 ,$0.92 ,$1.08
Carle Richland Memorial Hospital,8140054,CLEANER TIPOLISHER,812,,270,$1.22 ,$1.22 ,$0.93 ,$1.10 ,$1.04 ,$1.04 ,$1.04 ,$1.07 ,$1.04 ,$1.07 ,$1.07 ,$1.06 ,$1.04 ,$1.04 ,$1.04 ,$0.93 ,$1.10
Carle Richland Memorial Hospital,8140054,TUBE YANKAUER 34FR ARGYLE SX,230087,,270,$1.25 ,$1.25 ,$0.96 ,$1.13 ,$1.06 ,$1.06 ,$1.06 ,$1.10 ,$1.06 ,$1.10 ,$1.10 ,$1.09 ,$1.06 ,$1.06 ,$1.06 ,$0.96 ,$1.13
Carle Richland Memorial Hospital,8140054,BLADE ONLY SURGICAL #10 STRL BARD,234723,,270,$1.28 ,$1.28 ,$0.98 ,$1.15 ,$1.09 ,$1.09 ,$1.09 ,$1.13 ,$1.09 ,$1.13 ,$1.13 ,$1.11 ,$1.09 ,$1.09 ,$1.09 ,$0.98 ,$1.15
Carle Richland Memorial Hospital,8140054,BLADE ONLY SURGICAL #11 STRL BARD,234724,,270,$1.28 ,$1.28 ,$0.98 ,$1.15 ,$1.09 ,$1.09 ,$1.09 ,$1.13 ,$1.09 ,$1.13 ,$1.13 ,$1.11 ,$1.09 ,$1.09 ,$1.09 ,$0.98 ,$1.15
Carle Richland Memorial Hospital,8140054,BLADE ONLY SURGICAL #15 STRL BARD,234726,,270,$1.28 ,$1.28 ,$0.98 ,$1.15 ,$1.09 ,$1.09 ,$1.09 ,$1.13 ,$1.09 ,$1.13 ,$1.13 ,$1.11 ,$1.09 ,$1.09 ,$1.09 ,$0.98 ,$1.15
Carle Richland Memorial Hospital,8140054,BLADE ONLY SURGICAL #20 STRL BARD,234727,,270,$1.28 ,$1.28 ,$0.98 ,$1.15 ,$1.09 ,$1.09 ,$1.09 ,$1.13 ,$1.09 ,$1.13 ,$1.13 ,$1.11 ,$1.09 ,$1.09 ,$1.09 ,$0.98 ,$1.15
Carle Richland Memorial Hospital,8140054,SYRINGE CATHETER TIP 50ML,463,,270,$1.29 ,$1.29 ,$0.99 ,$1.16 ,$1.10 ,$1.10 ,$1.10 ,$1.14 ,$1.10 ,$1.14 ,$1.14 ,$1.12 ,$1.10 ,$1.10 ,$1.10 ,$0.99 ,$1.16
Carle Richland Memorial Hospital,8140054,DRESSING XEROFORM 1 X 8,163,,270,$1.31 ,$1.31 ,$1.00 ,$1.18 ,$1.11 ,$1.11 ,$1.11 ,$1.15 ,$1.11 ,$1.15 ,$1.15 ,$1.14 ,$1.11 ,$1.11 ,$1.11 ,$1.00 ,$1.18
Carle Richland Memorial Hospital,8140054,SYRINGE 50ML LL 40/BX,462,,270,$1.32 ,$1.32 ,$1.01 ,$1.19 ,$1.12 ,$1.12 ,$1.12 ,$1.16 ,$1.12 ,$1.16 ,$1.16 ,$1.15 ,$1.12 ,$1.12 ,$1.12 ,$1.01 ,$1.19
Carle Richland Memorial Hospital,8140054,BANDAGE ACE 2IN NS VELCRO,51,,270,$1.34 ,$1.34 ,$1.02 ,$1.21 ,$1.14 ,$1.14 ,$1.14 ,$1.18 ,$1.14 ,$1.18 ,$1.18 ,$1.17 ,$1.14 ,$1.14 ,$1.14 ,$1.02 ,$1.21
Carle Richland Memorial Hospital,8140054,TOWELS OR /6 PK ASC/RICH,11243,,270,$1.36 ,$1.36 ,$1.04 ,$1.22 ,$1.16 ,$1.16 ,$1.16 ,$1.20 ,$1.16 ,$1.20 ,$1.20 ,$1.18 ,$1.16 ,$1.16 ,$1.16 ,$1.04 ,$1.22
Carle Richland Memorial Hospital,8140054,DRESSING PETROLEUM GAUZE 3X9,9506,,270,$1.37 ,$1.37 ,$1.05 ,$1.23 ,$1.16 ,$1.16 ,$1.16 ,$1.21 ,$1.16 ,$1.21 ,$1.21 ,$1.19 ,$1.16 ,$1.16 ,$1.16 ,$1.05 ,$1.23
Carle Richland Memorial Hospital,8140054,CATH PLUG DRAIN TUBE PROTECT,234295,,270,$1.42 ,$1.42 ,$1.08 ,$1.28 ,$1.21 ,$1.21 ,$1.21 ,$1.25 ,$1.21 ,$1.25 ,$1.25 ,$1.24 ,$1.21 ,$1.21 ,$1.21 ,$1.08 ,$1.28
Carle Richland Memorial Hospital,8140054,CATHER URETHRAL 16FR ALL PRPS RIC,229715,,270,$1.50 ,$1.50 ,$1.15 ,$1.35 ,$1.28 ,$1.28 ,$1.28 ,$1.32 ,$1.28 ,$1.32 ,$1.32 ,$1.31 ,$1.28 ,$1.28 ,$1.28 ,$1.15 ,$1.35
Carle Richland Memorial Hospital,8140054,CATHETER URETHRL 16FR ALL PRPS LA,230085,,270,$1.50 ,$1.50 ,$1.15 ,$1.35 ,$1.28 ,$1.28 ,$1.28 ,$1.32 ,$1.28 ,$1.32 ,$1.32 ,$1.31 ,$1.28 ,$1.28 ,$1.28 ,$1.15 ,$1.35
Carle Richland Memorial Hospital,8140054,CATH URETHRAL ALL PURPOSE 14FR,232133,,270,$1.50 ,$1.50 ,$1.15 ,$1.35 ,$1.28 ,$1.28 ,$1.28 ,$1.32 ,$1.28 ,$1.32 ,$1.32 ,$1.31 ,$1.28 ,$1.28 ,$1.28 ,$1.15 ,$1.35
Carle Richland Memorial Hospital,8140054,CATHETER STRAIGHT 8FR LATEX,232218,,270,$1.50 ,$1.50 ,$1.15 ,$1.35 ,$1.28 ,$1.28 ,$1.28 ,$1.32 ,$1.28 ,$1.32 ,$1.32 ,$1.31 ,$1.28 ,$1.28 ,$1.28 ,$1.15 ,$1.35
Carle Richland Memorial Hospital,8140054,SYRINGE BULB 2 OZ,452,,270,$1.50 ,$1.50 ,$1.15 ,$1.35 ,$1.28 ,$1.28 ,$1.28 ,$1.32 ,$1.28 ,$1.32 ,$1.32 ,$1.31 ,$1.28 ,$1.28 ,$1.28 ,$1.15 ,$1.35
Carle Richland Memorial Hospital,8140054,SPONGE GAUZE 4 X 4 TRAY 8-PLY,411,,270,$1.63 ,$1.63 ,$1.25 ,$1.47 ,$1.39 ,$1.39 ,$1.39 ,$1.43 ,$1.39 ,$1.43 ,$1.43 ,$1.42 ,$1.39 ,$1.39 ,$1.39 ,$1.25 ,$1.47
Carle Richland Memorial Hospital,8140054,BANDAGE ACE 3IN NS VELCRO,52,,270,$1.66 ,$1.66 ,$1.27 ,$1.49 ,$1.41 ,$1.41 ,$1.41 ,$1.46 ,$1.41 ,$1.46 ,$1.46 ,$1.44 ,$1.41 ,$1.41 ,$1.41 ,$1.27 ,$1.49
Carle Richland Memorial Hospital,8140054,PADDING CAST 3IN 12/PK,55842,,270,$1.66 ,$1.66 ,$1.27 ,$1.49 ,$1.41 ,$1.41 ,$1.41 ,$1.46 ,$1.41 ,$1.46 ,$1.46 ,$1.44 ,$1.41 ,$1.41 ,$1.41 ,$1.27 ,$1.49
Carle Richland Memorial Hospital,8140054,MARKER SKIN W/RULER,229,,270,$1.70 ,$1.70 ,$1.30 ,$1.53 ,$1.45 ,$1.45 ,$1.45 ,$1.50 ,$1.45 ,$1.50 ,$1.50 ,$1.48 ,$1.45 ,$1.45 ,$1.45 ,$1.30 ,$1.53
Carle Richland Memorial Hospital,8140054,MARKER PEN STRL SURGICAL,232155,,270,$1.71 ,$1.71 ,$1.31 ,$1.54 ,$1.45 ,$1.45 ,$1.45 ,$1.50 ,$1.45 ,$1.50 ,$1.50 ,$1.49 ,$1.45 ,$1.45 ,$1.45 ,$1.31 ,$1.54
Carle Richland Memorial Hospital,8140054,DRESSING ADAPTIC 3 X 8 NON-ADHERI,158,,270,$1.77 ,$1.77 ,$1.35 ,$1.59 ,$1.50 ,$1.50 ,$1.50 ,$1.56 ,$1.50 ,$1.56 ,$1.56 ,$1.54 ,$1.50 ,$1.50 ,$1.50 ,$1.35 ,$1.59
Carle Richland Memorial Hospital,8140054,SPONGE WECK CEL SURGICAL SPEAR,233248,,270,$1.80 ,$1.80 ,$1.38 ,$1.62 ,$1.53 ,$1.53 ,$1.53 ,$1.58 ,$1.53 ,$1.58 ,$1.58 ,$1.57 ,$1.53 ,$1.53 ,$1.53 ,$1.38 ,$1.62
Carle Richland Memorial Hospital,8140054,DRESSING XEROFORM 5 X 9,232091,,270,$1.81 ,$1.81 ,$1.38 ,$1.63 ,$1.54 ,$1.54 ,$1.54 ,$1.59 ,$1.54 ,$1.59 ,$1.59 ,$1.57 ,$1.54 ,$1.54 ,$1.54 ,$1.38 ,$1.63
Carle Richland Memorial Hospital,8140054,DRESSING PETROLEUM GAUZE 1X8IN,184,,270,$1.82 ,$1.82 ,$1.39 ,$1.64 ,$1.55 ,$1.55 ,$1.55 ,$1.60 ,$1.55 ,$1.60 ,$1.60 ,$1.58 ,$1.55 ,$1.55 ,$1.55 ,$1.39 ,$1.64
Carle Richland Memorial Hospital,8140054,TUBING CONNECTING 6FT ARGYLE STER,232173,,270,$1.85 ,$1.85 ,$1.41 ,$1.67 ,$1.57 ,$1.57 ,$1.57 ,$1.63 ,$1.57 ,$1.63 ,$1.63 ,$1.61 ,$1.57 ,$1.57 ,$1.57 ,$1.41 ,$1.67
Carle Richland Memorial Hospital,8140054,DRESSING BIOCLUSIVE 2X3,232223,,270,$1.87 ,$1.87 ,$1.43 ,$1.68 ,$1.59 ,$1.59 ,$1.59 ,$1.65 ,$1.59 ,$1.65 ,$1.65 ,$1.63 ,$1.59 ,$1.59 ,$1.59 ,$1.43 ,$1.68
Carle Richland Memorial Hospital,8140054,COVER PIN WHITE 0.45,231074,,270,$1.98 ,$1.98 ,$1.51 ,$1.78 ,$1.68 ,$1.68 ,$1.68 ,$1.74 ,$1.68 ,$1.74 ,$1.74 ,$1.72 ,$1.68 ,$1.68 ,$1.68 ,$1.51 ,$1.78
Carle Richland Memorial Hospital,8140054,COVER PIN GREEN 0.62,231075,,270,$1.98 ,$1.98 ,$1.51 ,$1.78 ,$1.68 ,$1.68 ,$1.68 ,$1.74 ,$1.68 ,$1.74 ,$1.74 ,$1.72 ,$1.68 ,$1.68 ,$1.68 ,$1.51 ,$1.78
Carle Richland Memorial Hospital,8140054,CONTAINER SPECIMEN STERILE CLIKSE,133,,270,$2.02 ,$2.02 ,$1.54 ,$1.82 ,$1.72 ,$1.72 ,$1.72 ,$1.78 ,$1.72 ,$1.78 ,$1.78 ,$1.76 ,$1.72 ,$1.72 ,$1.72 ,$1.54 ,$1.82
Carle Richland Memorial Hospital,8140054,SPONGE KERLIX FLUFF 6 X 6,414,,270,$2.04 ,$2.04 ,$1.56 ,$1.84 ,$1.73 ,$1.73 ,$1.73 ,$1.80 ,$1.73 ,$1.80 ,$1.80 ,$1.77 ,$1.73 ,$1.73 ,$1.73 ,$1.56 ,$1.84
Carle Richland Memorial Hospital,8140054,BANDAGE ACE 4IN NS VELCRO,53,,270,$2.16 ,$2.16 ,$1.65 ,$1.94 ,$1.84 ,$1.84 ,$1.84 ,$1.90 ,$1.84 ,$1.90 ,$1.90 ,$1.88 ,$1.84 ,$1.84 ,$1.84 ,$1.65 ,$1.94
Carle Richland Memorial Hospital,8140054,SPONGE RAY-TEC 4 X 4 10 TRAY,417,,270,$2.18 ,$2.18 ,$1.67 ,$1.96 ,$1.85 ,$1.85 ,$1.85 ,$1.92 ,$1.85 ,$1.92 ,$1.92 ,$1.90 ,$1.85 ,$1.85 ,$1.85 ,$1.67 ,$1.96
Carle Richland Memorial Hospital,8140054,CONTAINER SPECIMEN 32OZ,232162,,270,$2.21 ,$2.21 ,$1.69 ,$1.99 ,$1.88 ,$1.88 ,$1.88 ,$1.94 ,$1.88 ,$1.94 ,$1.94 ,$1.92 ,$1.88 ,$1.88 ,$1.88 ,$1.69 ,$1.99
Carle Richland Memorial Hospital,8140054,STERISTRIP 0.25IN X 3IN,232089,,270,$2.22 ,$2.22 ,$1.70 ,$2.00 ,$1.89 ,$1.89 ,$1.89 ,$1.95 ,$1.89 ,$1.95 ,$1.95 ,$1.93 ,$1.89 ,$1.89 ,$1.89 ,$1.70 ,$2.00
Carle Richland Memorial Hospital,8140054,STERISTRIP 1/8IN X 3IN,9777,,270,$2.22 ,$2.22 ,$1.70 ,$2.00 ,$1.89 ,$1.89 ,$1.89 ,$1.95 ,$1.89 ,$1.95 ,$1.95 ,$1.93 ,$1.89 ,$1.89 ,$1.89 ,$1.70 ,$2.00
Carle Richland Memorial Hospital,8140054,SWAB CULTURE DUAL RED CAP APPLICA,10386,,270,$2.27 ,$2.27 ,$1.73 ,$2.04 ,$1.93 ,$1.93 ,$1.93 ,$2.00 ,$1.93 ,$2.00 ,$2.00 ,$1.97 ,$1.93 ,$1.93 ,$1.93 ,$1.73 ,$2.04
Carle Richland Memorial Hospital,8140054,DRAPE TOWEL ADHESIVE,1057,,270,$2.27 ,$2.27 ,$1.73 ,$2.04 ,$1.93 ,$1.93 ,$1.93 ,$2.00 ,$1.93 ,$2.00 ,$2.00 ,$1.97 ,$1.93 ,$1.93 ,$1.93 ,$1.73 ,$2.04
Carle Richland Memorial Hospital,8140054,STERISTRIP 1/4IN X 1-1/2IN,79877,,270,$2.30 ,$2.30 ,$1.76 ,$2.07 ,$1.96 ,$1.96 ,$1.96 ,$2.02 ,$1.96 ,$2.02 ,$2.02 ,$2.00 ,$1.96 ,$1.96 ,$1.96 ,$1.76 ,$2.07
Carle Richland Memorial Hospital,8140054,PADDING CAST 4IN 12/PK,311,,270,$2.39 ,$2.39 ,$1.83 ,$2.15 ,$2.03 ,$2.03 ,$2.03 ,$2.10 ,$2.03 ,$2.10 ,$2.10 ,$2.08 ,$2.03 ,$2.03 ,$2.03 ,$1.83 ,$2.15
Carle Richland Memorial Hospital,8140054,TUBE STOMACH LEVIN 16FR,230086,,270,$2.42 ,$2.42 ,$1.85 ,$2.18 ,$2.06 ,$2.06 ,$2.06 ,$2.13 ,$2.06 ,$2.13 ,$2.13 ,$2.11 ,$2.06 ,$2.06 ,$2.06 ,$1.85 ,$2.18
Carle Richland Memorial Hospital,8140054,PADDING CAST WEBRIL 2IN 24/PK UND,55844,,270,$2.42 ,$2.42 ,$1.85 ,$2.18 ,$2.06 ,$2.06 ,$2.06 ,$2.13 ,$2.06 ,$2.13 ,$2.13 ,$2.11 ,$2.06 ,$2.06 ,$2.06 ,$1.85 ,$2.18
Carle Richland Memorial Hospital,8140054,STOPCOCK 3WAY,232177,,270,$2.43 ,$2.43 ,$1.86 ,$2.19 ,$2.07 ,$2.07 ,$2.07 ,$2.14 ,$2.07 ,$2.14 ,$2.14 ,$2.11 ,$2.07 ,$2.07 ,$2.07 ,$1.86 ,$2.19
Carle Richland Memorial Hospital,8140054,STERIDRAPE SMALL TOWEL 17 X 11 40,419,,270,$2.48 ,$2.48 ,$1.89 ,$2.23 ,$2.11 ,$2.11 ,$2.11 ,$2.18 ,$2.11 ,$2.18 ,$2.18 ,$2.16 ,$2.11 ,$2.11 ,$2.11 ,$1.89 ,$2.23
Carle Richland Memorial Hospital,8140054,GAUZE ROLL KERLIX 4.5IN 100 ROLLS,220,,270,$2.55 ,$2.55 ,$1.95 ,$2.30 ,$2.17 ,$2.17 ,$2.17 ,$2.24 ,$2.17 ,$2.24 ,$2.24 ,$2.22 ,$2.17 ,$2.17 ,$2.17 ,$1.95 ,$2.30
Carle Richland Memorial Hospital,8140054,SYRINGE BULB 60CC,232187,,270,$2.61 ,$2.61 ,$1.99 ,$2.35 ,$2.22 ,$2.22 ,$2.22 ,$2.30 ,$2.22 ,$2.30 ,$2.30 ,$2.27 ,$2.22 ,$2.22 ,$2.22 ,$1.99 ,$2.35
Carle Richland Memorial Hospital,8140054,PAD PREPPING,232574,,270,$2.79 ,$2.79 ,$2.13 ,$2.51 ,$2.37 ,$2.37 ,$2.37 ,$2.46 ,$2.37 ,$2.46 ,$2.46 ,$2.43 ,$2.37 ,$2.37 ,$2.37 ,$2.13 ,$2.51
Carle Richland Memorial Hospital,8140054,SYRINGE BULB IRRIGATION 60CC,453,,270,$2.80 ,$2.80 ,$2.14 ,$2.52 ,$2.38 ,$2.38 ,$2.38 ,$2.46 ,$2.38 ,$2.46 ,$2.46 ,$2.44 ,$2.38 ,$2.38 ,$2.38 ,$2.14 ,$2.52
Carle Richland Memorial Hospital,8140054,SLEEVE CONVERTER STERILE,977,,270,$2.81 ,$2.81 ,$2.15 ,$2.53 ,$2.39 ,$2.39 ,$2.39 ,$2.47 ,$2.39 ,$2.47 ,$2.47 ,$2.44 ,$2.39 ,$2.39 ,$2.39 ,$2.15 ,$2.53
Carle Richland Memorial Hospital,8140054,CATH TRAY IRRIGATION,233183,,270,$2.85 ,$2.85 ,$2.18 ,$2.57 ,$2.42 ,$2.42 ,$2.42 ,$2.51 ,$2.42 ,$2.51 ,$2.51 ,$2.48 ,$2.42 ,$2.42 ,$2.42 ,$2.18 ,$2.57
Carle Richland Memorial Hospital,8140054,BINDER ABDOM LRG 46-62IN X 9IN,56,,270,$2.86 ,$2.86 ,$2.19 ,$2.57 ,$2.43 ,$2.43 ,$2.43 ,$2.52 ,$2.43 ,$2.52 ,$2.52 ,$2.49 ,$2.43 ,$2.43 ,$2.43 ,$2.19 ,$2.57
Carle Richland Memorial Hospital,8140054,OSTOMY EAKIN COHESIVE SEAL,234425,,270,$2.87 ,$2.87 ,$2.19 ,$2.58 ,$2.44 ,$2.44 ,$2.44 ,$2.53 ,$2.44 ,$2.53 ,$2.53 ,$2.50 ,$2.44 ,$2.44 ,$2.44 ,$2.19 ,$2.58
Carle Richland Memorial Hospital,8140054,CATH ROBINSON 12FR RED RUBBER STE,96,,270,$2.89 ,$2.89 ,$2.21 ,$2.60 ,$2.46 ,$2.46 ,$2.46 ,$2.54 ,$2.46 ,$2.54 ,$2.54 ,$2.51 ,$2.46 ,$2.46 ,$2.46 ,$2.21 ,$2.60
Carle Richland Memorial Hospital,8140054,CATH ROBINSON 14FR RED RUBBER STE,97,,270,$2.89 ,$2.89 ,$2.21 ,$2.60 ,$2.46 ,$2.46 ,$2.46 ,$2.54 ,$2.46 ,$2.54 ,$2.54 ,$2.51 ,$2.46 ,$2.46 ,$2.46 ,$2.21 ,$2.60
Carle Richland Memorial Hospital,8140054,BOWL UTILITY 32OZ STERILE,218258,,270,$2.93 ,$2.93 ,$2.24 ,$2.64 ,$2.49 ,$2.49 ,$2.49 ,$2.58 ,$2.49 ,$2.58 ,$2.58 ,$2.55 ,$2.49 ,$2.49 ,$2.49 ,$2.24 ,$2.64
Carle Richland Memorial Hospital,8140054,DECANTER BAG,560,,270,$2.93 ,$2.93 ,$2.24 ,$2.64 ,$2.49 ,$2.49 ,$2.49 ,$2.58 ,$2.49 ,$2.58 ,$2.58 ,$2.55 ,$2.49 ,$2.49 ,$2.49 ,$2.24 ,$2.64
Carle Richland Memorial Hospital,8140054,BANDAGE ACE 6IN NS VELCRO,54,,270,$3.16 ,$3.16 ,$2.41 ,$2.84 ,$2.69 ,$2.69 ,$2.69 ,$2.78 ,$2.69 ,$2.78 ,$2.78 ,$2.75 ,$2.69 ,$2.69 ,$2.69 ,$2.41 ,$2.84
Carle Richland Memorial Hospital,8140054,DRESSING XEROFORM 5 X 9,164,,270,$3.19 ,$3.19 ,$2.44 ,$2.87 ,$2.71 ,$2.71 ,$2.71 ,$2.81 ,$2.71 ,$2.81 ,$2.81 ,$2.78 ,$2.71 ,$2.71 ,$2.71 ,$2.44 ,$2.87
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN BORDER 3X3,232103,,270,$3.22 ,$3.22 ,$2.46 ,$2.90 ,$2.74 ,$2.74 ,$2.74 ,$2.83 ,$2.74 ,$2.83 ,$2.83 ,$2.80 ,$2.74 ,$2.74 ,$2.74 ,$2.46 ,$2.90
Carle Richland Memorial Hospital,8140054,PADDING CAST WEBRIL 3IN 12/PK UND,55845,,270,$3.30 ,$3.30 ,$2.52 ,$2.97 ,$2.81 ,$2.81 ,$2.81 ,$2.90 ,$2.81 ,$2.90 ,$2.90 ,$2.87 ,$2.81 ,$2.81 ,$2.81 ,$2.52 ,$2.97
Carle Richland Memorial Hospital,8140054,PADDING CAST 6IN 6/PK,55843,,270,$3.33 ,$3.33 ,$2.54 ,$3.00 ,$2.83 ,$2.83 ,$2.83 ,$2.93 ,$2.83 ,$2.93 ,$2.93 ,$2.90 ,$2.83 ,$2.83 ,$2.83 ,$2.54 ,$3.00
Carle Richland Memorial Hospital,8140054,BANDAGE ACE 4IN STERILE,581,,270,$3.35 ,$3.35 ,$2.56 ,$3.02 ,$2.85 ,$2.85 ,$2.85 ,$2.95 ,$2.85 ,$2.95 ,$2.95 ,$2.91 ,$2.85 ,$2.85 ,$2.85 ,$2.56 ,$3.02
Carle Richland Memorial Hospital,8140054,SPONGE PEANUT XRAY DETECT 3/8,234750,,270,$3.36 ,$3.36 ,$2.57 ,$3.02 ,$2.86 ,$2.86 ,$2.86 ,$2.96 ,$2.86 ,$2.96 ,$2.96 ,$2.92 ,$2.86 ,$2.86 ,$2.86 ,$2.57 ,$3.02
Carle Richland Memorial Hospital,8140054,COVER MAYO STAND,137,,270,$3.37 ,$3.37 ,$2.57 ,$3.03 ,$2.86 ,$2.86 ,$2.86 ,$2.97 ,$2.86 ,$2.97 ,$2.97 ,$2.93 ,$2.86 ,$2.86 ,$2.86 ,$2.57 ,$3.03
Carle Richland Memorial Hospital,8140054,MARKER SKIN FINE TIP,11044,,270,$3.39 ,$3.39 ,$2.59 ,$3.05 ,$2.88 ,$2.88 ,$2.88 ,$2.98 ,$2.88 ,$2.98 ,$2.98 ,$2.95 ,$2.88 ,$2.88 ,$2.88 ,$2.59 ,$3.05
Carle Richland Memorial Hospital,8140054,STERISTRIP 0.5 X 4IN,244088,,270,$3.43 ,$3.43 ,$2.62 ,$3.09 ,$2.92 ,$2.92 ,$2.92 ,$3.02 ,$2.92 ,$3.02 ,$3.02 ,$2.98 ,$2.92 ,$2.92 ,$2.92 ,$2.62 ,$3.09
Carle Richland Memorial Hospital,8140054,STERISTRIP 0.5 X 4IN,422,,270,$3.47 ,$3.47 ,$2.65 ,$3.12 ,$2.95 ,$2.95 ,$2.95 ,$3.05 ,$2.95 ,$3.05 ,$3.05 ,$3.02 ,$2.95 ,$2.95 ,$2.95 ,$2.65 ,$3.12
Carle Richland Memorial Hospital,8140054,STERISTRIP 0.25IN X 4IN,423,,270,$3.47 ,$3.47 ,$2.65 ,$3.12 ,$2.95 ,$2.95 ,$2.95 ,$3.05 ,$2.95 ,$3.05 ,$3.05 ,$3.02 ,$2.95 ,$2.95 ,$2.95 ,$2.65 ,$3.12
Carle Richland Memorial Hospital,8140054,STERIDRAPE LARGE TOWEL 17 X 23,997,,270,$3.59 ,$3.59 ,$2.74 ,$3.23 ,$3.05 ,$3.05 ,$3.05 ,$3.16 ,$3.05 ,$3.16 ,$3.16 ,$3.12 ,$3.05 ,$3.05 ,$3.05 ,$2.74 ,$3.23
Carle Richland Memorial Hospital,8140054,OSTOMY ACCUSEAL POUCH 70MM UROSTO,234429,,270,$3.60 ,$3.60 ,$2.75 ,$3.24 ,$3.06 ,$3.06 ,$3.06 ,$3.17 ,$3.06 ,$3.17 ,$3.17 ,$3.13 ,$3.06 ,$3.06 ,$3.06 ,$2.75 ,$3.24
Carle Richland Memorial Hospital,8140054,SPONGE LAP 18 X 4,416,,270,$3.65 ,$3.65 ,$2.79 ,$3.29 ,$3.10 ,$3.10 ,$3.10 ,$3.21 ,$3.10 ,$3.21 ,$3.21 ,$3.18 ,$3.10 ,$3.10 ,$3.10 ,$2.79 ,$3.29
Carle Richland Memorial Hospital,8140054,TUBING PENROSE 12IN STERILE LATEX,232174,,270,$3.68 ,$3.68 ,$2.81 ,$3.31 ,$3.13 ,$3.13 ,$3.13 ,$3.24 ,$3.13 ,$3.24 ,$3.24 ,$3.20 ,$3.13 ,$3.13 ,$3.13 ,$2.81 ,$3.31
Carle Richland Memorial Hospital,8140054,SET SECONDARY IV PIGGYBACK,343,,270,$3.74 ,$3.74 ,$2.86 ,$3.37 ,$3.18 ,$3.18 ,$3.18 ,$3.29 ,$3.18 ,$3.29 ,$3.29 ,$3.25 ,$3.18 ,$3.18 ,$3.18 ,$2.86 ,$3.37
Carle Richland Memorial Hospital,8140054,DRESSING SUPER SPONGE 6IN,232097,,270,$3.83 ,$3.83 ,$2.93 ,$3.45 ,$3.26 ,$3.26 ,$3.26 ,$3.37 ,$3.26 ,$3.37 ,$3.37 ,$3.33 ,$3.26 ,$3.26 ,$3.26 ,$2.93 ,$3.45
Carle Richland Memorial Hospital,8140054,DRESSING PETROLEUM GAUZE 6X36 VAS,232222,,270,$3.83 ,$3.83 ,$2.93 ,$3.45 ,$3.26 ,$3.26 ,$3.26 ,$3.37 ,$3.26 ,$3.37 ,$3.37 ,$3.33 ,$3.26 ,$3.26 ,$3.26 ,$2.93 ,$3.45
Carle Richland Memorial Hospital,8140054,NEEDLE MAGNETIC COUNTERS DISP,232156,,270,$3.84 ,$3.84 ,$2.93 ,$3.46 ,$3.26 ,$3.26 ,$3.26 ,$3.38 ,$3.26 ,$3.38 ,$3.38 ,$3.34 ,$3.26 ,$3.26 ,$3.26 ,$2.93 ,$3.46
Carle Richland Memorial Hospital,8140054,SPONGE GAUZE 4X4 12PLY STL 10S,244226,,270,$3.88 ,$3.88 ,$2.96 ,$3.49 ,$3.30 ,$3.30 ,$3.30 ,$3.41 ,$3.30 ,$3.41 ,$3.41 ,$3.38 ,$3.30 ,$3.30 ,$3.30 ,$2.96 ,$3.49
Carle Richland Memorial Hospital,8140054,PADDING CAST WEBRIL 4IN 12/PK UND,55846,,270,$3.92 ,$3.92 ,$2.99 ,$3.53 ,$3.33 ,$3.33 ,$3.33 ,$3.45 ,$3.33 ,$3.45 ,$3.45 ,$3.41 ,$3.33 ,$3.33 ,$3.33 ,$2.99 ,$3.53
Carle Richland Memorial Hospital,8140054,TUBING PENROSE 1X18 FLAT LATEX,232175,,270,$3.94 ,$3.94 ,$3.01 ,$3.55 ,$3.35 ,$3.35 ,$3.35 ,$3.47 ,$3.35 ,$3.47 ,$3.47 ,$3.43 ,$3.35 ,$3.35 ,$3.35 ,$3.01 ,$3.55
Carle Richland Memorial Hospital,8140054,OSTOMY STOMAHESIVE 4X4,234424,,270,$4.06 ,$4.06 ,$3.10 ,$3.65 ,$3.45 ,$3.45 ,$3.45 ,$3.57 ,$3.45 ,$3.57 ,$3.57 ,$3.53 ,$3.45 ,$3.45 ,$3.45 ,$3.10 ,$3.65
Carle Richland Memorial Hospital,8140054,DRESSING COVADERM 4X4,232102,,270,$4.10 ,$4.10 ,$3.13 ,$3.69 ,$3.49 ,$3.49 ,$3.49 ,$3.61 ,$3.49 ,$3.61 ,$3.61 ,$3.57 ,$3.49 ,$3.49 ,$3.49 ,$3.13 ,$3.69
Carle Richland Memorial Hospital,8140054,TUBE NG SALEM 10FR 50/CA,233223,,270,$4.11 ,$4.11 ,$3.14 ,$3.70 ,$3.49 ,$3.49 ,$3.49 ,$3.62 ,$3.49 ,$3.62 ,$3.62 ,$3.58 ,$3.49 ,$3.49 ,$3.49 ,$3.14 ,$3.70
Carle Richland Memorial Hospital,8140054,TUBE SUMP SALEM 18FR,234639,,270,$4.11 ,$4.11 ,$3.14 ,$3.70 ,$3.49 ,$3.49 ,$3.49 ,$3.62 ,$3.49 ,$3.62 ,$3.62 ,$3.58 ,$3.49 ,$3.49 ,$3.49 ,$3.14 ,$3.70
Carle Richland Memorial Hospital,8140054,BAG URINARY DRAIN 503ML DOVER,233939,,270,$4.14 ,$4.14 ,$3.16 ,$3.73 ,$3.52 ,$3.52 ,$3.52 ,$3.64 ,$3.52 ,$3.64 ,$3.64 ,$3.60 ,$3.52 ,$3.52 ,$3.52 ,$3.16 ,$3.73
Carle Richland Memorial Hospital,8140054,BITEBLOCK 100/BX,9364,,270,$4.28 ,$4.28 ,$3.27 ,$3.85 ,$3.64 ,$3.64 ,$3.64 ,$3.77 ,$3.64 ,$3.77 ,$3.77 ,$3.72 ,$3.64 ,$3.64 ,$3.64 ,$3.27 ,$3.85
Carle Richland Memorial Hospital,8140054,BALL COTTON STERILE 5PK,757,,270,$4.37 ,$4.37 ,$3.34 ,$3.93 ,$3.71 ,$3.71 ,$3.71 ,$3.85 ,$3.71 ,$3.85 ,$3.85 ,$3.80 ,$3.71 ,$3.71 ,$3.71 ,$3.34 ,$3.93
Carle Richland Memorial Hospital,8140054,SOCK SPECIMEN MEDIVAC 9IN STANDAR,226213,,270,$4.44 ,$4.44 ,$3.39 ,$4.00 ,$3.77 ,$3.77 ,$3.77 ,$3.91 ,$3.77 ,$3.91 ,$3.91 ,$3.86 ,$3.77 ,$3.77 ,$3.77 ,$3.39 ,$4.00
Carle Richland Memorial Hospital,8140054,DRESSING IV TEGADERM 4X6,170,,270,$4.57 ,$4.57 ,$3.49 ,$4.11 ,$3.88 ,$3.88 ,$3.88 ,$4.02 ,$3.88 ,$4.02 ,$4.02 ,$3.98 ,$3.88 ,$3.88 ,$3.88 ,$3.49 ,$4.11
Carle Richland Memorial Hospital,8140054,DRESSING ADAPTIC 3X8,232098,,270,$4.59 ,$4.59 ,$3.51 ,$4.13 ,$3.90 ,$3.90 ,$3.90 ,$4.04 ,$3.90 ,$4.04 ,$4.04 ,$3.99 ,$3.90 ,$3.90 ,$3.90 ,$3.51 ,$4.13
Carle Richland Memorial Hospital,8140054,CANISTER SUCTION 1500CC,69,,270,$4.61 ,$4.61 ,$3.52 ,$4.15 ,$3.92 ,$3.92 ,$3.92 ,$4.06 ,$3.92 ,$4.06 ,$4.06 ,$4.01 ,$3.92 ,$3.92 ,$3.92 ,$3.52 ,$4.15
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM 4X24 NON ADH,230091,,270,$4.65 ,$4.65 ,$3.55 ,$4.19 ,$3.95 ,$3.95 ,$3.95 ,$4.09 ,$3.95 ,$4.09 ,$4.09 ,$4.05 ,$3.95 ,$3.95 ,$3.95 ,$3.55 ,$4.19
Carle Richland Memorial Hospital,8140054,HANDLE LIGHT SLEEVE BLUE STRL,232157,,270,$4.92 ,$4.92 ,$3.76 ,$4.43 ,$4.18 ,$4.18 ,$4.18 ,$4.33 ,$4.18 ,$4.33 ,$4.33 ,$4.28 ,$4.18 ,$4.18 ,$4.18 ,$3.76 ,$4.43
Carle Richland Memorial Hospital,8140054,COVER 18IN CARM SNPKP,194674,,270,$4.95 ,$4.95 ,$3.78 ,$4.46 ,$4.21 ,$4.21 ,$4.21 ,$4.36 ,$4.21 ,$4.36 ,$4.36 ,$4.31 ,$4.21 ,$4.21 ,$4.21 ,$3.78 ,$4.46
Carle Richland Memorial Hospital,8140054,TUBE NG SALEM 16FR 10/CA,508,,270,$5.04 ,$5.04 ,$3.85 ,$4.54 ,$4.28 ,$4.28 ,$4.28 ,$4.44 ,$4.28 ,$4.44 ,$4.44 ,$4.38 ,$4.28 ,$4.28 ,$4.28 ,$3.85 ,$4.54
Carle Richland Memorial Hospital,8140054,BAG URINARY 200ML STERILE PEDS PE,9906,,270,$5.09 ,$5.09 ,$3.89 ,$4.58 ,$4.33 ,$4.33 ,$4.33 ,$4.48 ,$4.33 ,$4.48 ,$4.48 ,$4.43 ,$4.33 ,$4.33 ,$4.33 ,$3.89 ,$4.58
Carle Richland Memorial Hospital,8140054,DRESSING COVRSITE PLUS 6X6,232230,,270,$5.26 ,$5.26 ,$4.02 ,$4.73 ,$4.47 ,$4.47 ,$4.47 ,$4.63 ,$4.47 ,$4.63 ,$4.63 ,$4.58 ,$4.47 ,$4.47 ,$4.47 ,$4.02 ,$4.73
Carle Richland Memorial Hospital,8140054,PLASTER CAST 4IN FAST SETTING,55849,,270,$5.29 ,$5.29 ,$4.04 ,$4.76 ,$4.50 ,$4.50 ,$4.50 ,$4.66 ,$4.50 ,$4.66 ,$4.66 ,$4.60 ,$4.50 ,$4.50 ,$4.50 ,$4.04 ,$4.76
Carle Richland Memorial Hospital,8140054,PADDING CAST SYNTHETIC 6IN 20RL/B,11058,,270,$5.32 ,$5.32 ,$4.06 ,$4.79 ,$4.52 ,$4.52 ,$4.52 ,$4.68 ,$4.52 ,$4.68 ,$4.68 ,$4.63 ,$4.52 ,$4.52 ,$4.52 ,$4.06 ,$4.79
Carle Richland Memorial Hospital,8140054,BAG URINE LEG MEDIUM STRL 16 OZ,45,,270,$5.33 ,$5.33 ,$4.07 ,$4.80 ,$4.53 ,$4.53 ,$4.53 ,$4.69 ,$4.53 ,$4.69 ,$4.69 ,$4.64 ,$4.53 ,$4.53 ,$4.53 ,$4.07 ,$4.80
Carle Richland Memorial Hospital,8140054,WRAP COFLEX 4IN,1040,,270,$5.47 ,$5.47 ,$4.18 ,$4.92 ,$4.65 ,$4.65 ,$4.65 ,$4.81 ,$4.65 ,$4.81 ,$4.81 ,$4.76 ,$4.65 ,$4.65 ,$4.65 ,$4.18 ,$4.92
Carle Richland Memorial Hospital,8140054,CANISTER SUCTION 3000CC,70,,270,$5.68 ,$5.68 ,$4.34 ,$5.11 ,$4.83 ,$4.83 ,$4.83 ,$5.00 ,$4.83 ,$5.00 ,$5.00 ,$4.94 ,$4.83 ,$4.83 ,$4.83 ,$4.34 ,$5.11
Carle Richland Memorial Hospital,8140054,DRESSING MEPILEX BORDER 7X7 SACRU,232099,,270,$5.76 ,$5.76 ,$4.40 ,$5.18 ,$4.90 ,$4.90 ,$4.90 ,$5.07 ,$4.90 ,$5.07 ,$5.07 ,$5.01 ,$4.90 ,$4.90 ,$4.90 ,$4.40 ,$5.18
Carle Richland Memorial Hospital,8140054,BLADE ONLY SURGICAL #12 STRL BARD,234725,,270,$5.82 ,$5.82 ,$4.45 ,$5.24 ,$4.95 ,$4.95 ,$4.95 ,$5.12 ,$4.95 ,$5.12 ,$5.12 ,$5.06 ,$4.95 ,$4.95 ,$4.95 ,$4.45 ,$5.24
Carle Richland Memorial Hospital,8140054,PADDING UNDERCAST 6IN WEBRIL 6/BG,11059,,270,$5.93 ,$5.93 ,$4.53 ,$5.34 ,$5.04 ,$5.04 ,$5.04 ,$5.22 ,$5.04 ,$5.22 ,$5.22 ,$5.16 ,$5.04 ,$5.04 ,$5.04 ,$4.53 ,$5.34
Carle Richland Memorial Hospital,8140054,SPONGE LAP 18 X 18,415,,270,$5.93 ,$5.93 ,$4.53 ,$5.34 ,$5.04 ,$5.04 ,$5.04 ,$5.22 ,$5.04 ,$5.22 ,$5.22 ,$5.16 ,$5.04 ,$5.04 ,$5.04 ,$4.53 ,$5.34
Carle Richland Memorial Hospital,8140054,DRESSING GAUZE SPONGE N/S 2X2,232100,,270,$6.16 ,$6.16 ,$4.71 ,$5.54 ,$5.24 ,$5.24 ,$5.24 ,$5.42 ,$5.24 ,$5.42 ,$5.42 ,$5.36 ,$5.24 ,$5.24 ,$5.24 ,$4.71 ,$5.54
Carle Richland Memorial Hospital,8140054,DRESSING BIOCLUSIVE 4X5,232224,,270,$6.30 ,$6.30 ,$4.81 ,$5.67 ,$5.36 ,$5.36 ,$5.36 ,$5.54 ,$5.36 ,$5.54 ,$5.54 ,$5.48 ,$5.36 ,$5.36 ,$5.36 ,$4.81 ,$5.67
Carle Richland Memorial Hospital,8140054,STRIP PACKING PLAIN 0.5IN,308,,270,$6.38 ,$6.38 ,$4.87 ,$5.74 ,$5.42 ,$5.42 ,$5.42 ,$5.61 ,$5.42 ,$5.61 ,$5.61 ,$5.55 ,$5.42 ,$5.42 ,$5.42 ,$4.87 ,$5.74
Carle Richland Memorial Hospital,8140054,STRIP PACKING PLAIN 0.25IN,9633,,270,$6.40 ,$6.40 ,$4.89 ,$5.76 ,$5.44 ,$5.44 ,$5.44 ,$5.63 ,$5.44 ,$5.63 ,$5.63 ,$5.57 ,$5.44 ,$5.44 ,$5.44 ,$4.89 ,$5.76
Carle Richland Memorial Hospital,8140054,KIT CATH FEMALE 8FR W/GLOVE AND S,9550,,270,$6.46 ,$6.46 ,$4.94 ,$5.81 ,$5.49 ,$5.49 ,$5.49 ,$5.68 ,$5.49 ,$5.68 ,$5.68 ,$5.62 ,$5.49 ,$5.49 ,$5.49 ,$4.94 ,$5.81
Carle Richland Memorial Hospital,8140054,BLADE BEAVER MINI ROUND GREEN,233997,,270,$6.54 ,$6.54 ,$5.00 ,$5.89 ,$5.56 ,$5.56 ,$5.56 ,$5.76 ,$5.56 ,$5.76 ,$5.76 ,$5.69 ,$5.56 ,$5.56 ,$5.56 ,$5.00 ,$5.89
Carle Richland Memorial Hospital,8140054,OSTOMY ROD LOOP SUR FIT,234400,,270,$6.63 ,$6.63 ,$5.07 ,$5.97 ,$5.64 ,$5.64 ,$5.64 ,$5.83 ,$5.64 ,$5.83 ,$5.83 ,$5.77 ,$5.64 ,$5.64 ,$5.64 ,$5.07 ,$5.97
Carle Richland Memorial Hospital,8140054,DRESSING COVADERM 4X6,232106,,270,$6.66 ,$6.66 ,$5.09 ,$5.99 ,$5.66 ,$5.66 ,$5.66 ,$5.86 ,$5.66 ,$5.86 ,$5.86 ,$5.79 ,$5.66 ,$5.66 ,$5.66 ,$5.09 ,$5.99
Carle Richland Memorial Hospital,8140054,STRIP PACKING IODOFORM 0.25IN,306,,270,$6.68 ,$6.68 ,$5.10 ,$6.01 ,$5.68 ,$5.68 ,$5.68 ,$5.88 ,$5.68 ,$5.88 ,$5.88 ,$5.81 ,$5.68 ,$5.68 ,$5.68 ,$5.10 ,$6.01
Carle Richland Memorial Hospital,8140054,CATH FOLEY 10FR 3CC LATEX,233180,,270,$6.72 ,$6.72 ,$5.13 ,$6.05 ,$5.71 ,$5.71 ,$5.71 ,$5.91 ,$5.71 ,$5.91 ,$5.91 ,$5.85 ,$5.71 ,$5.71 ,$5.71 ,$5.13 ,$6.05
Carle Richland Memorial Hospital,8140054,SCALPEL #10 BLADE SAFETY DISP,326,,270,$6.73 ,$6.73 ,$5.14 ,$6.06 ,$5.72 ,$5.72 ,$5.72 ,$5.92 ,$5.72 ,$5.92 ,$5.92 ,$5.86 ,$5.72 ,$5.72 ,$5.72 ,$5.14 ,$6.06
Carle Richland Memorial Hospital,8140054,SOL .9 NACL 250ML,232211,,270,$6.75 ,$6.75 ,$5.16 ,$6.08 ,$5.74 ,$5.74 ,$5.74 ,$5.94 ,$5.74 ,$5.94 ,$5.94 ,$5.87 ,$5.74 ,$5.74 ,$5.74 ,$5.16 ,$6.08
Carle Richland Memorial Hospital,8140054,BAG FLATUS,8263,,270,$6.85 ,$6.85 ,$5.23 ,$6.17 ,$5.82 ,$5.82 ,$5.82 ,$6.03 ,$5.82 ,$6.03 ,$6.03 ,$5.96 ,$5.82 ,$5.82 ,$5.82 ,$5.23 ,$6.17
Carle Richland Memorial Hospital,8140054,BLADE BEAVER MINI,233998,,270,$6.86 ,$6.86 ,$5.24 ,$6.17 ,$5.83 ,$5.83 ,$5.83 ,$6.04 ,$5.83 ,$6.04 ,$6.04 ,$5.97 ,$5.83 ,$5.83 ,$5.83 ,$5.24 ,$6.17
Carle Richland Memorial Hospital,8140054,SCALPEL #15 BLADE SAFETY DISP,328,,270,$6.86 ,$6.86 ,$5.24 ,$6.17 ,$5.83 ,$5.83 ,$5.83 ,$6.04 ,$5.83 ,$6.04 ,$6.04 ,$5.97 ,$5.83 ,$5.83 ,$5.83 ,$5.24 ,$6.17
Carle Richland Memorial Hospital,8140054,CONTAINER SPECIMEN 64OZ,232164,,270,$6.88 ,$6.88 ,$5.26 ,$6.19 ,$5.85 ,$5.85 ,$5.85 ,$6.05 ,$5.85 ,$6.05 ,$6.05 ,$5.99 ,$5.85 ,$5.85 ,$5.85 ,$5.26 ,$6.19
Carle Richland Memorial Hospital,8140054,SOL ANTIFOG,544,,270,$6.92 ,$6.92 ,$5.29 ,$6.23 ,$5.88 ,$5.88 ,$5.88 ,$6.09 ,$5.88 ,$6.09 ,$6.09 ,$6.02 ,$5.88 ,$5.88 ,$5.88 ,$5.29 ,$6.23
Carle Richland Memorial Hospital,8140054,SOL .9 NACL 100ML,232209,,270,$6.93 ,$6.93 ,$5.29 ,$6.24 ,$5.89 ,$5.89 ,$5.89 ,$6.10 ,$5.89 ,$6.10 ,$6.10 ,$6.03 ,$5.89 ,$5.89 ,$5.89 ,$5.29 ,$6.24
Carle Richland Memorial Hospital,8140054,PLASTER CAST 6IN FAST SETTING,55850,,270,$6.96 ,$6.96 ,$5.32 ,$6.26 ,$5.92 ,$5.92 ,$5.92 ,$6.12 ,$5.92 ,$6.12 ,$6.12 ,$6.06 ,$5.92 ,$5.92 ,$5.92 ,$5.32 ,$6.26
Carle Richland Memorial Hospital,8140054,GLOVE SENSICARE SZ 6.5 STERILE,232168,,270,$6.98 ,$6.98 ,$5.33 ,$6.28 ,$5.93 ,$5.93 ,$5.93 ,$6.14 ,$5.93 ,$6.14 ,$6.14 ,$6.07 ,$5.93 ,$5.93 ,$5.93 ,$5.33 ,$6.28
Carle Richland Memorial Hospital,8140054,GLOVE SENSICARE SZ 6 STERILE,232169,,270,$6.98 ,$6.98 ,$5.33 ,$6.28 ,$5.93 ,$5.93 ,$5.93 ,$6.14 ,$5.93 ,$6.14 ,$6.14 ,$6.07 ,$5.93 ,$5.93 ,$5.93 ,$5.33 ,$6.28
Carle Richland Memorial Hospital,8140054,GLOVE SENSICARE SZ 7 STERILE,232170,,270,$6.98 ,$6.98 ,$5.33 ,$6.28 ,$5.93 ,$5.93 ,$5.93 ,$6.14 ,$5.93 ,$6.14 ,$6.14 ,$6.07 ,$5.93 ,$5.93 ,$5.93 ,$5.33 ,$6.28
Carle Richland Memorial Hospital,8140054,GLOVE SENSICARE SZ 7.5 STERILE,232171,,270,$6.98 ,$6.98 ,$5.33 ,$6.28 ,$5.93 ,$5.93 ,$5.93 ,$6.14 ,$5.93 ,$6.14 ,$6.14 ,$6.07 ,$5.93 ,$5.93 ,$5.93 ,$5.33 ,$6.28
Carle Richland Memorial Hospital,8140054,SOL D5 50ML,232206,,270,$6.98 ,$6.98 ,$5.33 ,$6.28 ,$5.93 ,$5.93 ,$5.93 ,$6.14 ,$5.93 ,$6.14 ,$6.14 ,$6.07 ,$5.93 ,$5.93 ,$5.93 ,$5.33 ,$6.28
Carle Richland Memorial Hospital,8140054,GLOVE SENSICARE SZ 8 STERILE,232685,,270,$6.98 ,$6.98 ,$5.33 ,$6.28 ,$5.93 ,$5.93 ,$5.93 ,$6.14 ,$5.93 ,$6.14 ,$6.14 ,$6.07 ,$5.93 ,$5.93 ,$5.93 ,$5.33 ,$6.28
Carle Richland Memorial Hospital,8140054,ADHESIVE SURGICAL MASTISOL,11267,,270,$7.02 ,$7.02 ,$5.36 ,$6.32 ,$5.97 ,$5.97 ,$5.97 ,$6.18 ,$5.97 ,$6.18 ,$6.18 ,$6.11 ,$5.97 ,$5.97 ,$5.97 ,$5.36 ,$6.32
Carle Richland Memorial Hospital,8140054,SPONGES TONSIL,232093,,270,$7.05 ,$7.05 ,$5.39 ,$6.35 ,$5.99 ,$5.99 ,$5.99 ,$6.20 ,$5.99 ,$6.20 ,$6.20 ,$6.13 ,$5.99 ,$5.99 ,$5.99 ,$5.39 ,$6.35
Carle Richland Memorial Hospital,8140054,DRAPE UDRAPE,155,,270,$7.09 ,$7.09 ,$5.42 ,$6.38 ,$6.03 ,$6.03 ,$6.03 ,$6.24 ,$6.03 ,$6.24 ,$6.24 ,$6.17 ,$6.03 ,$6.03 ,$6.03 ,$5.42 ,$6.38
Carle Richland Memorial Hospital,8140054,SOL .9 NACL 50ML,232208,,270,$7.16 ,$7.16 ,$5.47 ,$6.44 ,$6.09 ,$6.09 ,$6.09 ,$6.30 ,$6.09 ,$6.30 ,$6.30 ,$6.23 ,$6.09 ,$6.09 ,$6.09 ,$5.47 ,$6.44
Carle Richland Memorial Hospital,8140054,CATHETER INSYTE IV 20GAX1.88IN,230089,,270,$7.32 ,$7.32 ,$5.59 ,$6.59 ,$6.22 ,$6.22 ,$6.22 ,$6.44 ,$6.22 ,$6.44 ,$6.44 ,$6.37 ,$6.22 ,$6.22 ,$6.22 ,$5.59 ,$6.59
Carle Richland Memorial Hospital,8140054,CATH INSYTE AUTOGUARD 22GA,233235,,270,$7.32 ,$7.32 ,$5.59 ,$6.59 ,$6.22 ,$6.22 ,$6.22 ,$6.44 ,$6.22 ,$6.44 ,$6.44 ,$6.37 ,$6.22 ,$6.22 ,$6.22 ,$5.59 ,$6.59
Carle Richland Memorial Hospital,8140054,CATH INSYTE AUTOGUARD 18GA,234438,,270,$7.32 ,$7.32 ,$5.59 ,$6.59 ,$6.22 ,$6.22 ,$6.22 ,$6.44 ,$6.22 ,$6.44 ,$6.44 ,$6.37 ,$6.22 ,$6.22 ,$6.22 ,$5.59 ,$6.59
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM MAX FILM,232244,,270,$7.43 ,$7.43 ,$5.68 ,$6.69 ,$6.32 ,$6.32 ,$6.32 ,$6.54 ,$6.32 ,$6.54 ,$6.54 ,$6.46 ,$6.32 ,$6.32 ,$6.32 ,$5.68 ,$6.69
Carle Richland Memorial Hospital,8140054,PADDING CAST 4IN STERILE,672,,270,$28.47 ,$28.47 ,$21.75 ,$25.62 ,$24.20 ,$24.20 ,$24.20 ,$25.05 ,$24.20 ,$25.05 ,$25.05 ,$24.77 ,$24.20 ,$24.20 ,$24.20 ,$21.75 ,$25.62
Carle Richland Memorial Hospital,8140054,CATH URINE METER,232144,,270,$28.54 ,$28.54 ,$21.80 ,$25.69 ,$24.26 ,$24.26 ,$24.26 ,$25.12 ,$24.26 ,$25.12 ,$25.12 ,$24.83 ,$24.26 ,$24.26 ,$24.26 ,$21.80 ,$25.69
Carle Richland Memorial Hospital,8140054,DRAIN 10IN FLAT 1/2IN,232205,,270,$29.54 ,$29.54 ,$22.57 ,$26.59 ,$25.11 ,$25.11 ,$25.11 ,$26.00 ,$25.11 ,$26.00 ,$26.00 ,$25.70 ,$25.11 ,$25.11 ,$25.11 ,$22.57 ,$26.59
Carle Richland Memorial Hospital,8140054,CATH TRAY LUBRICATH 18FR 5CC LATE,232138,,270,$30.10 ,$30.10 ,$23.00 ,$27.09 ,$25.59 ,$25.59 ,$25.59 ,$26.49 ,$25.59 ,$26.49 ,$26.49 ,$26.19 ,$25.59 ,$25.59 ,$25.59 ,$23.00 ,$27.09
Carle Richland Memorial Hospital,8140054,DRAPE SPLIT ORTHO 87X125IN 10/CA,254164,,270,$30.34 ,$30.34 ,$23.18 ,$27.31 ,$25.79 ,$25.79 ,$25.79 ,$26.70 ,$25.79 ,$26.70 ,$26.70 ,$26.40 ,$25.79 ,$25.79 ,$25.79 ,$23.18 ,$27.31
Carle Richland Memorial Hospital,8140054,DRESSING GAUZE DERMACEA 8X12,232225,,270,$30.60 ,$30.60 ,$23.38 ,$27.54 ,$26.01 ,$26.01 ,$26.01 ,$26.93 ,$26.01 ,$26.93 ,$26.93 ,$26.62 ,$26.01 ,$26.01 ,$26.01 ,$23.38 ,$27.54
Carle Richland Memorial Hospital,8140054,DRESSING ALLEVYN HEEL,232233,,270,$30.82 ,$30.82 ,$23.55 ,$27.74 ,$26.20 ,$26.20 ,$26.20 ,$27.12 ,$26.20 ,$27.12 ,$27.12 ,$26.81 ,$26.20 ,$26.20 ,$26.20 ,$23.55 ,$27.74
Carle Richland Memorial Hospital,8140054,SET COLLECTION STERILE 6FT,232575,,270,$31.26 ,$31.26 ,$23.88 ,$28.13 ,$26.57 ,$26.57 ,$26.57 ,$27.51 ,$26.57 ,$27.51 ,$27.51 ,$27.20 ,$26.57 ,$26.57 ,$26.57 ,$23.88 ,$28.13
Carle Richland Memorial Hospital,8140054,DRESSING PROMOGRAN 4.1 SQUARE,232116,,270,$33.36 ,$33.36 ,$25.49 ,$30.02 ,$28.36 ,$28.36 ,$28.36 ,$29.36 ,$28.36 ,$29.36 ,$29.36 ,$29.02 ,$28.36 ,$28.36 ,$28.36 ,$25.49 ,$30.02
Carle Richland Memorial Hospital,8140054,SPLINT CLAVICLE PADDED MEDIUM,233196,,270,$34.83 ,$34.83 ,$26.61 ,$31.35 ,$29.61 ,$29.61 ,$29.61 ,$30.65 ,$29.61 ,$30.65 ,$30.65 ,$30.30 ,$29.61 ,$29.61 ,$29.61 ,$26.61 ,$31.35
Carle Richland Memorial Hospital,8140054,COLLAR CLAVICLE W/LINK SM,233937,,270,$34.83 ,$34.83 ,$26.61 ,$31.35 ,$29.61 ,$29.61 ,$29.61 ,$30.65 ,$29.61 ,$30.65 ,$30.65 ,$30.30 ,$29.61 ,$29.61 ,$29.61 ,$26.61 ,$31.35
Carle Richland Memorial Hospital,8140054,ELECTRODE BALL,234445,,270,$35.09 ,$35.09 ,$26.81 ,$31.58 ,$29.83 ,$29.83 ,$29.83 ,$30.88 ,$29.83 ,$30.88 ,$30.88 ,$30.53 ,$29.83 ,$29.83 ,$29.83 ,$26.81 ,$31.58
Carle Richland Memorial Hospital,8140054,TRAP POLYP,8443,,270,$36.00 ,$36.00 ,$27.50 ,$32.40 ,$30.60 ,$30.60 ,$30.60 ,$31.68 ,$30.60 ,$31.68 ,$31.68 ,$31.32 ,$30.60 ,$30.60 ,$30.60 ,$27.50 ,$32.40
Carle Richland Memorial Hospital,8140054,CATH COUDE 18FR,232146,,270,$36.04 ,$36.04 ,$27.53 ,$32.44 ,$30.63 ,$30.63 ,$30.63 ,$31.72 ,$30.63 ,$31.72 ,$31.72 ,$31.35 ,$30.63 ,$30.63 ,$30.63 ,$27.53 ,$32.44
Carle Richland Memorial Hospital,8140054,CATH COUDE 20FR,232147,,270,$36.04 ,$36.04 ,$27.53 ,$32.44 ,$30.63 ,$30.63 ,$30.63 ,$31.72 ,$30.63 ,$31.72 ,$31.72 ,$31.35 ,$30.63 ,$30.63 ,$30.63 ,$27.53 ,$32.44
Carle Richland Memorial Hospital,8140054,SPLINT CLAVICLE PADDED LARGE,233197,,270,$36.27 ,$36.27 ,$27.71 ,$32.64 ,$30.83 ,$30.83 ,$30.83 ,$31.92 ,$30.83 ,$31.92 ,$31.92 ,$31.55 ,$30.83 ,$30.83 ,$30.83 ,$27.71 ,$32.64
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 20FR 30CC 2-WAY,232220,,270,$37.09 ,$37.09 ,$28.34 ,$33.38 ,$31.53 ,$31.53 ,$31.53 ,$32.64 ,$31.53 ,$32.64 ,$32.64 ,$32.27 ,$31.53 ,$31.53 ,$31.53 ,$28.34 ,$33.38
Carle Richland Memorial Hospital,8140054,CATHETER FOLEY 18FR 30CC 3-WAY,232221,,270,$37.09 ,$37.09 ,$28.34 ,$33.38 ,$31.53 ,$31.53 ,$31.53 ,$32.64 ,$31.53 ,$32.64 ,$32.64 ,$32.27 ,$31.53 ,$31.53 ,$31.53 ,$28.34 ,$33.38
Carle Richland Memorial Hospital,8140054,CATH 3-WAY 24FR 30CC LATEX,742,,270,$37.12 ,$37.12 ,$28.36 ,$33.41 ,$31.55 ,$31.55 ,$31.55 ,$32.67 ,$31.55 ,$32.67 ,$32.67 ,$32.29 ,$31.55 ,$31.55 ,$31.55 ,$28.36 ,$33.41
Carle Richland Memorial Hospital,8140054,CATH 3-WAY 22FR 30CC LATEX,119,,270,$37.81 ,$37.81 ,$28.89 ,$34.03 ,$32.14 ,$32.14 ,$32.14 ,$33.27 ,$32.14 ,$33.27 ,$33.27 ,$32.89 ,$32.14 ,$32.14 ,$32.14 ,$28.89 ,$34.03
Carle Richland Memorial Hospital,8140054,TUR SET,232185,,270,$38.29 ,$38.29 ,$29.25 ,$34.46 ,$32.55 ,$32.55 ,$32.55 ,$33.70 ,$32.55 ,$33.70 ,$33.70 ,$33.31 ,$32.55 ,$32.55 ,$32.55 ,$29.25 ,$34.46
Carle Richland Memorial Hospital,8140054,TUBE CONNECTING 30CM,754,,270,$38.97 ,$38.97 ,$29.77 ,$35.07 ,$33.12 ,$33.12 ,$33.12 ,$34.29 ,$33.12 ,$34.29 ,$34.29 ,$33.90 ,$33.12 ,$33.12 ,$33.12 ,$29.77 ,$35.07
Carle Richland Memorial Hospital,8140054,DRESSING PROFORE BANDAGE SYSTM,232126,,270,$39.36 ,$39.36 ,$30.07 ,$35.42 ,$33.46 ,$33.46 ,$33.46 ,$34.64 ,$33.46 ,$34.64 ,$34.64 ,$34.24 ,$33.46 ,$33.46 ,$33.46 ,$30.07 ,$35.42
Carle Richland Memorial Hospital,8140054,CUFF TOURNIQUET 24IN 10/BX,1051,,270,$40.59 ,$40.59 ,$31.01 ,$36.53 ,$34.50 ,$34.50 ,$34.50 ,$35.72 ,$34.50 ,$35.72 ,$35.72 ,$35.31 ,$34.50 ,$34.50 ,$34.50 ,$31.01 ,$36.53
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM 6X7 NON ADH,232239,,270,$40.65 ,$40.65 ,$31.06 ,$36.59 ,$34.55 ,$34.55 ,$34.55 ,$35.77 ,$34.55 ,$35.77 ,$35.77 ,$35.37 ,$34.55 ,$34.55 ,$34.55 ,$31.06 ,$36.59
Carle Richland Memorial Hospital,8140054,DRAPE EXTREMITY SHEET KNEE TKA,199857,,270,$40.87 ,$40.87 ,$31.22 ,$36.78 ,$34.74 ,$34.74 ,$34.74 ,$35.97 ,$34.74 ,$35.97 ,$35.97 ,$35.56 ,$34.74 ,$34.74 ,$34.74 ,$31.22 ,$36.78
Carle Richland Memorial Hospital,8140054,PACK MAJOR DOUBLE BASIN,591,,270,$41.58 ,$41.58 ,$31.77 ,$37.42 ,$35.34 ,$35.34 ,$35.34 ,$36.59 ,$35.34 ,$36.59 ,$36.59 ,$36.17 ,$35.34 ,$35.34 ,$35.34 ,$31.77 ,$37.42
Carle Richland Memorial Hospital,8140054,PACK TRANSVERSE LAPAROTOMY II,232111,,270,$41.75 ,$41.75 ,$31.90 ,$37.58 ,$35.49 ,$35.49 ,$35.49 ,$36.74 ,$35.49 ,$36.74 ,$36.74 ,$36.32 ,$35.49 ,$35.49 ,$35.49 ,$31.90 ,$37.58
Carle Richland Memorial Hospital,8140054,DRESSING WOUND VAC WHITE FOAM 10/,536,,270,$42.06 ,$42.06 ,$32.13 ,$37.85 ,$35.75 ,$35.75 ,$35.75 ,$37.01 ,$35.75 ,$37.01 ,$37.01 ,$36.59 ,$35.75 ,$35.75 ,$35.75 ,$32.13 ,$37.85
Carle Richland Memorial Hospital,8140054,DRESSING HYPAFIX RETEN RL 4X10,232231,,270,$42.27 ,$42.27 ,$32.29 ,$38.04 ,$35.93 ,$35.93 ,$35.93 ,$37.20 ,$35.93 ,$37.20 ,$37.20 ,$36.77 ,$35.93 ,$35.93 ,$35.93 ,$32.29 ,$38.04
Carle Richland Memorial Hospital,8140054,SLING AND SWATHE MED DELUXE,233186,,270,$43.29 ,$43.29 ,$33.07 ,$38.96 ,$36.80 ,$36.80 ,$36.80 ,$38.10 ,$36.80 ,$38.10 ,$38.10 ,$37.66 ,$36.80 ,$36.80 ,$36.80 ,$33.07 ,$38.96
Carle Richland Memorial Hospital,8140054,SLING AND SWATHE LARGE DELUXE,233187,,270,$43.29 ,$43.29 ,$33.07 ,$38.96 ,$36.80 ,$36.80 ,$36.80 ,$38.10 ,$36.80 ,$38.10 ,$38.10 ,$37.66 ,$36.80 ,$36.80 ,$36.80 ,$33.07 ,$38.96
Carle Richland Memorial Hospital,8140054,ELECTRODE CAUTERY LLETZ LOOP,234767,,270,$44.60 ,$44.60 ,$34.07 ,$40.14 ,$37.91 ,$37.91 ,$37.91 ,$39.25 ,$37.91 ,$39.25 ,$39.25 ,$38.80 ,$37.91 ,$37.91 ,$37.91 ,$34.07 ,$40.14
Carle Richland Memorial Hospital,8140054,TUBING INSUFFLATOR,232178,,270,$45.00 ,$45.00 ,$34.38 ,$40.50 ,$38.25 ,$38.25 ,$38.25 ,$39.60 ,$38.25 ,$39.60 ,$39.60 ,$39.15 ,$38.25 ,$38.25 ,$38.25 ,$34.38 ,$40.50
Carle Richland Memorial Hospital,8140054,LEGGING ATHROMBIC REGULAR,38,,270,$45.18 ,$45.18 ,$34.52 ,$40.66 ,$38.40 ,$38.40 ,$38.40 ,$39.76 ,$38.40 ,$39.76 ,$39.76 ,$39.31 ,$38.40 ,$38.40 ,$38.40 ,$34.52 ,$40.66
Carle Richland Memorial Hospital,8140054,SPLINT COCKUP WRIST LEFT MEDIU,233198,,270,$45.72 ,$45.72 ,$34.93 ,$41.15 ,$38.86 ,$38.86 ,$38.86 ,$40.23 ,$38.86 ,$40.23 ,$40.23 ,$39.78 ,$38.86 ,$38.86 ,$38.86 ,$34.93 ,$41.15
Carle Richland Memorial Hospital,8140054,SPLINT COCKUP WRIST RIGHT SM,233199,,270,$45.72 ,$45.72 ,$34.93 ,$41.15 ,$38.86 ,$38.86 ,$38.86 ,$40.23 ,$38.86 ,$40.23 ,$40.23 ,$39.78 ,$38.86 ,$38.86 ,$38.86 ,$34.93 ,$41.15
Carle Richland Memorial Hospital,8140054,SPLINT COCKUP WRIST RIGHT MEDI,233200,,270,$45.72 ,$45.72 ,$34.93 ,$41.15 ,$38.86 ,$38.86 ,$38.86 ,$40.23 ,$38.86 ,$40.23 ,$40.23 ,$39.78 ,$38.86 ,$38.86 ,$38.86 ,$34.93 ,$41.15
Carle Richland Memorial Hospital,8140054,SPLINT COCKUP WRIST RIGHT LARG,233201,,270,$45.72 ,$45.72 ,$34.93 ,$41.15 ,$38.86 ,$38.86 ,$38.86 ,$40.23 ,$38.86 ,$40.23 ,$40.23 ,$39.78 ,$38.86 ,$38.86 ,$38.86 ,$34.93 ,$41.15
Carle Richland Memorial Hospital,8140054,SPLINT COCKUP WRIST LEFT SMALL,233202,,270,$45.72 ,$45.72 ,$34.93 ,$41.15 ,$38.86 ,$38.86 ,$38.86 ,$40.23 ,$38.86 ,$40.23 ,$40.23 ,$39.78 ,$38.86 ,$38.86 ,$38.86 ,$34.93 ,$41.15
Carle Richland Memorial Hospital,8140054,SPLINT COCKUP WRIST LEFT LARGE,233203,,270,$45.72 ,$45.72 ,$34.93 ,$41.15 ,$38.86 ,$38.86 ,$38.86 ,$40.23 ,$38.86 ,$40.23 ,$40.23 ,$39.78 ,$38.86 ,$38.86 ,$38.86 ,$34.93 ,$41.15
Carle Richland Memorial Hospital,8140054,ELECTRODE LOOP 10X10,234446,,270,$46.36 ,$46.36 ,$35.42 ,$41.72 ,$39.41 ,$39.41 ,$39.41 ,$40.80 ,$39.41 ,$40.80 ,$40.80 ,$40.33 ,$39.41 ,$39.41 ,$39.41 ,$35.42 ,$41.72
Carle Richland Memorial Hospital,8140054,ELECTRODE LOOP 15X12,234447,,270,$46.36 ,$46.36 ,$35.42 ,$41.72 ,$39.41 ,$39.41 ,$39.41 ,$40.80 ,$39.41 ,$40.80 ,$40.80 ,$40.33 ,$39.41 ,$39.41 ,$39.41 ,$35.42 ,$41.72
Carle Richland Memorial Hospital,8140054,ELECTRODE LOOP 20X15,234448,,270,$46.36 ,$46.36 ,$35.42 ,$41.72 ,$39.41 ,$39.41 ,$39.41 ,$40.80 ,$39.41 ,$40.80 ,$40.80 ,$40.33 ,$39.41 ,$39.41 ,$39.41 ,$35.42 ,$41.72
Carle Richland Memorial Hospital,8140054,KIT DEFENDO 5 PIECE W/CLEANING 50,207588,,270,$47.25 ,$47.25 ,$36.10 ,$42.53 ,$40.16 ,$40.16 ,$40.16 ,$41.58 ,$40.16 ,$41.58 ,$41.58 ,$41.11 ,$40.16 ,$40.16 ,$40.16 ,$36.10 ,$42.53
Carle Richland Memorial Hospital,8140054,CATH URETERAL POLLACK FLEXITIP,1217,,270,$47.83 ,$47.83 ,$36.54 ,$43.05 ,$40.66 ,$40.66 ,$40.66 ,$42.09 ,$40.66 ,$42.09 ,$42.09 ,$41.61 ,$40.66 ,$40.66 ,$40.66 ,$36.54 ,$43.05
Carle Richland Memorial Hospital,8140054,DRAPE LAVH/LAPAROSCOPY CA/8,192729,,270,$49.55 ,$49.55 ,$37.86 ,$44.60 ,$42.12 ,$42.12 ,$42.12 ,$43.60 ,$42.12 ,$43.60 ,$43.60 ,$43.11 ,$42.12 ,$42.12 ,$42.12 ,$37.86 ,$44.60
Carle Richland Memorial Hospital,8140054,COVER CIV FLEX EXTENDED LENGTH 61,214181,,270,$50.25 ,$50.25 ,$38.39 ,$45.23 ,$42.71 ,$42.71 ,$42.71 ,$44.22 ,$42.71 ,$44.22 ,$44.22 ,$43.72 ,$42.71 ,$42.71 ,$42.71 ,$38.39 ,$45.23
Carle Richland Memorial Hospital,8140054,KIT HEMOVAC EVACUATOR 3/16IN,232176,,270,$51.13 ,$51.13 ,$39.06 ,$46.02 ,$43.46 ,$43.46 ,$43.46 ,$44.99 ,$43.46 ,$44.99 ,$44.99 ,$44.48 ,$43.46 ,$43.46 ,$43.46 ,$39.06 ,$46.02
Carle Richland Memorial Hospital,8140054,CATH STRT RIBBED BLN 20FR 5CC LAT,685,,270,$52.59 ,$52.59 ,$40.18 ,$47.33 ,$44.70 ,$44.70 ,$44.70 ,$46.28 ,$44.70 ,$46.28 ,$46.28 ,$45.75 ,$44.70 ,$44.70 ,$44.70 ,$40.18 ,$47.33
Carle Richland Memorial Hospital,8140054,RMH KERATOME BLADE 2.5MM,235166,,270,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,8140054,ADHESIVE TOPICAL SKN EXOFIN 1ml /,205286,,270,$54.32 ,$54.32 ,$41.50 ,$48.89 ,$46.17 ,$46.17 ,$46.17 ,$47.80 ,$46.17 ,$47.80 ,$47.80 ,$47.26 ,$46.17 ,$46.17 ,$46.17 ,$41.50 ,$48.89
Carle Richland Memorial Hospital,8140054,CATH STRT RIBBED BLN 22FR 5CC LAT,686,,270,$54.68 ,$54.68 ,$41.78 ,$49.21 ,$46.48 ,$46.48 ,$46.48 ,$48.12 ,$46.48 ,$48.12 ,$48.12 ,$47.57 ,$46.48 ,$46.48 ,$46.48 ,$41.78 ,$49.21
Carle Richland Memorial Hospital,8140054,FORCEP RADIAL JAW JUMBO,232150,,270,$55.13 ,$55.13 ,$42.12 ,$49.62 ,$46.86 ,$46.86 ,$46.86 ,$48.51 ,$46.86 ,$48.51 ,$48.51 ,$47.96 ,$46.86 ,$46.86 ,$46.86 ,$42.12 ,$49.62
Carle Richland Memorial Hospital,8140054,CATH URETERAL WHISTLE 6FR 70CM 10,234375,,270,$55.17 ,$55.17 ,$42.15 ,$49.65 ,$46.89 ,$46.89 ,$46.89 ,$48.55 ,$46.89 ,$48.55 ,$48.55 ,$48.00 ,$46.89 ,$46.89 ,$46.89 ,$42.15 ,$49.65
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM MAX 8X8,232238,,270,$56.87 ,$56.87 ,$43.45 ,$51.18 ,$48.34 ,$48.34 ,$48.34 ,$50.05 ,$48.34 ,$50.05 ,$50.05 ,$49.48 ,$48.34 ,$48.34 ,$48.34 ,$43.45 ,$51.18
Carle Richland Memorial Hospital,8140054,TRAY LACERATION DISP,233185,,270,$56.89 ,$56.89 ,$43.46 ,$51.20 ,$48.36 ,$48.36 ,$48.36 ,$50.06 ,$48.36 ,$50.06 ,$50.06 ,$49.49 ,$48.36 ,$48.36 ,$48.36 ,$43.46 ,$51.20
Carle Richland Memorial Hospital,8140054,BAG PRESSURE INFUSE 3000ML 10/CA,211887,,270,$57.92 ,$57.92 ,$44.25 ,$52.13 ,$49.23 ,$49.23 ,$49.23 ,$50.97 ,$49.23 ,$50.97 ,$50.97 ,$50.39 ,$49.23 ,$49.23 ,$49.23 ,$44.25 ,$52.13
Carle Richland Memorial Hospital,8140054,DRAIN T WHELAN MOSS 18FR STEM,234764,,270,$58.49 ,$58.49 ,$44.69 ,$52.64 ,$49.72 ,$49.72 ,$49.72 ,$51.47 ,$49.72 ,$51.47 ,$51.47 ,$50.89 ,$49.72 ,$49.72 ,$49.72 ,$44.69 ,$52.64
Carle Richland Memorial Hospital,8140054,TRAY CATH URINE METER 16FR10CC SI,485,,270,$58.80 ,$58.80 ,$44.92 ,$52.92 ,$49.98 ,$49.98 ,$49.98 ,$51.74 ,$49.98 ,$51.74 ,$51.74 ,$51.16 ,$49.98 ,$49.98 ,$49.98 ,$44.92 ,$52.92
Carle Richland Memorial Hospital,8140054,SLEEVE VENODYNE 12IN,234300,,270,$58.95 ,$58.95 ,$45.04 ,$53.06 ,$50.11 ,$50.11 ,$50.11 ,$51.88 ,$50.11 ,$51.88 ,$51.88 ,$51.29 ,$50.11 ,$50.11 ,$50.11 ,$45.04 ,$53.06
Carle Richland Memorial Hospital,8140054,BLANKET UNDERBODY LG PEDS,229707,,270,$59.09 ,$59.09 ,$45.14 ,$53.18 ,$50.23 ,$50.23 ,$50.23 ,$52.00 ,$50.23 ,$52.00 ,$52.00 ,$51.41 ,$50.23 ,$50.23 ,$50.23 ,$45.14 ,$53.18
Carle Richland Memorial Hospital,8140054,DRAPE GYN/UROLOGY W/POUCH,789,,270,$59.13 ,$59.13 ,$45.18 ,$53.22 ,$50.26 ,$50.26 ,$50.26 ,$52.03 ,$50.26 ,$52.03 ,$52.03 ,$51.44 ,$50.26 ,$50.26 ,$50.26 ,$45.18 ,$53.22
Carle Richland Memorial Hospital,8140054,DRESSING POLYMEM CAVITY 3X12,232240,,270,$59.38 ,$59.38 ,$45.37 ,$53.44 ,$50.47 ,$50.47 ,$50.47 ,$52.25 ,$50.47 ,$52.25 ,$52.25 ,$51.66 ,$50.47 ,$50.47 ,$50.47 ,$45.37 ,$53.44
Carle Richland Memorial Hospital,8140054,BLADE MICRO FINE 10X28.5X0.4MM OS,234453,,270,$59.40 ,$59.40 ,$45.38 ,$53.46 ,$50.49 ,$50.49 ,$50.49 ,$52.27 ,$50.49 ,$52.27 ,$52.27 ,$51.68 ,$50.49 ,$50.49 ,$50.49 ,$45.38 ,$53.46
Carle Richland Memorial Hospital,8140054,NEEDLE BLUNT 15GA X 1.5,194673,,270,$61.10 ,$61.10 ,$46.68 ,$54.99 ,$51.94 ,$51.94 ,$51.94 ,$53.77 ,$51.94 ,$53.77 ,$53.77 ,$53.16 ,$51.94 ,$51.94 ,$51.94 ,$46.68 ,$54.99
Carle Richland Memorial Hospital,8140054,CANISTER SUCTION D AND C,1023,,270,$61.46 ,$61.46 ,$46.96 ,$55.31 ,$52.24 ,$52.24 ,$52.24 ,$54.08 ,$52.24 ,$54.08 ,$54.08 ,$53.47 ,$52.24 ,$52.24 ,$52.24 ,$46.96 ,$55.31
Carle Richland Memorial Hospital,8140054,DRESSING CSECTION POLYMEM 10/CA,232579,,270,$64.71 ,$64.71 ,$49.44 ,$58.24 ,$55.00 ,$55.00 ,$55.00 ,$56.94 ,$55.00 ,$56.94 ,$56.94 ,$56.30 ,$55.00 ,$55.00 ,$55.00 ,$49.44 ,$58.24
Carle Richland Memorial Hospital,8140054,TRAY LUMBAR PUNCTURE 20GAX23.5,233207,,270,$66.49 ,$66.49 ,$50.80 ,$59.84 ,$56.52 ,$56.52 ,$56.52 ,$58.51 ,$56.52 ,$58.51 ,$58.51 ,$57.85 ,$56.52 ,$56.52 ,$56.52 ,$50.80 ,$59.84
Carle Richland Memorial Hospital,8140054,RMH BVI BLADE,235177,,270,$67.50 ,$67.50 ,$51.57 ,$60.75 ,$57.38 ,$57.38 ,$57.38 ,$59.40 ,$57.38 ,$59.40 ,$59.40 ,$58.73 ,$57.38 ,$57.38 ,$57.38 ,$51.57 ,$60.75
Carle Richland Memorial Hospital,8140054,CANNULA CAPNOLINE ADULT CO2,235069,,270,$69.00 ,$69.00 ,$52.72 ,$62.10 ,$58.65 ,$58.65 ,$58.65 ,$60.72 ,$58.65 ,$60.72 ,$60.72 ,$60.03 ,$58.65 ,$58.65 ,$58.65 ,$52.72 ,$62.10
Carle Richland Memorial Hospital,8140054,LEGGING ATHROMBIC LARGE CALF,39,,270,$70.31 ,$70.31 ,$53.72 ,$63.28 ,$59.76 ,$59.76 ,$59.76 ,$61.87 ,$59.76 ,$61.87 ,$61.87 ,$61.17 ,$59.76 ,$59.76 ,$59.76 ,$53.72 ,$63.28
Carle Richland Memorial Hospital,8140054,MANIFOLD NEPTUNE 4PORT,232005,,270,$70.88 ,$70.88 ,$54.15 ,$63.79 ,$60.25 ,$60.25 ,$60.25 ,$62.37 ,$60.25 ,$62.37 ,$62.37 ,$61.67 ,$60.25 ,$60.25 ,$60.25 ,$54.15 ,$63.79
Carle Richland Memorial Hospital,8140054,CLIP HEMOCLIP WECK SMALL,233885,,270,$71.58 ,$71.58 ,$54.69 ,$64.42 ,$60.84 ,$60.84 ,$60.84 ,$62.99 ,$60.84 ,$62.99 ,$62.99 ,$62.27 ,$60.84 ,$60.84 ,$60.84 ,$54.69 ,$64.42
Carle Richland Memorial Hospital,8140054,SOL IRR .9 NACL 1000ML 12/CASE,363,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL IRR .9 NACL 3000ML 4/CASE,364,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL .9 NACL 1000ML 12/CASE,366,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL .9 NACL 500ML 24/CASE,369,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D10 1000ML 12/CASE,371,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 LR 1000ML 12/CASE,372,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 .9 NACL 1000ML 12/CASE,373,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 VIS IV 100ML VIS IV - 60/C,374,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 1000ML 12/CASE,377,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 250ML 24/CASE,379,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 500ML 24/CASE,384,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 .45 NACL 1000ML 12/CASE,385,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL D5 .225 NACL 1000ML 12/CASE,390,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL IRR GLYCINE 1.5 3000ML 4/CASE,393,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL LR 1000ML 12/CASE,396,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL IRR WATER 1000ML 12/CASE,400,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,SOL .45 NACL 1000ML 12/CASE,401,,270,$71.95 ,$71.95 ,$54.97 ,$64.76 ,$61.16 ,$61.16 ,$61.16 ,$63.32 ,$61.16 ,$63.32 ,$63.32 ,$62.60 ,$61.16 ,$61.16 ,$61.16 ,$54.97 ,$64.76
Carle Richland Memorial Hospital,8140054,KIT CATH ARTERIAL RADIAL,233942,,270,$72.00 ,$72.00 ,$55.01 ,$64.80 ,$61.20 ,$61.20 ,$61.20 ,$63.36 ,$61.20 ,$63.36 ,$63.36 ,$62.64 ,$61.20 ,$61.20 ,$61.20 ,$55.01 ,$64.80
Carle Richland Memorial Hospital,8140054,RMH CENTURION BALANCED PHACO TIP 45 DEGREE,235162,,270,$72.00 ,$72.00 ,$55.01 ,$64.80 ,$61.20 ,$61.20 ,$61.20 ,$63.36 ,$61.20 ,$63.36 ,$63.36 ,$62.64 ,$61.20 ,$61.20 ,$61.20 ,$55.01 ,$64.80
Carle Richland Memorial Hospital,8140054,RMH EYE DRAPE 8065117020,235168,,270,$72.00 ,$72.00 ,$55.01 ,$64.80 ,$61.20 ,$61.20 ,$61.20 ,$63.36 ,$61.20 ,$63.36 ,$63.36 ,$62.64 ,$61.20 ,$61.20 ,$61.20 ,$55.01 ,$64.80
Carle Richland Memorial Hospital,8140054,ELECTRODE PAD PHYSIO ADULT,232212,,270,$72.72 ,$72.72 ,$55.56 ,$65.45 ,$61.81 ,$61.81 ,$61.81 ,$63.99 ,$61.81 ,$63.99 ,$63.99 ,$63.27 ,$61.81 ,$61.81 ,$61.81 ,$55.56 ,$65.45
Carle Richland Memorial Hospital,8140054,SURGICELL 4 X 8IN,1029,,270,$75.00 ,$75.00 ,$57.30 ,$67.50 ,$63.75 ,$63.75 ,$63.75 ,$66.00 ,$63.75 ,$66.00 ,$66.00 ,$65.25 ,$63.75 ,$63.75 ,$63.75 ,$57.30 ,$67.50
Carle Richland Memorial Hospital,8140054,CAUTERY HI TEMP/VASECTOMY TIP,10077,,270,$75.61 ,$75.61 ,$57.77 ,$68.05 ,$64.27 ,$64.27 ,$64.27 ,$66.54 ,$64.27 ,$66.54 ,$66.54 ,$65.78 ,$64.27 ,$64.27 ,$64.27 ,$57.77 ,$68.05
Carle Richland Memorial Hospital,8140054,SNARE CAPIVATOR II 15MM SINGLE US,234706,,270,$75.63 ,$75.63 ,$57.78 ,$68.07 ,$64.29 ,$64.29 ,$64.29 ,$66.55 ,$64.29 ,$66.55 ,$66.55 ,$65.80 ,$64.29 ,$64.29 ,$64.29 ,$57.78 ,$68.07
Carle Richland Memorial Hospital,8140054,TROCAR KII FIOS 5X100MM,1201,,270,$76.50 ,$76.50 ,$58.45 ,$68.85 ,$65.03 ,$65.03 ,$65.03 ,$67.32 ,$65.03 ,$67.32 ,$67.32 ,$66.56 ,$65.03 ,$65.03 ,$65.03 ,$58.45 ,$68.85
Carle Richland Memorial Hospital,8140054,FORCEP HOT BIOPSY DISP,232145,,270,$76.50 ,$76.50 ,$58.45 ,$68.85 ,$65.03 ,$65.03 ,$65.03 ,$67.32 ,$65.03 ,$67.32 ,$67.32 ,$66.56 ,$65.03 ,$65.03 ,$65.03 ,$58.45 ,$68.85
Carle Richland Memorial Hospital,8140054,DRAPE SHOULDER BEACH CHAIR,1002,,270,$77.85 ,$77.85 ,$59.48 ,$70.07 ,$66.17 ,$66.17 ,$66.17 ,$68.51 ,$66.17 ,$68.51 ,$68.51 ,$67.73 ,$66.17 ,$66.17 ,$66.17 ,$59.48 ,$70.07
Carle Richland Memorial Hospital,8140054,BAG STERILE FLUID COLLECTOR,233992,,270,$79.09 ,$79.09 ,$60.42 ,$71.18 ,$67.23 ,$67.23 ,$67.23 ,$69.60 ,$67.23 ,$69.60 ,$69.60 ,$68.81 ,$67.23 ,$67.23 ,$67.23 ,$60.42 ,$71.18
Carle Richland Memorial Hospital,8140054,ADHESIVE TOPICAL SKN DERMABOND US,11341,,270,$79.80 ,$79.80 ,$60.97 ,$71.82 ,$67.83 ,$67.83 ,$67.83 ,$70.22 ,$67.83 ,$70.22 ,$70.22 ,$69.43 ,$67.83 ,$67.83 ,$67.83 ,$60.97 ,$71.82
Carle Richland Memorial Hospital,8140054,PACK LAP CHOLECYSTECTOMY,232128,,270,$79.81 ,$79.81 ,$60.97 ,$71.83 ,$67.84 ,$67.84 ,$67.84 ,$70.23 ,$67.84 ,$70.23 ,$70.23 ,$69.43 ,$67.84 ,$67.84 ,$67.84 ,$60.97 ,$71.83
Carle Richland Memorial Hospital,8140054,TROCAR KII BLADED 5X100MM,1203,,270,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8140054,WARMER SCOPE,233219,,270,$81.34 ,$81.34 ,$62.14 ,$73.21 ,$69.14 ,$69.14 ,$69.14 ,$71.58 ,$69.14 ,$71.58 ,$71.58 ,$70.77 ,$69.14 ,$69.14 ,$69.14 ,$62.14 ,$73.21
Carle Richland Memorial Hospital,8140054,HEMOCLIP WECK LARGE,234454,,270,$81.81 ,$81.81 ,$62.50 ,$73.63 ,$69.54 ,$69.54 ,$69.54 ,$71.99 ,$69.54 ,$71.99 ,$71.99 ,$71.17 ,$69.54 ,$69.54 ,$69.54 ,$62.50 ,$73.63
Carle Richland Memorial Hospital,8140054,TROCAR VERSAPORT 5MM,232201,,270,$81.99 ,$81.99 ,$62.64 ,$73.79 ,$69.69 ,$69.69 ,$69.69 ,$72.15 ,$69.69 ,$72.15 ,$72.15 ,$71.33 ,$69.69 ,$69.69 ,$69.69 ,$62.64 ,$73.79
Carle Richland Memorial Hospital,8140054,BLANKET WARMER UNDERBODY ADULT,217469,,270,$85.23 ,$85.23 ,$65.12 ,$76.71 ,$72.45 ,$72.45 ,$72.45 ,$75.00 ,$72.45 ,$75.00 ,$75.00 ,$74.15 ,$72.45 ,$72.45 ,$72.45 ,$65.12 ,$76.71
Carle Richland Memorial Hospital,8140054,BRACE ANKLE RIGHT AIR STIRRUP,233189,,270,$85.40 ,$85.40 ,$65.25 ,$76.86 ,$72.59 ,$72.59 ,$72.59 ,$75.15 ,$72.59 ,$75.15 ,$75.15 ,$74.30 ,$72.59 ,$72.59 ,$72.59 ,$65.25 ,$76.86
Carle Richland Memorial Hospital,8140054,BRACE ANKLE LEFT AIR STIRRUP,233190,,270,$85.40 ,$85.40 ,$65.25 ,$76.86 ,$72.59 ,$72.59 ,$72.59 ,$75.15 ,$72.59 ,$75.15 ,$75.15 ,$74.30 ,$72.59 ,$72.59 ,$72.59 ,$65.25 ,$76.86
Carle Richland Memorial Hospital,8140054,ELECTRODE PAD PHYSIO PEDS,232213,,270,$86.67 ,$86.67 ,$66.22 ,$78.00 ,$73.67 ,$73.67 ,$73.67 ,$76.27 ,$73.67 ,$76.27 ,$76.27 ,$75.40 ,$73.67 ,$73.67 ,$73.67 ,$66.22 ,$78.00
Carle Richland Memorial Hospital,8140054,GRID BIOPSY ACCU GRID 4.65IN,234404,,270,$89.91 ,$89.91 ,$68.69 ,$80.92 ,$76.42 ,$76.42 ,$76.42 ,$79.12 ,$76.42 ,$79.12 ,$79.12 ,$78.22 ,$76.42 ,$76.42 ,$76.42 ,$68.69 ,$80.92
Carle Richland Memorial Hospital,8140054,DRESSING AQUACEL AG 3.5X4,232120,,270,$91.54 ,$91.54 ,$69.94 ,$82.39 ,$77.81 ,$77.81 ,$77.81 ,$80.56 ,$77.81 ,$80.56 ,$80.56 ,$79.64 ,$77.81 ,$77.81 ,$77.81 ,$69.94 ,$82.39
Carle Richland Memorial Hospital,8140054,SLEEVE VENODYNE 22IN,234303,,270,$94.14 ,$94.14 ,$71.92 ,$84.73 ,$80.02 ,$80.02 ,$80.02 ,$82.84 ,$80.02 ,$82.84 ,$82.84 ,$81.90 ,$80.02 ,$80.02 ,$80.02 ,$71.92 ,$84.73
Carle Richland Memorial Hospital,8140054,CUFF TOURNIQUET 18IN 10/BX,1050,,270,$94.28 ,$94.28 ,$72.03 ,$84.85 ,$80.14 ,$80.14 ,$80.14 ,$82.97 ,$80.14 ,$82.97 ,$82.97 ,$82.02 ,$80.14 ,$80.14 ,$80.14 ,$72.03 ,$84.85
Carle Richland Memorial Hospital,8140054,TIP SCISSOR ENDOCUT,907,,270,$94.28 ,$94.28 ,$72.03 ,$84.85 ,$80.14 ,$80.14 ,$80.14 ,$82.97 ,$80.14 ,$82.97 ,$82.97 ,$82.02 ,$80.14 ,$80.14 ,$80.14 ,$72.03 ,$84.85
Carle Richland Memorial Hospital,8140054,TROCAR HASSON 12X100MM SM CONE BL,1146,,270,$94.50 ,$94.50 ,$72.20 ,$85.05 ,$80.33 ,$80.33 ,$80.33 ,$83.16 ,$80.33 ,$83.16 ,$83.16 ,$82.22 ,$80.33 ,$80.33 ,$80.33 ,$72.20 ,$85.05
Carle Richland Memorial Hospital,8140054,TROCAR KII BLADED 12X100MM,1207,,270,$94.50 ,$94.50 ,$72.20 ,$85.05 ,$80.33 ,$80.33 ,$80.33 ,$83.16 ,$80.33 ,$83.16 ,$83.16 ,$82.22 ,$80.33 ,$80.33 ,$80.33 ,$72.20 ,$85.05
Carle Richland Memorial Hospital,8140054,FIBERWIRE REVERSE CUT NEEDLE 2/5,131147,,270,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8140054,IMMOBILIZER KNEE UNIVERSAL 19,233188,,270,$99.36 ,$99.36 ,$75.91 ,$89.42 ,$84.46 ,$84.46 ,$84.46 ,$87.44 ,$84.46 ,$87.44 ,$87.44 ,$86.44 ,$84.46 ,$84.46 ,$84.46 ,$75.91 ,$89.42
Carle Richland Memorial Hospital,8140054,SENSOR ADHESIVE OXISENSOR NEO,233205,,270,$99.54 ,$99.54 ,$76.05 ,$89.59 ,$84.61 ,$84.61 ,$84.61 ,$87.60 ,$84.61 ,$87.60 ,$87.60 ,$86.60 ,$84.61 ,$84.61 ,$84.61 ,$76.05 ,$89.59
Carle Richland Memorial Hospital,8140054,CATH COUVELAIRE 3WAY 20FR,234351,,270,$100.10 ,$100.10 ,$76.48 ,$90.09 ,$85.09 ,$85.09 ,$85.09 ,$88.09 ,$85.09 ,$88.09 ,$88.09 ,$87.09 ,$85.09 ,$85.09 ,$85.09 ,$76.48 ,$90.09
Carle Richland Memorial Hospital,8140054,CATH COUVELAIRE 3WAY 22FR,234352,,270,$100.10 ,$100.10 ,$76.48 ,$90.09 ,$85.09 ,$85.09 ,$85.09 ,$88.09 ,$85.09 ,$88.09 ,$88.09 ,$87.09 ,$85.09 ,$85.09 ,$85.09 ,$76.48 ,$90.09
Carle Richland Memorial Hospital,8140054,CATH COUVELAIRE 3WAY 24FR,234353,,270,$100.10 ,$100.10 ,$76.48 ,$90.09 ,$85.09 ,$85.09 ,$85.09 ,$88.09 ,$85.09 ,$88.09 ,$88.09 ,$87.09 ,$85.09 ,$85.09 ,$85.09 ,$76.48 ,$90.09
Carle Richland Memorial Hospital,8140054,CATHETER 16FR 5CC FOLEY BARDEX LA,683,,270,$100.13 ,$100.13 ,$76.50 ,$90.12 ,$85.11 ,$85.11 ,$85.11 ,$88.11 ,$85.11 ,$88.11 ,$88.11 ,$87.11 ,$85.11 ,$85.11 ,$85.11 ,$76.50 ,$90.12
Carle Richland Memorial Hospital,8140054,CATH STRT RIBBED BLN 18FR 5CC LAT,684,,270,$100.13 ,$100.13 ,$76.50 ,$90.12 ,$85.11 ,$85.11 ,$85.11 ,$88.11 ,$85.11 ,$88.11 ,$88.11 ,$87.11 ,$85.11 ,$85.11 ,$85.11 ,$76.50 ,$90.12
Carle Richland Memorial Hospital,8140054,CAUTERY CORD ACTIVE DAC,746,,270,$104.40 ,$104.40 ,$79.76 ,$93.96 ,$88.74 ,$88.74 ,$88.74 ,$91.87 ,$88.74 ,$91.87 ,$91.87 ,$90.83 ,$88.74 ,$88.74 ,$88.74 ,$79.76 ,$93.96
Carle Richland Memorial Hospital,8140054,DRESSING AQUACEL AG 3.5X6,232121,,270,$105.86 ,$105.86 ,$80.88 ,$95.27 ,$89.98 ,$89.98 ,$89.98 ,$93.16 ,$89.98 ,$93.16 ,$93.16 ,$92.10 ,$89.98 ,$89.98 ,$89.98 ,$80.88 ,$95.27
Carle Richland Memorial Hospital,8140054,SENSOR FOREHEAD LNCS TFA-1 10/BX,233206,,270,$108.00 ,$108.00 ,$82.51 ,$97.20 ,$91.80 ,$91.80 ,$91.80 ,$95.04 ,$91.80 ,$95.04 ,$95.04 ,$93.96 ,$91.80 ,$91.80 ,$91.80 ,$82.51 ,$97.20
Carle Richland Memorial Hospital,8140054,SNARE ROTATE POLYPECTOMY 20MM SIN,234707,,270,$108.61 ,$108.61 ,$82.98 ,$97.75 ,$92.32 ,$92.32 ,$92.32 ,$95.58 ,$92.32 ,$95.58 ,$95.58 ,$94.49 ,$92.32 ,$92.32 ,$92.32 ,$82.98 ,$97.75
Carle Richland Memorial Hospital,8140054,KIWI PALM PUMP OMNICUPS,232577,,270,$109.08 ,$109.08 ,$83.34 ,$98.17 ,$92.72 ,$92.72 ,$92.72 ,$95.99 ,$92.72 ,$95.99 ,$95.99 ,$94.90 ,$92.72 ,$92.72 ,$92.72 ,$83.34 ,$98.17
Carle Richland Memorial Hospital,8140054,PACK SHOULDER OPEN,232115,,270,$109.67 ,$109.67 ,$83.79 ,$98.70 ,$93.22 ,$93.22 ,$93.22 ,$96.51 ,$93.22 ,$96.51 ,$96.51 ,$95.41 ,$93.22 ,$93.22 ,$93.22 ,$83.79 ,$98.70
Carle Richland Memorial Hospital,8140054,DRAIN CATH MALECOT 4-WING 28FR LA,232219,,270,$111.08 ,$111.08 ,$84.87 ,$99.97 ,$94.42 ,$94.42 ,$94.42 ,$97.75 ,$94.42 ,$97.75 ,$97.75 ,$96.64 ,$94.42 ,$94.42 ,$94.42 ,$84.87 ,$99.97
Carle Richland Memorial Hospital,8140054,TRAY THORACENTESIS DISP PHARMASEA,233940,,270,$111.32 ,$111.32 ,$85.05 ,$100.19 ,$94.62 ,$94.62 ,$94.62 ,$97.96 ,$94.62 ,$97.96 ,$97.96 ,$96.85 ,$94.62 ,$94.62 ,$94.62 ,$85.05 ,$100.19
Carle Richland Memorial Hospital,8140054,CUFF TOURNIQUET 30IN 10/BX,1052,,270,$112.18 ,$112.18 ,$85.71 ,$100.96 ,$95.35 ,$95.35 ,$95.35 ,$98.72 ,$95.35 ,$98.72 ,$98.72 ,$97.60 ,$95.35 ,$95.35 ,$95.35 ,$85.71 ,$100.96
Carle Richland Memorial Hospital,8140054,PACK ARTHROSCOPY III,232112,,270,$112.28 ,$112.28 ,$85.78 ,$101.05 ,$95.44 ,$95.44 ,$95.44 ,$98.81 ,$95.44 ,$98.81 ,$98.81 ,$97.68 ,$95.44 ,$95.44 ,$95.44 ,$85.78 ,$101.05
Carle Richland Memorial Hospital,8140054,TROCAR KII BLADED 5X100MM DL DUAL,1204,,270,$112.50 ,$112.50 ,$85.95 ,$101.25 ,$95.63 ,$95.63 ,$95.63 ,$99.00 ,$95.63 ,$99.00 ,$99.00 ,$97.88 ,$95.63 ,$95.63 ,$95.63 ,$85.95 ,$101.25
Carle Richland Memorial Hospital,8140054,CANNULA TWISTIN 7MMX7CM PURPLE,235476,,270,$112.50 ,$112.50 ,$85.95 ,$101.25 ,$95.63 ,$95.63 ,$95.63 ,$99.00 ,$95.63 ,$99.00 ,$99.00 ,$97.88 ,$95.63 ,$95.63 ,$95.63 ,$85.95 ,$101.25
Carle Richland Memorial Hospital,8140054,NEEDLE ACUJECT VARI INJECTION,235793,,270,$112.50 ,$112.50 ,$85.95 ,$101.25 ,$95.63 ,$95.63 ,$95.63 ,$99.00 ,$95.63 ,$99.00 ,$99.00 ,$97.88 ,$95.63 ,$95.63 ,$95.63 ,$85.95 ,$101.25
Carle Richland Memorial Hospital,8140054,STOCKINETTE IMPERVIOUS LARGE 4/CA,254163,,270,$115.61 ,$115.61 ,$88.33 ,$104.05 ,$98.27 ,$98.27 ,$98.27 ,$101.74 ,$98.27 ,$101.74 ,$101.74 ,$100.58 ,$98.27 ,$98.27 ,$98.27 ,$88.33 ,$104.05
Carle Richland Memorial Hospital,8140054,GLOVE EXAM NITRILE XLARGE PREMIER,10753,,270,$115.90 ,$115.90 ,$88.55 ,$104.31 ,$98.52 ,$98.52 ,$98.52 ,$101.99 ,$98.52 ,$101.99 ,$101.99 ,$100.83 ,$98.52 ,$98.52 ,$98.52 ,$88.55 ,$104.31
Carle Richland Memorial Hospital,8140054,GLOVE EXAM NITRILE LARGE PREMIER,110003,,270,$115.90 ,$115.90 ,$88.55 ,$104.31 ,$98.52 ,$98.52 ,$98.52 ,$101.99 ,$98.52 ,$101.99 ,$101.99 ,$100.83 ,$98.52 ,$98.52 ,$98.52 ,$88.55 ,$104.31
Carle Richland Memorial Hospital,8140054,GLOVE EXAM NITRILE SMALL PREMIER,110004,,270,$115.90 ,$115.90 ,$88.55 ,$104.31 ,$98.52 ,$98.52 ,$98.52 ,$101.99 ,$98.52 ,$101.99 ,$101.99 ,$100.83 ,$98.52 ,$98.52 ,$98.52 ,$88.55 ,$104.31
Carle Richland Memorial Hospital,8140054,GLOVE EXAM NITRILE MEDIUM PREMIER,110005,,270,$115.90 ,$115.90 ,$88.55 ,$104.31 ,$98.52 ,$98.52 ,$98.52 ,$101.99 ,$98.52 ,$101.99 ,$101.99 ,$100.83 ,$98.52 ,$98.52 ,$98.52 ,$88.55 ,$104.31
Carle Richland Memorial Hospital,8140054,CUFF TOURNIQUET 34IN 10/BX,1053,,270,$121.35 ,$121.35 ,$92.71 ,$109.22 ,$103.15 ,$103.15 ,$103.15 ,$106.79 ,$103.15 ,$106.79 ,$106.79 ,$105.57 ,$103.15 ,$103.15 ,$103.15 ,$92.71 ,$109.22
Carle Richland Memorial Hospital,8140054,GUIDEWIRE NICORE .035IN 150CM,234410,,270,$121.50 ,$121.50 ,$92.83 ,$109.35 ,$103.28 ,$103.28 ,$103.28 ,$106.92 ,$103.28 ,$106.92 ,$106.92 ,$105.71 ,$103.28 ,$103.28 ,$103.28 ,$92.83 ,$109.35
Carle Richland Memorial Hospital,8140054,KIT PRESSURE MONITORING SUMMIT,233184,,270,$122.13 ,$122.13 ,$93.31 ,$109.92 ,$103.81 ,$103.81 ,$103.81 ,$107.47 ,$103.81 ,$107.47 ,$107.47 ,$106.25 ,$103.81 ,$103.81 ,$103.81 ,$93.31 ,$109.92
Carle Richland Memorial Hospital,8140054,STAPLER SKIN APPOSE,232192,,270,$124.26 ,$124.26 ,$94.93 ,$111.83 ,$105.62 ,$105.62 ,$105.62 ,$109.35 ,$105.62 ,$109.35 ,$109.35 ,$108.11 ,$105.62 ,$105.62 ,$105.62 ,$94.93 ,$111.83
Carle Richland Memorial Hospital,8140054,PENCIL SMOKE EVAC COATED PB 10 PE,216964,,270,$128.25 ,$128.25 ,$97.98 ,$115.43 ,$109.01 ,$109.01 ,$109.01 ,$112.86 ,$109.01 ,$112.86 ,$112.86 ,$111.58 ,$109.01 ,$109.01 ,$109.01 ,$97.98 ,$115.43
Carle Richland Memorial Hospital,8140054,PENCIL SMOKE EVACUATOR NEPTUNE,235484,,270,$128.25 ,$128.25 ,$97.98 ,$115.43 ,$109.01 ,$109.01 ,$109.01 ,$112.86 ,$109.01 ,$112.86 ,$112.86 ,$111.58 ,$109.01 ,$109.01 ,$109.01 ,$97.98 ,$115.43
Carle Richland Memorial Hospital,8140054,BLADE DERMATOME 8800,600,,270,$128.48 ,$128.48 ,$98.16 ,$115.63 ,$109.21 ,$109.21 ,$109.21 ,$113.06 ,$109.21 ,$113.06 ,$113.06 ,$111.78 ,$109.21 ,$109.21 ,$109.21 ,$98.16 ,$115.63
Carle Richland Memorial Hospital,8140054,CUFF TOURNIQUET 42IN 10/BX,1054,,270,$130.08 ,$130.08 ,$99.38 ,$117.07 ,$110.57 ,$110.57 ,$110.57 ,$114.47 ,$110.57 ,$114.47 ,$114.47 ,$113.17 ,$110.57 ,$110.57 ,$110.57 ,$99.38 ,$117.07
Carle Richland Memorial Hospital,8140054,PULSAVAC SUCTION IRRIGATION,232132,,270,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8140054,DRESSING HYDROFERA BLUE 50/CA,232248,,270,$135.87 ,$135.87 ,$103.80 ,$122.28 ,$115.49 ,$115.49 ,$115.49 ,$119.57 ,$115.49 ,$119.57 ,$119.57 ,$118.21 ,$115.49 ,$115.49 ,$115.49 ,$103.80 ,$122.28
Carle Richland Memorial Hospital,8140054,CAUTERY PENCIL TRIVERSE BOVIE HAN,234705,,270,$136.53 ,$136.53 ,$104.31 ,$122.88 ,$116.05 ,$116.05 ,$116.05 ,$120.15 ,$116.05 ,$120.15 ,$120.15 ,$118.78 ,$116.05 ,$116.05 ,$116.05 ,$104.31 ,$122.88
Carle Richland Memorial Hospital,8140054,DRESSING AQUACEL AG 3.5X10,232118,,270,$139.30 ,$139.30 ,$106.43 ,$125.37 ,$118.41 ,$118.41 ,$118.41 ,$122.58 ,$118.41 ,$122.58 ,$122.58 ,$121.19 ,$118.41 ,$118.41 ,$118.41 ,$106.43 ,$125.37
Carle Richland Memorial Hospital,8140054,RMH SALMON SLEEVE,235170,,270,$139.50 ,$139.50 ,$106.58 ,$125.55 ,$118.58 ,$118.58 ,$118.58 ,$122.76 ,$118.58 ,$122.76 ,$122.76 ,$121.37 ,$118.58 ,$118.58 ,$118.58 ,$106.58 ,$125.55
Carle Richland Memorial Hospital,8140054,BLADE SAW 7X29.5MM,233246,,270,$142.70 ,$142.70 ,$109.02 ,$128.43 ,$121.30 ,$121.30 ,$121.30 ,$125.58 ,$121.30 ,$125.58 ,$125.58 ,$124.15 ,$121.30 ,$121.30 ,$121.30 ,$109.02 ,$128.43
Carle Richland Memorial Hospital,8140054,DRAPE SHOULDER FLUID CONTROL,232113,,270,$144.48 ,$144.48 ,$110.38 ,$130.03 ,$122.81 ,$122.81 ,$122.81 ,$127.14 ,$122.81 ,$127.14 ,$127.14 ,$125.70 ,$122.81 ,$122.81 ,$122.81 ,$110.38 ,$130.03
Carle Richland Memorial Hospital,8140054,GUIDEWIRE STR TIP FIXED 0.035,234406,,270,$146.03 ,$146.03 ,$111.57 ,$131.43 ,$124.13 ,$124.13 ,$124.13 ,$128.51 ,$124.13 ,$128.51 ,$128.51 ,$127.05 ,$124.13 ,$124.13 ,$124.13 ,$111.57 ,$131.43
Carle Richland Memorial Hospital,8140054,BLADE THIN PRECISE 9X0.38X25MM WE,642,,270,$146.25 ,$146.25 ,$111.74 ,$131.63 ,$124.31 ,$124.31 ,$124.31 ,$128.70 ,$124.31 ,$128.70 ,$128.70 ,$127.24 ,$124.31 ,$124.31 ,$124.31 ,$111.74 ,$131.63
Carle Richland Memorial Hospital,8140054,SURGICELL 2 X 3IN,1032,,270,$150.49 ,$150.49 ,$114.97 ,$135.44 ,$127.92 ,$127.92 ,$127.92 ,$132.43 ,$127.92 ,$132.43 ,$132.43 ,$130.93 ,$127.92 ,$127.92 ,$127.92 ,$114.97 ,$135.44
Carle Richland Memorial Hospital,8140054,PACK ORTHO V-HIP,235464,,270,$151.74 ,$151.74 ,$115.93 ,$136.57 ,$128.98 ,$128.98 ,$128.98 ,$133.53 ,$128.98 ,$133.53 ,$133.53 ,$132.01 ,$128.98 ,$128.98 ,$128.98 ,$115.93 ,$136.57
Carle Richland Memorial Hospital,8140054,CATH URETERAL CONE 5FR,234376,,270,$151.76 ,$151.76 ,$115.94 ,$136.58 ,$129.00 ,$129.00 ,$129.00 ,$133.55 ,$129.00 ,$133.55 ,$133.55 ,$132.03 ,$129.00 ,$129.00 ,$129.00 ,$115.94 ,$136.58
Carle Richland Memorial Hospital,8140054,CARTRIDGE GREEN PROXIMATE 30MM 12,1183,,270,$154.26 ,$154.26 ,$117.85 ,$138.83 ,$131.12 ,$131.12 ,$131.12 ,$135.75 ,$131.12 ,$135.75 ,$135.75 ,$134.21 ,$131.12 ,$131.12 ,$131.12 ,$117.85 ,$138.83
Carle Richland Memorial Hospital,8140054,KIT ENDOVIVE G TUBE RT ANG 14F,234769,,270,$154.80 ,$154.80 ,$118.27 ,$139.32 ,$131.58 ,$131.58 ,$131.58 ,$136.22 ,$131.58 ,$136.22 ,$136.22 ,$134.68 ,$131.58 ,$131.58 ,$131.58 ,$118.27 ,$139.32
Carle Richland Memorial Hospital,8140054,KIT ENDOVIVE G TUBE RT ANG 16F,234770,,270,$154.80 ,$154.80 ,$118.27 ,$139.32 ,$131.58 ,$131.58 ,$131.58 ,$136.22 ,$131.58 ,$136.22 ,$136.22 ,$134.68 ,$131.58 ,$131.58 ,$131.58 ,$118.27 ,$139.32
Carle Richland Memorial Hospital,8140054,KIT ENDOVIVE G TUBE RT ANG 18F,234771,,270,$154.80 ,$154.80 ,$118.27 ,$139.32 ,$131.58 ,$131.58 ,$131.58 ,$136.22 ,$131.58 ,$136.22 ,$136.22 ,$134.68 ,$131.58 ,$131.58 ,$131.58 ,$118.27 ,$139.32
Carle Richland Memorial Hospital,8140054,KIT ENDOVIVE G TUBE RT ANG 20F,234772,,270,$154.80 ,$154.80 ,$118.27 ,$139.32 ,$131.58 ,$131.58 ,$131.58 ,$136.22 ,$131.58 ,$136.22 ,$136.22 ,$134.68 ,$131.58 ,$131.58 ,$131.58 ,$118.27 ,$139.32
Carle Richland Memorial Hospital,8140054,DRESSING AQUACEL AG 3.5X12,232119,,270,$155.21 ,$155.21 ,$118.58 ,$139.69 ,$131.93 ,$131.93 ,$131.93 ,$136.58 ,$131.93 ,$136.58 ,$136.58 ,$135.03 ,$131.93 ,$131.93 ,$131.93 ,$118.58 ,$139.69
Carle Richland Memorial Hospital,8140054,PACK ORTHO VIII LOWER EXTREMTY,233991,,270,$155.53 ,$155.53 ,$118.82 ,$139.98 ,$132.20 ,$132.20 ,$132.20 ,$136.87 ,$132.20 ,$136.87 ,$136.87 ,$135.31 ,$132.20 ,$132.20 ,$132.20 ,$118.82 ,$139.98
Carle Richland Memorial Hospital,8140054,SPLINT 2X15FT ORTHOGLASS,233993,,270,$156.31 ,$156.31 ,$119.42 ,$140.68 ,$132.86 ,$132.86 ,$132.86 ,$137.55 ,$132.86 ,$137.55 ,$137.55 ,$135.99 ,$132.86 ,$132.86 ,$132.86 ,$119.42 ,$140.68
Carle Richland Memorial Hospital,8140054,DEVICE SPHERE INFLATION,210642,,270,$157.50 ,$157.50 ,$120.33 ,$141.75 ,$133.88 ,$133.88 ,$133.88 ,$138.60 ,$133.88 ,$138.60 ,$138.60 ,$137.03 ,$133.88 ,$133.88 ,$133.88 ,$120.33 ,$141.75
Carle Richland Memorial Hospital,8140054,MANIPULATOR UTERINE K-UMI 12/bx,110211,,270,$159.37 ,$159.37 ,$121.76 ,$143.43 ,$135.46 ,$135.46 ,$135.46 ,$140.25 ,$135.46 ,$140.25 ,$140.25 ,$138.65 ,$135.46 ,$135.46 ,$135.46 ,$121.76 ,$143.43
Carle Richland Memorial Hospital,8140054,CATH URETERAL DUAL LUMEN 10FX5,240255,,270,$164.52 ,$164.52 ,$125.69 ,$148.07 ,$139.84 ,$139.84 ,$139.84 ,$144.78 ,$139.84 ,$144.78 ,$144.78 ,$143.13 ,$139.84 ,$139.84 ,$139.84 ,$125.69 ,$148.07
Carle Richland Memorial Hospital,8140054,BULB PATHFINDER IRRIGATION,234299,,270,$166.50 ,$166.50 ,$127.21 ,$149.85 ,$141.53 ,$141.53 ,$141.53 ,$146.52 ,$141.53 ,$146.52 ,$146.52 ,$144.86 ,$141.53 ,$141.53 ,$141.53 ,$127.21 ,$149.85
Carle Richland Memorial Hospital,8140054,MARKER GI TRACT SPOT BCMPT N-PYRG,206962,,270,$171.00 ,$171.00 ,$130.64 ,$153.90 ,$145.35 ,$145.35 ,$145.35 ,$150.48 ,$145.35 ,$150.48 ,$150.48 ,$148.77 ,$145.35 ,$145.35 ,$145.35 ,$130.64 ,$153.90
Carle Richland Memorial Hospital,8140054,KWIRE .062 1.66MM SS,5245,,270,$171.00 ,$171.00 ,$130.64 ,$153.90 ,$145.35 ,$145.35 ,$145.35 ,$150.48 ,$145.35 ,$150.48 ,$150.48 ,$148.77 ,$145.35 ,$145.35 ,$145.35 ,$130.64 ,$153.90
Carle Richland Memorial Hospital,8140054,DRAIN CATH MALECOT 4-WAY 14 FR,240256,,270,$172.13 ,$172.13 ,$131.51 ,$154.92 ,$146.31 ,$146.31 ,$146.31 ,$151.47 ,$146.31 ,$151.47 ,$151.47 ,$149.75 ,$146.31 ,$146.31 ,$146.31 ,$131.51 ,$154.92
Carle Richland Memorial Hospital,8140054,DEVICE RAPID RHINO 5.5CM UNI INFL,3800,,270,$174.15 ,$174.15 ,$133.05 ,$156.74 ,$148.03 ,$148.03 ,$148.03 ,$153.25 ,$148.03 ,$153.25 ,$153.25 ,$151.51 ,$148.03 ,$148.03 ,$148.03 ,$133.05 ,$156.74
Carle Richland Memorial Hospital,8140054,SET IRRIGATION FLUID WARMING,232578,,270,$174.98 ,$174.98 ,$133.68 ,$157.48 ,$148.73 ,$148.73 ,$148.73 ,$153.98 ,$148.73 ,$153.98 ,$153.98 ,$152.23 ,$148.73 ,$148.73 ,$148.73 ,$133.68 ,$157.48
Carle Richland Memorial Hospital,8140054,DRESSING WOUND VAC MEDIUM,529,,270,$176.12 ,$176.12 ,$134.56 ,$158.51 ,$149.70 ,$149.70 ,$149.70 ,$154.99 ,$149.70 ,$154.99 ,$154.99 ,$153.22 ,$149.70 ,$149.70 ,$149.70 ,$134.56 ,$158.51
Carle Richland Memorial Hospital,8140054,ELECTRODE NEEDLE LAPAROSCOPIC,909,,270,$179.92 ,$179.92 ,$137.46 ,$161.93 ,$152.93 ,$152.93 ,$152.93 ,$158.33 ,$152.93 ,$158.33 ,$158.33 ,$156.53 ,$152.93 ,$152.93 ,$152.93 ,$137.46 ,$161.93
Carle Richland Memorial Hospital,8140054,DRAPE POUCH C-ARMOR,820,,270,$187.50 ,$187.50 ,$143.25 ,$168.75 ,$159.38 ,$159.38 ,$159.38 ,$165.00 ,$159.38 ,$165.00 ,$165.00 ,$163.13 ,$159.38 ,$159.38 ,$159.38 ,$143.25 ,$168.75
Carle Richland Memorial Hospital,8140054,NEEDLE SURGINEEDLE 120MM 14GA,232202,,270,$189.52 ,$189.52 ,$144.79 ,$170.57 ,$161.09 ,$161.09 ,$161.09 ,$166.78 ,$161.09 ,$166.78 ,$166.78 ,$164.88 ,$161.09 ,$161.09 ,$161.09 ,$144.79 ,$170.57
Carle Richland Memorial Hospital,8140054,GUIDEWIRE KWIRE 1.25MM,233822,,270,$189.86 ,$189.86 ,$145.05 ,$170.87 ,$161.38 ,$161.38 ,$161.38 ,$167.08 ,$161.38 ,$167.08 ,$167.08 ,$165.18 ,$161.38 ,$161.38 ,$161.38 ,$145.05 ,$170.87
Carle Richland Memorial Hospital,8140054,GUIDEWIRE KWIRE 1.6MM,233823,,270,$189.86 ,$189.86 ,$145.05 ,$170.87 ,$161.38 ,$161.38 ,$161.38 ,$167.08 ,$161.38 ,$167.08 ,$167.08 ,$165.18 ,$161.38 ,$161.38 ,$161.38 ,$145.05 ,$170.87
Carle Richland Memorial Hospital,8140054,GUIDEWIRE KWIRE 2.0MM,233824,,270,$189.86 ,$189.86 ,$145.05 ,$170.87 ,$161.38 ,$161.38 ,$161.38 ,$167.08 ,$161.38 ,$167.08 ,$167.08 ,$165.18 ,$161.38 ,$161.38 ,$161.38 ,$145.05 ,$170.87
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 2.5MM,233825,,270,$189.86 ,$189.86 ,$145.05 ,$170.87 ,$161.38 ,$161.38 ,$161.38 ,$167.08 ,$161.38 ,$167.08 ,$167.08 ,$165.18 ,$161.38 ,$161.38 ,$161.38 ,$145.05 ,$170.87
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 3.5MM,233826,,270,$189.86 ,$189.86 ,$145.05 ,$170.87 ,$161.38 ,$161.38 ,$161.38 ,$167.08 ,$161.38 ,$167.08 ,$167.08 ,$165.18 ,$161.38 ,$161.38 ,$161.38 ,$145.05 ,$170.87
Carle Richland Memorial Hospital,8140054,RELOAD MULTIFIRE GIA 60-3.8MM,234414,,270,$194.16 ,$194.16 ,$148.34 ,$174.74 ,$165.04 ,$165.04 ,$165.04 ,$170.86 ,$165.04 ,$170.86 ,$170.86 ,$168.92 ,$165.04 ,$165.04 ,$165.04 ,$148.34 ,$174.74
Carle Richland Memorial Hospital,8140054,MAT FLOOR SUCTION USA-X10 INCREME,933,,270,$196.65 ,$196.65 ,$150.24 ,$176.99 ,$167.15 ,$167.15 ,$167.15 ,$173.05 ,$167.15 ,$173.05 ,$173.05 ,$171.09 ,$167.15 ,$167.15 ,$167.15 ,$150.24 ,$176.99
Carle Richland Memorial Hospital,8140054,SET TUBE ARTHROSCOPY TUBE USE WIT,134529,,270,$208.62 ,$208.62 ,$159.39 ,$187.76 ,$177.33 ,$177.33 ,$177.33 ,$183.59 ,$177.33 ,$183.59 ,$183.59 ,$181.50 ,$177.33 ,$177.33 ,$177.33 ,$159.39 ,$187.76
Carle Richland Memorial Hospital,8140054,DEVICE CORE BIOPSY 18G 20MM 5 PER,595,,270,$209.40 ,$209.40 ,$159.98 ,$188.46 ,$177.99 ,$177.99 ,$177.99 ,$184.27 ,$177.99 ,$184.27 ,$184.27 ,$182.18 ,$177.99 ,$177.99 ,$177.99 ,$159.98 ,$188.46
Carle Richland Memorial Hospital,8140054,IRRIGATOR SUCTION STRYKER FLOW,219,,270,$213.86 ,$213.86 ,$163.39 ,$192.47 ,$181.78 ,$181.78 ,$181.78 ,$188.20 ,$181.78 ,$188.20 ,$188.20 ,$186.06 ,$181.78 ,$181.78 ,$181.78 ,$163.39 ,$192.47
Carle Richland Memorial Hospital,8140054,FIBERWIRE TIGERWIRE 38IN C-13 REV,234740,,270,$216.00 ,$216.00 ,$165.02 ,$194.40 ,$183.60 ,$183.60 ,$183.60 ,$190.08 ,$183.60 ,$190.08 ,$190.08 ,$187.92 ,$183.60 ,$183.60 ,$183.60 ,$165.02 ,$194.40
Carle Richland Memorial Hospital,8140054,SPLINT 3X15FT ORTHOGLASS 2/CA,233999,,270,$222.11 ,$222.11 ,$169.69 ,$199.90 ,$188.79 ,$188.79 ,$188.79 ,$195.46 ,$188.79 ,$195.46 ,$195.46 ,$193.24 ,$188.79 ,$188.79 ,$188.79 ,$169.69 ,$199.90
Carle Richland Memorial Hospital,8140054,SYSTEM ANTIFOG SEE SHARP SCOPE HO,217554,,270,$222.75 ,$222.75 ,$170.18 ,$200.48 ,$189.34 ,$189.34 ,$189.34 ,$196.02 ,$189.34 ,$196.02 ,$196.02 ,$193.79 ,$189.34 ,$189.34 ,$189.34 ,$170.18 ,$200.48
Carle Richland Memorial Hospital,8140054,ULTRASLING III SMALL,234441,,270,$224.91 ,$224.91 ,$171.83 ,$202.42 ,$191.17 ,$191.17 ,$191.17 ,$197.92 ,$191.17 ,$197.92 ,$197.92 ,$195.67 ,$191.17 ,$191.17 ,$191.17 ,$171.83 ,$202.42
Carle Richland Memorial Hospital,8140054,TAPE FIBER 2MM MULT OF 6,131149,,270,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8140054,POSITIONER ARM STRL DISP,235667,,270,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8140054,CATH CHOLANGIOGRAM 4.5FR TAUT,234450,,270,$227.25 ,$227.25 ,$173.62 ,$204.53 ,$193.16 ,$193.16 ,$193.16 ,$199.98 ,$193.16 ,$199.98 ,$199.98 ,$197.71 ,$193.16 ,$193.16 ,$193.16 ,$173.62 ,$204.53
Carle Richland Memorial Hospital,8140054,GUIDEWIRE SOLOHYDRO .035X150,234398,,270,$228.96 ,$228.96 ,$174.93 ,$206.06 ,$194.62 ,$194.62 ,$194.62 ,$201.48 ,$194.62 ,$201.48 ,$201.48 ,$199.20 ,$194.62 ,$194.62 ,$194.62 ,$174.93 ,$206.06
Carle Richland Memorial Hospital,8140054,PIN GUIDE 2.8 X 230MM,233300,,270,$229.32 ,$229.32 ,$175.20 ,$206.39 ,$194.92 ,$194.92 ,$194.92 ,$201.80 ,$194.92 ,$201.80 ,$201.80 ,$199.51 ,$194.92 ,$194.92 ,$194.92 ,$175.20 ,$206.39
Carle Richland Memorial Hospital,8140054,GUIDEWIRE SMOOTH 3.2X300MM,233393,,270,$229.32 ,$229.32 ,$175.20 ,$206.39 ,$194.92 ,$194.92 ,$194.92 ,$201.80 ,$194.92 ,$201.80 ,$201.80 ,$199.51 ,$194.92 ,$194.92 ,$194.92 ,$175.20 ,$206.39
Carle Richland Memorial Hospital,8140054,GUIDEWIRE THREADED 3.2X300MM,233394,,270,$229.32 ,$229.32 ,$175.20 ,$206.39 ,$194.92 ,$194.92 ,$194.92 ,$201.80 ,$194.92 ,$201.80 ,$201.80 ,$199.51 ,$194.92 ,$194.92 ,$194.92 ,$175.20 ,$206.39
Carle Richland Memorial Hospital,8140054,GUIDEPIN SMOOTH 1.6MMX6IN,233445,,270,$243.27 ,$243.27 ,$185.86 ,$218.94 ,$206.78 ,$206.78 ,$206.78 ,$214.08 ,$206.78 ,$214.08 ,$214.08 ,$211.64 ,$206.78 ,$206.78 ,$206.78 ,$185.86 ,$218.94
Carle Richland Memorial Hospital,8140054,PIN GUIDE SMOOTH 1.6MMX9IN,233447,,270,$243.27 ,$243.27 ,$185.86 ,$218.94 ,$206.78 ,$206.78 ,$206.78 ,$214.08 ,$206.78 ,$214.08 ,$214.08 ,$211.64 ,$206.78 ,$206.78 ,$206.78 ,$185.86 ,$218.94
Carle Richland Memorial Hospital,8140054,PIN GUIDE SMOOTH 1.25MMX6IN,233489,,270,$243.27 ,$243.27 ,$185.86 ,$218.94 ,$206.78 ,$206.78 ,$206.78 ,$214.08 ,$206.78 ,$214.08 ,$214.08 ,$211.64 ,$206.78 ,$206.78 ,$206.78 ,$185.86 ,$218.94
Carle Richland Memorial Hospital,8140054,NEEDLE VENIPUNCTURE PRO DEVICE,232158,,270,$250.85 ,$250.85 ,$191.65 ,$225.77 ,$213.22 ,$213.22 ,$213.22 ,$220.75 ,$213.22 ,$220.75 ,$220.75 ,$218.24 ,$213.22 ,$213.22 ,$213.22 ,$191.65 ,$225.77
Carle Richland Memorial Hospital,8140054,PROBE SUCT/IRRIG TUBING DAVOL,232131,,270,$251.08 ,$251.08 ,$191.83 ,$225.97 ,$213.42 ,$213.42 ,$213.42 ,$220.95 ,$213.42 ,$220.95 ,$220.95 ,$218.44 ,$213.42 ,$213.42 ,$213.42 ,$191.83 ,$225.97
Carle Richland Memorial Hospital,8140054,BAG ENDO 10MM MULTI RETREVAL CA/5,196682,,270,$258.75 ,$258.75 ,$197.69 ,$232.88 ,$219.94 ,$219.94 ,$219.94 ,$227.70 ,$219.94 ,$227.70 ,$227.70 ,$225.11 ,$219.94 ,$219.94 ,$219.94 ,$197.69 ,$232.88
Carle Richland Memorial Hospital,8140054,SPLINT 4X15FT ORTHOGLASS 2/CA,234000,,270,$266.56 ,$266.56 ,$203.65 ,$239.90 ,$226.58 ,$226.58 ,$226.58 ,$234.57 ,$226.58 ,$234.57 ,$234.57 ,$231.91 ,$226.58 ,$226.58 ,$226.58 ,$203.65 ,$239.90
Carle Richland Memorial Hospital,8140054,PAD GROUNDING POLYHESIVE II,232149,,270,$274.23 ,$274.23 ,$209.51 ,$246.81 ,$233.10 ,$233.10 ,$233.10 ,$241.32 ,$233.10 ,$241.32 ,$241.32 ,$238.58 ,$233.10 ,$233.10 ,$233.10 ,$209.51 ,$246.81
Carle Richland Memorial Hospital,8140054,GUIDEWIRE KWIRE 2.0MM,233359,,270,$282.15 ,$282.15 ,$215.56 ,$253.94 ,$239.83 ,$239.83 ,$239.83 ,$248.29 ,$239.83 ,$248.29 ,$248.29 ,$245.47 ,$239.83 ,$239.83 ,$239.83 ,$215.56 ,$253.94
Carle Richland Memorial Hospital,8140054,RELOAD MULTIFIRE GIA 80-3.8MM,234416,,270,$283.84 ,$283.84 ,$216.85 ,$255.46 ,$241.26 ,$241.26 ,$241.26 ,$249.78 ,$241.26 ,$249.78 ,$249.78 ,$246.94 ,$241.26 ,$241.26 ,$241.26 ,$216.85 ,$255.46
Carle Richland Memorial Hospital,8140054,GUIDEWIRE ZIP HDS STR .035X150 5/,195710,,270,$283.86 ,$283.86 ,$216.87 ,$255.47 ,$241.28 ,$241.28 ,$241.28 ,$249.80 ,$241.28 ,$249.80 ,$249.80 ,$246.96 ,$241.28 ,$241.28 ,$241.28 ,$216.87 ,$255.47
Carle Richland Memorial Hospital,8140054,GLIDEWIRE ZIPWIRE 0.025 STR 150CM,234377,,270,$283.86 ,$283.86 ,$216.87 ,$255.47 ,$241.28 ,$241.28 ,$241.28 ,$249.80 ,$241.28 ,$249.80 ,$249.80 ,$246.96 ,$241.28 ,$241.28 ,$241.28 ,$216.87 ,$255.47
Carle Richland Memorial Hospital,8140054,GUIDEWIRE CALIB 3.2X300MM,233395,,270,$285.48 ,$285.48 ,$218.11 ,$256.93 ,$242.66 ,$242.66 ,$242.66 ,$251.22 ,$242.66 ,$251.22 ,$251.22 ,$248.37 ,$242.66 ,$242.66 ,$242.66 ,$218.11 ,$256.93
Carle Richland Memorial Hospital,8140054,BLADE RESECTOR 4.0,235482,,270,$299.73 ,$299.73 ,$228.99 ,$269.76 ,$254.77 ,$254.77 ,$254.77 ,$263.76 ,$254.77 ,$263.76 ,$263.76 ,$260.77 ,$254.77 ,$254.77 ,$254.77 ,$228.99 ,$269.76
Carle Richland Memorial Hospital,8140054,ELECTRODE BUGBEE 5FR 58CM FULGERA,234864,,270,$304.04 ,$304.04 ,$232.29 ,$273.64 ,$258.43 ,$258.43 ,$258.43 ,$267.56 ,$258.43 ,$267.56 ,$267.56 ,$264.51 ,$258.43 ,$258.43 ,$258.43 ,$232.29 ,$273.64
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 2.5X110MM,233606,,270,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 3.5X110MM,233607,,270,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 2X100MM,233745,,270,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 3.2X145MM,233746,,270,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 4.5X145MM,233747,,270,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 2.7MMX100,233820,,270,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8140054,EXTENDER ELECTRODE 13.5 BOVIE HAN,234703,,270,$313.83 ,$313.83 ,$239.77 ,$282.45 ,$266.76 ,$266.76 ,$266.76 ,$276.17 ,$266.76 ,$276.17 ,$276.17 ,$273.03 ,$266.76 ,$266.76 ,$266.76 ,$239.77 ,$282.45
Carle Richland Memorial Hospital,8140054,ELECTRODE RIGHT ANG LOOP 24FR,233236,,270,$316.80 ,$316.80 ,$242.04 ,$285.12 ,$269.28 ,$269.28 ,$269.28 ,$278.78 ,$269.28 ,$278.78 ,$278.78 ,$275.62 ,$269.28 ,$269.28 ,$269.28 ,$242.04 ,$285.12
Carle Richland Memorial Hospital,8140054,DEVICE PEANUT 5MM ENDO LAP,233996,,270,$319.74 ,$319.74 ,$244.28 ,$287.77 ,$271.78 ,$271.78 ,$271.78 ,$281.37 ,$271.78 ,$281.37 ,$281.37 ,$278.17 ,$271.78 ,$271.78 ,$271.78 ,$244.28 ,$287.77
Carle Richland Memorial Hospital,8140054,APPLIER LG TITANIUM CLIPS 3/BX,1153,,270,$321.06 ,$321.06 ,$245.29 ,$288.95 ,$272.90 ,$272.90 ,$272.90 ,$282.53 ,$272.90 ,$282.53 ,$282.53 ,$279.32 ,$272.90 ,$272.90 ,$272.90 ,$245.29 ,$288.95
Carle Richland Memorial Hospital,8140054,GUIDE WIRE 3.2MM 400MM,6293,,270,$324.90 ,$324.90 ,$248.22 ,$292.41 ,$276.17 ,$276.17 ,$276.17 ,$285.91 ,$276.17 ,$285.91 ,$285.91 ,$282.66 ,$276.17 ,$276.17 ,$276.17 ,$248.22 ,$292.41
Carle Richland Memorial Hospital,8140054,DEVICE RAPID RHINO POSTERIOR BX/1,233204,,270,$348.30 ,$348.30 ,$266.10 ,$313.47 ,$296.06 ,$296.06 ,$296.06 ,$306.50 ,$296.06 ,$306.50 ,$306.50 ,$303.02 ,$296.06 ,$296.06 ,$296.06 ,$266.10 ,$313.47
Carle Richland Memorial Hospital,8140054,GUIDEWIRE KWIRE 1.25X150MM,233603,,270,$356.00 ,$356.00 ,$271.98 ,$320.40 ,$302.60 ,$302.60 ,$302.60 ,$313.28 ,$302.60 ,$313.28 ,$313.28 ,$309.72 ,$302.60 ,$302.60 ,$302.60 ,$271.98 ,$320.40
Carle Richland Memorial Hospital,8140054,KWIRE 1.6X150MM,233604,,270,$356.00 ,$356.00 ,$271.98 ,$320.40 ,$302.60 ,$302.60 ,$302.60 ,$313.28 ,$302.60 ,$313.28 ,$313.28 ,$309.72 ,$302.60 ,$302.60 ,$302.60 ,$271.98 ,$320.40
Carle Richland Memorial Hospital,8140054,KWIRE 2.0X150MM,233605,,270,$356.00 ,$356.00 ,$271.98 ,$320.40 ,$302.60 ,$302.60 ,$302.60 ,$313.28 ,$302.60 ,$313.28 ,$313.28 ,$309.72 ,$302.60 ,$302.60 ,$302.60 ,$271.98 ,$320.40
Carle Richland Memorial Hospital,8140054,GUIDEPIN PARTIAL 1.6MMX6IN,233446,,270,$370.80 ,$370.80 ,$283.29 ,$333.72 ,$315.18 ,$315.18 ,$315.18 ,$326.30 ,$315.18 ,$326.30 ,$326.30 ,$322.60 ,$315.18 ,$315.18 ,$315.18 ,$283.29 ,$333.72
Carle Richland Memorial Hospital,8140054,PIN GUIDE PARTIAL 1.6MMX9IN,233448,,270,$370.80 ,$370.80 ,$283.29 ,$333.72 ,$315.18 ,$315.18 ,$315.18 ,$326.30 ,$315.18 ,$326.30 ,$326.30 ,$322.60 ,$315.18 ,$315.18 ,$315.18 ,$283.29 ,$333.72
Carle Richland Memorial Hospital,8140054,PIN GUIDE PARTIAL 1.25MMX6IN,233490,,270,$370.80 ,$370.80 ,$283.29 ,$333.72 ,$315.18 ,$315.18 ,$315.18 ,$326.30 ,$315.18 ,$326.30 ,$326.30 ,$322.60 ,$315.18 ,$315.18 ,$315.18 ,$283.29 ,$333.72
Carle Richland Memorial Hospital,8140054,KIT CEMENT MIXING SMART MIX,235,,270,$392.12 ,$392.12 ,$299.58 ,$352.91 ,$333.30 ,$333.30 ,$333.30 ,$345.07 ,$333.30 ,$345.07 ,$345.07 ,$341.14 ,$333.30 ,$333.30 ,$333.30 ,$299.58 ,$352.91
Carle Richland Memorial Hospital,8140054,TAP QC 4.5X125MM,233748,,270,$400.50 ,$400.50 ,$305.98 ,$360.45 ,$340.43 ,$340.43 ,$340.43 ,$352.44 ,$340.43 ,$352.44 ,$352.44 ,$348.44 ,$340.43 ,$340.43 ,$340.43 ,$305.98 ,$360.45
Carle Richland Memorial Hospital,8140054,RMH CENTURION PHACO TUBING PACK,235161,,270,$400.50 ,$400.50 ,$305.98 ,$360.45 ,$340.43 ,$340.43 ,$340.43 ,$352.44 ,$340.43 ,$352.44 ,$352.44 ,$348.44 ,$340.43 ,$340.43 ,$340.43 ,$305.98 ,$360.45
Carle Richland Memorial Hospital,8140054,NET ROTH FOOD BOLUS,8446,,270,$405.00 ,$405.00 ,$309.42 ,$364.50 ,$344.25 ,$344.25 ,$344.25 ,$356.40 ,$344.25 ,$356.40 ,$356.40 ,$352.35 ,$344.25 ,$344.25 ,$344.25 ,$309.42 ,$364.50
Carle Richland Memorial Hospital,8140054,RELOAD MULTIFIRE GIA 80-4.8,234298,,270,$411.68 ,$411.68 ,$314.52 ,$370.51 ,$349.93 ,$349.93 ,$349.93 ,$362.28 ,$349.93 ,$362.28 ,$362.28 ,$358.16 ,$349.93 ,$349.93 ,$349.93 ,$314.52 ,$370.51
Carle Richland Memorial Hospital,8140054,BIT DRILL 2.2MM,233883,,270,$418.50 ,$418.50 ,$319.73 ,$376.65 ,$355.73 ,$355.73 ,$355.73 ,$368.28 ,$355.73 ,$368.28 ,$368.28 ,$364.10 ,$355.73 ,$355.73 ,$355.73 ,$319.73 ,$376.65
Carle Richland Memorial Hospital,8140054,BIT DRILL 2.9MM,233884,,270,$418.50 ,$418.50 ,$319.73 ,$376.65 ,$355.73 ,$355.73 ,$355.73 ,$368.28 ,$355.73 ,$368.28 ,$368.28 ,$364.10 ,$355.73 ,$355.73 ,$355.73 ,$319.73 ,$376.65
Carle Richland Memorial Hospital,8140054,STENT INLAY OPTIMA 4.7FR 22CM,234417,,270,$423.00 ,$423.00 ,$323.17 ,$380.70 ,$359.55 ,$359.55 ,$359.55 ,$372.24 ,$359.55 ,$372.24 ,$372.24 ,$368.01 ,$359.55 ,$359.55 ,$359.55 ,$323.17 ,$380.70
Carle Richland Memorial Hospital,8140054,KIT STANDARD PEG 20FR,234765,,270,$427.50 ,$427.50 ,$326.61 ,$384.75 ,$363.38 ,$363.38 ,$363.38 ,$376.20 ,$363.38 ,$376.20 ,$376.20 ,$371.93 ,$363.38 ,$363.38 ,$363.38 ,$326.61 ,$384.75
Carle Richland Memorial Hospital,8140054,STENT INLAY OPTIMA 4.7FR 26CM,232204,,270,$435.69 ,$435.69 ,$332.87 ,$392.12 ,$370.34 ,$370.34 ,$370.34 ,$383.41 ,$370.34 ,$383.41 ,$383.41 ,$379.05 ,$370.34 ,$370.34 ,$370.34 ,$332.87 ,$392.12
Carle Richland Memorial Hospital,8140054,STENT INLAY OPTIMA 4.7FR 24CM,234418,,270,$435.69 ,$435.69 ,$332.87 ,$392.12 ,$370.34 ,$370.34 ,$370.34 ,$383.41 ,$370.34 ,$383.41 ,$383.41 ,$379.05 ,$370.34 ,$370.34 ,$370.34 ,$332.87 ,$392.12
Carle Richland Memorial Hospital,8140054,BIT DRILL 2.5X205MM,233608,,270,$444.96 ,$444.96 ,$339.95 ,$400.46 ,$378.22 ,$378.22 ,$378.22 ,$391.56 ,$378.22 ,$391.56 ,$391.56 ,$387.12 ,$378.22 ,$378.22 ,$378.22 ,$339.95 ,$400.46
Carle Richland Memorial Hospital,8140054,STAPLER TA 90MM 3.5MM,223235,,270,$464.80 ,$464.80 ,$355.11 ,$418.32 ,$395.08 ,$395.08 ,$395.08 ,$409.02 ,$395.08 ,$409.02 ,$409.02 ,$404.38 ,$395.08 ,$395.08 ,$395.08 ,$355.11 ,$418.32
Carle Richland Memorial Hospital,8140054,RETRIEVER SUTURE HEWSON 6/BX,3699,,270,$466.56 ,$466.56 ,$356.45 ,$419.90 ,$396.58 ,$396.58 ,$396.58 ,$410.57 ,$396.58 ,$410.57 ,$410.57 ,$405.91 ,$396.58 ,$396.58 ,$396.58 ,$356.45 ,$419.90
Carle Richland Memorial Hospital,8140054,STAPLER MULTIFIRE GIA 60-3.8MM,234412,,270,$468.15 ,$468.15 ,$357.67 ,$421.34 ,$397.93 ,$397.93 ,$397.93 ,$411.97 ,$397.93 ,$411.97 ,$411.97 ,$407.29 ,$397.93 ,$397.93 ,$397.93 ,$357.67 ,$421.34
Carle Richland Memorial Hospital,8140054,RELOAD ENDOPATH 2.5MM WHITE STAPL,227335,,270,$469.02 ,$469.02 ,$358.33 ,$422.12 ,$398.67 ,$398.67 ,$398.67 ,$412.74 ,$398.67 ,$412.74 ,$412.74 ,$408.05 ,$398.67 ,$398.67 ,$398.67 ,$358.33 ,$422.12
Carle Richland Memorial Hospital,8140054,RELOAD ENDOPATH 3.5MM BLUE BX/12,235058,,270,$469.02 ,$469.02 ,$358.33 ,$422.12 ,$398.67 ,$398.67 ,$398.67 ,$412.74 ,$398.67 ,$412.74 ,$412.74 ,$408.05 ,$398.67 ,$398.67 ,$398.67 ,$358.33 ,$422.12
Carle Richland Memorial Hospital,8140054,BIT DRILL 3.2X200MM,233315,,270,$472.68 ,$472.68 ,$361.13 ,$425.41 ,$401.78 ,$401.78 ,$401.78 ,$415.96 ,$401.78 ,$415.96 ,$415.96 ,$411.23 ,$401.78 ,$401.78 ,$401.78 ,$361.13 ,$425.41
Carle Richland Memorial Hospital,8140054,BIT DRILL 2.2X100MM,233314,,270,$477.36 ,$477.36 ,$364.70 ,$429.62 ,$405.76 ,$405.76 ,$405.76 ,$420.08 ,$405.76 ,$420.08 ,$420.08 ,$415.30 ,$405.76 ,$405.76 ,$405.76 ,$364.70 ,$429.62
Carle Richland Memorial Hospital,8140054,ELECTRODE ROLLER BALL 24/26FR,233994,,270,$478.80 ,$478.80 ,$365.80 ,$430.92 ,$406.98 ,$406.98 ,$406.98 ,$421.34 ,$406.98 ,$421.34 ,$421.34 ,$416.56 ,$406.98 ,$406.98 ,$406.98 ,$365.80 ,$430.92
Carle Richland Memorial Hospital,8140054,CAUTERY PENCIL W/HAND CONTROL,232151,,270,$490.16 ,$490.16 ,$374.48 ,$441.14 ,$416.64 ,$416.64 ,$416.64 ,$431.34 ,$416.64 ,$431.34 ,$431.34 ,$426.44 ,$416.64 ,$416.64 ,$416.64 ,$374.48 ,$441.14
Carle Richland Memorial Hospital,8140054,TROCAR VERSAPORT 5-12,232197,,270,$530.26 ,$530.26 ,$405.12 ,$477.23 ,$450.72 ,$450.72 ,$450.72 ,$466.63 ,$450.72 ,$466.63 ,$466.63 ,$461.33 ,$450.72 ,$450.72 ,$450.72 ,$405.12 ,$477.23
Carle Richland Memorial Hospital,8140054,BIT DRILL 3.6X125MM,233301,,270,$533.52 ,$533.52 ,$407.61 ,$480.17 ,$453.49 ,$453.49 ,$453.49 ,$469.50 ,$453.49 ,$469.50 ,$469.50 ,$464.16 ,$453.49 ,$453.49 ,$453.49 ,$407.61 ,$480.17
Carle Richland Memorial Hospital,8140054,APPLIER ENDO 5MM ML CLIPS 3/BX,1151,,270,$538.90 ,$538.90 ,$411.72 ,$485.01 ,$458.07 ,$458.07 ,$458.07 ,$474.23 ,$458.07 ,$474.23 ,$474.23 ,$468.84 ,$458.07 ,$458.07 ,$458.07 ,$411.72 ,$485.01
Carle Richland Memorial Hospital,8140054,CLIP INSTINCT HEMOCLIP,110224,,270,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8140054,SET PNEUMOTHORAX,233941,,270,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8140054,BIT DRILL 2.7X205MM,233609,,270,$548.82 ,$548.82 ,$419.30 ,$493.94 ,$466.50 ,$466.50 ,$466.50 ,$482.96 ,$466.50 ,$482.96 ,$482.96 ,$477.47 ,$466.50 ,$466.50 ,$466.50 ,$419.30 ,$493.94
Carle Richland Memorial Hospital,8140054,RELOAD MULTIFIRE GIA 3.0 - 3.5,232200,,270,$550.94 ,$550.94 ,$420.92 ,$495.85 ,$468.30 ,$468.30 ,$468.30 ,$484.83 ,$468.30 ,$484.83 ,$484.83 ,$479.32 ,$468.30 ,$468.30 ,$468.30 ,$420.92 ,$495.85
Carle Richland Memorial Hospital,8140054,ELECTRODE BUGBEE 3FR SHORT TIP FU,234861,,270,$550.94 ,$550.94 ,$420.92 ,$495.85 ,$468.30 ,$468.30 ,$468.30 ,$484.83 ,$468.30 ,$484.83 ,$484.83 ,$479.32 ,$468.30 ,$468.30 ,$468.30 ,$420.92 ,$495.85
Carle Richland Memorial Hospital,8140054,SHEATH URETERAL ACCESS 25CM,234401,,270,$562.50 ,$562.50 ,$429.75 ,$506.25 ,$478.13 ,$478.13 ,$478.13 ,$495.00 ,$478.13 ,$495.00 ,$495.00 ,$489.38 ,$478.13 ,$478.13 ,$478.13 ,$429.75 ,$506.25
Carle Richland Memorial Hospital,8140054,TROCAR BLUNTPORT 5MM-12MM,232198,,270,$579.21 ,$579.21 ,$442.52 ,$521.29 ,$492.33 ,$492.33 ,$492.33 ,$509.70 ,$492.33 ,$509.70 ,$509.70 ,$503.91 ,$492.33 ,$492.33 ,$492.33 ,$442.52 ,$521.29
Carle Richland Memorial Hospital,8140054,SHEATH URETERAL ACCESS 35CM,234402,,270,$579.38 ,$579.38 ,$442.65 ,$521.44 ,$492.47 ,$492.47 ,$492.47 ,$509.85 ,$492.47 ,$509.85 ,$509.85 ,$504.06 ,$492.47 ,$492.47 ,$492.47 ,$442.65 ,$521.44
Carle Richland Memorial Hospital,8140054,ROD REAM 3.0MM STERILE,10860,,270,$585.90 ,$585.90 ,$447.63 ,$527.31 ,$498.02 ,$498.02 ,$498.02 ,$515.59 ,$498.02 ,$515.59 ,$515.59 ,$509.73 ,$498.02 ,$498.02 ,$498.02 ,$447.63 ,$527.31
Carle Richland Memorial Hospital,8140054,GUIDEWIRE KWIRE 3.2X450MM,233277,,270,$594.36 ,$594.36 ,$454.09 ,$534.92 ,$505.21 ,$505.21 ,$505.21 ,$523.04 ,$505.21 ,$523.04 ,$523.04 ,$517.09 ,$505.21 ,$505.21 ,$505.21 ,$454.09 ,$534.92
Carle Richland Memorial Hospital,8140054,FORCEP GRASPING TALON BX/5,223381,,270,$625.50 ,$625.50 ,$477.88 ,$562.95 ,$531.68 ,$531.68 ,$531.68 ,$550.44 ,$531.68 ,$550.44 ,$550.44 ,$544.19 ,$531.68 ,$531.68 ,$531.68 ,$477.88 ,$562.95
Carle Richland Memorial Hospital,8140054,NEEDLE SCORPION SUREFIRE,235474,,270,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,8140054,NEEDLE EZ IO LD 15G 45MM FOR PATI,112969,,270,$641.70 ,$641.70 ,$490.26 ,$577.53 ,$545.45 ,$545.45 ,$545.45 ,$564.70 ,$545.45 ,$564.70 ,$564.70 ,$558.28 ,$545.45 ,$545.45 ,$545.45 ,$490.26 ,$577.53
Carle Richland Memorial Hospital,8140054,SET EZ-IO NEEDLE 15GA ADULT 15GA,815,,270,$641.70 ,$641.70 ,$490.26 ,$577.53 ,$545.45 ,$545.45 ,$545.45 ,$564.70 ,$545.45 ,$564.70 ,$564.70 ,$558.28 ,$545.45 ,$545.45 ,$545.45 ,$490.26 ,$577.53
Carle Richland Memorial Hospital,8140054,SET EZ-IO NEEDLE 15GA PEDS 15GA 1,816,,270,$641.70 ,$641.70 ,$490.26 ,$577.53 ,$545.45 ,$545.45 ,$545.45 ,$564.70 ,$545.45 ,$564.70 ,$564.70 ,$558.28 ,$545.45 ,$545.45 ,$545.45 ,$490.26 ,$577.53
Carle Richland Memorial Hospital,8140054,PROBE QUICKSILVER BIPOLAR 7FR,8656,,270,$652.50 ,$652.50 ,$498.51 ,$587.25 ,$554.63 ,$554.63 ,$554.63 ,$574.20 ,$554.63 ,$574.20 ,$574.20 ,$567.68 ,$554.63 ,$554.63 ,$554.63 ,$498.51 ,$587.25
Carle Richland Memorial Hospital,8140054,KIT CATH 4LUMEN CV 8.5FR 20CM ARR,9870,,270,$655.23 ,$655.23 ,$500.60 ,$589.71 ,$556.95 ,$556.95 ,$556.95 ,$576.60 ,$556.95 ,$576.60 ,$576.60 ,$570.05 ,$556.95 ,$556.95 ,$556.95 ,$500.60 ,$589.71
Carle Richland Memorial Hospital,8140054,BARRER INTERCEED 4X3IN 10/CA HEMO,219955,,270,$675.00 ,$675.00 ,$515.70 ,$607.50 ,$573.75 ,$573.75 ,$573.75 ,$594.00 ,$573.75 ,$594.00 ,$594.00 ,$587.25 ,$573.75 ,$573.75 ,$573.75 ,$515.70 ,$607.50
Carle Richland Memorial Hospital,8140054,BIT DRILL 3.2MM,233397,,270,$685.62 ,$685.62 ,$523.81 ,$617.06 ,$582.78 ,$582.78 ,$582.78 ,$603.35 ,$582.78 ,$603.35 ,$603.35 ,$596.49 ,$582.78 ,$582.78 ,$582.78 ,$523.81 ,$617.06
Carle Richland Memorial Hospital,8140054,BALLOON ESOPH DIL 10-11-12MM,207623,,270,$697.50 ,$697.50 ,$532.89 ,$627.75 ,$592.88 ,$592.88 ,$592.88 ,$613.80 ,$592.88 ,$613.80 ,$613.80 ,$606.83 ,$592.88 ,$592.88 ,$592.88 ,$532.89 ,$627.75
Carle Richland Memorial Hospital,8140054,ELECTRODE HF RESECTION 24FR 12 DE,234348,,270,$729.00 ,$729.00 ,$556.96 ,$656.10 ,$619.65 ,$619.65 ,$619.65 ,$641.52 ,$619.65 ,$641.52 ,$641.52 ,$634.23 ,$619.65 ,$619.65 ,$619.65 ,$556.96 ,$656.10
Carle Richland Memorial Hospital,8140054,BIT DRILL 4.2MM EX,6234,,270,$735.30 ,$735.30 ,$561.77 ,$661.77 ,$625.01 ,$625.01 ,$625.01 ,$647.06 ,$625.01 ,$647.06 ,$647.06 ,$639.71 ,$625.01 ,$625.01 ,$625.01 ,$561.77 ,$661.77
Carle Richland Memorial Hospital,8140054,RELOAD STAPLER TA 60MM 3.5MM,234415,,270,$740.24 ,$740.24 ,$565.54 ,$666.22 ,$629.20 ,$629.20 ,$629.20 ,$651.41 ,$629.20 ,$651.41 ,$651.41 ,$644.01 ,$629.20 ,$629.20 ,$629.20 ,$565.54 ,$666.22
Carle Richland Memorial Hospital,8140054,PROBE SERFAS ENERGY,235483,,270,$761.09 ,$761.09 ,$581.47 ,$684.98 ,$646.93 ,$646.93 ,$646.93 ,$669.76 ,$646.93 ,$669.76 ,$669.76 ,$662.15 ,$646.93 ,$646.93 ,$646.93 ,$581.47 ,$684.98
Carle Richland Memorial Hospital,8140054,RELOAD STAPLER TA 90MM 3.5MM,234423,,270,$764.29 ,$764.29 ,$583.92 ,$687.86 ,$649.65 ,$649.65 ,$649.65 ,$672.58 ,$649.65 ,$672.58 ,$672.58 ,$664.93 ,$649.65 ,$649.65 ,$649.65 ,$583.92 ,$687.86
Carle Richland Memorial Hospital,8140054,EXTRACTOR STONE 1.5X115CM TIPLESS,1789,,270,$783.00 ,$783.00 ,$598.21 ,$704.70 ,$665.55 ,$665.55 ,$665.55 ,$689.04 ,$665.55 ,$689.04 ,$689.04 ,$681.21 ,$665.55 ,$665.55 ,$665.55 ,$598.21 ,$704.70
Carle Richland Memorial Hospital,8140054,STAPLER MULTIFIRE GIA 80-3.8,234296,,270,$789.53 ,$789.53 ,$603.20 ,$710.58 ,$671.10 ,$671.10 ,$671.10 ,$694.79 ,$671.10 ,$694.79 ,$694.79 ,$686.89 ,$671.10 ,$671.10 ,$671.10 ,$603.20 ,$710.58
Carle Richland Memorial Hospital,8140054,STAPLER MULTIFIRE GIA 80-4.8,234297,,270,$789.53 ,$789.53 ,$603.20 ,$710.58 ,$671.10 ,$671.10 ,$671.10 ,$694.79 ,$671.10 ,$694.79 ,$694.79 ,$686.89 ,$671.10 ,$671.10 ,$671.10 ,$603.20 ,$710.58
Carle Richland Memorial Hospital,8140054,PASSER SUTURE CARTERTHOMAS XL BX/,52602,,270,$792.00 ,$792.00 ,$605.09 ,$712.80 ,$673.20 ,$673.20 ,$673.20 ,$696.96 ,$673.20 ,$696.96 ,$696.96 ,$689.04 ,$673.20 ,$673.20 ,$673.20 ,$605.09 ,$712.80
Carle Richland Memorial Hospital,8140054,PACK C-SECTION,233990,,270,$797.85 ,$797.85 ,$609.56 ,$718.07 ,$678.17 ,$678.17 ,$678.17 ,$702.11 ,$678.17 ,$702.11 ,$702.11 ,$694.13 ,$678.17 ,$678.17 ,$678.17 ,$609.56 ,$718.07
Carle Richland Memorial Hospital,8140054,RELOAD STAPLER TA 60MM 4.8MM,234768,,270,$802.51 ,$802.51 ,$613.12 ,$722.26 ,$682.13 ,$682.13 ,$682.13 ,$706.21 ,$682.13 ,$706.21 ,$706.21 ,$698.18 ,$682.13 ,$682.13 ,$682.13 ,$613.12 ,$722.26
Carle Richland Memorial Hospital,8140054,RMH MALYUGIN RING,235173,,270,$805.50 ,$805.50 ,$615.40 ,$724.95 ,$684.68 ,$684.68 ,$684.68 ,$708.84 ,$684.68 ,$708.84 ,$708.84 ,$700.79 ,$684.68 ,$684.68 ,$684.68 ,$615.40 ,$724.95
Carle Richland Memorial Hospital,8140054,RMH IRIS HOOKS,235174,,270,$805.50 ,$805.50 ,$615.40 ,$724.95 ,$684.68 ,$684.68 ,$684.68 ,$708.84 ,$684.68 ,$708.84 ,$708.84 ,$700.79 ,$684.68 ,$684.68 ,$684.68 ,$615.40 ,$724.95
Carle Richland Memorial Hospital,8140054,PORT VASC ACCESS SMART PORT CT,240056,,270,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8140054,BALLOON WRGD DIL 12-13.5-15MM,207626,,270,$855.00 ,$855.00 ,$653.22 ,$769.50 ,$726.75 ,$726.75 ,$726.75 ,$752.40 ,$726.75 ,$752.40 ,$752.40 ,$743.85 ,$726.75 ,$726.75 ,$726.75 ,$653.22 ,$769.50
Carle Richland Memorial Hospital,8140054,BALLOON WRGD DIL 15-16.5-18MM,207627,,270,$855.00 ,$855.00 ,$653.22 ,$769.50 ,$726.75 ,$726.75 ,$726.75 ,$752.40 ,$726.75 ,$752.40 ,$752.40 ,$743.85 ,$726.75 ,$726.75 ,$726.75 ,$653.22 ,$769.50
Carle Richland Memorial Hospital,8140054,BIT DRILL AO 4.2X300MM,233280,,270,$863.46 ,$863.46 ,$659.68 ,$777.11 ,$733.94 ,$733.94 ,$733.94 ,$759.84 ,$733.94 ,$759.84 ,$759.84 ,$751.21 ,$733.94 ,$733.94 ,$733.94 ,$659.68 ,$777.11
Carle Richland Memorial Hospital,8140054,GUIDEWIRE BALL TIP 3X800MM,233275,,270,$872.82 ,$872.82 ,$666.83 ,$785.54 ,$741.90 ,$741.90 ,$741.90 ,$768.08 ,$741.90 ,$768.08 ,$768.08 ,$759.35 ,$741.90 ,$741.90 ,$741.90 ,$666.83 ,$785.54
Carle Richland Memorial Hospital,8140054,BASKET STONE NITINOL NGAGE 1.7,105985,,270,$873.00 ,$873.00 ,$666.97 ,$785.70 ,$742.05 ,$742.05 ,$742.05 ,$768.24 ,$742.05 ,$768.24 ,$768.24 ,$759.51 ,$742.05 ,$742.05 ,$742.05 ,$666.97 ,$785.70
Carle Richland Memorial Hospital,8140054,BASKET STONE NITINOL NTRAPT,234403,,270,$873.00 ,$873.00 ,$666.97 ,$785.70 ,$742.05 ,$742.05 ,$742.05 ,$768.24 ,$742.05 ,$768.24 ,$768.24 ,$759.51 ,$742.05 ,$742.05 ,$742.05 ,$666.97 ,$785.70
Carle Richland Memorial Hospital,8140054,BASKET SKYLITE NITINOL TIPLESS,234405,,270,$877.50 ,$877.50 ,$670.41 ,$789.75 ,$745.88 ,$745.88 ,$745.88 ,$772.20 ,$745.88 ,$772.20 ,$772.20 ,$763.43 ,$745.88 ,$745.88 ,$745.88 ,$670.41 ,$789.75
Carle Richland Memorial Hospital,8140054,BIT DRILL AO 4.2X180MM,233278,,270,$886.86 ,$886.86 ,$677.56 ,$798.17 ,$753.83 ,$753.83 ,$753.83 ,$780.44 ,$753.83 ,$780.44 ,$780.44 ,$771.57 ,$753.83 ,$753.83 ,$753.83 ,$677.56 ,$798.17
Carle Richland Memorial Hospital,8140054,BIT DRILL AO 4.2X230MM,233279,,270,$889.20 ,$889.20 ,$679.35 ,$800.28 ,$755.82 ,$755.82 ,$755.82 ,$782.50 ,$755.82 ,$782.50 ,$782.50 ,$773.60 ,$755.82 ,$755.82 ,$755.82 ,$679.35 ,$800.28
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 2.0MMX175,233821,,270,$889.92 ,$889.92 ,$679.90 ,$800.93 ,$756.43 ,$756.43 ,$756.43 ,$783.13 ,$756.43 ,$783.13 ,$783.13 ,$774.23 ,$756.43 ,$756.43 ,$756.43 ,$679.90 ,$800.93
Carle Richland Memorial Hospital,8140054,GUIDEWIRE BALL TIP 3X1000MM,233276,,270,$912.60 ,$912.60 ,$697.23 ,$821.34 ,$775.71 ,$775.71 ,$775.71 ,$803.09 ,$775.71 ,$803.09 ,$803.09 ,$793.96 ,$775.71 ,$775.71 ,$775.71 ,$697.23 ,$821.34
Carle Richland Memorial Hospital,8140054,PROTECTOR ORTHO ALEXIS SM/MD,245242,,270,$922.50 ,$922.50 ,$704.79 ,$830.25 ,$784.13 ,$784.13 ,$784.13 ,$811.80 ,$784.13 ,$811.80 ,$811.80 ,$802.58 ,$784.13 ,$784.13 ,$784.13 ,$704.79 ,$830.25
Carle Richland Memorial Hospital,8140054,STAPLER ETS FLEX45 W/ WHITE 3/BX,1116,,270,$938.03 ,$938.03 ,$716.65 ,$844.23 ,$797.33 ,$797.33 ,$797.33 ,$825.47 ,$797.33 ,$825.47 ,$825.47 ,$816.09 ,$797.33 ,$797.33 ,$797.33 ,$716.65 ,$844.23
Carle Richland Memorial Hospital,8140054,DRAPE OEC MOBILE X-RAY STERILE,251166,,270,$945.00 ,$945.00 ,$721.98 ,$850.50 ,$803.25 ,$803.25 ,$803.25 ,$831.60 ,$803.25 ,$831.60 ,$831.60 ,$822.15 ,$803.25 ,$803.25 ,$803.25 ,$721.98 ,$850.50
Carle Richland Memorial Hospital,8140054,TUBE GASTRO TRI FUNNEL 20FR,234783,,270,$954.00 ,$954.00 ,$728.86 ,$858.60 ,$810.90 ,$810.90 ,$810.90 ,$839.52 ,$810.90 ,$839.52 ,$839.52 ,$829.98 ,$810.90 ,$810.90 ,$810.90 ,$728.86 ,$858.60
Carle Richland Memorial Hospital,8140054,BLADE KOBYGARD SINGLE USE,240127,,270,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,8140054,BALLOON UROFORCE 5MMX10CM,234381,,270,$972.00 ,$972.00 ,$742.61 ,$874.80 ,$826.20 ,$826.20 ,$826.20 ,$855.36 ,$826.20 ,$855.36 ,$855.36 ,$845.64 ,$826.20 ,$826.20 ,$826.20 ,$742.61 ,$874.80
Carle Richland Memorial Hospital,8140054,BALLOON UROFORCE 5MMX4CM,235614,,270,$972.00 ,$972.00 ,$742.61 ,$874.80 ,$826.20 ,$826.20 ,$826.20 ,$855.36 ,$826.20 ,$855.36 ,$855.36 ,$845.64 ,$826.20 ,$826.20 ,$826.20 ,$742.61 ,$874.80
Carle Richland Memorial Hospital,8140054,PROTECTOR ORTHO ALEXIS MD/LG,245198,,270,"$1,012.50 ","$1,012.50 ",$773.55 ,$911.25 ,$860.63 ,$860.63 ,$860.63 ,$891.00 ,$860.63 ,$891.00 ,$891.00 ,$880.88 ,$860.63 ,$860.63 ,$860.63 ,$773.55 ,$911.25
Carle Richland Memorial Hospital,8140054,CATH NEPHR XFORCE 10MMX15CM,234382,,270,"$1,066.05 ","$1,066.05 ",$814.46 ,$959.45 ,$906.14 ,$906.14 ,$906.14 ,$938.12 ,$906.14 ,$938.12 ,$938.12 ,$927.46 ,$906.14 ,$906.14 ,$906.14 ,$814.46 ,$959.45
Carle Richland Memorial Hospital,8140054,BIT DRILL 2.0MM,233360,,270,"$1,089.27 ","$1,089.27 ",$832.20 ,$980.34 ,$925.88 ,$925.88 ,$925.88 ,$958.56 ,$925.88 ,$958.56 ,$958.56 ,$947.66 ,$925.88 ,$925.88 ,$925.88 ,$832.20 ,$980.34
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 3.5MM,233361,,270,"$1,089.27 ","$1,089.27 ",$832.20 ,$980.34 ,$925.88 ,$925.88 ,$925.88 ,$958.56 ,$925.88 ,$958.56 ,$958.56 ,$947.66 ,$925.88 ,$925.88 ,$925.88 ,$832.20 ,$980.34
Carle Richland Memorial Hospital,8140054,BUR FLUTE ROUND 4.0MM,163338,,270,"$1,097.69 ","$1,097.69 ",$838.64 ,$987.92 ,$933.04 ,$933.04 ,$933.04 ,$965.97 ,$933.04 ,$965.97 ,$965.97 ,$954.99 ,$933.04 ,$933.04 ,$933.04 ,$838.64 ,$987.92
Carle Richland Memorial Hospital,8140054,STAPLER 25MM CIRCULAR STAPLER 3/B,1168,,270,"$1,111.55 ","$1,111.55 ",$849.22 ,"$1,000.40 ",$944.82 ,$944.82 ,$944.82 ,$978.16 ,$944.82 ,$978.16 ,$978.16 ,$967.05 ,$944.82 ,$944.82 ,$944.82 ,$849.22 ,"$1,000.40 "
Carle Richland Memorial Hospital,8140054,TUBE GASTRO TRI FUNNEL 18FR,234782,,270,"$1,143.00 ","$1,143.00 ",$873.25 ,"$1,028.70 ",$971.55 ,$971.55 ,$971.55 ,"$1,005.84 ",$971.55 ,"$1,005.84 ","$1,005.84 ",$994.41 ,$971.55 ,$971.55 ,$971.55 ,$873.25 ,"$1,028.70 "
Carle Richland Memorial Hospital,8140054,TUBE GASTRIC 18FR 3-LUMEN MOSS JE,504,,270,"$1,147.50 ","$1,147.50 ",$876.69 ,"$1,032.75 ",$975.38 ,$975.38 ,$975.38 ,"$1,009.80 ",$975.38 ,"$1,009.80 ","$1,009.80 ",$998.33 ,$975.38 ,$975.38 ,$975.38 ,$876.69 ,"$1,032.75 "
Carle Richland Memorial Hospital,8140054,SYSTEM OPTIFIX AT30,252804,,270,"$1,194.75 ","$1,194.75 ",$912.79 ,"$1,075.28 ","$1,015.54 ","$1,015.54 ","$1,015.54 ","$1,051.38 ","$1,015.54 ","$1,051.38 ","$1,051.38 ","$1,039.43 ","$1,015.54 ","$1,015.54 ","$1,015.54 ",$912.79 ,"$1,075.28 "
Carle Richland Memorial Hospital,8140054,HEMOSTATIC INTERCEED 4X3IN use #3,1580,,270,"$1,217.16 ","$1,217.16 ",$929.91 ,"$1,095.44 ","$1,034.59 ","$1,034.59 ","$1,034.59 ","$1,071.10 ","$1,034.59 ","$1,071.10 ","$1,071.10 ","$1,058.93 ","$1,034.59 ","$1,034.59 ","$1,034.59 ",$929.91 ,"$1,095.44 "
Carle Richland Memorial Hospital,8140054,STAPLER MULTIFIRE GIA 30 - 3.5,232199,,270,"$1,264.20 ","$1,264.20 ",$965.85 ,"$1,137.78 ","$1,074.57 ","$1,074.57 ","$1,074.57 ","$1,112.50 ","$1,074.57 ","$1,112.50 ","$1,112.50 ","$1,099.85 ","$1,074.57 ","$1,074.57 ","$1,074.57 ",$965.85 ,"$1,137.78 "
Carle Richland Memorial Hospital,8140054,CAPSULE / DELIVERY BRAVO PH 5/PK,228766,,270,"$1,341.00 ","$1,341.00 ","$1,024.52 ","$1,206.90 ","$1,139.85 ","$1,139.85 ","$1,139.85 ","$1,180.08 ","$1,139.85 ","$1,180.08 ","$1,180.08 ","$1,166.67 ","$1,139.85 ","$1,139.85 ","$1,139.85 ","$1,024.52 ","$1,206.90 "
Carle Richland Memorial Hospital,8140054,STAPLER MF TA 60-3.5 TI BLUE,234411,,270,"$1,508.45 ","$1,508.45 ","$1,152.46 ","$1,357.61 ","$1,282.18 ","$1,282.18 ","$1,282.18 ","$1,327.44 ","$1,282.18 ","$1,327.44 ","$1,327.44 ","$1,312.35 ","$1,282.18 ","$1,282.18 ","$1,282.18 ","$1,152.46 ","$1,357.61 "
Carle Richland Memorial Hospital,8140054,STAPLER TA 60MM 4.8MM,234413,,270,"$1,508.45 ","$1,508.45 ","$1,152.46 ","$1,357.61 ","$1,282.18 ","$1,282.18 ","$1,282.18 ","$1,327.44 ","$1,282.18 ","$1,327.44 ","$1,327.44 ","$1,312.35 ","$1,282.18 ","$1,282.18 ","$1,282.18 ","$1,152.46 ","$1,357.61 "
Carle Richland Memorial Hospital,8140054,STAPLER TA 30MM 4.8MM,234399,,270,"$1,533.21 ","$1,533.21 ","$1,171.37 ","$1,379.89 ","$1,303.23 ","$1,303.23 ","$1,303.23 ","$1,349.22 ","$1,303.23 ","$1,349.22 ","$1,349.22 ","$1,333.89 ","$1,303.23 ","$1,303.23 ","$1,303.23 ","$1,171.37 ","$1,379.89 "
Carle Richland Memorial Hospital,8140054,STAPLER CEEA31 CURVED PREM PLS,232195,,270,"$1,575.57 ","$1,575.57 ","$1,203.74 ","$1,418.01 ","$1,339.23 ","$1,339.23 ","$1,339.23 ","$1,386.50 ","$1,339.23 ","$1,386.50 ","$1,386.50 ","$1,370.75 ","$1,339.23 ","$1,339.23 ","$1,339.23 ","$1,203.74 ","$1,418.01 "
Carle Richland Memorial Hospital,8140054,STAPLER CEEA28 CURVED PREM PLS,232196,,270,"$1,575.57 ","$1,575.57 ","$1,203.74 ","$1,418.01 ","$1,339.23 ","$1,339.23 ","$1,339.23 ","$1,386.50 ","$1,339.23 ","$1,386.50 ","$1,386.50 ","$1,370.75 ","$1,339.23 ","$1,339.23 ","$1,339.23 ","$1,203.74 ","$1,418.01 "
Carle Richland Memorial Hospital,8140054,BIT DRILL QC 5.0MM,233362,,270,"$1,670.76 ","$1,670.76 ","$1,276.46 ","$1,503.68 ","$1,420.15 ","$1,420.15 ","$1,420.15 ","$1,470.27 ","$1,420.15 ","$1,470.27 ","$1,470.27 ","$1,453.56 ","$1,420.15 ","$1,420.15 ","$1,420.15 ","$1,276.46 ","$1,503.68 "
Carle Richland Memorial Hospital,8140054,LIGASURE BLUNT LAP SEALER/DVDR,232203,,270,"$2,050.93 ","$2,050.93 ","$1,566.91 ","$1,845.84 ","$1,743.29 ","$1,743.29 ","$1,743.29 ","$1,804.82 ","$1,743.29 ","$1,804.82 ","$1,804.82 ","$1,784.31 ","$1,743.29 ","$1,743.29 ","$1,743.29 ","$1,566.91 ","$1,845.84 "
Carle Richland Memorial Hospital,8140054,BIT DRILL CANN 2.7MM,233449,,270,"$2,284.16 ","$2,284.16 ","$1,745.10 ","$2,055.74 ","$1,941.54 ","$1,941.54 ","$1,941.54 ","$2,010.06 ","$1,941.54 ","$2,010.06 ","$2,010.06 ","$1,987.22 ","$1,941.54 ","$1,941.54 ","$1,941.54 ","$1,745.10 ","$2,055.74 "
Carle Richland Memorial Hospital,8140054,BIT DRILL CANN 2.3MM,233491,,270,"$2,284.16 ","$2,284.16 ","$1,745.10 ","$2,055.74 ","$1,941.54 ","$1,941.54 ","$1,941.54 ","$2,010.06 ","$1,941.54 ","$2,010.06 ","$2,010.06 ","$1,987.22 ","$1,941.54 ","$1,941.54 ","$1,941.54 ","$1,745.10 ","$2,055.74 "
Carle Richland Memorial Hospital,8140054,DEVICE CAPSURE 15 FIXATION,234443,,270,"$2,363.40 ","$2,363.40 ","$1,805.64 ","$2,127.06 ","$2,008.89 ","$2,008.89 ","$2,008.89 ","$2,079.79 ","$2,008.89 ","$2,079.79 ","$2,079.79 ","$2,056.16 ","$2,008.89 ","$2,008.89 ","$2,008.89 ","$1,805.64 ","$2,127.06 "
Carle Richland Memorial Hospital,8140054,FIBER SLIMLINE 200 DFL SMOOTH SIN,234397,,270,"$2,423.93 ","$2,423.93 ","$1,851.88 ","$2,181.54 ","$2,060.34 ","$2,060.34 ","$2,060.34 ","$2,133.06 ","$2,060.34 ","$2,133.06 ","$2,133.06 ","$2,108.82 ","$2,060.34 ","$2,060.34 ","$2,060.34 ","$1,851.88 ","$2,181.54 "
Carle Richland Memorial Hospital,8140054,FIBER SLIMLINE 365,234408,,270,"$2,475.23 ","$2,475.23 ","$1,891.08 ","$2,227.71 ","$2,103.95 ","$2,103.95 ","$2,103.95 ","$2,178.20 ","$2,103.95 ","$2,178.20 ","$2,178.20 ","$2,153.45 ","$2,103.95 ","$2,103.95 ","$2,103.95 ","$1,891.08 ","$2,227.71 "
Carle Richland Memorial Hospital,8140054,STAPLER HEM PROLAPSE 33MM-3.5,234455,,270,"$2,613.83 ","$2,613.83 ","$1,996.97 ","$2,352.45 ","$2,221.76 ","$2,221.76 ","$2,221.76 ","$2,300.17 ","$2,221.76 ","$2,300.17 ","$2,300.17 ","$2,274.03 ","$2,221.76 ","$2,221.76 ","$2,221.76 ","$1,996.97 ","$2,352.45 "
Carle Richland Memorial Hospital,8140054,STAPLER HEM PROLAPSE 33MM-4.8,234456,,270,"$2,613.83 ","$2,613.83 ","$1,996.97 ","$2,352.45 ","$2,221.76 ","$2,221.76 ","$2,221.76 ","$2,300.17 ","$2,221.76 ","$2,300.17 ","$2,300.17 ","$2,274.03 ","$2,221.76 ","$2,221.76 ","$2,221.76 ","$1,996.97 ","$2,352.45 "
Carle Richland Memorial Hospital,8140054,TUBE BLAKEMORE ESOPH NASO 20FR LA,234784,,270,"$2,621.30 ","$2,621.30 ","$2,002.67 ","$2,359.17 ","$2,228.11 ","$2,228.11 ","$2,228.11 ","$2,306.74 ","$2,228.11 ","$2,306.74 ","$2,306.74 ","$2,280.53 ","$2,228.11 ","$2,228.11 ","$2,228.11 ","$2,002.67 ","$2,359.17 "
Carle Richland Memorial Hospital,8140054,BIT DRILL CANN 4.9MM,233396,,270,"$2,635.43 ","$2,635.43 ","$2,013.47 ","$2,371.89 ","$2,240.12 ","$2,240.12 ","$2,240.12 ","$2,319.18 ","$2,240.12 ","$2,319.18 ","$2,319.18 ","$2,292.82 ","$2,240.12 ","$2,240.12 ","$2,240.12 ","$2,013.47 ","$2,371.89 "
Carle Richland Memorial Hospital,8140054,KIT GELPOINT ADVANCED ACCESS,240258,,270,"$3,037.50 ","$3,037.50 ","$2,320.65 ","$2,733.75 ","$2,581.88 ","$2,581.88 ","$2,581.88 ","$2,673.00 ","$2,581.88 ","$2,673.00 ","$2,673.00 ","$2,642.63 ","$2,581.88 ","$2,581.88 ","$2,581.88 ","$2,320.65 ","$2,733.75 "
Carle Richland Memorial Hospital,8140054,MORCELLATOR LINA XCISE,233995,,270,"$3,165.75 ","$3,165.75 ","$2,418.63 ","$2,849.18 ","$2,690.89 ","$2,690.89 ","$2,690.89 ","$2,785.86 ","$2,690.89 ","$2,785.86 ","$2,785.86 ","$2,754.20 ","$2,690.89 ","$2,690.89 ","$2,690.89 ","$2,418.63 ","$2,849.18 "
Carle Richland Memorial Hospital,8140054,BIT DRILL 16MM CANNULATED FLEX,233044,,270,"$3,587.04 ","$3,587.04 ","$2,740.50 ","$3,228.34 ","$3,048.98 ","$3,048.98 ","$3,048.98 ","$3,156.60 ","$3,048.98 ","$3,156.60 ","$3,156.60 ","$3,120.72 ","$3,048.98 ","$3,048.98 ","$3,048.98 ","$2,740.50 ","$3,228.34 "
Carle Richland Memorial Hospital,8140054,DEVICE CAPSURE 30 FIXATION,234444,,270,"$3,681.45 ","$3,681.45 ","$2,812.63 ","$3,313.31 ","$3,129.23 ","$3,129.23 ","$3,129.23 ","$3,239.68 ","$3,129.23 ","$3,239.68 ","$3,239.68 ","$3,202.86 ","$3,129.23 ","$3,129.23 ","$3,129.23 ","$2,812.63 ","$3,313.31 "
Carle Richland Memorial Hospital,8140054,LIGASURE IMPACT OPEN SEALER DV,240259,,270,"$4,288.46 ","$4,288.46 ","$3,276.38 ","$3,859.61 ","$3,645.19 ","$3,645.19 ","$3,645.19 ","$3,773.84 ","$3,645.19 ","$3,773.84 ","$3,773.84 ","$3,730.96 ","$3,645.19 ","$3,645.19 ","$3,645.19 ","$3,276.38 ","$3,859.61 "
Carle Richland Memorial Hospital,8140054,LIGASURE SEAL/DIV MARYLAND JAW,252802,,270,"$4,756.50 ","$4,756.50 ","$3,633.97 ","$4,280.85 ","$4,043.03 ","$4,043.03 ","$4,043.03 ","$4,185.72 ","$4,043.03 ","$4,185.72 ","$4,185.72 ","$4,138.16 ","$4,043.03 ","$4,043.03 ","$4,043.03 ","$3,633.97 ","$4,280.85 "
Carle Richland Memorial Hospital,8140054,NOVASURE 3/BX,233216,,270,"$5,175.00 ","$5,175.00 ","$3,953.70 ","$4,657.50 ","$4,398.75 ","$4,398.75 ","$4,398.75 ","$4,554.00 ","$4,398.75 ","$4,554.00 ","$4,554.00 ","$4,502.25 ","$4,398.75 ","$4,398.75 ","$4,398.75 ","$3,953.70 ","$4,657.50 "
Carle Richland Memorial Hospital,8140054,FIBER SLIMLINE 1000,234409,,270,"$5,771.25 ","$5,771.25 ","$4,409.24 ","$5,194.13 ","$4,905.56 ","$4,905.56 ","$4,905.56 ","$5,078.70 ","$4,905.56 ","$5,078.70 ","$5,078.70 ","$5,020.99 ","$4,905.56 ","$4,905.56 ","$4,905.56 ","$4,409.24 ","$5,194.13 "
Carle Richland Memorial Hospital,8140054,RMH LITHOTRIPSY BUNDLE,235639,,270,"$8,325.00 ","$8,325.00 ","$6,360.30 ","$7,492.50 ","$7,076.25 ","$7,076.25 ","$7,076.25 ","$7,326.00 ","$7,076.25 ","$7,326.00 ","$7,326.00 ","$7,242.75 ","$7,076.25 ","$7,076.25 ","$7,076.25 ","$6,360.30 ","$7,492.50 "
Carle Richland Memorial Hospital,8140054,DEVICE MYOSURE REACH EXTEND,233218,,270,"$8,932.55 ","$8,932.55 ","$6,824.47 ","$8,039.30 ","$7,592.67 ","$7,592.67 ","$7,592.67 ","$7,860.64 ","$7,592.67 ","$7,860.64 ","$7,860.64 ","$7,771.32 ","$7,592.67 ","$7,592.67 ","$7,592.67 ","$6,824.47 ","$8,039.30 "
Carle Richland Memorial Hospital,8140057,DRESSING SPONGE GAUZE 4X4 STR,230083,,270,$1.38 ,$1.38 ,$1.05 ,$1.24 ,$1.17 ,$1.17 ,$1.17 ,$1.21 ,$1.17 ,$1.21 ,$1.21 ,$1.20 ,$1.17 ,$1.17 ,$1.17 ,$1.05 ,$1.24
Carle Richland Memorial Hospital,8140062,SUTURE 0 PDS II 27IN CT 1,233239,,270,$3.50 ,$3.50 ,$2.67 ,$3.15 ,$2.98 ,$2.98 ,$2.98 ,$3.08 ,$2.98 ,$3.08 ,$3.08 ,$3.05 ,$2.98 ,$2.98 ,$2.98 ,$2.67 ,$3.15
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 SILK SH 30IN K833H,1412,,270,$4.60 ,$4.60 ,$3.51 ,$4.14 ,$3.91 ,$3.91 ,$3.91 ,$4.05 ,$3.91 ,$4.05 ,$4.05 ,$4.00 ,$3.91 ,$3.91 ,$3.91 ,$3.51 ,$4.14
Carle Richland Memorial Hospital,8140062,SUTURE 0 SILK 30IN CT-1 424H,234716,,270,$5.00 ,$5.00 ,$3.82 ,$4.50 ,$4.25 ,$4.25 ,$4.25 ,$4.40 ,$4.25 ,$4.40 ,$4.40 ,$4.35 ,$4.25 ,$4.25 ,$4.25 ,$3.82 ,$4.50
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL SH 27IN J417H,1291,,270,$5.44 ,$5.44 ,$4.16 ,$4.90 ,$4.62 ,$4.62 ,$4.62 ,$4.79 ,$4.62 ,$4.79 ,$4.79 ,$4.73 ,$4.62 ,$4.62 ,$4.62 ,$4.16 ,$4.90
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL DYED 27IN BX/36,217496,,270,$5.44 ,$5.44 ,$4.16 ,$4.90 ,$4.62 ,$4.62 ,$4.62 ,$4.79 ,$4.62 ,$4.79 ,$4.79 ,$4.73 ,$4.62 ,$4.62 ,$4.62 ,$4.16 ,$4.90
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL CT-1 27IN J259,1284,,270,$5.60 ,$5.60 ,$4.28 ,$5.04 ,$4.76 ,$4.76 ,$4.76 ,$4.93 ,$4.76 ,$4.93 ,$4.93 ,$4.87 ,$4.76 ,$4.76 ,$4.76 ,$4.28 ,$5.04
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 VICRYL SH 27IN J415H,1312,,270,$5.61 ,$5.61 ,$4.29 ,$5.05 ,$4.77 ,$4.77 ,$4.77 ,$4.94 ,$4.77 ,$4.94 ,$4.94 ,$4.88 ,$4.77 ,$4.77 ,$4.77 ,$4.29 ,$5.05
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 VICRYL SH 27IN J416H,1303,,270,$5.62 ,$5.62 ,$4.29 ,$5.06 ,$4.78 ,$4.78 ,$4.78 ,$4.95 ,$4.78 ,$4.95 ,$4.95 ,$4.89 ,$4.78 ,$4.78 ,$4.78 ,$4.29 ,$5.06
Carle Richland Memorial Hospital,8140062,SUTURE 0 VICRYL CT-1 36IN BX/36,1272,,270,$5.75 ,$5.75 ,$4.39 ,$5.18 ,$4.89 ,$4.89 ,$4.89 ,$5.06 ,$4.89 ,$5.06 ,$5.06 ,$5.00 ,$4.89 ,$4.89 ,$4.89 ,$4.39 ,$5.18
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL CT-2 27IN J333,1287,,270,$5.79 ,$5.79 ,$4.42 ,$5.21 ,$4.92 ,$4.92 ,$4.92 ,$5.10 ,$4.92 ,$5.10 ,$5.10 ,$5.04 ,$4.92 ,$4.92 ,$4.92 ,$4.42 ,$5.21
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 VICRYL RB-1 UNDYED J21,214737,,270,$5.85 ,$5.85 ,$4.47 ,$5.27 ,$4.97 ,$4.97 ,$4.97 ,$5.15 ,$4.97 ,$5.15 ,$5.15 ,$5.09 ,$4.97 ,$4.97 ,$4.97 ,$4.47 ,$5.27
Carle Richland Memorial Hospital,8140062,SUTURE 1 VICRYL CT-1 J947H,244635,,270,$6.11 ,$6.11 ,$4.67 ,$5.50 ,$5.19 ,$5.19 ,$5.19 ,$5.38 ,$5.19 ,$5.38 ,$5.38 ,$5.32 ,$5.19 ,$5.19 ,$5.19 ,$4.67 ,$5.50
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 SILK FS2 683G,64373,,270,$6.25 ,$6.25 ,$4.78 ,$5.63 ,$5.31 ,$5.31 ,$5.31 ,$5.50 ,$5.31 ,$5.50 ,$5.50 ,$5.44 ,$5.31 ,$5.31 ,$5.31 ,$4.78 ,$5.63
Carle Richland Memorial Hospital,8140062,SUTURE 0 ETHIBOND 30IN CT-2,233241,,270,$6.49 ,$6.49 ,$4.96 ,$5.84 ,$5.52 ,$5.52 ,$5.52 ,$5.71 ,$5.52 ,$5.71 ,$5.71 ,$5.65 ,$5.52 ,$5.52 ,$5.52 ,$4.96 ,$5.84
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 SILK BLK BR FSL 30IN 3,234537,,270,$6.57 ,$6.57 ,$5.02 ,$5.91 ,$5.58 ,$5.58 ,$5.58 ,$5.78 ,$5.58 ,$5.78 ,$5.78 ,$5.72 ,$5.58 ,$5.58 ,$5.58 ,$5.02 ,$5.91
Carle Richland Memorial Hospital,8140062,SUTURE 0 VICRYL UR-6 27IN J603H,1268,,270,$6.73 ,$6.73 ,$5.14 ,$6.06 ,$5.72 ,$5.72 ,$5.72 ,$5.92 ,$5.72 ,$5.92 ,$5.92 ,$5.86 ,$5.72 ,$5.72 ,$5.72 ,$5.14 ,$6.06
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL UR-6 27IN J602,1294,,270,$6.82 ,$6.82 ,$5.21 ,$6.14 ,$5.80 ,$5.80 ,$5.80 ,$6.00 ,$5.80 ,$6.00 ,$6.00 ,$5.93 ,$5.80 ,$5.80 ,$5.80 ,$5.21 ,$6.14
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL PLUS 27IN RB-1,234731,,270,$6.99 ,$6.99 ,$5.34 ,$6.29 ,$5.94 ,$5.94 ,$5.94 ,$6.15 ,$5.94 ,$6.15 ,$6.15 ,$6.08 ,$5.94 ,$5.94 ,$5.94 ,$5.34 ,$6.29
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 VICRYL TF 27IN J433H,1320,,270,$7.26 ,$7.26 ,$5.55 ,$6.53 ,$6.17 ,$6.17 ,$6.17 ,$6.39 ,$6.17 ,$6.39 ,$6.39 ,$6.32 ,$6.17 ,$6.17 ,$6.17 ,$5.55 ,$6.53
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 SILK FS-1 18IN 684G,1415,,270,$7.31 ,$7.31 ,$5.58 ,$6.58 ,$6.21 ,$6.21 ,$6.21 ,$6.43 ,$6.21 ,$6.43 ,$6.43 ,$6.36 ,$6.21 ,$6.21 ,$6.21 ,$5.58 ,$6.58
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 VICRYL 27IN RB-1,234704,,270,$7.31 ,$7.31 ,$5.58 ,$6.58 ,$6.21 ,$6.21 ,$6.21 ,$6.43 ,$6.21 ,$6.43 ,$6.43 ,$6.36 ,$6.21 ,$6.21 ,$6.21 ,$5.58 ,$6.58
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 VICRYL PLUS 27IN RB VC,234715,,270,$7.45 ,$7.45 ,$5.69 ,$6.71 ,$6.33 ,$6.33 ,$6.33 ,$6.56 ,$6.33 ,$6.56 ,$6.56 ,$6.48 ,$6.33 ,$6.33 ,$6.33 ,$5.69 ,$6.71
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 ETHILON 30IN FS-1 669H,234717,,270,$7.49 ,$7.49 ,$5.72 ,$6.74 ,$6.37 ,$6.37 ,$6.37 ,$6.59 ,$6.37 ,$6.59 ,$6.59 ,$6.52 ,$6.37 ,$6.37 ,$6.37 ,$5.72 ,$6.74
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 ETHILN BLK MONO FS2 18,233887,,270,$7.74 ,$7.74 ,$5.91 ,$6.97 ,$6.58 ,$6.58 ,$6.58 ,$6.81 ,$6.58 ,$6.81 ,$6.81 ,$6.73 ,$6.58 ,$6.58 ,$6.58 ,$5.91 ,$6.97
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 VICRYL REEL,11110,,270,$7.80 ,$7.80 ,$5.96 ,$7.02 ,$6.63 ,$6.63 ,$6.63 ,$6.86 ,$6.63 ,$6.86 ,$6.86 ,$6.79 ,$6.63 ,$6.63 ,$6.63 ,$5.96 ,$7.02
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL REEL J286G,11109,,270,$7.95 ,$7.95 ,$6.07 ,$7.16 ,$6.76 ,$6.76 ,$6.76 ,$7.00 ,$6.76 ,$7.00 ,$7.00 ,$6.92 ,$6.76 ,$6.76 ,$6.76 ,$6.07 ,$7.16
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 ETHILONG 30IN FSL 1,233243,,270,$8.14 ,$8.14 ,$6.22 ,$7.33 ,$6.92 ,$6.92 ,$6.92 ,$7.16 ,$6.92 ,$7.16 ,$7.16 ,$7.08 ,$6.92 ,$6.92 ,$6.92 ,$6.22 ,$7.33
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 VICRYL 27IN FS-1,233242,,270,$8.37 ,$8.37 ,$6.39 ,$7.53 ,$7.11 ,$7.11 ,$7.11 ,$7.37 ,$7.11 ,$7.37 ,$7.37 ,$7.28 ,$7.11 ,$7.11 ,$7.11 ,$6.39 ,$7.53
Carle Richland Memorial Hospital,8140062,SUTURE 1 PROLENE CTX 30IN BX/36,1334,,270,$8.74 ,$8.74 ,$6.68 ,$7.87 ,$7.43 ,$7.43 ,$7.43 ,$7.69 ,$7.43 ,$7.69 ,$7.69 ,$7.60 ,$7.43 ,$7.43 ,$7.43 ,$6.68 ,$7.87
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 SILK 30IN TIE A305H,1413,,270,$8.94 ,$8.94 ,$6.83 ,$8.05 ,$7.60 ,$7.60 ,$7.60 ,$7.87 ,$7.60 ,$7.87 ,$7.87 ,$7.78 ,$7.60 ,$7.60 ,$7.60 ,$6.83 ,$8.05
Carle Richland Memorial Hospital,8140062,SUTURE 0 PROLENE CT-1 30IN 8424H,1330,,270,$9.20 ,$9.20 ,$7.03 ,$8.28 ,$7.82 ,$7.82 ,$7.82 ,$8.10 ,$7.82 ,$8.10 ,$8.10 ,$8.00 ,$7.82 ,$7.82 ,$7.82 ,$7.03 ,$8.28
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 PDS SH 27IN Z317H,1475,,270,$9.40 ,$9.40 ,$7.18 ,$8.46 ,$7.99 ,$7.99 ,$7.99 ,$8.27 ,$7.99 ,$8.27 ,$8.27 ,$8.18 ,$7.99 ,$7.99 ,$7.99 ,$7.18 ,$8.46
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 PROLENE FS-2 18IN 868,1345,,270,$10.62 ,$10.62 ,$8.11 ,$9.56 ,$9.03 ,$9.03 ,$9.03 ,$9.35 ,$9.03 ,$9.35 ,$9.35 ,$9.24 ,$9.03 ,$9.03 ,$9.03 ,$8.11 ,$9.56
Carle Richland Memorial Hospital,8140062,SUTURE 0 CHROMIC 54IN TIE S114H,1375,,270,$10.62 ,$10.62 ,$8.11 ,$9.56 ,$9.03 ,$9.03 ,$9.03 ,$9.35 ,$9.03 ,$9.35 ,$9.35 ,$9.24 ,$9.03 ,$9.03 ,$9.03 ,$8.11 ,$9.56
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 PROLENE FS-2 18IN,232189,,270,$10.79 ,$10.79 ,$8.24 ,$9.71 ,$9.17 ,$9.17 ,$9.17 ,$9.50 ,$9.17 ,$9.50 ,$9.50 ,$9.39 ,$9.17 ,$9.17 ,$9.17 ,$8.24 ,$9.71
Carle Richland Memorial Hospital,8140062,SUTURE 1 PDS CTX 36IN Z371T,1468,,270,$11.13 ,$11.13 ,$8.50 ,$10.02 ,$9.46 ,$9.46 ,$9.46 ,$9.79 ,$9.46 ,$9.79 ,$9.79 ,$9.68 ,$9.46 ,$9.46 ,$9.46 ,$8.50 ,$10.02
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 CHROMIC SH 27IN G123H,1380,,270,$11.17 ,$11.17 ,$8.53 ,$10.05 ,$9.49 ,$9.49 ,$9.49 ,$9.83 ,$9.49 ,$9.83 ,$9.83 ,$9.72 ,$9.49 ,$9.49 ,$9.49 ,$8.53 ,$10.05
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 PLAIN 70CM CT-1 843H,234719,,270,$11.38 ,$11.38 ,$8.69 ,$10.24 ,$9.67 ,$9.67 ,$9.67 ,$10.01 ,$9.67 ,$10.01 ,$10.01 ,$9.90 ,$9.67 ,$9.67 ,$9.67 ,$8.69 ,$10.24
Carle Richland Memorial Hospital,8140062,SUTURE 1 CHROMIC GUT 54IN S115H,234730,,270,$11.52 ,$11.52 ,$8.80 ,$10.37 ,$9.79 ,$9.79 ,$9.79 ,$10.14 ,$9.79 ,$10.14 ,$10.14 ,$10.02 ,$9.79 ,$9.79 ,$9.79 ,$8.80 ,$10.37
Carle Richland Memorial Hospital,8140062,SUTURE 0 CHROMIC 27IN SH 1,233237,,270,$12.05 ,$12.05 ,$9.21 ,$10.85 ,$10.24 ,$10.24 ,$10.24 ,$10.60 ,$10.24 ,$10.60 ,$10.60 ,$10.48 ,$10.24 ,$10.24 ,$10.24 ,$9.21 ,$10.85
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 CHROMIC SH G121H,11210,,270,$12.14 ,$12.14 ,$9.27 ,$10.93 ,$10.32 ,$10.32 ,$10.32 ,$10.68 ,$10.32 ,$10.68 ,$10.68 ,$10.56 ,$10.32 ,$10.32 ,$10.32 ,$9.27 ,$10.93
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 PROLENE SH,11122,,270,$12.22 ,$12.22 ,$9.34 ,$11.00 ,$10.39 ,$10.39 ,$10.39 ,$10.75 ,$10.39 ,$10.75 ,$10.75 ,$10.63 ,$10.39 ,$10.39 ,$10.39 ,$9.34 ,$11.00
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 PROLENE 30IN FSLX,234656,,270,$13.40 ,$13.40 ,$10.24 ,$12.06 ,$11.39 ,$11.39 ,$11.39 ,$11.79 ,$11.39 ,$11.79 ,$11.79 ,$11.66 ,$11.39 ,$11.39 ,$11.39 ,$10.24 ,$12.06
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 ETHILON P-3 BLACK 18IN,1456,,270,$13.51 ,$13.51 ,$10.32 ,$12.16 ,$11.48 ,$11.48 ,$11.48 ,$11.89 ,$11.48 ,$11.89 ,$11.89 ,$11.75 ,$11.48 ,$11.48 ,$11.48 ,$10.32 ,$12.16
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 ETHILON PS2 BLK MONO P,11162,,270,$14.16 ,$14.16 ,$10.82 ,$12.74 ,$12.04 ,$12.04 ,$12.04 ,$12.46 ,$12.04 ,$12.46 ,$12.46 ,$12.32 ,$12.04 ,$12.04 ,$12.04 ,$10.82 ,$12.74
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 VICRYL 18IN PS-4 J507G,234733,,270,$15.45 ,$15.45 ,$11.80 ,$13.91 ,$13.13 ,$13.13 ,$13.13 ,$13.60 ,$13.13 ,$13.60 ,$13.60 ,$13.44 ,$13.13 ,$13.13 ,$13.13 ,$11.80 ,$13.91
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 VICRYL PS-2 18IN UNDYE,64271,,270,$15.45 ,$15.45 ,$11.80 ,$13.91 ,$13.13 ,$13.13 ,$13.13 ,$13.60 ,$13.13 ,$13.60 ,$13.60 ,$13.44 ,$13.13 ,$13.13 ,$13.13 ,$11.80 ,$13.91
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 ETHILON P-3 BLACK 18IN,1452,,270,$15.75 ,$15.75 ,$12.03 ,$14.18 ,$13.39 ,$13.39 ,$13.39 ,$13.86 ,$13.39 ,$13.86 ,$13.86 ,$13.70 ,$13.39 ,$13.39 ,$13.39 ,$12.03 ,$14.18
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 ETHILON 18IN PC-1,233245,,270,$17.13 ,$17.13 ,$13.09 ,$15.42 ,$14.56 ,$14.56 ,$14.56 ,$15.07 ,$14.56 ,$15.07 ,$15.07 ,$14.90 ,$14.56 ,$14.56 ,$14.56 ,$13.09 ,$15.42
Carle Richland Memorial Hospital,8140062,SUTURE 6-0 ETHILON 18IN PC-1 1856,234720,,270,$17.35 ,$17.35 ,$13.26 ,$15.62 ,$14.75 ,$14.75 ,$14.75 ,$15.27 ,$14.75 ,$15.27 ,$15.27 ,$15.09 ,$14.75 ,$14.75 ,$14.75 ,$13.26 ,$15.62
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 VICRYL DYED 27IN J315H,232161,,270,$17.67 ,$17.67 ,$13.50 ,$15.90 ,$15.02 ,$15.02 ,$15.02 ,$15.55 ,$15.02 ,$15.55 ,$15.55 ,$15.37 ,$15.02 ,$15.02 ,$15.02 ,$13.50 ,$15.90
Carle Richland Memorial Hospital,8140062,SUTURE 1 PDS TP-1 96IN Z880G,1469,,270,$18.40 ,$18.40 ,$14.06 ,$16.56 ,$15.64 ,$15.64 ,$15.64 ,$16.19 ,$15.64 ,$16.19 ,$16.19 ,$16.01 ,$15.64 ,$15.64 ,$15.64 ,$14.06 ,$16.56
Carle Richland Memorial Hospital,8140062,SUTURE 0 SOFSILK 18IN S-176,234762,,270,$18.56 ,$18.56 ,$14.18 ,$16.70 ,$15.78 ,$15.78 ,$15.78 ,$16.33 ,$15.78 ,$16.33 ,$16.33 ,$16.15 ,$15.78 ,$15.78 ,$15.78 ,$14.18 ,$16.70
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 MONOCRYL PS2 Y496G,232246,,270,$20.70 ,$20.70 ,$15.81 ,$18.63 ,$17.60 ,$17.60 ,$17.60 ,$18.22 ,$17.60 ,$18.22 ,$18.22 ,$18.01 ,$17.60 ,$17.60 ,$17.60 ,$15.81 ,$18.63
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 SOFSILK 30IN V-20 GS-8,236340,,270,$21.57 ,$21.57 ,$16.48 ,$19.41 ,$18.33 ,$18.33 ,$18.33 ,$18.98 ,$18.33 ,$18.98 ,$18.98 ,$18.77 ,$18.33 ,$18.33 ,$18.33 ,$16.48 ,$19.41
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 PROLENE MH 48IN DOUBLE,1337,,270,$22.41 ,$22.41 ,$17.12 ,$20.17 ,$19.05 ,$19.05 ,$19.05 ,$19.72 ,$19.05 ,$19.72 ,$19.72 ,$19.50 ,$19.05 ,$19.05 ,$19.05 ,$17.12 ,$20.17
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 MONOCRYL P-3 18IN Y49,1517,,270,$22.44 ,$22.44 ,$17.14 ,$20.20 ,$19.07 ,$19.07 ,$19.07 ,$19.75 ,$19.07 ,$19.75 ,$19.75 ,$19.52 ,$19.07 ,$19.07 ,$19.07 ,$17.14 ,$20.20
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 MONOCRYL P-3 18IN Y49,1514,,270,$22.77 ,$22.77 ,$17.40 ,$20.49 ,$19.35 ,$19.35 ,$19.35 ,$20.04 ,$19.35 ,$20.04 ,$20.04 ,$19.81 ,$19.35 ,$19.35 ,$19.35 ,$17.40 ,$20.49
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 PROLENE 3/8 CIRCLE,234655,,270,$24.06 ,$24.06 ,$18.38 ,$21.65 ,$20.45 ,$20.45 ,$20.45 ,$21.17 ,$20.45 ,$21.17 ,$21.17 ,$20.93 ,$20.45 ,$20.45 ,$20.45 ,$18.38 ,$21.65
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 ETHILON 30IN FSL 1671H,234718,,270,$24.09 ,$24.09 ,$18.40 ,$21.68 ,$20.48 ,$20.48 ,$20.48 ,$21.20 ,$20.48 ,$21.20 ,$21.20 ,$20.96 ,$20.48 ,$20.48 ,$20.48 ,$18.40 ,$21.68
Carle Richland Memorial Hospital,8140062,SUTURE 6-0 PROLENE P-3,11128,,270,$24.14 ,$24.14 ,$18.44 ,$21.73 ,$20.52 ,$20.52 ,$20.52 ,$21.24 ,$20.52 ,$21.24 ,$21.24 ,$21.00 ,$20.52 ,$20.52 ,$20.52 ,$18.44 ,$21.73
Carle Richland Memorial Hospital,8140062,SUTURE 5-0 SOFSILK 30IN C-12 SS-6,234763,,270,$28.34 ,$28.34 ,$21.65 ,$25.51 ,$24.09 ,$24.09 ,$24.09 ,$24.94 ,$24.09 ,$24.94 ,$24.94 ,$24.66 ,$24.09 ,$24.09 ,$24.09 ,$21.65 ,$25.51
Carle Richland Memorial Hospital,8140062,SUTURE 0 CHROMIC GUT 30IN GS21 CG,234737,,270,$28.89 ,$28.89 ,$22.07 ,$26.00 ,$24.56 ,$24.56 ,$24.56 ,$25.42 ,$24.56 ,$25.42 ,$25.42 ,$25.13 ,$24.56 ,$24.56 ,$24.56 ,$22.07 ,$26.00
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 SILK 30IN TIE,233240,,270,$28.98 ,$28.98 ,$22.14 ,$26.08 ,$24.63 ,$24.63 ,$24.63 ,$25.50 ,$24.63 ,$25.50 ,$25.50 ,$25.21 ,$24.63 ,$24.63 ,$24.63 ,$22.14 ,$26.08
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 MONOSOF 30IN C-16,233244,,270,$32.40 ,$32.40 ,$24.75 ,$29.16 ,$27.54 ,$27.54 ,$27.54 ,$28.51 ,$27.54 ,$28.51 ,$28.51 ,$28.19 ,$27.54 ,$27.54 ,$27.54 ,$24.75 ,$29.16
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 CHROMIC GUT C-13 30IN,234735,,270,$32.56 ,$32.56 ,$24.88 ,$29.30 ,$27.68 ,$27.68 ,$27.68 ,$28.65 ,$27.68 ,$28.65 ,$28.65 ,$28.33 ,$27.68 ,$27.68 ,$27.68 ,$24.88 ,$29.30
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 VICRYL 18IN VIOLET J10,234713,,270,$32.90 ,$32.90 ,$25.14 ,$29.61 ,$27.97 ,$27.97 ,$27.97 ,$28.95 ,$27.97 ,$28.95 ,$28.95 ,$28.62 ,$27.97 ,$27.97 ,$27.97 ,$25.14 ,$29.61
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 CHROMIC 30IN CV-23,233238,,270,$32.99 ,$32.99 ,$25.20 ,$29.69 ,$28.04 ,$28.04 ,$28.04 ,$29.03 ,$28.04 ,$29.03 ,$29.03 ,$28.70 ,$28.04 ,$28.04 ,$28.04 ,$25.20 ,$29.69
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 VICRYL 18IN VIOLET J10,234714,,270,$33.13 ,$33.13 ,$25.31 ,$29.82 ,$28.16 ,$28.16 ,$28.16 ,$29.15 ,$28.16 ,$29.15 ,$29.15 ,$28.82 ,$28.16 ,$28.16 ,$28.16 ,$25.31 ,$29.82
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 VICRYL 18IN VIOLET J10,234712,,270,$33.86 ,$33.86 ,$25.87 ,$30.47 ,$28.78 ,$28.78 ,$28.78 ,$29.80 ,$28.78 ,$29.80 ,$29.80 ,$29.46 ,$28.78 ,$28.78 ,$28.78 ,$25.87 ,$30.47
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 CHROMIC GUT SH-1 27,232194,,270,$33.93 ,$33.93 ,$25.92 ,$30.54 ,$28.84 ,$28.84 ,$28.84 ,$29.86 ,$28.84 ,$29.86 ,$29.86 ,$29.52 ,$28.84 ,$28.84 ,$28.84 ,$25.92 ,$30.54
Carle Richland Memorial Hospital,8140062,SUTURE 0 CHROMIC GUT CT-1 27IN,232191,,270,$34.04 ,$34.04 ,$26.01 ,$30.64 ,$28.93 ,$28.93 ,$28.93 ,$29.96 ,$28.93 ,$29.96 ,$29.96 ,$29.61 ,$28.93 ,$28.93 ,$28.93 ,$26.01 ,$30.64
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 PLAIN GUT 30IN V-20 GG,234745,,270,$34.69 ,$34.69 ,$26.50 ,$31.22 ,$29.49 ,$29.49 ,$29.49 ,$30.53 ,$29.49 ,$30.53 ,$30.53 ,$30.18 ,$29.49 ,$29.49 ,$29.49 ,$26.50 ,$31.22
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 CHROMIC GUT CT-1 27,232190,,270,$35.67 ,$35.67 ,$27.25 ,$32.10 ,$30.32 ,$30.32 ,$30.32 ,$31.39 ,$30.32 ,$31.39 ,$31.39 ,$31.03 ,$30.32 ,$30.32 ,$30.32 ,$27.25 ,$32.10
Carle Richland Memorial Hospital,8140062,SUTURE 3-0 SILK SH 30IN MS C017D,1417,,270,$37.00 ,$37.00 ,$28.27 ,$33.30 ,$31.45 ,$31.45 ,$31.45 ,$32.56 ,$31.45 ,$32.56 ,$32.56 ,$32.19 ,$31.45 ,$31.45 ,$31.45 ,$28.27 ,$33.30
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 CHROMIC GUT GS21 30IN,234736,,270,$38.15 ,$38.15 ,$29.15 ,$34.34 ,$32.43 ,$32.43 ,$32.43 ,$33.57 ,$32.43 ,$33.57 ,$33.57 ,$33.19 ,$32.43 ,$32.43 ,$32.43 ,$29.15 ,$34.34
Carle Richland Memorial Hospital,8140062,SUTURE 1 CHROMIC GUT 36IN GS21 CG,234738,,270,$40.79 ,$40.79 ,$31.16 ,$36.71 ,$34.67 ,$34.67 ,$34.67 ,$35.90 ,$34.67 ,$35.90 ,$35.90 ,$35.49 ,$34.67 ,$34.67 ,$34.67 ,$31.16 ,$36.71
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 ETHIBOND 18IN MO-6 CX4,234711,,270,$52.42 ,$52.42 ,$40.05 ,$47.18 ,$44.56 ,$44.56 ,$44.56 ,$46.13 ,$44.56 ,$46.13 ,$46.13 ,$45.61 ,$44.56 ,$44.56 ,$44.56 ,$40.05 ,$47.18
Carle Richland Memorial Hospital,8140062,SUTURE 4-0 MONOSOF 18IN P-13,233247,,270,$72.65 ,$72.65 ,$55.50 ,$65.39 ,$61.75 ,$61.75 ,$61.75 ,$63.93 ,$61.75 ,$63.93 ,$63.93 ,$63.21 ,$61.75 ,$61.75 ,$61.75 ,$55.50 ,$65.39
Carle Richland Memorial Hospital,8140062,SUTURE PDS 1 CTX CR Z765D,10317,,270,$74.07 ,$74.07 ,$56.59 ,$66.66 ,$62.96 ,$62.96 ,$62.96 ,$65.18 ,$62.96 ,$65.18 ,$65.18 ,$64.44 ,$62.96 ,$62.96 ,$62.96 ,$56.59 ,$66.66
Carle Richland Memorial Hospital,8140062,SUTURE 2 FIBERWIRE TAPER 38IN INC,1496,,270,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8140062,SUTURE 2-0 FIBERWIRE T-13 18IN,1497,,270,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8140062,SUTURE 0 FIBERWIRE T-4 38IN,234741,,270,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8140062,SUTURE GORETEX CV-3 36IN PH24 3N1,234732,,270,$115.50 ,$115.50 ,$88.24 ,$103.95 ,$98.18 ,$98.18 ,$98.18 ,$101.64 ,$98.18 ,$101.64 ,$101.64 ,$100.49 ,$98.18 ,$98.18 ,$98.18 ,$88.24 ,$103.95
Carle Richland Memorial Hospital,8140062,SUTURE GORETEX CV-0 36IN THX36 0N,234728,,270,$121.50 ,$121.50 ,$92.83 ,$109.35 ,$103.28 ,$103.28 ,$103.28 ,$106.92 ,$103.28 ,$106.92 ,$106.92 ,$105.71 ,$103.28 ,$103.28 ,$103.28 ,$92.83 ,$109.35
Carle Richland Memorial Hospital,8140062,SUTURE GORETEX CV-5 36IN PT17 5N1,234734,,270,$130.87 ,$130.87 ,$99.98 ,$117.78 ,$111.24 ,$111.24 ,$111.24 ,$115.17 ,$111.24 ,$115.17 ,$115.17 ,$113.86 ,$111.24 ,$111.24 ,$111.24 ,$99.98 ,$117.78
Carle Richland Memorial Hospital,8140062,SUTURE 2 FIBERWIRE BLU/WH 38IN,234739,,270,$157.50 ,$157.50 ,$120.33 ,$141.75 ,$133.88 ,$133.88 ,$133.88 ,$138.60 ,$133.88 ,$138.60 ,$138.60 ,$137.03 ,$133.88 ,$133.88 ,$133.88 ,$120.33 ,$141.75
Carle Richland Memorial Hospital,8140062,SUTURE FIBERLOOP #2,228983,,270,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8030044,POSITIONER MEDIUM WITH COVER 01581400239,,E0190,271,$133.00 ,$133.00 ,$101.61 ,$119.70 ,$113.05 ,$113.05 ,$113.05 ,$117.04 ,$113.05 ,$117.04 ,$117.04 ,$115.71 ,$113.05 ,$113.05 ,$113.05 ,$101.61 ,$119.70
Carle Richland Memorial Hospital,8030045,POSITIONER LARGE WITH COVER 01581400200,,E0190,271,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8600000,OXYGEN PER HOUR,,,271,$11.00 ,$11.00 ,$8.40 ,$9.90 ,$9.35 ,$9.35 ,$9.35 ,$9.68 ,$9.35 ,$9.68 ,$9.68 ,$9.57 ,$9.35 ,$9.35 ,$9.35 ,$8.40 ,$9.90
Carle Richland Memorial Hospital,8670240,AEROCHAMBER,,,271,$21.44 ,$21.44 ,$16.38 ,$19.30 ,$18.22 ,$18.22 ,$18.22 ,$18.87 ,$18.22 ,$18.87 ,$18.87 ,$18.65 ,$18.22 ,$18.22 ,$18.22 ,$16.38 ,$19.30
Carle Richland Memorial Hospital,8670241,DISP. RESUSCITATION BAGS,,,271,$63.45 ,$63.45 ,$48.48 ,$57.11 ,$53.93 ,$53.93 ,$53.93 ,$55.84 ,$53.93 ,$55.84 ,$55.84 ,$55.20 ,$53.93 ,$53.93 ,$53.93 ,$48.48 ,$57.11
Carle Richland Memorial Hospital,8670242,AQUA PAKS,,,271,$68.81 ,$68.81 ,$52.57 ,$61.93 ,$58.49 ,$58.49 ,$58.49 ,$60.55 ,$58.49 ,$60.55 ,$60.55 ,$59.86 ,$58.49 ,$58.49 ,$58.49 ,$52.57 ,$61.93
Carle Richland Memorial Hospital,8670243,CONNECTING TUBE,,,271,$67.05 ,$67.05 ,$51.23 ,$60.35 ,$56.99 ,$56.99 ,$56.99 ,$59.00 ,$56.99 ,$59.00 ,$59.00 ,$58.33 ,$56.99 ,$56.99 ,$56.99 ,$51.23 ,$60.35
Carle Richland Memorial Hospital,8670245,DISP RESUSCITATION MASK,,,271,$81.35 ,$81.35 ,$62.15 ,$73.22 ,$69.15 ,$69.15 ,$69.15 ,$71.59 ,$69.15 ,$71.59 ,$71.59 ,$70.77 ,$69.15 ,$69.15 ,$69.15 ,$62.15 ,$73.22
Carle Richland Memorial Hospital,8670247,AEROSOL GENERATOR,,,271,$156.40 ,$156.40 ,$119.49 ,$140.76 ,$132.94 ,$132.94 ,$132.94 ,$137.63 ,$132.94 ,$137.63 ,$137.63 ,$136.07 ,$132.94 ,$132.94 ,$132.94 ,$119.49 ,$140.76
Carle Richland Memorial Hospital,8670248,HIGH-FLOW OXYGEN KIT,,,271,$162.89 ,$162.89 ,$124.45 ,$146.60 ,$138.46 ,$138.46 ,$138.46 ,$143.34 ,$138.46 ,$143.34 ,$143.34 ,$141.71 ,$138.46 ,$138.46 ,$138.46 ,$124.45 ,$146.60
Carle Richland Memorial Hospital,8670249,DISPOSABLE VEST FOR CPT,,,271,$246.75 ,$246.75 ,$188.52 ,$222.08 ,$209.74 ,$209.74 ,$209.74 ,$217.14 ,$209.74 ,$217.14 ,$217.14 ,$214.67 ,$209.74 ,$209.74 ,$209.74 ,$188.52 ,$222.08
Carle Richland Memorial Hospital,8670252,ORAL AIRWAY,,,271,$30.40 ,$30.40 ,$23.23 ,$27.36 ,$25.84 ,$25.84 ,$25.84 ,$26.75 ,$25.84 ,$26.75 ,$26.75 ,$26.45 ,$25.84 ,$25.84 ,$25.84 ,$23.23 ,$27.36
Carle Richland Memorial Hospital,8670262,OXISENSOR INFANT,,,271,$314.60 ,$314.60 ,$240.35 ,$283.14 ,$267.41 ,$267.41 ,$267.41 ,$276.85 ,$267.41 ,$276.85 ,$276.85 ,$273.70 ,$267.41 ,$267.41 ,$267.41 ,$240.35 ,$283.14
Carle Richland Memorial Hospital,8670263,OXISENSOR NEONATAL,,,271,$314.60 ,$314.60 ,$240.35 ,$283.14 ,$267.41 ,$267.41 ,$267.41 ,$276.85 ,$267.41 ,$276.85 ,$276.85 ,$273.70 ,$267.41 ,$267.41 ,$267.41 ,$240.35 ,$283.14
Carle Richland Memorial Hospital,8670264,OXISENSOR ADULT,,,271,$249.35 ,$249.35 ,$190.50 ,$224.42 ,$211.95 ,$211.95 ,$211.95 ,$219.43 ,$211.95 ,$219.43 ,$219.43 ,$216.93 ,$211.95 ,$211.95 ,$211.95 ,$190.50 ,$224.42
Carle Richland Memorial Hospital,8670265,REVERSE FINGER KNUCKLE BENDER,,,271,$115.29 ,$115.29 ,$88.08 ,$103.76 ,$98.00 ,$98.00 ,$98.00 ,$101.46 ,$98.00 ,$101.46 ,$101.46 ,$100.30 ,$98.00 ,$98.00 ,$98.00 ,$88.08 ,$103.76
Carle Richland Memorial Hospital,8670266,D RING COCK UP SPLINT,,,271,$127.82 ,$127.82 ,$97.65 ,$115.04 ,$108.65 ,$108.65 ,$108.65 ,$112.48 ,$108.65 ,$112.48 ,$112.48 ,$111.20 ,$108.65 ,$108.65 ,$108.65 ,$97.65 ,$115.04
Carle Richland Memorial Hospital,8670267,PIP DIP FLEXION STRAP,,,271,$28.61 ,$28.61 ,$21.86 ,$25.75 ,$24.32 ,$24.32 ,$24.32 ,$25.18 ,$24.32 ,$25.18 ,$25.18 ,$24.89 ,$24.32 ,$24.32 ,$24.32 ,$21.86 ,$25.75
Carle Richland Memorial Hospital,8670268,UNIVERSAL SLING,,,271,$182.33 ,$182.33 ,$139.30 ,$164.10 ,$154.98 ,$154.98 ,$154.98 ,$160.45 ,$154.98 ,$160.45 ,$160.45 ,$158.63 ,$154.98 ,$154.98 ,$154.98 ,$139.30 ,$164.10
Carle Richland Memorial Hospital,8670269,FINGER KNUCKLE BENDER,,,271,$121.55 ,$121.55 ,$92.86 ,$109.40 ,$103.32 ,$103.32 ,$103.32 ,$106.96 ,$103.32 ,$106.96 ,$106.96 ,$105.75 ,$103.32 ,$103.32 ,$103.32 ,$92.86 ,$109.40
Carle Richland Memorial Hospital,8670271,DYNAMIC PIP EXTENSION ASSIST,,,271,$140.32 ,$140.32 ,$107.20 ,$126.29 ,$119.27 ,$119.27 ,$119.27 ,$123.48 ,$119.27 ,$123.48 ,$123.48 ,$122.08 ,$119.27 ,$119.27 ,$119.27 ,$107.20 ,$126.29
Carle Richland Memorial Hospital,8670272,STAX FINGER SPLINT,,,271,$27.72 ,$27.72 ,$21.18 ,$24.95 ,$23.56 ,$23.56 ,$23.56 ,$24.39 ,$23.56 ,$24.39 ,$24.39 ,$24.12 ,$23.56 ,$23.56 ,$23.56 ,$21.18 ,$24.95
Carle Richland Memorial Hospital,8670273,FINGER THERMOPLASTIC SPLINT,,,271,$33.06 ,$33.06 ,$25.26 ,$29.75 ,$28.10 ,$28.10 ,$28.10 ,$29.09 ,$28.10 ,$29.09 ,$29.09 ,$28.76 ,$28.10 ,$28.10 ,$28.10 ,$25.26 ,$29.75
Carle Richland Memorial Hospital,8670274,SIMPLE THERMOPLASTIC SPLINT,,,271,$159.06 ,$159.06 ,$121.52 ,$143.15 ,$135.20 ,$135.20 ,$135.20 ,$139.97 ,$135.20 ,$139.97 ,$139.97 ,$138.38 ,$135.20 ,$135.20 ,$135.20 ,$121.52 ,$143.15
Carle Richland Memorial Hospital,8670275,ISOTONER GLOVE,,,271,$80.44 ,$80.44 ,$61.46 ,$72.40 ,$68.37 ,$68.37 ,$68.37 ,$70.79 ,$68.37 ,$70.79 ,$70.79 ,$69.98 ,$68.37 ,$68.37 ,$68.37 ,$61.46 ,$72.40
Carle Richland Memorial Hospital,8670276,FLEXION FINGER SPRING,,,271,$99.19 ,$99.19 ,$75.78 ,$89.27 ,$84.31 ,$84.31 ,$84.31 ,$87.29 ,$84.31 ,$87.29 ,$87.29 ,$86.30 ,$84.31 ,$84.31 ,$84.31 ,$75.78 ,$89.27
Carle Richland Memorial Hospital,8670277,JOINT JACK,,,271,$222.54 ,$222.54 ,$170.02 ,$200.29 ,$189.16 ,$189.16 ,$189.16 ,$195.84 ,$189.16 ,$195.84 ,$195.84 ,$193.61 ,$189.16 ,$189.16 ,$189.16 ,$170.02 ,$200.29
Carle Richland Memorial Hospital,8670278,THERMOPLASTIC SPLINT,,,271,$176.97 ,$176.97 ,$135.21 ,$159.27 ,$150.42 ,$150.42 ,$150.42 ,$155.73 ,$150.42 ,$155.73 ,$155.73 ,$153.96 ,$150.42 ,$150.42 ,$150.42 ,$135.21 ,$159.27
Carle Richland Memorial Hospital,8670280,CRUTCH TIPS PR,,,271,$26.82 ,$26.82 ,$20.49 ,$24.14 ,$22.80 ,$22.80 ,$22.80 ,$23.60 ,$22.80 ,$23.60 ,$23.60 ,$23.33 ,$22.80 ,$22.80 ,$22.80 ,$20.49 ,$24.14
Carle Richland Memorial Hospital,8670281,CPM-DAILY CHARGE,,,271,$435.25 ,$435.25 ,$332.53 ,$391.73 ,$369.96 ,$369.96 ,$369.96 ,$383.02 ,$369.96 ,$383.02 ,$383.02 ,$378.67 ,$369.96 ,$369.96 ,$369.96 ,$332.53 ,$391.73
Carle Richland Memorial Hospital,8670282,CPM-SINGLE USE KIT,,,271,$670.28 ,$670.28 ,$512.09 ,$603.25 ,$569.74 ,$569.74 ,$569.74 ,$589.85 ,$569.74 ,$589.85 ,$589.85 ,$583.14 ,$569.74 ,$569.74 ,$569.74 ,$512.09 ,$603.25
Carle Richland Memorial Hospital,8670283,PAVLIK HARNESS (PEDIATRIC),,,271,$189.47 ,$189.47 ,$144.76 ,$170.52 ,$161.05 ,$161.05 ,$161.05 ,$166.73 ,$161.05 ,$166.73 ,$166.73 ,$164.84 ,$161.05 ,$161.05 ,$161.05 ,$144.76 ,$170.52
Carle Richland Memorial Hospital,8670284,STOCKINGS-JOBST CUSTOM BK,,,271,$285.98 ,$285.98 ,$218.49 ,$257.38 ,$243.08 ,$243.08 ,$243.08 ,$251.66 ,$243.08 ,$251.66 ,$251.66 ,$248.80 ,$243.08 ,$243.08 ,$243.08 ,$218.49 ,$257.38
Carle Richland Memorial Hospital,8670285,STOCKINGS-JOBST CUSTOM TL,,,271,$318.17 ,$318.17 ,$243.08 ,$286.35 ,$270.44 ,$270.44 ,$270.44 ,$279.99 ,$270.44 ,$279.99 ,$279.99 ,$276.81 ,$270.44 ,$270.44 ,$270.44 ,$243.08 ,$286.35
Carle Richland Memorial Hospital,8670286,STOCKINGS-JOBST CUSTOM WH,,,271,$840.99 ,$840.99 ,$642.52 ,$756.89 ,$714.84 ,$714.84 ,$714.84 ,$740.07 ,$714.84 ,$740.07 ,$740.07 ,$731.66 ,$714.84 ,$714.84 ,$714.84 ,$642.52 ,$756.89
Carle Richland Memorial Hospital,8670287,LUMBOSACRAL SUPPORT,,,271,$244.89 ,$244.89 ,$187.10 ,$220.40 ,$208.16 ,$208.16 ,$208.16 ,$215.50 ,$208.16 ,$215.50 ,$215.50 ,$213.05 ,$208.16 ,$208.16 ,$208.16 ,$187.10 ,$220.40
Carle Richland Memorial Hospital,8670288,TENNIS ELBOW SPLINT,,,271,$69.70 ,$69.70 ,$53.25 ,$62.73 ,$59.25 ,$59.25 ,$59.25 ,$61.34 ,$59.25 ,$61.34 ,$61.34 ,$60.64 ,$59.25 ,$59.25 ,$59.25 ,$53.25 ,$62.73
Carle Richland Memorial Hospital,8670289,TENNIS ELBOW SPLINT-GEL,,,271,$109.04 ,$109.04 ,$83.31 ,$98.14 ,$92.68 ,$92.68 ,$92.68 ,$95.96 ,$92.68 ,$95.96 ,$95.96 ,$94.86 ,$92.68 ,$92.68 ,$92.68 ,$83.31 ,$98.14
Carle Richland Memorial Hospital,8670290,BRACE CASH ORTHOSIS,,,271,$477.24 ,$477.24 ,$364.61 ,$429.52 ,$405.65 ,$405.65 ,$405.65 ,$419.97 ,$405.65 ,$419.97 ,$419.97 ,$415.20 ,$405.65 ,$405.65 ,$405.65 ,$364.61 ,$429.52
Carle Richland Memorial Hospital,8670291,HIP ORTHOSIS,,,271,"$1,739.18 ","$1,739.18 ","$1,328.73 ","$1,565.26 ","$1,478.30 ","$1,478.30 ","$1,478.30 ","$1,530.48 ","$1,478.30 ","$1,530.48 ","$1,530.48 ","$1,513.09 ","$1,478.30 ","$1,478.30 ","$1,478.30 ","$1,328.73 ","$1,565.26 "
Carle Richland Memorial Hospital,8645267,HEARING AID SUPPLIES/ACCESSORIES,,V5267,271,$16.00 ,$16.00 ,$12.22 ,$14.40 ,$13.60 ,$13.60 ,$13.60 ,$14.08 ,$13.60 ,$14.08 ,$14.08 ,$13.92 ,$13.60 ,$13.60 ,$13.60 ,$12.22 ,$14.40
Carle Richland Memorial Hospital,8645264,EAR MOLD/INSERT,,V5264,271,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8645265,"EAR MOLD/INSERT, DISP",,V5265,271,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,7550441,Pessary Gelhorn 1 3/4 In,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550442,Pessary Gelhorn 2 Inch,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550443,Pessary Gelhorn 2 1/4 In,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550444,Pessary Gelhorn 2 1/2 In,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550445,Pessary Gelhorn 2 3/4,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550446,Pessary Gelhorn 3 Inch,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550555,Pessary Gelhorn 3 1/2 In,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550556,Pessary Gelhorn 1 1/2 In,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550675,Pessary Gelhorn Short 1.5,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550766,Pessary Gelhorn Shrt 1.75,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550870,Pessary Gelhorn Shrt 2.5,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550872,Pessary Gelhorn Shrt 2in,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550942,Pessary Gelhorn 3 1/4 In,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7550943,Pessary Gelhorn Shrt 2.25,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7577697,Pessary Gelhorn Shrt 2.75,,A4562,271,$214.00 ,$214.00 ,$163.50 ,$192.60 ,$181.90 ,$181.90 ,$181.90 ,$188.32 ,$181.90 ,$188.32 ,$188.32 ,$186.18 ,$181.90 ,$181.90 ,$181.90 ,$163.50 ,$192.60
Carle Richland Memorial Hospital,7577888,Pessary Gelhorn Shrt 3.25,,A4562,271,$221.00 ,$221.00 ,$168.84 ,$198.90 ,$187.85 ,$187.85 ,$187.85 ,$194.48 ,$187.85 ,$194.48 ,$194.48 ,$192.27 ,$187.85 ,$187.85 ,$187.85 ,$168.84 ,$198.90
Carle Richland Memorial Hospital,8170001,EPIDURAL NERVE BLOCK TRAY,,,272,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8130003,NEEDLE SPINAL PEN POINT 25GX5 (620573),,A4215,272,$41.31 ,$41.31 ,$31.56 ,$37.18 ,$35.11 ,$35.11 ,$35.11 ,$36.35 ,$35.11 ,$36.35 ,$36.35 ,$35.94 ,$35.11 ,$35.11 ,$35.11 ,$31.56 ,$37.18
Carle Richland Memorial Hospital,8130005,NEEDLE SPINAL 22GA X 3.5IN (212100),,A4215,272,$43.40 ,$43.40 ,$33.16 ,$39.06 ,$36.89 ,$36.89 ,$36.89 ,$38.19 ,$36.89 ,$38.19 ,$38.19 ,$37.76 ,$36.89 ,$36.89 ,$36.89 ,$33.16 ,$39.06
Carle Richland Memorial Hospital,8670239,MIST TENT PER DAY,,,272,$295.84 ,$295.84 ,$226.02 ,$266.26 ,$251.46 ,$251.46 ,$251.46 ,$260.34 ,$251.46 ,$260.34 ,$260.34 ,$257.38 ,$251.46 ,$251.46 ,$251.46 ,$226.02 ,$266.26
Carle Richland Memorial Hospital,8670246,ENDO TUBE,,,272,$96.53 ,$96.53 ,$73.75 ,$86.88 ,$82.05 ,$82.05 ,$82.05 ,$84.95 ,$82.05 ,$84.95 ,$84.95 ,$83.98 ,$82.05 ,$82.05 ,$82.05 ,$73.75 ,$86.88
Carle Richland Memorial Hospital,8670250,MUCUS TRAP,,,272,$55.40 ,$55.40 ,$42.33 ,$49.86 ,$47.09 ,$47.09 ,$47.09 ,$48.75 ,$47.09 ,$48.75 ,$48.75 ,$48.20 ,$47.09 ,$47.09 ,$47.09 ,$42.33 ,$49.86
Carle Richland Memorial Hospital,8670251,NASOPHARNGEAL AIRWAY,,,272,$128.69 ,$128.69 ,$98.32 ,$115.82 ,$109.39 ,$109.39 ,$109.39 ,$113.25 ,$109.39 ,$113.25 ,$113.25 ,$111.96 ,$109.39 ,$109.39 ,$109.39 ,$98.32 ,$115.82
Carle Richland Memorial Hospital,8670253,OXYGEN CANNULA,,,272,$80.44 ,$80.44 ,$61.46 ,$72.40 ,$68.37 ,$68.37 ,$68.37 ,$70.79 ,$68.37 ,$70.79 ,$70.79 ,$69.98 ,$68.37 ,$68.37 ,$68.37 ,$61.46 ,$72.40
Carle Richland Memorial Hospital,8670254,OXYGEN CATHETERS,,,272,$69.70 ,$69.70 ,$53.25 ,$62.73 ,$59.25 ,$59.25 ,$59.25 ,$61.34 ,$59.25 ,$61.34 ,$61.34 ,$60.64 ,$59.25 ,$59.25 ,$59.25 ,$53.25 ,$62.73
Carle Richland Memorial Hospital,8670256,OXYGEN MASKS,,,272,$108.16 ,$108.16 ,$82.63 ,$97.34 ,$91.94 ,$91.94 ,$91.94 ,$95.18 ,$91.94 ,$95.18 ,$95.18 ,$94.10 ,$91.94 ,$91.94 ,$91.94 ,$82.63 ,$97.34
Carle Richland Memorial Hospital,8670258,T-PIECE,,,272,$11.61 ,$11.61 ,$8.87 ,$10.45 ,$9.87 ,$9.87 ,$9.87 ,$10.22 ,$9.87 ,$10.22 ,$10.22 ,$10.10 ,$9.87 ,$9.87 ,$9.87 ,$8.87 ,$10.45
Carle Richland Memorial Hospital,8670259,TRACH CARE SUCTION CATHETER,,,272,$289.57 ,$289.57 ,$221.23 ,$260.61 ,$246.13 ,$246.13 ,$246.13 ,$254.82 ,$246.13 ,$254.82 ,$254.82 ,$251.93 ,$246.13 ,$246.13 ,$246.13 ,$221.23 ,$260.61
Carle Richland Memorial Hospital,8670260,TRACHEOSTOMY-SINGLE CUFF,,,272,$364.64 ,$364.64 ,$278.58 ,$328.18 ,$309.94 ,$309.94 ,$309.94 ,$320.88 ,$309.94 ,$320.88 ,$320.88 ,$317.24 ,$309.94 ,$309.94 ,$309.94 ,$278.58 ,$328.18
Carle Richland Memorial Hospital,8670261,YANKAUER SUCTION INSTRUMENT,,,272,$67.91 ,$67.91 ,$51.88 ,$61.12 ,$57.72 ,$57.72 ,$57.72 ,$59.76 ,$57.72 ,$59.76 ,$59.76 ,$59.08 ,$57.72 ,$57.72 ,$57.72 ,$51.88 ,$61.12
Carle Richland Memorial Hospital,8940033,PICC 3 FRENCH SINGLE LUMEN 3CG,,C1751,272,"$3,708.00 ","$3,708.00 ","$2,832.91 ","$3,337.20 ","$3,151.80 ","$3,151.80 ","$3,151.80 ","$3,263.04 ","$3,151.80 ","$3,263.04 ","$3,263.04 ","$3,225.96 ","$3,151.80 ","$3,151.80 ","$3,151.80 ","$2,832.91 ","$3,337.20 "
Carle Richland Memorial Hospital,8940034,PICC 4 FRENCH DUAL LUMEN 3CG,,C1751,272,"$3,804.00 ","$3,804.00 ","$2,906.26 ","$3,423.60 ","$3,233.40 ","$3,233.40 ","$3,233.40 ","$3,347.52 ","$3,233.40 ","$3,347.52 ","$3,347.52 ","$3,309.48 ","$3,233.40 ","$3,233.40 ","$3,233.40 ","$2,906.26 ","$3,423.60 "
Carle Richland Memorial Hospital,8030196,MIDLINE 4 FR DOUBLE LUMEN MAX BARRIER TRAY,,C1751,272,$761.00 ,$761.00 ,$581.40 ,$684.90 ,$646.85 ,$646.85 ,$646.85 ,$669.68 ,$646.85 ,$669.68 ,$669.68 ,$662.07 ,$646.85 ,$646.85 ,$646.85 ,$581.40 ,$684.90
Carle Richland Memorial Hospital,8980272,"water for injection, sterile injection solution",409488723,,272,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980272,"water for injection, sterile injection solution",409488724,,272,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8670047,CRUTCHES PR,,,273,$165.34 ,$165.34 ,$126.32 ,$148.81 ,$140.54 ,$140.54 ,$140.54 ,$145.50 ,$140.54 ,$145.50 ,$145.50 ,$143.85 ,$140.54 ,$140.54 ,$140.54 ,$126.32 ,$148.81
Carle Richland Memorial Hospital,8670078,FOREARM BASE THUMB SPICA GAUNT,,L3808,274,$100.00 ,$100.00 ,$76.40 ,$90.00 ,$85.00 ,$85.00 ,$85.00 ,$88.00 ,$85.00 ,$88.00 ,$88.00 ,$87.00 ,$85.00 ,$85.00 ,$85.00 ,$76.40 ,$90.00
Carle Richland Memorial Hospital,8670210,SO CAP DESIGN W/O JNT CF,,L3671,274,"$1,006.98 ","$1,006.98 ",$769.33 ,$906.28 ,$855.93 ,$855.93 ,$855.93 ,$886.14 ,$855.93 ,$886.14 ,$886.14 ,$876.07 ,$855.93 ,$855.93 ,$855.93 ,$769.33 ,$906.28
Carle Richland Memorial Hospital,8670211,SO AIRPLANE W/WO JNT CF,,L3674,274,"$1,309.09 ","$1,309.09 ","$1,000.14 ","$1,178.18 ","$1,112.73 ","$1,112.73 ","$1,112.73 ","$1,152.00 ","$1,112.73 ","$1,152.00 ","$1,152.00 ","$1,138.91 ","$1,112.73 ","$1,112.73 ","$1,112.73 ","$1,000.14 ","$1,178.18 "
Carle Richland Memorial Hospital,8670212,EO W/O JNTS CF,,L3702,274,$449.52 ,$449.52 ,$343.43 ,$404.57 ,$382.09 ,$382.09 ,$382.09 ,$395.58 ,$382.09 ,$395.58 ,$395.58 ,$391.08 ,$382.09 ,$382.09 ,$382.09 ,$343.43 ,$404.57
Carle Richland Memorial Hospital,8670213,FOREARM/ARM CUFFS EXT/FLEX A,,L3730,274,"$1,006.98 ","$1,006.98 ",$769.33 ,$906.28 ,$855.93 ,$855.93 ,$855.93 ,$886.14 ,$855.93 ,$886.14 ,$886.14 ,$876.07 ,$855.93 ,$855.93 ,$855.93 ,$769.33 ,$906.28
Carle Richland Memorial Hospital,8670214,EWHO W/O JNTS CF,,L3763,274,$872.72 ,$872.72 ,$666.76 ,$785.45 ,$741.81 ,$741.81 ,$741.81 ,$767.99 ,$741.81 ,$767.99 ,$767.99 ,$759.27 ,$741.81 ,$741.81 ,$741.81 ,$666.76 ,$785.45
Carle Richland Memorial Hospital,8670215,EWHO W/JNTS CF,,L3764,274,$901.80 ,$901.80 ,$688.98 ,$811.62 ,$766.53 ,$766.53 ,$766.53 ,$793.58 ,$766.53 ,$793.58 ,$793.58 ,$784.57 ,$766.53 ,$766.53 ,$766.53 ,$688.98 ,$811.62
Carle Richland Memorial Hospital,8670216,EWHFO RIGID W/O JNTS CF,,L3765,274,"$1,417.84 ","$1,417.84 ","$1,083.23 ","$1,276.06 ","$1,205.16 ","$1,205.16 ","$1,205.16 ","$1,247.70 ","$1,205.16 ","$1,247.70 ","$1,247.70 ","$1,233.52 ","$1,205.16 ","$1,205.16 ","$1,205.16 ","$1,083.23 ","$1,276.06 "
Carle Richland Memorial Hospital,8670217,EWHFO W/JNT CF,,L3766,274,"$1,503.77 ","$1,503.77 ","$1,148.88 ","$1,353.39 ","$1,278.20 ","$1,278.20 ","$1,278.20 ","$1,323.32 ","$1,278.20 ","$1,323.32 ","$1,323.32 ","$1,308.28 ","$1,278.20 ","$1,278.20 ","$1,278.20 ","$1,148.88 ","$1,353.39 "
Carle Richland Memorial Hospital,8670218,WHFO W/JNT CUSTOM FAB,,L3806,274,$503.50 ,$503.50 ,$384.67 ,$453.15 ,$427.98 ,$427.98 ,$427.98 ,$443.08 ,$427.98 ,$443.08 ,$443.08 ,$438.05 ,$427.98 ,$427.98 ,$427.98 ,$384.67 ,$453.15
Carle Richland Memorial Hospital,8670219,WHFO RIGID W/O JNTS,,L3808,274,$475.30 ,$475.30 ,$363.13 ,$427.77 ,$404.01 ,$404.01 ,$404.01 ,$418.26 ,$404.01 ,$418.26 ,$418.26 ,$413.51 ,$404.01 ,$404.01 ,$404.01 ,$363.13 ,$427.77
Carle Richland Memorial Hospital,8670220,WHO W/NONTORSION JNT CF,,L3905,274,"$1,100.97 ","$1,100.97 ",$841.14 ,$990.87 ,$935.82 ,$935.82 ,$935.82 ,$968.85 ,$935.82 ,$968.85 ,$968.85 ,$957.84 ,$935.82 ,$935.82 ,$935.82 ,$841.14 ,$990.87
Carle Richland Memorial Hospital,8670221,WHO W/O JNTS CF,,L3906,274,$676.69 ,$676.69 ,$516.99 ,$609.02 ,$575.19 ,$575.19 ,$575.19 ,$595.49 ,$575.19 ,$595.49 ,$595.49 ,$588.72 ,$575.19 ,$575.19 ,$575.19 ,$516.99 ,$609.02
Carle Richland Memorial Hospital,8670222,WHO COCK-UP PREFAB,,L3908,274,$97.19 ,$97.19 ,$74.25 ,$87.47 ,$82.61 ,$82.61 ,$82.61 ,$85.53 ,$82.61 ,$85.53 ,$85.53 ,$84.56 ,$82.61 ,$82.61 ,$82.61 ,$74.25 ,$87.47
Carle Richland Memorial Hospital,8670223,HFO W/O JNT CF,,L3913,274,$391.52 ,$391.52 ,$299.12 ,$352.37 ,$332.79 ,$332.79 ,$332.79 ,$344.54 ,$332.79 ,$344.54 ,$344.54 ,$340.62 ,$332.79 ,$332.79 ,$332.79 ,$299.12 ,$352.37
Carle Richland Memorial Hospital,8670224,HO W/O JNTS CF,,L3919,274,$302.11 ,$302.11 ,$230.81 ,$271.90 ,$256.79 ,$256.79 ,$256.79 ,$265.86 ,$256.79 ,$265.86 ,$265.86 ,$262.84 ,$256.79 ,$256.79 ,$256.79 ,$230.81 ,$271.90
Carle Richland Memorial Hospital,8670225,HFO W/JNTS CF,,L3921,274,$459.18 ,$459.18 ,$350.81 ,$413.26 ,$390.30 ,$390.30 ,$390.30 ,$404.08 ,$390.30 ,$404.08 ,$404.08 ,$399.49 ,$390.30 ,$390.30 ,$390.30 ,$350.81 ,$413.26
Carle Richland Memorial Hospital,8670226,HFO W/O JNTS PREFAB,,L3923,274,$112.49 ,$112.49 ,$85.94 ,$101.24 ,$95.62 ,$95.62 ,$95.62 ,$98.99 ,$95.62 ,$98.99 ,$98.99 ,$97.87 ,$95.62 ,$95.62 ,$95.62 ,$85.94 ,$101.24
Carle Richland Memorial Hospital,8670227,FO NONTORSION PREFAB,,L3925,274,$88.22 ,$88.22 ,$67.40 ,$79.40 ,$74.99 ,$74.99 ,$74.99 ,$77.63 ,$74.99 ,$77.63 ,$77.63 ,$76.75 ,$74.99 ,$74.99 ,$74.99 ,$67.40 ,$79.40
Carle Richland Memorial Hospital,8670228,FO W/O JOINTS CF,,L3933,274,$262.13 ,$262.13 ,$200.27 ,$235.92 ,$222.81 ,$222.81 ,$222.81 ,$230.67 ,$222.81 ,$230.67 ,$230.67 ,$228.05 ,$222.81 ,$222.81 ,$222.81 ,$200.27 ,$235.92
Carle Richland Memorial Hospital,8670229,FO NONTORSION JNT CF,,L3935,274,$503.50 ,$503.50 ,$384.67 ,$453.15 ,$427.98 ,$427.98 ,$427.98 ,$443.08 ,$427.98 ,$443.08 ,$443.08 ,$438.05 ,$427.98 ,$427.98 ,$427.98 ,$384.67 ,$453.15
Carle Richland Memorial Hospital,8670230,SEWHO CAP DESIGN W/O JNT CF,,L3961,274,"$1,859.56 ","$1,859.56 ","$1,420.70 ","$1,673.60 ","$1,580.63 ","$1,580.63 ","$1,580.63 ","$1,636.41 ","$1,580.63 ","$1,636.41 ","$1,636.41 ","$1,617.82 ","$1,580.63 ","$1,580.63 ","$1,580.63 ","$1,420.70 ","$1,673.60 "
Carle Richland Memorial Hospital,8670231,SEWHO AIRPLANE W/O JNT CF,,L3967,274,"$2,195.24 ","$2,195.24 ","$1,677.16 ","$1,975.72 ","$1,865.95 ","$1,865.95 ","$1,865.95 ","$1,931.81 ","$1,865.95 ","$1,931.81 ","$1,931.81 ","$1,909.86 ","$1,865.95 ","$1,865.95 ","$1,865.95 ","$1,677.16 ","$1,975.72 "
Carle Richland Memorial Hospital,8670232,SEWHO CAP DESIGN W/JNT,,L3971,274,"$2,094.54 ","$2,094.54 ","$1,600.23 ","$1,885.09 ","$1,780.36 ","$1,780.36 ","$1,780.36 ","$1,843.20 ","$1,780.36 ","$1,843.20 ","$1,843.20 ","$1,822.25 ","$1,780.36 ","$1,780.36 ","$1,780.36 ","$1,600.23 ","$1,885.09 "
Carle Richland Memorial Hospital,8670233,SEWHO AIRPLANE W/JNT CF,,L3973,274,"$2,195.24 ","$2,195.24 ","$1,677.16 ","$1,975.72 ","$1,865.95 ","$1,865.95 ","$1,865.95 ","$1,931.81 ","$1,865.95 ","$1,931.81 ","$1,931.81 ","$1,909.86 ","$1,865.95 ","$1,865.95 ","$1,865.95 ","$1,677.16 ","$1,975.72 "
Carle Richland Memorial Hospital,8670234,SEWHFO CAP DESIGN W/O JNT CF,,L3975,274,"$1,859.56 ","$1,859.56 ","$1,420.70 ","$1,673.60 ","$1,580.63 ","$1,580.63 ","$1,580.63 ","$1,636.41 ","$1,580.63 ","$1,636.41 ","$1,636.41 ","$1,617.82 ","$1,580.63 ","$1,580.63 ","$1,580.63 ","$1,420.70 ","$1,673.60 "
Carle Richland Memorial Hospital,8670235,SEWHFO AIRPLAND W/O JNT CF,,L3976,274,"$1,859.56 ","$1,859.56 ","$1,420.70 ","$1,673.60 ","$1,580.63 ","$1,580.63 ","$1,580.63 ","$1,636.41 ","$1,580.63 ","$1,636.41 ","$1,636.41 ","$1,617.82 ","$1,580.63 ","$1,580.63 ","$1,580.63 ","$1,420.70 ","$1,673.60 "
Carle Richland Memorial Hospital,8670236,SEWHFO CAP DESIGN W/JNT CF,,L3977,274,"$2,094.54 ","$2,094.54 ","$1,600.23 ","$1,885.09 ","$1,780.36 ","$1,780.36 ","$1,780.36 ","$1,843.20 ","$1,780.36 ","$1,843.20 ","$1,843.20 ","$1,822.25 ","$1,780.36 ","$1,780.36 ","$1,780.36 ","$1,600.23 ","$1,885.09 "
Carle Richland Memorial Hospital,8670237,SEWHFO AIRPLANE W/JNT CF,,L3978,274,"$2,195.24 ","$2,195.24 ","$1,677.16 ","$1,975.72 ","$1,865.95 ","$1,865.95 ","$1,865.95 ","$1,931.81 ","$1,865.95 ","$1,931.81 ","$1,931.81 ","$1,909.86 ","$1,865.95 ","$1,865.95 ","$1,865.95 ","$1,677.16 ","$1,975.72 "
Carle Richland Memorial Hospital,8100704,TRIFOCAL LENS,,V2788,276,"$1,095.00 ","$1,095.00 ",$836.58 ,$985.50 ,$930.75 ,$930.75 ,$930.75 ,$963.60 ,$930.75 ,$963.60 ,$963.60 ,$952.65 ,$930.75 ,$930.75 ,$930.75 ,$836.58 ,$985.50
Carle Richland Memorial Hospital,8100700,"RMH LENS, TECNIS ZCTxxx TORIC",235182,V2787,276,$595.00 ,$595.00 ,$454.58 ,$535.50 ,$505.75 ,$505.75 ,$505.75 ,$523.60 ,$505.75 ,$523.60 ,$523.60 ,$517.65 ,$505.75 ,$505.75 ,$505.75 ,$454.58 ,$535.50
Carle Richland Memorial Hospital,8100700,"RMH LENS, TECNIS SYMFONY ZXTxxx TORIC",235183,V2787,276,$595.00 ,$595.00 ,$454.58 ,$535.50 ,$505.75 ,$505.75 ,$505.75 ,$523.60 ,$505.75 ,$523.60 ,$523.60 ,$517.65 ,$505.75 ,$505.75 ,$505.75 ,$454.58 ,$535.50
Carle Richland Memorial Hospital,8100700,"RMH LENS, ALCON SN6ATx TORIC",235189,V2787,276,$595.00 ,$595.00 ,$454.58 ,$535.50 ,$505.75 ,$505.75 ,$505.75 ,$523.60 ,$505.75 ,$523.60 ,$523.60 ,$517.65 ,$505.75 ,$505.75 ,$505.75 ,$454.58 ,$535.50
Carle Richland Memorial Hospital,8100701,"RMH LENS, TECNIS SYMFONY ZXRxxx MULTI-FOCAL",235184,V2788,276,$995.00 ,$995.00 ,$760.18 ,$895.50 ,$845.75 ,$845.75 ,$845.75 ,$875.60 ,$845.75 ,$875.60 ,$875.60 ,$865.65 ,$845.75 ,$845.75 ,$845.75 ,$760.18 ,$895.50
Carle Richland Memorial Hospital,8100704,"RMH LENS, ALCON PANOPTIX TFNTxx TRI-FOCAL",235185,V2788,276,"$1,095.00 ","$1,095.00 ",$836.58 ,$985.50 ,$930.75 ,$930.75 ,$930.75 ,$963.60 ,$930.75 ,$963.60 ,$963.60 ,$952.65 ,$930.75 ,$930.75 ,$930.75 ,$836.58 ,$985.50
Carle Richland Memorial Hospital,8170125,"RMH LENS, TECNIS ZCBxxx MONO-FOCAL",235171,V2632,276,$693.00 ,$693.00 ,$529.45 ,$623.70 ,$589.05 ,$589.05 ,$589.05 ,$609.84 ,$589.05 ,$609.84 ,$609.84 ,$602.91 ,$589.05 ,$589.05 ,$589.05 ,$529.45 ,$623.70
Carle Richland Memorial Hospital,8170125,"RMH LENS, ALCON ACYRSOF IQ SN60WF MONO-FOCAL",235172,V2632,276,$693.00 ,$693.00 ,$529.45 ,$623.70 ,$589.05 ,$589.05 ,$589.05 ,$609.84 ,$589.05 ,$609.84 ,$609.84 ,$602.91 ,$589.05 ,$589.05 ,$589.05 ,$529.45 ,$623.70
Carle Richland Memorial Hospital,8170125,"RMH LENS, ALCON MA60AC MONOFOCAL",235190,V2632,276,$693.00 ,$693.00 ,$529.45 ,$623.70 ,$589.05 ,$589.05 ,$589.05 ,$609.84 ,$589.05 ,$609.84 ,$609.84 ,$602.91 ,$589.05 ,$589.05 ,$589.05 ,$529.45 ,$623.70
Carle Richland Memorial Hospital,8170125,"RMH LENS, ALCON ACRYSOF SA60ATx MONO-FOCAL",235191,V2632,276,$693.00 ,$693.00 ,$529.45 ,$623.70 ,$589.05 ,$589.05 ,$589.05 ,$609.84 ,$589.05 ,$609.84 ,$609.84 ,$602.91 ,$589.05 ,$589.05 ,$589.05 ,$529.45 ,$623.70
Carle Richland Memorial Hospital,8030031,KIT COOL GUARD START UP 626270,,C1752,278,$866.00 ,$866.00 ,$661.62 ,$779.40 ,$736.10 ,$736.10 ,$736.10 ,$762.08 ,$736.10 ,$762.08 ,$762.08 ,$753.42 ,$736.10 ,$736.10 ,$736.10 ,$661.62 ,$779.40
Carle Richland Memorial Hospital,8030033,CATHETER ICY 626268,,C1752,278,"$3,909.00 ","$3,909.00 ","$2,986.48 ","$3,518.10 ","$3,322.65 ","$3,322.65 ","$3,322.65 ","$3,439.92 ","$3,322.65 ","$3,439.92 ","$3,439.92 ","$3,400.83 ","$3,322.65 ","$3,322.65 ","$3,322.65 ","$2,986.48 ","$3,518.10 "
Carle Richland Memorial Hospital,8030100,CATH ARROW 3 LUMEN CV (C1751),,C1751,278,$667.81 ,$667.81 ,$510.21 ,$601.03 ,$567.64 ,$567.64 ,$567.64 ,$587.67 ,$567.64 ,$587.67 ,$587.67 ,$580.99 ,$567.64 ,$567.64 ,$567.64 ,$510.21 ,$601.03
Carle Richland Memorial Hospital,8414648,BREAST LOCALIZATION NEEDLE,,C1819,278,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,7453072,Cautery Essure System,,A4264,278,"$5,850.00 ","$5,850.00 ","$4,469.40 ","$5,265.00 ","$4,972.50 ","$4,972.50 ","$4,972.50 ","$5,148.00 ","$4,972.50 ","$5,148.00 ","$5,148.00 ","$5,089.50 ","$4,972.50 ","$4,972.50 ","$4,972.50 ","$4,469.40 ","$5,265.00 "
Carle Richland Memorial Hospital,8170020,RMH CAPSULAR TENSION RING,235175,,278,"$1,174.50 ","$1,174.50 ",$897.32 ,"$1,057.05 ",$998.33 ,$998.33 ,$998.33 ,"$1,033.56 ",$998.33 ,"$1,033.56 ","$1,033.56 ","$1,021.82 ",$998.33 ,$998.33 ,$998.33 ,$897.32 ,"$1,057.05 "
Carle Richland Memorial Hospital,8170603,SCREW 3.5MM CORT 16MM,233526,C1713,278,$109.80 ,$109.80 ,$83.89 ,$98.82 ,$93.33 ,$93.33 ,$93.33 ,$96.62 ,$93.33 ,$96.62 ,$96.62 ,$95.53 ,$93.33 ,$93.33 ,$93.33 ,$83.89 ,$98.82
Carle Richland Memorial Hospital,8170603,SCREW 3.5MM CORT 18MM,233527,C1713,278,$109.80 ,$109.80 ,$83.89 ,$98.82 ,$93.33 ,$93.33 ,$93.33 ,$96.62 ,$93.33 ,$96.62 ,$96.62 ,$95.53 ,$93.33 ,$93.33 ,$93.33 ,$83.89 ,$98.82
Carle Richland Memorial Hospital,8170603,SCREW 3.5MM CORT 20MM,233528,C1713,278,$109.80 ,$109.80 ,$83.89 ,$98.82 ,$93.33 ,$93.33 ,$93.33 ,$96.62 ,$93.33 ,$96.62 ,$96.62 ,$95.53 ,$93.33 ,$93.33 ,$93.33 ,$83.89 ,$98.82
Carle Richland Memorial Hospital,8170603,SCREW 3.5MM CORT 22MM,233529,C1713,278,$109.80 ,$109.80 ,$83.89 ,$98.82 ,$93.33 ,$93.33 ,$93.33 ,$96.62 ,$93.33 ,$96.62 ,$96.62 ,$95.53 ,$93.33 ,$93.33 ,$93.33 ,$83.89 ,$98.82
Carle Richland Memorial Hospital,8170603,CAP END DISPOSABLE 3MM,233313,C1713,278,$208.26 ,$208.26 ,$159.11 ,$187.43 ,$177.02 ,$177.02 ,$177.02 ,$183.27 ,$177.02 ,$183.27 ,$183.27 ,$181.19 ,$177.02 ,$177.02 ,$177.02 ,$159.11 ,$187.43
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM SEMI TUBULAR 4H,233637,C1713,278,$249.21 ,$249.21 ,$190.40 ,$224.29 ,$211.83 ,$211.83 ,$211.83 ,$219.30 ,$211.83 ,$219.30 ,$219.30 ,$216.81 ,$211.83 ,$211.83 ,$211.83 ,$190.40 ,$224.29
Carle Richland Memorial Hospital,8170603,NUT CORTICAL 4900-45-50,233744,C1713,278,$249.21 ,$249.21 ,$190.40 ,$224.29 ,$211.83 ,$211.83 ,$211.83 ,$219.30 ,$211.83 ,$219.30 ,$219.30 ,$216.81 ,$211.83 ,$211.83 ,$211.83 ,$190.40 ,$224.29
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 3H,233610,C1713,278,$261.05 ,$261.05 ,$199.44 ,$234.95 ,$221.89 ,$221.89 ,$221.89 ,$229.72 ,$221.89 ,$229.72 ,$229.72 ,$227.11 ,$221.89 ,$221.89 ,$221.89 ,$199.44 ,$234.95
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM SEMI TUBULAR 5H,233638,C1713,278,$261.05 ,$261.05 ,$199.44 ,$234.95 ,$221.89 ,$221.89 ,$221.89 ,$229.72 ,$221.89 ,$229.72 ,$229.72 ,$227.11 ,$221.89 ,$221.89 ,$221.89 ,$199.44 ,$234.95
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 4H,233611,C1713,278,$278.87 ,$278.87 ,$213.06 ,$250.98 ,$237.04 ,$237.04 ,$237.04 ,$245.41 ,$237.04 ,$245.41 ,$245.41 ,$242.62 ,$237.04 ,$237.04 ,$237.04 ,$213.06 ,$250.98
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 5H,233612,C1713,278,$278.87 ,$278.87 ,$213.06 ,$250.98 ,$237.04 ,$237.04 ,$237.04 ,$245.41 ,$237.04 ,$245.41 ,$245.41 ,$242.62 ,$237.04 ,$237.04 ,$237.04 ,$213.06 ,$250.98
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM SEMI TUBULAR 6H,233639,C1713,278,$278.87 ,$278.87 ,$213.06 ,$250.98 ,$237.04 ,$237.04 ,$237.04 ,$245.41 ,$237.04 ,$245.41 ,$245.41 ,$242.62 ,$237.04 ,$237.04 ,$237.04 ,$213.06 ,$250.98
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM SEMI TUBULAR 7H,233640,C1713,278,$284.81 ,$284.81 ,$217.59 ,$256.33 ,$242.09 ,$242.09 ,$242.09 ,$250.63 ,$242.09 ,$250.63 ,$250.63 ,$247.78 ,$242.09 ,$242.09 ,$242.09 ,$217.59 ,$256.33
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 6H,233613,C1713,278,$290.75 ,$290.75 ,$222.13 ,$261.68 ,$247.14 ,$247.14 ,$247.14 ,$255.86 ,$247.14 ,$255.86 ,$255.86 ,$252.95 ,$247.14 ,$247.14 ,$247.14 ,$222.13 ,$261.68
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 7H,233614,C1713,278,$290.75 ,$290.75 ,$222.13 ,$261.68 ,$247.14 ,$247.14 ,$247.14 ,$255.86 ,$247.14 ,$255.86 ,$255.86 ,$252.95 ,$247.14 ,$247.14 ,$247.14 ,$222.13 ,$261.68
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 8H,233615,C1713,278,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 9H,233616,C1713,278,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8170603,PLATE 1/3 TUBULAR 10H,233617,C1713,278,$311.49 ,$311.49 ,$237.98 ,$280.34 ,$264.77 ,$264.77 ,$264.77 ,$274.11 ,$264.77 ,$274.11 ,$274.11 ,$271.00 ,$264.77 ,$264.77 ,$264.77 ,$237.98 ,$280.34
Carle Richland Memorial Hospital,8170603,PIN HALF APEX SLF 5MM 180X50MM,233311,C1713,278,$403.65 ,$403.65 ,$308.39 ,$363.29 ,$343.10 ,$343.10 ,$343.10 ,$355.21 ,$343.10 ,$355.21 ,$355.21 ,$351.18 ,$343.10 ,$343.10 ,$343.10 ,$308.39 ,$363.29
Carle Richland Memorial Hospital,8170603,PIN HALF APEX SLF 3MM 110X25MM,233308,C1713,278,$409.50 ,$409.50 ,$312.86 ,$368.55 ,$348.08 ,$348.08 ,$348.08 ,$360.36 ,$348.08 ,$360.36 ,$360.36 ,$356.27 ,$348.08 ,$348.08 ,$348.08 ,$312.86 ,$368.55
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 3H,233618,C1713,278,$474.66 ,$474.66 ,$362.64 ,$427.19 ,$403.46 ,$403.46 ,$403.46 ,$417.70 ,$403.46 ,$417.70 ,$417.70 ,$412.95 ,$403.46 ,$403.46 ,$403.46 ,$362.64 ,$427.19
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 12MM,233827,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 13MM,233828,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 14MM,233829,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 15MM,233830,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 16MM,233831,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 18MM,233832,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 20MM,233833,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 22MM,233834,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 24MM,233835,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 26MM,233836,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 28MM,233837,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PEG 2.2MM SMOOTH LOCK 30MM,233838,C1713,278,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 5H,233619,C1713,278,$504.32 ,$504.32 ,$385.30 ,$453.89 ,$428.67 ,$428.67 ,$428.67 ,$443.80 ,$428.67 ,$443.80 ,$443.80 ,$438.76 ,$428.67 ,$428.67 ,$428.67 ,$385.30 ,$453.89
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 4H,234862,C1713,278,$504.32 ,$504.32 ,$385.30 ,$453.89 ,$428.67 ,$428.67 ,$428.67 ,$443.80 ,$428.67 ,$443.80 ,$443.80 ,$438.76 ,$428.67 ,$428.67 ,$428.67 ,$385.30 ,$453.89
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 5H,234863,C1713,278,$504.32 ,$504.32 ,$385.30 ,$453.89 ,$428.67 ,$428.67 ,$428.67 ,$443.80 ,$428.67 ,$443.80 ,$443.80 ,$438.76 ,$428.67 ,$428.67 ,$428.67 ,$385.30 ,$453.89
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 6H,233620,C1713,278,$548.82 ,$548.82 ,$419.30 ,$493.94 ,$466.50 ,$466.50 ,$466.50 ,$482.96 ,$466.50 ,$482.96 ,$482.96 ,$477.47 ,$466.50 ,$466.50 ,$466.50 ,$419.30 ,$493.94
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 7H,233621,C1713,278,$563.63 ,$563.63 ,$430.61 ,$507.27 ,$479.09 ,$479.09 ,$479.09 ,$495.99 ,$479.09 ,$495.99 ,$495.99 ,$490.36 ,$479.09 ,$479.09 ,$479.09 ,$430.61 ,$507.27
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 6H,234865,C1713,278,$563.63 ,$563.63 ,$430.61 ,$507.27 ,$479.09 ,$479.09 ,$479.09 ,$495.99 ,$479.09 ,$495.99 ,$495.99 ,$490.36 ,$479.09 ,$479.09 ,$479.09 ,$430.61 ,$507.27
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 7H,234867,C1713,278,$563.63 ,$563.63 ,$430.61 ,$507.27 ,$479.09 ,$479.09 ,$479.09 ,$495.99 ,$479.09 ,$495.99 ,$495.99 ,$490.36 ,$479.09 ,$479.09 ,$479.09 ,$430.61 ,$507.27
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 8H,234869,C1713,278,$563.63 ,$563.63 ,$430.61 ,$507.27 ,$479.09 ,$479.09 ,$479.09 ,$495.99 ,$479.09 ,$495.99 ,$495.99 ,$490.36 ,$479.09 ,$479.09 ,$479.09 ,$430.61 ,$507.27
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 9H,234871,C1713,278,$563.63 ,$563.63 ,$430.61 ,$507.27 ,$479.09 ,$479.09 ,$479.09 ,$495.99 ,$479.09 ,$495.99 ,$495.99 ,$490.36 ,$479.09 ,$479.09 ,$479.09 ,$430.61 ,$507.27
Carle Richland Memorial Hospital,8170603,PIN HALF APEX SLF 3MM 120X35MM,233309,C1713,278,$566.28 ,$566.28 ,$432.64 ,$509.65 ,$481.34 ,$481.34 ,$481.34 ,$498.33 ,$481.34 ,$498.33 ,$498.33 ,$492.66 ,$481.34 ,$481.34 ,$481.34 ,$432.64 ,$509.65
Carle Richland Memorial Hospital,8170603,PIN HALF APEX SLF 4MM 180X40MM,233310,C1713,278,$566.28 ,$566.28 ,$432.64 ,$509.65 ,$481.34 ,$481.34 ,$481.34 ,$498.33 ,$481.34 ,$498.33 ,$498.33 ,$492.66 ,$481.34 ,$481.34 ,$481.34 ,$432.64 ,$509.65
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 8H,233622,C1713,278,$578.48 ,$578.48 ,$441.96 ,$520.63 ,$491.71 ,$491.71 ,$491.71 ,$509.06 ,$491.71 ,$509.06 ,$509.06 ,$503.28 ,$491.71 ,$491.71 ,$491.71 ,$441.96 ,$520.63
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 9H,233623,C1713,278,$608.13 ,$608.13 ,$464.61 ,$547.32 ,$516.91 ,$516.91 ,$516.91 ,$535.15 ,$516.91 ,$535.15 ,$535.15 ,$529.07 ,$516.91 ,$516.91 ,$516.91 ,$464.61 ,$547.32
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 10H,233624,C1713,278,$622.98 ,$622.98 ,$475.96 ,$560.68 ,$529.53 ,$529.53 ,$529.53 ,$548.22 ,$529.53 ,$548.22 ,$548.22 ,$541.99 ,$529.53 ,$529.53 ,$529.53 ,$475.96 ,$560.68
Carle Richland Memorial Hospital,8170603,PIN APEX TRANSFIX 4/5 250X40MM,233312,C1713,278,$650.52 ,$650.52 ,$497.00 ,$585.47 ,$552.94 ,$552.94 ,$552.94 ,$572.46 ,$552.94 ,$572.46 ,$572.46 ,$565.95 ,$552.94 ,$552.94 ,$552.94 ,$497.00 ,$585.47
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 5H LOCK 1/3 TUBLR,233583,C1713,278,$652.64 ,$652.64 ,$498.62 ,$587.38 ,$554.74 ,$554.74 ,$554.74 ,$574.32 ,$554.74 ,$574.32 ,$574.32 ,$567.80 ,$554.74 ,$554.74 ,$554.74 ,$498.62 ,$587.38
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 6H LOCK 1/3 TUBLR,233584,C1713,278,$667.44 ,$667.44 ,$509.92 ,$600.70 ,$567.32 ,$567.32 ,$567.32 ,$587.35 ,$567.32 ,$587.35 ,$587.35 ,$580.67 ,$567.32 ,$567.32 ,$567.32 ,$509.92 ,$600.70
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 7H LOCK 1/3 TUBLR,233585,C1713,278,$697.14 ,$697.14 ,$532.61 ,$627.43 ,$592.57 ,$592.57 ,$592.57 ,$613.48 ,$592.57 ,$613.48 ,$613.48 ,$606.51 ,$592.57 ,$592.57 ,$592.57 ,$532.61 ,$627.43
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 12H,233625,C1713,278,$697.14 ,$697.14 ,$532.61 ,$627.43 ,$592.57 ,$592.57 ,$592.57 ,$613.48 ,$592.57 ,$613.48 ,$613.48 ,$606.51 ,$592.57 ,$592.57 ,$592.57 ,$532.61 ,$627.43
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 8H LOCK 1/3 TUBLR,233586,C1713,278,$726.80 ,$726.80 ,$555.28 ,$654.12 ,$617.78 ,$617.78 ,$617.78 ,$639.58 ,$617.78 ,$639.58 ,$639.58 ,$632.32 ,$617.78 ,$617.78 ,$617.78 ,$555.28 ,$654.12
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 10H LOCK 1/3 TUBLR,233587,C1713,278,$741.60 ,$741.60 ,$566.58 ,$667.44 ,$630.36 ,$630.36 ,$630.36 ,$652.61 ,$630.36 ,$652.61 ,$652.61 ,$645.19 ,$630.36 ,$630.36 ,$630.36 ,$566.58 ,$667.44
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 10H,234873,C1713,278,$741.60 ,$741.60 ,$566.58 ,$667.44 ,$630.36 ,$630.36 ,$630.36 ,$652.61 ,$630.36 ,$652.61 ,$652.61 ,$645.19 ,$630.36 ,$630.36 ,$630.36 ,$566.58 ,$667.44
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 11H,234875,C1713,278,$741.60 ,$741.60 ,$566.58 ,$667.44 ,$630.36 ,$630.36 ,$630.36 ,$652.61 ,$630.36 ,$652.61 ,$652.61 ,$645.19 ,$630.36 ,$630.36 ,$630.36 ,$566.58 ,$667.44
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM NARROW CON DCP 12H,234876,C1713,278,$741.60 ,$741.60 ,$566.58 ,$667.44 ,$630.36 ,$630.36 ,$630.36 ,$652.61 ,$630.36 ,$652.61 ,$652.61 ,$645.19 ,$630.36 ,$630.36 ,$630.36 ,$566.58 ,$667.44
Carle Richland Memorial Hospital,8170603,SCREW CANN 4.0MM 1/3X34MM,233410,C1713,278,$806.40 ,$806.40 ,$616.09 ,$725.76 ,$685.44 ,$685.44 ,$685.44 ,$709.63 ,$685.44 ,$709.63 ,$709.63 ,$701.57 ,$685.44 ,$685.44 ,$685.44 ,$616.09 ,$725.76
Carle Richland Memorial Hospital,8170603,SCREW CANN 4.0MM 1/3X38MM,233412,C1713,278,$806.40 ,$806.40 ,$616.09 ,$725.76 ,$685.44 ,$685.44 ,$685.44 ,$709.63 ,$685.44 ,$709.63 ,$709.63 ,$701.57 ,$685.44 ,$685.44 ,$685.44 ,$616.09 ,$725.76
Carle Richland Memorial Hospital,8170603,SCREW CANN 4.0MM 1/2X60MM,233443,C1713,278,$806.40 ,$806.40 ,$616.09 ,$725.76 ,$685.44 ,$685.44 ,$685.44 ,$709.63 ,$685.44 ,$709.63 ,$709.63 ,$701.57 ,$685.44 ,$685.44 ,$685.44 ,$616.09 ,$725.76
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM T 4H,233643,C1713,278,$845.46 ,$845.46 ,$645.93 ,$760.91 ,$718.64 ,$718.64 ,$718.64 ,$744.00 ,$718.64 ,$744.00 ,$744.00 ,$735.55 ,$718.64 ,$718.64 ,$718.64 ,$645.93 ,$760.91
Carle Richland Memorial Hospital,8170603,CAP END TI STANDARD,233271,C1713,278,$903.24 ,$903.24 ,$690.08 ,$812.92 ,$767.75 ,$767.75 ,$767.75 ,$794.85 ,$767.75 ,$794.85 ,$794.85 ,$785.82 ,$767.75 ,$767.75 ,$767.75 ,$690.08 ,$812.92
Carle Richland Memorial Hospital,8170603,CAP END TI PLUS 5MM,233272,C1713,278,$903.24 ,$903.24 ,$690.08 ,$812.92 ,$767.75 ,$767.75 ,$767.75 ,$794.85 ,$767.75 ,$794.85 ,$794.85 ,$785.82 ,$767.75 ,$767.75 ,$767.75 ,$690.08 ,$812.92
Carle Richland Memorial Hospital,8170603,CAP END TI PLUS 10MM,233273,C1713,278,$903.24 ,$903.24 ,$690.08 ,$812.92 ,$767.75 ,$767.75 ,$767.75 ,$794.85 ,$767.75 ,$794.85 ,$794.85 ,$785.82 ,$767.75 ,$767.75 ,$767.75 ,$690.08 ,$812.92
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM WIDE CON DCP 10H,234874,C1713,278,$904.77 ,$904.77 ,$691.24 ,$814.29 ,$769.05 ,$769.05 ,$769.05 ,$796.20 ,$769.05 ,$796.20 ,$796.20 ,$787.15 ,$769.05 ,$769.05 ,$769.05 ,$691.24 ,$814.29
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM SPOON 5H,233641,C1713,278,$934.43 ,$934.43 ,$713.90 ,$840.99 ,$794.27 ,$794.27 ,$794.27 ,$822.30 ,$794.27 ,$822.30 ,$822.30 ,$812.95 ,$794.27 ,$794.27 ,$794.27 ,$713.90 ,$840.99
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM WIDE CON DCP 12H,234877,C1713,278,$978.93 ,$978.93 ,$747.90 ,$881.04 ,$832.09 ,$832.09 ,$832.09 ,$861.46 ,$832.09 ,$861.46 ,$861.46 ,$851.67 ,$832.09 ,$832.09 ,$832.09 ,$747.90 ,$881.04
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM WIDE CON DCP 14H,234878,C1713,278,$978.93 ,$978.93 ,$747.90 ,$881.04 ,$832.09 ,$832.09 ,$832.09 ,$861.46 ,$832.09 ,$861.46 ,$861.46 ,$851.67 ,$832.09 ,$832.09 ,$832.09 ,$747.90 ,$881.04
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM T 6H,233644,C1713,278,$993.78 ,$993.78 ,$759.25 ,$894.40 ,$844.71 ,$844.71 ,$844.71 ,$874.53 ,$844.71 ,$874.53 ,$874.53 ,$864.59 ,$844.71 ,$844.71 ,$844.71 ,$759.25 ,$894.40
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM SPOON 6H,233642,C1713,278,"$1,008.59 ","$1,008.59 ",$770.56 ,$907.73 ,$857.30 ,$857.30 ,$857.30 ,$887.56 ,$857.30 ,$887.56 ,$887.56 ,$877.47 ,$857.30 ,$857.30 ,$857.30 ,$770.56 ,$907.73
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM L BUTTRESS LT 4H,233647,C1713,278,"$1,082.75 ","$1,082.75 ",$827.22 ,$974.48 ,$920.34 ,$920.34 ,$920.34 ,$952.82 ,$920.34 ,$952.82 ,$952.82 ,$941.99 ,$920.34 ,$920.34 ,$920.34 ,$827.22 ,$974.48
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM L BUTTRESS RT 4H,233648,C1713,278,"$1,082.75 ","$1,082.75 ",$827.22 ,$974.48 ,$920.34 ,$920.34 ,$920.34 ,$952.82 ,$920.34 ,$952.82 ,$952.82 ,$941.99 ,$920.34 ,$920.34 ,$920.34 ,$827.22 ,$974.48
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 4H LOCK CONTOUR,233588,C1713,278,"$1,156.91 ","$1,156.91 ",$883.88 ,"$1,041.22 ",$983.37 ,$983.37 ,$983.37 ,"$1,018.08 ",$983.37 ,"$1,018.08 ","$1,018.08 ","$1,006.51 ",$983.37 ,$983.37 ,$983.37 ,$883.88 ,"$1,041.22 "
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM T BUTTRESS 4H,233646,C1713,278,"$1,201.41 ","$1,201.41 ",$917.88 ,"$1,081.27 ","$1,021.20 ","$1,021.20 ","$1,021.20 ","$1,057.24 ","$1,021.20 ","$1,057.24 ","$1,057.24 ","$1,045.23 ","$1,021.20 ","$1,021.20 ","$1,021.20 ",$917.88 ,"$1,081.27 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 5H LOCK CONTOUR,233589,C1713,278,"$1,216.26 ","$1,216.26 ",$929.22 ,"$1,094.63 ","$1,033.82 ","$1,033.82 ","$1,033.82 ","$1,070.31 ","$1,033.82 ","$1,070.31 ","$1,070.31 ","$1,058.15 ","$1,033.82 ","$1,033.82 ","$1,033.82 ",$929.22 ,"$1,094.63 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM COMPRESSION 14H,233626,C1713,278,"$1,245.92 ","$1,245.92 ",$951.88 ,"$1,121.33 ","$1,059.03 ","$1,059.03 ","$1,059.03 ","$1,096.41 ","$1,059.03 ","$1,096.41 ","$1,096.41 ","$1,083.95 ","$1,059.03 ","$1,059.03 ","$1,059.03 ",$951.88 ,"$1,121.33 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 6H LOCK CONTOUR,233590,C1713,278,"$1,290.42 ","$1,290.42 ",$985.88 ,"$1,161.38 ","$1,096.86 ","$1,096.86 ","$1,096.86 ","$1,135.57 ","$1,096.86 ","$1,135.57 ","$1,135.57 ","$1,122.67 ","$1,096.86 ","$1,096.86 ","$1,096.86 ",$985.88 ,"$1,161.38 "
Carle Richland Memorial Hospital,8170603,PLATE 4.5MM T 8H,233645,C1713,278,"$1,334.88 ","$1,334.88 ","$1,019.85 ","$1,201.39 ","$1,134.65 ","$1,134.65 ","$1,134.65 ","$1,174.69 ","$1,134.65 ","$1,174.69 ","$1,174.69 ","$1,161.35 ","$1,134.65 ","$1,134.65 ","$1,134.65 ","$1,019.85 ","$1,201.39 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 7H LOCK CONTOUR,233591,C1713,278,"$1,349.73 ","$1,349.73 ","$1,031.19 ","$1,214.76 ","$1,147.27 ","$1,147.27 ","$1,147.27 ","$1,187.76 ","$1,147.27 ","$1,187.76 ","$1,187.76 ","$1,174.27 ","$1,147.27 ","$1,147.27 ","$1,147.27 ","$1,031.19 ","$1,214.76 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 8H LOCK CONTOUR,233592,C1713,278,"$1,409.04 ","$1,409.04 ","$1,076.51 ","$1,268.14 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,239.96 ","$1,197.68 ","$1,239.96 ","$1,239.96 ","$1,225.86 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,076.51 ","$1,268.14 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM T LOCK OBLIQ RT 3H,233597,C1713,278,"$1,409.04 ","$1,409.04 ","$1,076.51 ","$1,268.14 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,239.96 ","$1,197.68 ","$1,239.96 ","$1,239.96 ","$1,225.86 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,076.51 ","$1,268.14 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM T LOCK OBLIQ LT 3H,233599,C1713,278,"$1,409.04 ","$1,409.04 ","$1,076.51 ","$1,268.14 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,239.96 ","$1,197.68 ","$1,239.96 ","$1,239.96 ","$1,225.86 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,076.51 ","$1,268.14 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM T LOCK 5H,233601,C1713,278,"$1,409.04 ","$1,409.04 ","$1,076.51 ","$1,268.14 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,239.96 ","$1,197.68 ","$1,239.96 ","$1,239.96 ","$1,225.86 ","$1,197.68 ","$1,197.68 ","$1,197.68 ","$1,076.51 ","$1,268.14 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 9H LOCK CONTOUR,233593,C1713,278,"$1,438.74 ","$1,438.74 ","$1,099.20 ","$1,294.87 ","$1,222.93 ","$1,222.93 ","$1,222.93 ","$1,266.09 ","$1,222.93 ","$1,266.09 ","$1,266.09 ","$1,251.70 ","$1,222.93 ","$1,222.93 ","$1,222.93 ","$1,099.20 ","$1,294.87 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM T LOCK OBLIQ RT 4H,233598,C1713,278,"$1,468.40 ","$1,468.40 ","$1,121.86 ","$1,321.56 ","$1,248.14 ","$1,248.14 ","$1,248.14 ","$1,292.19 ","$1,248.14 ","$1,292.19 ","$1,292.19 ","$1,277.51 ","$1,248.14 ","$1,248.14 ","$1,248.14 ","$1,121.86 ","$1,321.56 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM T LOCK OBLIQ LT 4H,233600,C1713,278,"$1,468.40 ","$1,468.40 ","$1,121.86 ","$1,321.56 ","$1,248.14 ","$1,248.14 ","$1,248.14 ","$1,292.19 ","$1,248.14 ","$1,292.19 ","$1,292.19 ","$1,277.51 ","$1,248.14 ","$1,248.14 ","$1,248.14 ","$1,121.86 ","$1,321.56 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 10H LOCK CONTOUR,233594,C1713,278,"$1,483.20 ","$1,483.20 ","$1,133.16 ","$1,334.88 ","$1,260.72 ","$1,260.72 ","$1,260.72 ","$1,305.22 ","$1,260.72 ","$1,305.22 ","$1,305.22 ","$1,290.38 ","$1,260.72 ","$1,260.72 ","$1,260.72 ","$1,133.16 ","$1,334.88 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 12H LOCK CONTOUR,233595,C1713,278,"$1,631.52 ","$1,631.52 ","$1,246.48 ","$1,468.37 ","$1,386.79 ","$1,386.79 ","$1,386.79 ","$1,435.74 ","$1,386.79 ","$1,435.74 ","$1,435.74 ","$1,419.42 ","$1,386.79 ","$1,386.79 ","$1,386.79 ","$1,246.48 ","$1,468.37 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM T LOCK 6H,233602,C1713,278,"$1,631.52 ","$1,631.52 ","$1,246.48 ","$1,468.37 ","$1,386.79 ","$1,386.79 ","$1,386.79 ","$1,435.74 ","$1,386.79 ","$1,435.74 ","$1,435.74 ","$1,419.42 ","$1,386.79 ","$1,386.79 ","$1,386.79 ","$1,246.48 ","$1,468.37 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 3H,233627,C1713,278,"$1,661.22 ","$1,661.22 ","$1,269.17 ","$1,495.10 ","$1,412.04 ","$1,412.04 ","$1,412.04 ","$1,461.87 ","$1,412.04 ","$1,461.87 ","$1,461.87 ","$1,445.26 ","$1,412.04 ","$1,412.04 ","$1,412.04 ","$1,269.17 ","$1,495.10 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 4H,233628,C1713,278,"$1,720.53 ","$1,720.53 ","$1,314.48 ","$1,548.48 ","$1,462.45 ","$1,462.45 ","$1,462.45 ","$1,514.07 ","$1,462.45 ","$1,514.07 ","$1,514.07 ","$1,496.86 ","$1,462.45 ","$1,462.45 ","$1,462.45 ","$1,314.48 ","$1,548.48 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 5H,233629,C1713,278,"$1,735.38 ","$1,735.38 ","$1,325.83 ","$1,561.84 ","$1,475.07 ","$1,475.07 ","$1,475.07 ","$1,527.13 ","$1,475.07 ","$1,527.13 ","$1,527.13 ","$1,509.78 ","$1,475.07 ","$1,475.07 ","$1,475.07 ","$1,325.83 ","$1,561.84 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM 14H LOCK CONTOUR,233596,C1713,278,"$1,839.20 ","$1,839.20 ","$1,405.15 ","$1,655.28 ","$1,563.32 ","$1,563.32 ","$1,563.32 ","$1,618.50 ","$1,563.32 ","$1,618.50 ","$1,618.50 ","$1,600.10 ","$1,563.32 ","$1,563.32 ","$1,563.32 ","$1,405.15 ","$1,655.28 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 6H,233630,C1713,278,"$1,987.52 ","$1,987.52 ","$1,518.47 ","$1,788.77 ","$1,689.39 ","$1,689.39 ","$1,689.39 ","$1,749.02 ","$1,689.39 ","$1,749.02 ","$1,749.02 ","$1,729.14 ","$1,689.39 ","$1,689.39 ","$1,689.39 ","$1,518.47 ","$1,788.77 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 7H,233631,C1713,278,"$2,076.48 ","$2,076.48 ","$1,586.43 ","$1,868.83 ","$1,765.01 ","$1,765.01 ","$1,765.01 ","$1,827.30 ","$1,765.01 ","$1,827.30 ","$1,827.30 ","$1,806.54 ","$1,765.01 ","$1,765.01 ","$1,765.01 ","$1,586.43 ","$1,868.83 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 8H,233632,C1713,278,"$2,150.64 ","$2,150.64 ","$1,643.09 ","$1,935.58 ","$1,828.04 ","$1,828.04 ","$1,828.04 ","$1,892.56 ","$1,828.04 ","$1,892.56 ","$1,892.56 ","$1,871.06 ","$1,828.04 ","$1,828.04 ","$1,828.04 ","$1,643.09 ","$1,935.58 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 9H,233633,C1713,278,"$2,210.00 ","$2,210.00 ","$1,688.44 ","$1,989.00 ","$1,878.50 ","$1,878.50 ","$1,878.50 ","$1,944.80 ","$1,878.50 ","$1,944.80 ","$1,944.80 ","$1,922.70 ","$1,878.50 ","$1,878.50 ","$1,878.50 ","$1,688.44 ","$1,989.00 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 10H,233634,C1713,278,"$2,224.80 ","$2,224.80 ","$1,699.75 ","$2,002.32 ","$1,891.08 ","$1,891.08 ","$1,891.08 ","$1,957.82 ","$1,891.08 ","$1,957.82 ","$1,957.82 ","$1,935.58 ","$1,891.08 ","$1,891.08 ","$1,891.08 ","$1,699.75 ","$2,002.32 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 11H,233635,C1713,278,"$2,328.66 ","$2,328.66 ","$1,779.10 ","$2,095.79 ","$1,979.36 ","$1,979.36 ","$1,979.36 ","$2,049.22 ","$1,979.36 ","$2,049.22 ","$2,049.22 ","$2,025.93 ","$1,979.36 ","$1,979.36 ","$1,979.36 ","$1,779.10 ","$2,095.79 "
Carle Richland Memorial Hospital,8170603,PLATE 3.5MM RECON 12H,233636,C1713,278,"$2,402.82 ","$2,402.82 ","$1,835.75 ","$2,162.54 ","$2,042.40 ","$2,042.40 ","$2,042.40 ","$2,114.48 ","$2,042.40 ","$2,114.48 ","$2,114.48 ","$2,090.45 ","$2,042.40 ","$2,042.40 ","$2,042.40 ","$1,835.75 ","$2,162.54 "
Carle Richland Memorial Hospital,8170603,CLAMP 2H PIN YELLOW 15MM,233306,C1713,278,"$2,721.60 ","$2,721.60 ","$2,079.30 ","$2,449.44 ","$2,313.36 ","$2,313.36 ","$2,313.36 ","$2,395.01 ","$2,313.36 ","$2,395.01 ","$2,395.01 ","$2,367.79 ","$2,313.36 ","$2,313.36 ","$2,313.36 ","$2,079.30 ","$2,449.44 "
Carle Richland Memorial Hospital,8170603,PLATE 10H RT DISTAL LOCK LATFB,233758,C1713,278,"$3,411.36 ","$3,411.36 ","$2,606.28 ","$3,070.22 ","$2,899.66 ","$2,899.66 ","$2,899.66 ","$3,002.00 ","$2,899.66 ","$3,002.00 ","$3,002.00 ","$2,967.88 ","$2,899.66 ","$2,899.66 ","$2,899.66 ","$2,606.28 ","$3,070.22 "
Carle Richland Memorial Hospital,8170603,PLATE 10H LT DISTAL LOCK LATFB,233762,C1713,278,"$3,411.36 ","$3,411.36 ","$2,606.28 ","$3,070.22 ","$2,899.66 ","$2,899.66 ","$2,899.66 ","$3,002.00 ","$2,899.66 ","$3,002.00 ","$3,002.00 ","$2,967.88 ","$2,899.66 ","$2,899.66 ","$2,899.66 ","$2,606.28 ","$3,070.22 "
Carle Richland Memorial Hospital,8170603,CLAMP PIN YELLOW 15MM,233307,C1713,278,"$4,626.00 ","$4,626.00 ","$3,534.26 ","$4,163.40 ","$3,932.10 ","$3,932.10 ","$3,932.10 ","$4,070.88 ","$3,932.10 ","$4,070.88 ","$4,070.88 ","$4,024.62 ","$3,932.10 ","$3,932.10 ","$3,932.10 ","$3,534.26 ","$4,163.40 "
Carle Richland Memorial Hospital,8170603,NAIL TROCHANTRIC TI 11X180 130,233249,C1713,278,"$6,654.96 ","$6,654.96 ","$5,084.39 ","$5,989.46 ","$5,656.72 ","$5,656.72 ","$5,656.72 ","$5,856.36 ","$5,656.72 ","$5,856.36 ","$5,856.36 ","$5,789.82 ","$5,656.72 ","$5,656.72 ","$5,656.72 ","$5,084.39 ","$5,989.46 "
Carle Richland Memorial Hospital,8170603,NAIL TROCHANTRIC TI 11X180 125,233250,C1713,278,"$6,654.96 ","$6,654.96 ","$5,084.39 ","$5,989.46 ","$5,656.72 ","$5,656.72 ","$5,656.72 ","$5,856.36 ","$5,656.72 ","$5,856.36 ","$5,856.36 ","$5,789.82 ","$5,656.72 ","$5,656.72 ","$5,656.72 ","$5,084.39 ","$5,989.46 "
Carle Richland Memorial Hospital,8170603,NAIL TROCHANTRIC TI 10X170 130,233251,C1713,278,"$7,834.32 ","$7,834.32 ","$5,985.42 ","$7,050.89 ","$6,659.17 ","$6,659.17 ","$6,659.17 ","$6,894.20 ","$6,659.17 ","$6,894.20 ","$6,894.20 ","$6,815.86 ","$6,659.17 ","$6,659.17 ","$6,659.17 ","$5,985.42 ","$7,050.89 "
Carle Richland Memorial Hospital,8170603,NAIL TROCHANTRIC TI 10X170 125,233252,C1713,278,"$7,834.32 ","$7,834.32 ","$5,985.42 ","$7,050.89 ","$6,659.17 ","$6,659.17 ","$6,659.17 ","$6,894.20 ","$6,659.17 ","$6,894.20 ","$6,894.20 ","$6,815.86 ","$6,659.17 ","$6,659.17 ","$6,659.17 ","$5,985.42 ","$7,050.89 "
Carle Richland Memorial Hospital,8179042,GEL ALLOSYNC DBM 1CC,234451,C1762,278,$945.00 ,$945.00 ,$721.98 ,$850.50 ,$803.25 ,$803.25 ,$803.25 ,$831.60 ,$803.25 ,$831.60 ,$831.60 ,$822.15 ,$803.25 ,$803.25 ,$803.25 ,$721.98 ,$850.50
Carle Richland Memorial Hospital,8980294,racepinephrine 2.25 % solution for nebulization,487590199,J7699,294,$10.72 ,$10.72 ,$8.19 ,$9.65 ,$9.11 ,$9.11 ,$9.11 ,$9.43 ,$9.11 ,$9.43 ,$9.43 ,$9.33 ,$9.11 ,$9.11 ,$9.11 ,$8.19 ,$9.65
Carle Richland Memorial Hospital,8386903,ANTIGEN TYPING,,86902,300,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,8386920,COMPATIBILITY IMMEDIATE SPIN,,86920,300,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8386922,COMPATABILITY AHG,,86922,300,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8387002,URINE CULTURE PRESUMPTIVE ID,,87088,300,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8387040,"BACTERIAL CULTURE, BLOOD",,87040,300,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8387046,ENT PATH CULT / ADNL PATHOGENS,,87046,300,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8387050,BLOOD CULTURE,,87040,300,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8387075,BACT CULT ANY SRC ANAEROBIC,,87075,300,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8387095,ENTERIC PATHOGENS CULTURE,,87045,300,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8387102,"FUNGAL CULT, OTHER SRC, ISOLAT",,87102,300,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8387103,"FUNGAL CULTURE, BLOOD",,87103,300,$345.00 ,$345.00 ,$263.58 ,$310.50 ,$293.25 ,$293.25 ,$293.25 ,$303.60 ,$293.25 ,$303.60 ,$303.60 ,$300.15 ,$293.25 ,$293.25 ,$293.25 ,$263.58 ,$310.50
Carle Richland Memorial Hospital,8387105,"FUNGAL CULTURE, ENVIRONMENTAL",,87102,300,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8387110,URINE CULTURE,,87086,300,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8387116,"CULT, TUBRCL/ACID-FAST BACILLI",,87116,300,$5.00 ,$5.00 ,$3.82 ,$4.50 ,$4.25 ,$4.25 ,$4.25 ,$4.40 ,$4.25 ,$4.40 ,$4.40 ,$4.35 ,$4.25 ,$4.25 ,$4.25 ,$3.82 ,$4.50
Carle Richland Memorial Hospital,8387118,AFB ISOLATE IDENTIFICATION,,87118,300,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8387169,"MACROSCOPIC EXAM, PARASITE",,87169,300,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8387171,HOMOGENIZATN TISSUE FR CULTURE,,87176,300,$97.00 ,$97.00 ,$74.11 ,$87.30 ,$82.45 ,$82.45 ,$82.45 ,$85.36 ,$82.45 ,$85.36 ,$85.36 ,$84.39 ,$82.45 ,$82.45 ,$82.45 ,$74.11 ,$87.30
Carle Richland Memorial Hospital,8387187,SERUM BACTERICIDAL TITER,,87197,300,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8387205,"SMEAR, PRIMARY SRCE RTN STAIN",,87205,300,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8387206,"SMEAR, PRIMARY SRC FLRSNT/AF",,87206,300,$5.00 ,$5.00 ,$3.82 ,$4.50 ,$4.25 ,$4.25 ,$4.25 ,$4.40 ,$4.25 ,$4.40 ,$4.40 ,$4.35 ,$4.25 ,$4.25 ,$4.25 ,$3.82 ,$4.50
Carle Richland Memorial Hospital,8387425,ROTOVIRUS ANTIGEN,,87425,300,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8387997,MICROSCOPIC EXAM,,87999,300,$68.00 ,$68.00 ,$51.95 ,$61.20 ,$57.80 ,$57.80 ,$57.80 ,$59.84 ,$57.80 ,$59.84 ,$59.84 ,$59.16 ,$57.80 ,$57.80 ,$57.80 ,$51.95 ,$61.20
Carle Richland Memorial Hospital,8389051,"CELL CT & DIFF, MISC. FLUID",,89051,300,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8389190,NASAL SMEAR EOS,,89190,300,$93.00 ,$93.00 ,$71.05 ,$83.70 ,$79.05 ,$79.05 ,$79.05 ,$81.84 ,$79.05 ,$81.84 ,$81.84 ,$80.91 ,$79.05 ,$79.05 ,$79.05 ,$71.05 ,$83.70
Carle Richland Memorial Hospital,8300006,CBC W/AUTOMATED DIFFERENTIAL,,85025,300,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8300007,HEPATITIS B SURFACE ANTIGEN,,87340,300,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8300008,RUBELLA IGG SCREEN,,86762,300,$96.00 ,$96.00 ,$73.34 ,$86.40 ,$81.60 ,$81.60 ,$81.60 ,$84.48 ,$81.60 ,$84.48 ,$84.48 ,$83.52 ,$81.60 ,$81.60 ,$81.60 ,$73.34 ,$86.40
Carle Richland Memorial Hospital,8300009,LABORATORY TEST,,86592,300,$64.00 ,$64.00 ,$48.90 ,$57.60 ,$54.40 ,$54.40 ,$54.40 ,$56.32 ,$54.40 ,$56.32 ,$56.32 ,$55.68 ,$54.40 ,$54.40 ,$54.40 ,$48.90 ,$57.60
Carle Richland Memorial Hospital,8381519,UA-DIPSTICK ONLY (ITC LAB),,81003,300,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,8381489,ESR (PHOTOMETRIC),,85652,300,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8080047,"BASIC METABOLIC PANEL, CALCIUM IONIZED",,80047,300,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8381545,PROTHROMBIN TIME-SUBSTITUTION/IMMED,,85611,300,$64.00 ,$64.00 ,$48.90 ,$57.60 ,$54.40 ,$54.40 ,$54.40 ,$56.32 ,$54.40 ,$56.32 ,$56.32 ,$55.68 ,$54.40 ,$54.40 ,$54.40 ,$48.90 ,$57.60
Carle Richland Memorial Hospital,8381547,PROTHROMBIN TIME-SUBSTITUTION/INCUBATED,,85611,300,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,8381548,"THROMBOPLASTIN TIME, PTL (PTT)-SUBSTITUTION/IMMED",,85732,300,$84.00 ,$84.00 ,$64.18 ,$75.60 ,$71.40 ,$71.40 ,$71.40 ,$73.92 ,$71.40 ,$73.92 ,$73.92 ,$73.08 ,$71.40 ,$71.40 ,$71.40 ,$64.18 ,$75.60
Carle Richland Memorial Hospital,8381549,"THROMBOPLASTIN TIME, PTL (PTT)-INCUBATED",,85730,300,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8381550,"THROMBOPLASTIN TIME, PTL (PTT)-SUBSTITUTION/INCUBATED",,85732,300,$84.00 ,$84.00 ,$64.18 ,$75.60 ,$71.40 ,$71.40 ,$71.40 ,$73.92 ,$71.40 ,$73.92 ,$73.92 ,$73.08 ,$71.40 ,$71.40 ,$71.40 ,$64.18 ,$75.60
Carle Richland Memorial Hospital,8300002,CMP PANEL,,80053,300,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8300003,CBC W/AUTO DIFF,,85025,300,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8300004,TSH,,84443,300,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8809612,CATH URINE SPECIMEN COLLECTION,,P9612,300,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8280047,CHG BASIC METABOLIC PANEL CALCIUM IONIZED,,80047,300,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8381640,PROTHROMBIN TIME-SUBSTITUTION/IMM,,85611,300,$64.00 ,$64.00 ,$48.90 ,$57.60 ,$54.40 ,$54.40 ,$54.40 ,$56.32 ,$54.40 ,$56.32 ,$56.32 ,$55.68 ,$54.40 ,$54.40 ,$54.40 ,$48.90 ,$57.60
Carle Richland Memorial Hospital,8380253,COLLECTION OF DOT DRUG SCREEN,,99001,300,$38.00 ,$38.00 ,$29.03 ,$34.20 ,$32.30 ,$32.30 ,$32.30 ,$33.44 ,$32.30 ,$33.44 ,$33.44 ,$33.06 ,$32.30 ,$32.30 ,$32.30 ,$29.03 ,$34.20
Carle Richland Memorial Hospital,8380255,"ALCOHOL EMPLOYMENT, BREATH",,82075,300,$52.00 ,$52.00 ,$39.73 ,$46.80 ,$44.20 ,$44.20 ,$44.20 ,$45.76 ,$44.20 ,$45.76 ,$45.76 ,$45.24 ,$44.20 ,$44.20 ,$44.20 ,$39.73 ,$46.80
Carle Richland Memorial Hospital,8082930,OCCULT BLOOD & PH - GASTRIC,,82930,300,$52.00 ,$52.00 ,$39.73 ,$46.80 ,$44.20 ,$44.20 ,$44.20 ,$45.76 ,$44.20 ,$45.76 ,$45.76 ,$45.24 ,$44.20 ,$44.20 ,$44.20 ,$39.73 ,$46.80
Carle Richland Memorial Hospital,8382216,RPR(DX)REFL FTA,,86592,300,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8382249,PROTEIN ELECTRO.,,84165,300,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8382265,GGT,,82977,300,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382290,MYCOBACT SM CULT,,87116,300,$78.00 ,$78.00 ,$59.59 ,$70.20 ,$66.30 ,$66.30 ,$66.30 ,$68.64 ,$66.30 ,$68.64 ,$68.64 ,$67.86 ,$66.30 ,$66.30 ,$66.30 ,$59.59 ,$70.20
Carle Richland Memorial Hospital,8382291,MYCOBACT SM CULT,,87206,300,$78.00 ,$78.00 ,$59.59 ,$70.20 ,$66.30 ,$66.30 ,$66.30 ,$68.64 ,$66.30 ,$68.64 ,$68.64 ,$67.86 ,$66.30 ,$66.30 ,$66.30 ,$59.59 ,$70.20
Carle Richland Memorial Hospital,8382295,PREALBUMIN,,84134,300,$124.67 ,$124.67 ,$95.25 ,$112.20 ,$105.97 ,$105.97 ,$105.97 ,$109.71 ,$105.97 ,$109.71 ,$109.71 ,$108.46 ,$105.97 ,$105.97 ,$105.97 ,$95.25 ,$112.20
Carle Richland Memorial Hospital,8382314,"CREATININE, OTHER SOURCE",,82575,300,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8382323,D-DIMER,,85378,300,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,8382332,POST VAS ANALYSIS,,89310,300,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8382266,"HAPTOGLOBIN, REF",,83010,300,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8382385,"EVEROLIMUS,BLOOD",,80169,300,$491.38 ,$491.38 ,$375.41 ,$442.24 ,$417.67 ,$417.67 ,$417.67 ,$432.41 ,$417.67 ,$432.41 ,$432.41 ,$427.50 ,$417.67 ,$417.67 ,$417.67 ,$375.41 ,$442.24
Carle Richland Memorial Hospital,8382395,"FECAL FAT, QUAL",,82705,300,$398.45 ,$398.45 ,$304.42 ,$358.61 ,$338.68 ,$338.68 ,$338.68 ,$350.64 ,$338.68 ,$350.64 ,$350.64 ,$346.65 ,$338.68 ,$338.68 ,$338.68 ,$304.42 ,$358.61
Carle Richland Memorial Hospital,8382396,"CULT,FUNGUS,OTHER",,87102,300,$113.38 ,$113.38 ,$86.62 ,$102.04 ,$96.37 ,$96.37 ,$96.37 ,$99.77 ,$96.37 ,$99.77 ,$99.77 ,$98.64 ,$96.37 ,$96.37 ,$96.37 ,$86.62 ,$102.04
Carle Richland Memorial Hospital,8382397,"CULT,FUNGUS,OTHER",,87206,300,$133.38 ,$133.38 ,$101.90 ,$120.04 ,$113.37 ,$113.37 ,$113.37 ,$117.37 ,$113.37 ,$117.37 ,$117.37 ,$116.04 ,$113.37 ,$113.37 ,$113.37 ,$101.90 ,$120.04
Carle Richland Memorial Hospital,8382408,"PROTEIN C, ANTIGEN",,85302,300,$428.16 ,$428.16 ,$327.11 ,$385.34 ,$363.94 ,$363.94 ,$363.94 ,$376.78 ,$363.94 ,$376.78 ,$376.78 ,$372.50 ,$363.94 ,$363.94 ,$363.94 ,$327.11 ,$385.34
Carle Richland Memorial Hospital,8382409,"PROTEIN S AG, TOTAL",,85305,300,$115.74 ,$115.74 ,$88.43 ,$104.17 ,$98.38 ,$98.38 ,$98.38 ,$101.85 ,$98.38 ,$101.85 ,$101.85 ,$100.69 ,$98.38 ,$98.38 ,$98.38 ,$88.43 ,$104.17
Carle Richland Memorial Hospital,8382410,TRANSFERRIN,,84466,300,$259.12 ,$259.12 ,$197.97 ,$233.21 ,$220.25 ,$220.25 ,$220.25 ,$228.03 ,$220.25 ,$228.03 ,$228.03 ,$225.43 ,$220.25 ,$220.25 ,$220.25 ,$197.97 ,$233.21
Carle Richland Memorial Hospital,8382413,CERULOPLASMIN REF,,82390,300,$449.42 ,$449.42 ,$343.36 ,$404.48 ,$382.01 ,$382.01 ,$382.01 ,$395.49 ,$382.01 ,$395.49 ,$395.49 ,$391.00 ,$382.01 ,$382.01 ,$382.01 ,$343.36 ,$404.48
Carle Richland Memorial Hospital,8382457,"CREATININE CLEARANCE, 24 HR REF",,82575,300,$20.66 ,$20.66 ,$15.78 ,$18.59 ,$17.56 ,$17.56 ,$17.56 ,$18.18 ,$17.56 ,$18.18 ,$18.18 ,$17.97 ,$17.56 ,$17.56 ,$17.56 ,$15.78 ,$18.59
Carle Richland Memorial Hospital,8382497,"T3 TOTAL, S REF",,84480,300,$8.86 ,$8.86 ,$6.77 ,$7.97 ,$7.53 ,$7.53 ,$7.53 ,$7.80 ,$7.53 ,$7.80 ,$7.80 ,$7.71 ,$7.53 ,$7.53 ,$7.53 ,$6.77 ,$7.97
Carle Richland Memorial Hospital,8382866,"SMEAR, FLUORESCENT AND/OR ACID FAST STAIN",,87206,300,$81.30 ,$81.30 ,$62.11 ,$73.17 ,$69.11 ,$69.11 ,$69.11 ,$71.54 ,$69.11 ,$71.54 ,$71.54 ,$70.73 ,$69.11 ,$69.11 ,$69.11 ,$62.11 ,$73.17
Carle Richland Memorial Hospital,8382869,MYCOBACTERIA CULTURE,,87116,300,$221.80 ,$221.80 ,$169.46 ,$199.62 ,$188.53 ,$188.53 ,$188.53 ,$195.18 ,$188.53 ,$195.18 ,$195.18 ,$192.97 ,$188.53 ,$188.53 ,$188.53 ,$169.46 ,$199.62
Carle Richland Memorial Hospital,8286308,MONO TEST,,86308,300,$19.00 ,$19.00 ,$14.52 ,$17.10 ,$16.15 ,$16.15 ,$16.15 ,$16.72 ,$16.15 ,$16.72 ,$16.72 ,$16.53 ,$16.15 ,$16.15 ,$16.15 ,$14.52 ,$17.10
Carle Richland Memorial Hospital,8026415,VENIPUNCTURE,,36415,300,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8399008,VENIPUNCTURE FOR LAB SPECIMEN,,36415,300,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8380051,ELECTROLYTE PANEL,,80051,300,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8380058,HEPATIC FUNCTION PANEL,,80076,300,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8380069,RENAL FUNCTION PANEL,,80069,300,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,8380127,PARATHORMONE (PTH),,83970,300,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8380170,DRUG ASSAY -GENTAMYCIN,,80170,300,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8380200,DRUG ASSAY -TOBRAMYCIN,,80200,300,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8380202,DRUG ASSAY -VANCOMYCIN,,80202,300,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8381000,URINALYSIS AUTO W/MICROSCOPY,,81001,300,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8381001,URINALYSIS -GLUCOSE,,81002,300,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,8381002,URINALYSIS -MICROSCOPIC ONLY,,81015,300,$66.00 ,$66.00 ,$50.42 ,$59.40 ,$56.10 ,$56.10 ,$56.10 ,$58.08 ,$56.10 ,$58.08 ,$58.08 ,$57.42 ,$56.10 ,$56.10 ,$56.10 ,$50.42 ,$59.40
Carle Richland Memorial Hospital,8381003,CLINITEST,,81002,300,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,8381004,URINALYSIS AUTO W/O MICROSCOPY,,81003,300,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,8381009,URINALYSIS -SPECIFIC GRAVITY,,81002,300,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,8381010,LEUKOCYTE ESTERASE FLD,,81002,300,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8381050,VOL MEASURE -TIMED COLLCTN EA,,81050,300,$24.00 ,$24.00 ,$18.34 ,$21.60 ,$20.40 ,$20.40 ,$20.40 ,$21.12 ,$20.40 ,$21.12 ,$21.12 ,$20.88 ,$20.40 ,$20.40 ,$20.40 ,$18.34 ,$21.60
Carle Richland Memorial Hospital,8382391,CERULOPLASMIN,,82390,300,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8382465,"CHOLESTEROL, SERUM, TOTAL",,82465,300,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8382552,CK MB FRACTION,,82553,300,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8382575,CREATININE CLEARANCE,,82575,300,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8382641,DRUG ASSAY -DIGOXIN,,80162,300,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8382731,FETAL FIBRONECTIN,,82731,300,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8382940,PREALBUMIN,,84134,300,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8382950,"GLUCOSE, POST GLUCOSE DOSE",,82950,300,$92.00 ,$92.00 ,$70.29 ,$82.80 ,$78.20 ,$78.20 ,$78.20 ,$80.96 ,$78.20 ,$80.96 ,$80.96 ,$80.04 ,$78.20 ,$78.20 ,$78.20 ,$70.29 ,$82.80
Carle Richland Memorial Hospital,8382953,"GTT, THREE SPECIMENS",,82951,300,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8382954,"GTT, EA ADDL BEYOND THREE",,82952,300,$64.00 ,$64.00 ,$48.90 ,$57.60 ,$54.40 ,$54.40 ,$54.40 ,$56.32 ,$54.40 ,$56.32 ,$56.32 ,$55.68 ,$54.40 ,$54.40 ,$54.40 ,$48.90 ,$57.60
Carle Richland Memorial Hospital,8382977,"GLUTAMYLTRANSFERASE, GAMMA",,82977,300,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8383010,"HAPTOGLOBIN, QUANTITATIVE",,83010,300,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8383160,URINE PREGNANCY TEST,,81025,300,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8383439,"TRIIODOTHYRONINE T3, TOTAL",,84480,300,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,8383540,IRON,,83540,300,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8383550,IRON BINDING CAPACITY,,83550,300,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8383690,LIPASE,,83690,300,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8383703,LIPID PROFILE,,80061,300,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8383725,DRUG ASSAY -LITHIUM,,80178,300,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8383930,"OSMOLALITY, BLOOD",,83930,300,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8383970,"PARATHYROID HORMONE,INTACT REF",,83970,300,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8384140,"POTASSIUM, SERUM",,84132,300,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8384142,DRUG ASSAY -PROCAINAMIDE +,,80192,300,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8384316,"SPECIFIC GRAVITY, BODY FLUID",,84315,300,$35.00 ,$35.00 ,$26.74 ,$31.50 ,$29.75 ,$29.75 ,$29.75 ,$30.80 ,$29.75 ,$30.80 ,$30.80 ,$30.45 ,$29.75 ,$29.75 ,$29.75 ,$26.74 ,$31.50
Carle Richland Memorial Hospital,8384420,DRUG ASSAY -THEOPHYLLINE,,80198,300,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8384450,"TRANSFERASE, ASPARTATE AMINO",,84450,300,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8384550,"URIC ACID, BLOOD",,84550,300,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8385000,BLEEDING TIME,,85002,300,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8385003,APT TEST FOR FETAL HGB,,83033,300,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8385306,PROTEIN S ANTIGEN FREE,,85306,300,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,8385362,FIBRIN DEGREDATION PRODUCTS,,85362,300,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8385391,D-DIMER,,85378,300,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,8385460,"FMH SCREEN, ROSETTE",,85461,300,$67.00 ,$67.00 ,$51.19 ,$60.30 ,$56.95 ,$56.95 ,$56.95 ,$58.96 ,$56.95 ,$58.96 ,$58.96 ,$58.29 ,$56.95 ,$56.95 ,$56.95 ,$51.19 ,$60.30
Carle Richland Memorial Hospital,8385545,KLEIHAUER-BETKE TEST,,85460,300,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8385635,REPTILASE TEST (VENOM TIME),,85635,300,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8385641,"RETICULOCYTE COUNT, AUTOMATED",,85045,300,$87.00 ,$87.00 ,$66.47 ,$78.30 ,$73.95 ,$73.95 ,$73.95 ,$76.56 ,$73.95 ,$76.56 ,$76.56 ,$75.69 ,$73.95 ,$73.95 ,$73.95 ,$66.47 ,$78.30
Carle Richland Memorial Hospital,8385651,ESR WESTERGREN,,85652,300,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8385670,THROMBIN TIME,,85670,300,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,8385730,"THROMBOPLASTIN TIME, PTL (PTT)",,85730,300,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8385732,CORRECTION STUDIES,,85732,300,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8385810,"VISCOSITY, SERUM REF",,85810,300,$84.00 ,$84.00 ,$64.18 ,$75.60 ,$71.40 ,$71.40 ,$71.40 ,$73.92 ,$71.40 ,$73.92 ,$73.92 ,$73.08 ,$71.40 ,$71.40 ,$71.40 ,$64.18 ,$75.60
Carle Richland Memorial Hospital,8386019,ANTIGEN TYPING,,86905,300,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,8386049,LABORATORY TEST,,G0432,300,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8386080,"BLOOD TYPING, ABO",,86900,300,$65.00 ,$65.00 ,$49.66 ,$58.50 ,$55.25 ,$55.25 ,$55.25 ,$57.20 ,$55.25 ,$57.20 ,$57.20 ,$56.55 ,$55.25 ,$55.25 ,$55.25 ,$49.66 ,$58.50
Carle Richland Memorial Hospital,8386100,"BLOOD TYPING, RH",,86901,300,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8386149,ACTIVATED PROTEIN C RESISTANCE,,85307,300,$390.00 ,$390.00 ,$297.96 ,$351.00 ,$331.50 ,$331.50 ,$331.50 ,$343.20 ,$331.50 ,$343.20 ,$343.20 ,$339.30 ,$331.50 ,$331.50 ,$331.50 ,$297.96 ,$351.00
Carle Richland Memorial Hospital,8386203,FROZEN PLASMA PREP,,86927,300,$72.00 ,$72.00 ,$55.01 ,$64.80 ,$61.20 ,$61.20 ,$61.20 ,$63.36 ,$61.20 ,$63.36 ,$63.36 ,$62.64 ,$61.20 ,$61.20 ,$61.20 ,$55.01 ,$64.80
Carle Richland Memorial Hospital,8386300,MONO TEST,,86308,300,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8386305,LABORATORY TEST FOR ANTIBODY,,86701,300,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8386307,HEPATITIS B SURFACE ANTIBODY,,86706,300,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8386340,TRANSFERRIN,,84466,300,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8386415,LABORATORY TEST,,86592,300,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,8386416,LABORATORY TEST,,86593,300,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,36415,"COLLECTION VENOUS BLOOD,VENIPUNCTURE",,36415,300,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,81002,URINALYSIS NONAUTO W/O SCOPE,,81002,300,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,81003,"URINALYSIS, AUTO, W/O SCOPE",,81003,300,$36.00 ,$36.00 ,$27.50 ,$32.40 ,$30.60 ,$30.60 ,$30.60 ,$31.68 ,$30.60 ,$31.68 ,$31.68 ,$31.32 ,$30.60 ,$30.60 ,$30.60 ,$27.50 ,$32.40
Carle Richland Memorial Hospital,81025,URINE PREGNANCY TEST,,81025,300,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,82270,"BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN",,82270,300,$41.00 ,$41.00 ,$31.32 ,$36.90 ,$34.85 ,$34.85 ,$34.85 ,$36.08 ,$34.85 ,$36.08 ,$36.08 ,$35.67 ,$34.85 ,$34.85 ,$34.85 ,$31.32 ,$36.90
Carle Richland Memorial Hospital,82962,GLUCOSE BLOOD TEST,,82962,300,$38.00 ,$38.00 ,$29.03 ,$34.20 ,$32.30 ,$32.30 ,$32.30 ,$33.44 ,$32.30 ,$33.44 ,$33.44 ,$33.06 ,$32.30 ,$32.30 ,$32.30 ,$29.03 ,$34.20
Carle Richland Memorial Hospital,85610,PROTHROMBIN TIME,,85610,300,$52.00 ,$52.00 ,$39.73 ,$46.80 ,$44.20 ,$44.20 ,$44.20 ,$45.76 ,$44.20 ,$45.76 ,$45.76 ,$45.24 ,$44.20 ,$44.20 ,$44.20 ,$39.73 ,$46.80
Carle Richland Memorial Hospital,Q0114,Fern test,,Q0114,300,$64.00 ,$64.00 ,$48.90 ,$57.60 ,$54.40 ,$54.40 ,$54.40 ,$56.32 ,$54.40 ,$56.32 ,$56.32 ,$55.68 ,$54.40 ,$54.40 ,$54.40 ,$48.90 ,$57.60
Carle Richland Memorial Hospital,87804,"DETECT AGENT,IMMUN,DIR OBS,INFLUENZA",,87804,300,$88.00 ,$88.00 ,$67.23 ,$79.20 ,$74.80 ,$74.80 ,$74.80 ,$77.44 ,$74.80 ,$77.44 ,$77.44 ,$76.56 ,$74.80 ,$74.80 ,$74.80 ,$67.23 ,$79.20
Carle Richland Memorial Hospital,87807,"DETECT AGENT,IMMUN,DIR OBS, RSV",,87807,300,$89.00 ,$89.00 ,$68.00 ,$80.10 ,$75.65 ,$75.65 ,$75.65 ,$78.32 ,$75.65 ,$78.32 ,$78.32 ,$77.43 ,$75.65 ,$75.65 ,$75.65 ,$68.00 ,$80.10
Carle Richland Memorial Hospital,87502,INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES,,87502,300,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,8650003,ABG ANALYSIS ONLY,,82803,301,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8381363,"DRUG SCREEN, SNGL CLASS LIST A; INST IA OR EIA SYSTEM, PER DOS",,80307,301,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8381365,SALICYLATE,,80307,301,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,8381366,ACETAMINOPHEN,,80307,301,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,8381369,K2 SPICE DRUG SCREEN REF,,80306,301,$76.00 ,$76.00 ,$58.06 ,$68.40 ,$64.60 ,$64.60 ,$64.60 ,$66.88 ,$64.60 ,$66.88 ,$66.88 ,$66.12 ,$64.60 ,$64.60 ,$64.60 ,$58.06 ,$68.40
Carle Richland Memorial Hospital,8389072,GLUCOSE BODY FLUID (CSF),,82945,301,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8381458,DHEA SULFATE,,82626,301,$375.00 ,$375.00 ,$286.50 ,$337.50 ,$318.75 ,$318.75 ,$318.75 ,$330.00 ,$318.75 ,$330.00 ,$330.00 ,$326.25 ,$318.75 ,$318.75 ,$318.75 ,$286.50 ,$337.50
Carle Richland Memorial Hospital,8381461,IMMUNOGLOBULIN E (IGE),,82785,301,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8381462,INSULIN,,83525,301,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8381463,C-PEPTIDE,,84681,301,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8382306,25 OH VITAMIN D TOTAL,,82306,301,$440.00 ,$440.00 ,$336.16 ,$396.00 ,$374.00 ,$374.00 ,$374.00 ,$387.20 ,$374.00 ,$387.20 ,$387.20 ,$382.80 ,$374.00 ,$374.00 ,$374.00 ,$336.16 ,$396.00
Carle Richland Memorial Hospital,8381514,COMPREHENSIVE METABOLIC PANEL (ITC LAB),,80053,301,$405.00 ,$405.00 ,$309.42 ,$364.50 ,$344.25 ,$344.25 ,$344.25 ,$356.40 ,$344.25 ,$356.40 ,$356.40 ,$352.35 ,$344.25 ,$344.25 ,$344.25 ,$309.42 ,$364.50
Carle Richland Memorial Hospital,8380628,"PSA, DIAGNOSTIC (VISTA)",,84153,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8380629,"PSA, SCREENING (VISTA)",,G0103,301,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8282962,GLUCOSE BLOOD TEST,,82962,301,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8288720,BILIRUBIN TOTAL TRANSCUTANEOUS,,88720,301,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8381538,"DRUG SCREEN PANEL, URINE",,80307,301,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8380148,PROCALCITONIN,,84145,301,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8381580,GAMMAGLOBULIN IGA/IGD/IGG/IGM,,82784,301,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8381591,"CALPROTECTIN, FECAL",,83993,301,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8282330,"ASSAY OF CALCIUM, IONIZED",,82330,301,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8282565,ASSAY OF CREATININE,,82565,301,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8082962,GLUCOSE BLOOD TEST,,82962,301,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8380620,FECAL OCCULT BLOOD,,82274,301,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8380993,AMIKACIN LEVEL,,80150,301,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8282803,"BLOOD GASES: PH, PO2 & PCO2",,82803,301,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8380232,BLOOD GASES ISTAT G3 PLUS,,82803,301,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8381087,"TC (TRIIODOTHYRONINE), FREE",,84481,301,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8084112,AMNISURE,,84112,301,$710.00 ,$710.00 ,$542.44 ,$639.00 ,$603.50 ,$603.50 ,$603.50 ,$624.80 ,$603.50 ,$624.80 ,$624.80 ,$617.70 ,$603.50 ,$603.50 ,$603.50 ,$542.44 ,$639.00
Carle Richland Memorial Hospital,8082330,IONIZED CALCIUM,,82330,301,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8082270,OCCULT BLOOD - FECES,,82270,301,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8028720,BILIRUBIN TOTAL TRANSCUTANEOUS,,88720,301,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8382214,"VIT D,25-OH,TOTAL,IA",,82306,301,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8382226,CEA,,82378,301,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8382229,PROTEIN ELECTRO.,,84155,301,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8382250,STONE ANALYSIS,,82365,301,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,8382251,PROLACTIN,,84146,301,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,8382253,"T-3, FREE",,84481,301,$450.00 ,$450.00 ,$343.80 ,$405.00 ,$382.50 ,$382.50 ,$382.50 ,$396.00 ,$382.50 ,$396.00 ,$396.00 ,$391.50 ,$382.50 ,$382.50 ,$382.50 ,$343.80 ,$405.00
Carle Richland Memorial Hospital,8382254,FSH,,83001,301,$620.00 ,$620.00 ,$473.68 ,$558.00 ,$527.00 ,$527.00 ,$527.00 ,$545.60 ,$527.00 ,$545.60 ,$545.60 ,$539.40 ,$527.00 ,$527.00 ,$527.00 ,$473.68 ,$558.00
Carle Richland Memorial Hospital,8382255,METHYLMALONIC ACID,,83921,301,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8382258,LH,,83002,301,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8382259,KAPPA/LAMBDA W/RATIO,,83883,301,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8382261,IMMUNOGLOBULIN A,,82784,301,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8382262,"THC METAB., GC/MS U",,80349,301,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8382263,"TACROLIMUS, LC/MS/MS",,80197,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8382264,LEVETIRACETAM,,80177,301,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8382267,IMMUNOGLOBULIN G,,82784,301,$250.64 ,$250.64 ,$191.49 ,$225.58 ,$213.04 ,$213.04 ,$213.04 ,$220.56 ,$213.04 ,$220.56 ,$220.56 ,$218.06 ,$213.04 ,$213.04 ,$213.04 ,$191.49 ,$225.58
Carle Richland Memorial Hospital,8382281,PROGESTERONE,,84144,301,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8382282,"CORTISOL, TOTAL",,82533,301,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8382284,VITAMIN A (RETINOL),,84590,301,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,8382285,IMMUNOGLOBULIN M,,82784,301,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8382286,"VITAMIN B1,THIAMINE",,84425,301,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8382294,"AFP,TUMOR (CHIRON)",,82105,301,$351.71 ,$351.71 ,$268.71 ,$316.54 ,$298.95 ,$298.95 ,$298.95 ,$309.50 ,$298.95 ,$309.50 ,$309.50 ,$305.99 ,$298.95 ,$298.95 ,$298.95 ,$268.71 ,$316.54
Carle Richland Memorial Hospital,8382296,"CALPROTECTIN,STOOL",,83993,301,$155.99 ,$155.99 ,$119.18 ,$140.39 ,$132.59 ,$132.59 ,$132.59 ,$137.27 ,$132.59 ,$137.27 ,$137.27 ,$135.71 ,$132.59 ,$132.59 ,$132.59 ,$119.18 ,$140.39
Carle Richland Memorial Hospital,8382308,FECAL OCCULT BLOOD,,82272,301,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8382312,"ALCOHOL, SERUM",,80320,301,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8382313,ACETAMINOPHEN,,80329,301,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8382316,SALICYLATE,,80329,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8382324,ACETONE,,82010,301,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,8382326,PROM,,84112,301,$710.00 ,$710.00 ,$542.44 ,$639.00 ,$603.50 ,$603.50 ,$603.50 ,$624.80 ,$603.50 ,$624.80 ,$624.80 ,$617.70 ,$603.50 ,$603.50 ,$603.50 ,$542.44 ,$639.00
Carle Richland Memorial Hospital,8382329,"DRUG SCREEN PANEL, URINE",,80306,301,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8382330,GASTRIC BLOOD/PH,,83986,301,$58.00 ,$58.00 ,$44.31 ,$52.20 ,$49.30 ,$49.30 ,$49.30 ,$51.04 ,$49.30 ,$51.04 ,$51.04 ,$50.46 ,$49.30 ,$49.30 ,$49.30 ,$44.31 ,$52.20
Carle Richland Memorial Hospital,8382331,UREA TEST FOR H. PYLORI,,83013,301,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8382287,"TESTOSTERONE, REF",,84403,301,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8382257,"ESTRADIOL, REF",,82670,301,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8382341,"ALBUMIN, SERUM, REF",,82040,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8382350,"HEPATITIS ACUTE PANEL, REF",,80074,301,$535.29 ,$535.29 ,$408.96 ,$481.76 ,$455.00 ,$455.00 ,$455.00 ,$471.06 ,$455.00 ,$471.06 ,$471.06 ,$465.70 ,$455.00 ,$455.00 ,$455.00 ,$408.96 ,$481.76
Carle Richland Memorial Hospital,8382354,"BLOOD GASES, ARTERIAL",,82805,301,$420.00 ,$420.00 ,$320.88 ,$378.00 ,$357.00 ,$357.00 ,$357.00 ,$369.60 ,$357.00 ,$369.60 ,$369.60 ,$365.40 ,$357.00 ,$357.00 ,$357.00 ,$320.88 ,$378.00
Carle Richland Memorial Hospital,8382355,"BLOOD GASES, CAPILLARY",,82805,301,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8382371,"DHEA-SULFATE, REF",,82627,301,$498.70 ,$498.70 ,$381.01 ,$448.83 ,$423.90 ,$423.90 ,$423.90 ,$438.86 ,$423.90 ,$438.86 ,$438.86 ,$433.87 ,$423.90 ,$423.90 ,$423.90 ,$381.01 ,$448.83
Carle Richland Memorial Hospital,8382375,"VITAMIN E, REF",,84446,301,$274.23 ,$274.23 ,$209.51 ,$246.81 ,$233.10 ,$233.10 ,$233.10 ,$241.32 ,$233.10 ,$241.32 ,$241.32 ,$238.58 ,$233.10 ,$233.10 ,$233.10 ,$209.51 ,$246.81
Carle Richland Memorial Hospital,8382377,"SARS-COV-2 (COVID-19) AB, IGG, S",,86769,301,$169.00 ,$169.00 ,$129.12 ,$152.10 ,$143.65 ,$143.65 ,$143.65 ,$148.72 ,$143.65 ,$148.72 ,$148.72 ,$147.03 ,$143.65 ,$143.65 ,$143.65 ,$129.12 ,$152.10
Carle Richland Memorial Hospital,8382382,OSMOLALITY (U),,83935,301,$248.92 ,$248.92 ,$190.17 ,$224.03 ,$211.58 ,$211.58 ,$211.58 ,$219.05 ,$211.58 ,$219.05 ,$219.05 ,$216.56 ,$211.58 ,$211.58 ,$211.58 ,$190.17 ,$224.03
Carle Richland Memorial Hospital,8382383,"VITAMIN D,1,25",,82652,301,$591.28 ,$591.28 ,$451.74 ,$532.15 ,$502.59 ,$502.59 ,$502.59 ,$520.33 ,$502.59 ,$520.33 ,$520.33 ,$514.41 ,$502.59 ,$502.59 ,$502.59 ,$451.74 ,$532.15
Carle Richland Memorial Hospital,8382386,"FOLATE, RBC",,82747,301,$338.21 ,$338.21 ,$258.39 ,$304.39 ,$287.48 ,$287.48 ,$287.48 ,$297.62 ,$287.48 ,$297.62 ,$297.62 ,$294.24 ,$287.48 ,$287.48 ,$287.48 ,$258.39 ,$304.39
Carle Richland Memorial Hospital,8382833,COPPER,,82525,301,$105.35 ,$105.35 ,$80.49 ,$94.82 ,$89.55 ,$89.55 ,$89.55 ,$92.71 ,$89.55 ,$92.71 ,$92.71 ,$91.65 ,$89.55 ,$89.55 ,$89.55 ,$80.49 ,$94.82
Carle Richland Memorial Hospital,8382412,PRA LC/MS/MS,,84244,301,$912.42 ,$912.42 ,$697.09 ,$821.18 ,$775.56 ,$775.56 ,$775.56 ,$802.93 ,$775.56 ,$802.93 ,$802.93 ,$793.81 ,$775.56 ,$775.56 ,$775.56 ,$697.09 ,$821.18
Carle Richland Memorial Hospital,8382390,"VITAMIN K, PLASMA",,84597,301,$155.99 ,$155.99 ,$119.18 ,$140.39 ,$132.59 ,$132.59 ,$132.59 ,$137.27 ,$132.59 ,$137.27 ,$137.27 ,$135.71 ,$132.59 ,$132.59 ,$132.59 ,$119.18 ,$140.39
Carle Richland Memorial Hospital,8382399,METANPH.24 HR URINE,,83835,301,$265.05 ,$265.05 ,$202.50 ,$238.55 ,$225.29 ,$225.29 ,$225.29 ,$233.24 ,$225.29 ,$233.24 ,$233.24 ,$230.59 ,$225.29 ,$225.29 ,$225.29 ,$202.50 ,$238.55
Carle Richland Memorial Hospital,8382402,ALK PHOS ISOENZYMES,,84075,301,$169.06 ,$169.06 ,$129.16 ,$152.15 ,$143.70 ,$143.70 ,$143.70 ,$148.77 ,$143.70 ,$148.77 ,$148.77 ,$147.08 ,$143.70 ,$143.70 ,$143.70 ,$129.16 ,$152.15
Carle Richland Memorial Hospital,8382403,ALK PHOS ISOENZYMES,,84080,301,$125.42 ,$125.42 ,$95.82 ,$112.88 ,$106.61 ,$106.61 ,$106.61 ,$110.37 ,$106.61 ,$110.37 ,$110.37 ,$109.12 ,$106.61 ,$106.61 ,$106.61 ,$95.82 ,$112.88
Carle Richland Memorial Hospital,8382406,"ESTROGEN, TOTAL (S)",,82672,301,$646.50 ,$646.50 ,$493.93 ,$581.85 ,$549.53 ,$549.53 ,$549.53 ,$568.92 ,$549.53 ,$568.92 ,$568.92 ,$562.46 ,$549.53 ,$549.53 ,$549.53 ,$493.93 ,$581.85
Carle Richland Memorial Hospital,8382419,"CREATININE, I-STAT",,82565,301,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8382449,"PANCREATIC ELASTASE, F REF",,83520,301,$90.00 ,$90.00 ,$68.76 ,$81.00 ,$76.50 ,$76.50 ,$76.50 ,$79.20 ,$76.50 ,$79.20 ,$79.20 ,$78.30 ,$76.50 ,$76.50 ,$76.50 ,$68.76 ,$81.00
Carle Richland Memorial Hospital,8383721,DIRECT LDL,,83721,301,$143.75 ,$143.75 ,$109.83 ,$129.38 ,$122.19 ,$122.19 ,$122.19 ,$126.50 ,$122.19 ,$126.50 ,$126.50 ,$125.06 ,$122.19 ,$122.19 ,$122.19 ,$109.83 ,$129.38
Carle Richland Memorial Hospital,8382469,"COPPER, RBC",,82525,301,$29.37 ,$29.37 ,$22.44 ,$26.43 ,$24.96 ,$24.96 ,$24.96 ,$25.85 ,$24.96 ,$25.85 ,$25.85 ,$25.55 ,$24.96 ,$24.96 ,$24.96 ,$22.44 ,$26.43
Carle Richland Memorial Hospital,8382471,INHIBIN B,,82397,301,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8382472,TSH RECEPTOR BINDING AB,,83520,301,$98.93 ,$98.93 ,$75.58 ,$89.04 ,$84.09 ,$84.09 ,$84.09 ,$87.06 ,$84.09 ,$87.06 ,$87.06 ,$86.07 ,$84.09 ,$84.09 ,$84.09 ,$75.58 ,$89.04
Carle Richland Memorial Hospital,8382479,"SEX HORMONE BINDING GLOBULIN, S",,84270,301,$28.19 ,$28.19 ,$21.54 ,$25.37 ,$23.96 ,$23.96 ,$23.96 ,$24.81 ,$23.96 ,$24.81 ,$24.81 ,$24.53 ,$23.96 ,$23.96 ,$23.96 ,$21.54 ,$25.37
Carle Richland Memorial Hospital,8382529,"OPIATES, GC/MS, U REF",,80361,301,$22.80 ,$22.80 ,$17.42 ,$20.52 ,$19.38 ,$19.38 ,$19.38 ,$20.06 ,$19.38 ,$20.06 ,$20.06 ,$19.84 ,$19.38 ,$19.38 ,$19.38 ,$17.42 ,$20.52
Carle Richland Memorial Hospital,8382522,"PTH RELATED PROTEIN, REF",,83519,301,$71.44 ,$71.44 ,$54.58 ,$64.30 ,$60.72 ,$60.72 ,$60.72 ,$62.87 ,$60.72 ,$62.87 ,$62.87 ,$62.15 ,$60.72 ,$60.72 ,$60.72 ,$54.58 ,$64.30
Carle Richland Memorial Hospital,8383533,"RIBOSOMAL P AB, REF",,83516,301,$56.38 ,$56.38 ,$43.07 ,$50.74 ,$47.92 ,$47.92 ,$47.92 ,$49.61 ,$47.92 ,$49.61 ,$49.61 ,$49.05 ,$47.92 ,$47.92 ,$47.92 ,$43.07 ,$50.74
Carle Richland Memorial Hospital,8382562,"BENZODIAZEPINES CONFIRMATION, U, REF",,80347,301,$87.83 ,$87.83 ,$67.10 ,$79.05 ,$74.66 ,$74.66 ,$74.66 ,$77.29 ,$74.66 ,$77.29 ,$77.29 ,$76.41 ,$74.66 ,$74.66 ,$74.66 ,$67.10 ,$79.05
Carle Richland Memorial Hospital,8382584,CARBOXYHEMOGLOBIN,,82375,301,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8382583,"NICOTINE AND METABOLITES, REF",,80323,301,$70.20 ,$70.20 ,$53.63 ,$63.18 ,$59.67 ,$59.67 ,$59.67 ,$61.78 ,$59.67 ,$61.78 ,$61.78 ,$61.07 ,$59.67 ,$59.67 ,$59.67 ,$53.63 ,$63.18
Carle Richland Memorial Hospital,8382551,"PANCREATIC ELASTASE-1, FECAL",,83520,301,$215.04 ,$215.04 ,$164.29 ,$193.54 ,$182.78 ,$182.78 ,$182.78 ,$189.24 ,$182.78 ,$189.24 ,$189.24 ,$187.08 ,$182.78 ,$182.78 ,$182.78 ,$164.29 ,$193.54
Carle Richland Memorial Hospital,8382601,"BENZODIAZEPINES, QUANT, U",,80346,301,$22.35 ,$22.35 ,$17.08 ,$20.12 ,$19.00 ,$19.00 ,$19.00 ,$19.67 ,$19.00 ,$19.67 ,$19.67 ,$19.44 ,$19.00 ,$19.00 ,$19.00 ,$17.08 ,$20.12
Carle Richland Memorial Hospital,8382580,"RHEUMATOID FACTOR, IGG, S REF",,83520,301,$28.77 ,$28.77 ,$21.98 ,$25.89 ,$24.45 ,$24.45 ,$24.45 ,$25.32 ,$24.45 ,$25.32 ,$25.32 ,$25.03 ,$24.45 ,$24.45 ,$24.45 ,$21.98 ,$25.89
Carle Richland Memorial Hospital,8382506,"TRYPTASE, REF",,83520,301,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382558,AMPHETAMINE,,80324,301,$24.75 ,$24.75 ,$18.91 ,$22.28 ,$21.04 ,$21.04 ,$21.04 ,$21.78 ,$21.04 ,$21.78 ,$21.78 ,$21.53 ,$21.04 ,$21.04 ,$21.04 ,$18.91 ,$22.28
Carle Richland Memorial Hospital,8382557,MDA,,80359,301,$24.75 ,$24.75 ,$18.91 ,$22.28 ,$21.04 ,$21.04 ,$21.04 ,$21.78 ,$21.04 ,$21.78 ,$21.78 ,$21.53 ,$21.04 ,$21.04 ,$21.04 ,$18.91 ,$22.28
Carle Richland Memorial Hospital,8382785,"CYCLOSPORINE A TROUGH, B [REF]",,80158,301,$68.74 ,$68.74 ,$52.52 ,$61.87 ,$58.43 ,$58.43 ,$58.43 ,$60.49 ,$58.43 ,$60.49 ,$60.49 ,$59.80 ,$58.43 ,$58.43 ,$58.43 ,$52.52 ,$61.87
Carle Richland Memorial Hospital,8382774,"SODIUM, 24-HOUR URINE",,84300,301,$21.84 ,$21.84 ,$16.69 ,$19.66 ,$18.56 ,$18.56 ,$18.56 ,$19.22 ,$18.56 ,$19.22 ,$19.22 ,$19.00 ,$18.56 ,$18.56 ,$18.56 ,$16.69 ,$19.66
Carle Richland Memorial Hospital,8382796,"MUSK ANTIBODY, REF",,83519,301,$540.80 ,$540.80 ,$413.17 ,$486.72 ,$459.68 ,$459.68 ,$459.68 ,$475.90 ,$459.68 ,$475.90 ,$475.90 ,$470.50 ,$459.68 ,$459.68 ,$459.68 ,$413.17 ,$486.72
Carle Richland Memorial Hospital,8382473,"CPT- CREATININE, URINE",,82570,301,$31.04 ,$31.04 ,$23.71 ,$27.94 ,$26.38 ,$26.38 ,$26.38 ,$27.32 ,$26.38 ,$27.32 ,$27.32 ,$27.00 ,$26.38 ,$26.38 ,$26.38 ,$23.71 ,$27.94
Carle Richland Memorial Hospital,8382503,"CPT-PROTEIN TOTAL, URINE",,84156,301,$31.04 ,$31.04 ,$23.71 ,$27.94 ,$26.38 ,$26.38 ,$26.38 ,$27.32 ,$26.38 ,$27.32 ,$27.32 ,$27.00 ,$26.38 ,$26.38 ,$26.38 ,$23.71 ,$27.94
Carle Richland Memorial Hospital,8382507,CPT-ELECTROPHORETIC FRACTIONATION,,84166,301,$31.05 ,$31.05 ,$23.72 ,$27.95 ,$26.39 ,$26.39 ,$26.39 ,$27.32 ,$26.39 ,$27.32 ,$27.32 ,$27.01 ,$26.39 ,$26.39 ,$26.39 ,$23.72 ,$27.95
Carle Richland Memorial Hospital,8382508,"CARNITINE, S [REF]",,82379,301,$112.09 ,$112.09 ,$85.64 ,$100.88 ,$95.28 ,$95.28 ,$95.28 ,$98.64 ,$95.28 ,$98.64 ,$98.64 ,$97.52 ,$95.28 ,$95.28 ,$95.28 ,$85.64 ,$100.88
Carle Richland Memorial Hospital,8382509,"CARNITINE, U [REF]",,82379,301,$312.40 ,$312.40 ,$238.67 ,$281.16 ,$265.54 ,$265.54 ,$265.54 ,$274.91 ,$265.54 ,$274.91 ,$274.91 ,$271.79 ,$265.54 ,$265.54 ,$265.54 ,$238.67 ,$281.16
Carle Richland Memorial Hospital,8382512,SELENIUM REF,,84255,301,$56.51 ,$56.51 ,$43.17 ,$50.86 ,$48.03 ,$48.03 ,$48.03 ,$49.73 ,$48.03 ,$49.73 ,$49.73 ,$49.16 ,$48.03 ,$48.03 ,$48.03 ,$43.17 ,$50.86
Carle Richland Memorial Hospital,8382965,"SARS-COV-2 AB (IGG) SPIKE, REF",,86769,301,$43.00 ,$43.00 ,$32.85 ,$38.70 ,$36.55 ,$36.55 ,$36.55 ,$37.84 ,$36.55 ,$37.84 ,$37.84 ,$37.41 ,$36.55 ,$36.55 ,$36.55 ,$32.85 ,$38.70
Carle Richland Memorial Hospital,8382981,"HISTONE AUTOANTIBODIES, REF",,83516,301,$28.78 ,$28.78 ,$21.99 ,$25.90 ,$24.46 ,$24.46 ,$24.46 ,$25.33 ,$24.46 ,$25.33 ,$25.33 ,$25.04 ,$24.46 ,$24.46 ,$24.46 ,$21.99 ,$25.90
Carle Richland Memorial Hospital,8383123,"ESTRADIOL, SERUM, REF",,82670,301,$23.70 ,$23.70 ,$18.11 ,$21.33 ,$20.15 ,$20.15 ,$20.15 ,$20.86 ,$20.15 ,$20.86 ,$20.86 ,$20.62 ,$20.15 ,$20.15 ,$20.15 ,$18.11 ,$21.33
Carle Richland Memorial Hospital,8383146,"TESTOSTERONE,F/WKLYBD+T LC/MS, REF",,84410,301,$69.00 ,$69.00 ,$52.72 ,$62.10 ,$58.65 ,$58.65 ,$58.65 ,$60.72 ,$58.65 ,$60.72 ,$60.72 ,$60.03 ,$58.65 ,$58.65 ,$58.65 ,$52.72 ,$62.10
Carle Richland Memorial Hospital,8383149,"PSA, ULTRASENSITIVE, REF",,84153,301,$19.42 ,$19.42 ,$14.84 ,$17.48 ,$16.51 ,$16.51 ,$16.51 ,$17.09 ,$16.51 ,$17.09 ,$17.09 ,$16.90 ,$16.51 ,$16.51 ,$16.51 ,$14.84 ,$17.48
Carle Richland Memorial Hospital,8282043,"MICROALBUMIN, URINE, QUANT",,82043,301,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8280307,DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE,,80307,301,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8380849,DISACCHARIDASE ANALYSIS REF,,82657,301,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8380956,"TRYPTASE, S REF",,83520,301,$58.60 ,$58.60 ,$44.77 ,$52.74 ,$49.81 ,$49.81 ,$49.81 ,$51.57 ,$49.81 ,$51.57 ,$51.57 ,$50.98 ,$49.81 ,$49.81 ,$49.81 ,$44.77 ,$52.74
Carle Richland Memorial Hospital,8384402,"TESTOSTERONE, FREE, S REF",,84402,301,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8380229,GASTRIC OCCULT BLOOD,,82271,301,$65.00 ,$65.00 ,$49.66 ,$58.50 ,$55.25 ,$55.25 ,$55.25 ,$57.20 ,$55.25 ,$57.20 ,$57.20 ,$56.55 ,$55.25 ,$55.25 ,$55.25 ,$49.66 ,$58.50
Carle Richland Memorial Hospital,8380230,"PREG, QUAL-SERUM",,84703,301,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8380037,IMMUNOGLOB FREE LIGHT CHAINS,,83883,301,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8380049,BASIC METABOLIC PANEL,,80048,301,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8380050,GENERAL HEALTH PANEL,,80050,301,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,8380054,COMPREHENSIVE METABOLIC PANEL,,80053,301,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8380055,OBSTETRIC PANEL,,80055,301,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,8380074,HEPATITIS ACUTE PANEL,,80074,301,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8380100,"PHENOLPHTHALEIN, STOOL",,84999,301,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8380311,TISSUE TRANSGLUT. IGA,,83516,301,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8380335,"LACTOFERRIN, FECAL, QUAL.",,83630,301,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8381006,:MYOGLOBIN,,83874,301,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8382009,B-HYDROXYBUTYRATE,,82010,301,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,8382024,"ACTH, PLASMA REF",,82024,301,"$1,117.33 ","$1,117.33 ",$853.64 ,"$1,005.60 ",$949.73 ,$949.73 ,$949.73 ,$983.25 ,$949.73 ,$983.25 ,$983.25 ,$972.08 ,$949.73 ,$949.73 ,$949.73 ,$853.64 ,"$1,005.60 "
Carle Richland Memorial Hospital,8382035,ALBUMIN BODY FLUID,,82042,301,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8382037,ALBUMIN -SYNOVIAL FLUID,,82042,301,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8382040,"ALBUMIN, SERUM",,82040,301,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8382043,"MICROALBUMIN, URINE, QUANT",,82043,301,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8382087,CYCLOSPORINE ASSAY,,80158,301,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,8382105,"ALPHA-FETOPROTEIN, SERUM",,82105,301,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,8382140,AMMONIA,,82140,301,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8382150,AMYLASE,,82150,301,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8382175,"ARSENIC, BLOOD REF",,82175,301,$84.00 ,$84.00 ,$64.18 ,$75.60 ,$71.40 ,$71.40 ,$71.40 ,$73.92 ,$71.40 ,$73.92 ,$73.92 ,$73.08 ,$71.40 ,$71.40 ,$71.40 ,$64.18 ,$75.60
Carle Richland Memorial Hospital,8382247,"BILIRUBIN, TOTAL",,82247,301,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8382248,"BILIRUBIN, DIRECT",,82248,301,$72.00 ,$72.00 ,$55.01 ,$64.80 ,$61.20 ,$61.20 ,$61.20 ,$63.36 ,$61.20 ,$63.36 ,$63.36 ,$62.64 ,$61.20 ,$61.20 ,$61.20 ,$55.01 ,$64.80
Carle Richland Memorial Hospital,8382270,OCCULT BLOOD,,82270,301,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8382272,OCCULT BLOOD -SINGLE SPECIMEN,,82272,301,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8382309,CALCIUM (PTH-INTACT) REF,,82310,301,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8382310,"CALCIUM, TOTAL",,82310,301,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8382311,"CALCIUM, IONIZED",,82330,301,$40.00 ,$40.00 ,$30.56 ,$36.00 ,$34.00 ,$34.00 ,$34.00 ,$35.20 ,$34.00 ,$35.20 ,$35.20 ,$34.80 ,$34.00 ,$34.00 ,$34.00 ,$30.56 ,$36.00
Carle Richland Memorial Hospital,8382340,"CALCIUM, URINE",,82340,301,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8382374,CARBON DIOXIDE (BICARBONATE),,82374,301,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8382435,"CHLORIDE, BLOOD",,82435,301,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382436,"CHLORIDE, URINE",,82436,301,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8382438,"CHLORIDE, STOOL",,82438,301,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8382466,"CHOLESTROL, BODY FLUID",,84999,301,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8382550,CREATINE KINASE CK/CPK/TOTAL,,82550,301,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8382555,CK TOTAL,,82550,301,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8382565,"CREATININE, BLOOD",,82565,301,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382570,"CREATININE, OTHER SOURCE",,82570,301,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8382607,VITAMIN B12,,82607,301,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8382646,DRUG ASSAY -PRIMIDONE,,80188,301,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8382655,DRUG ASSAY -PHENYTOIN,,80185,301,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8382656,DRUG ASSAY -PHENOBARBITAL,,80184,301,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,8382659,DRUG ASSAY -CARBAMAZEPINE TOTL,,80156,301,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8382668,ERYTHROPOIETIN REF,,82668,301,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,8382677,"ESTRIOL, UNCONJUGATED",,82677,301,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8382743,"FOLIC ACID (FOLATE), SERUM",,82746,301,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8382784,GAMMAGLOBULIN IGA/IGD/IGG/IGM,,82784,301,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8382787,GAMMAGLOBULIN IGE REF,,82785,301,$7.60 ,$7.60 ,$5.81 ,$6.84 ,$6.46 ,$6.46 ,$6.46 ,$6.69 ,$6.46 ,$6.69 ,$6.69 ,$6.61 ,$6.46 ,$6.46 ,$6.46 ,$5.81 ,$6.84
Carle Richland Memorial Hospital,8382944,HOMOCYSTEINE ASSAY,,83090,301,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8382947,"GLUCOSE, QUANTITATIVE",,82947,301,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8382960,G6PD SCREEN,,82960,301,$89.00 ,$89.00 ,$68.00 ,$80.10 ,$75.65 ,$75.65 ,$75.65 ,$78.32 ,$75.65 ,$78.32 ,$78.32 ,$77.43 ,$75.65 ,$75.65 ,$75.65 ,$68.00 ,$80.10
Carle Richland Memorial Hospital,8383014,FERRITIN,,82728,301,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,8383025,"HEMOGLOBIN, GLYCATED (A1C)",,83036,301,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8383070,HEMOSIDERIN URINE QUALITATIVE,,83070,301,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8383112,"ALDOSTERONE, SERUM REF",,82088,301,$932.79 ,$932.79 ,$712.65 ,$839.51 ,$792.87 ,$792.87 ,$792.87 ,$820.86 ,$792.87 ,$820.86 ,$820.86 ,$811.53 ,$792.87 ,$792.87 ,$792.87 ,$712.65 ,$839.51
Carle Richland Memorial Hospital,8383180,"CORTISOL, TOTAL",,82533,301,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8383246,ASSAY -ESTRADIOL,,82670,301,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,8383304,LUTEINIZING HORMONE (LH),,83002,301,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,8383311,FOLLICLE STIMULATING HORMONE,,83001,301,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8383350,PROGESTRONE,,84144,301,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,8383390,INSULIN REF,,83525,301,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,8383405,TESTOSTERONE,,84403,301,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,8383455,T-4,,84436,301,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,8383480,TSH,,84443,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8383494,"TISS TRANSGLUTAMIN AB, IGA, S REF",,83516,301,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8383496,"OH-PROGESTERONE, 17-ALPHA REF",,83498,301,$642.26 ,$642.26 ,$490.69 ,$578.03 ,$545.92 ,$545.92 ,$545.92 ,$565.19 ,$545.92 ,$565.19 ,$565.19 ,$558.77 ,$545.92 ,$545.92 ,$545.92 ,$490.69 ,$578.03
Carle Richland Memorial Hospital,8383534,B-NATRIURETIC PEPTIDE,,83880,301,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,8383605,LACTIC ACID,,83605,301,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,8383615,LACTATE DEHYDROGENASE (LD/LDH),,83615,301,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8383631,"LDL CHOLESTEROL, DIRECT",,83721,301,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8383655,"LEAD, BLOOD REF",,83655,301,$84.00 ,$84.00 ,$64.18 ,$75.60 ,$71.40 ,$71.40 ,$71.40 ,$73.92 ,$71.40 ,$73.92 ,$73.92 ,$73.08 ,$71.40 ,$71.40 ,$71.40 ,$64.18 ,$75.60
Carle Richland Memorial Hospital,8383661,L/S RATIO,,83661,301,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8383685,DRUG ASSAY -LIDOCAINE,,80176,301,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8383718,HDL CHOLESTEROL,,83718,301,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8383735,MAGNESIUM,,83735,301,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8383736,"MAGNESIUM, URINE",,83735,301,$26.00 ,$26.00 ,$19.86 ,$23.40 ,$22.10 ,$22.10 ,$22.10 ,$22.88 ,$22.10 ,$22.88 ,$22.88 ,$22.62 ,$22.10 ,$22.10 ,$22.10 ,$19.86 ,$23.40
Carle Richland Memorial Hospital,8383831,MERCURY BLOOD REF,,83825,301,$84.00 ,$84.00 ,$64.18 ,$75.60 ,$71.40 ,$71.40 ,$71.40 ,$73.92 ,$71.40 ,$73.92 ,$73.92 ,$73.08 ,$71.40 ,$71.40 ,$71.40 ,$64.18 ,$75.60
Carle Richland Memorial Hospital,8383872,"MUCIN, SYNOVIAL FLUID(ROPES TE",,83872,301,$78.00 ,$78.00 ,$59.59 ,$70.20 ,$66.30 ,$66.30 ,$66.30 ,$68.64 ,$66.30 ,$68.64 ,$68.64 ,$67.86 ,$66.30 ,$66.30 ,$66.30 ,$59.59 ,$70.20
Carle Richland Memorial Hospital,8383883,"ALBUMIN, CSF",,82042,301,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8383931,"OSMOLALITY, STOOL",,84999,301,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8383932,OSMOLALITY -BODY FLUID,,84999,301,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8383935,"OSMOLALITY, URINE",,83935,301,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8383986,"PH, BODY FLUID, EXCEPT BLOOD",,83986,301,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8384075,ALKALINE PHOSPHATASE,,84075,301,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8384081,PHOPHATIDYLGLYCEROL (IA MTHD),,84081,301,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8384100,PHOSPHORUS INORGAN (PHOSPHATE),,84100,301,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8384105,"PHOSPHORUS, URINE",,84105,301,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8384132,POTASSIUM BODY FLUID,,84999,301,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8384133,"POTASSIUM, URINE",,84133,301,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8384146,PROLACTIN,,84146,301,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,8384152,PSA TOTAL REF,,84153,301,$98.98 ,$98.98 ,$75.62 ,$89.08 ,$84.13 ,$84.13 ,$84.13 ,$87.10 ,$84.13 ,$87.10 ,$87.10 ,$86.11 ,$84.13 ,$84.13 ,$84.13 ,$75.62 ,$89.08
Carle Richland Memorial Hospital,8384154,PSA FREE,,84154,301,$98.98 ,$98.98 ,$75.62 ,$89.08 ,$84.13 ,$84.13 ,$84.13 ,$87.10 ,$84.13 ,$87.10 ,$87.10 ,$86.11 ,$84.13 ,$84.13 ,$84.13 ,$75.62 ,$89.08
Carle Richland Memorial Hospital,8384155,"PROTEIN, TOTAL, SERUM",,84155,301,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8384156,"PROTEIN, TOTAL, URINE",,84156,301,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8384157,"PROTEIN, TOTAL, OTHER SOURCE",,84157,301,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8384270,ASSAY SEX HORMONE GLOBUL REF,,84270,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8384295,SODIUM SERUM PLASM/WHOLE BLOOD,,84295,301,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8384296,"SODIUM, BODY FLUID",,84302,301,$69.00 ,$69.00 ,$52.72 ,$62.10 ,$58.65 ,$58.65 ,$58.65 ,$60.72 ,$58.65 ,$60.72 ,$60.72 ,$60.03 ,$58.65 ,$58.65 ,$58.65 ,$52.72 ,$62.10
Carle Richland Memorial Hospital,8384300,"SODIUM, URINE",,84300,301,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8384317,"PHOSPHORUS, RANDOM URINE",,84105,301,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8384403,ASSAY TOTAL TESTOSTERONE REF,,84403,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8384433,"THYROGLOBULIN, QUANT. REF",,84432,301,$118.94 ,$118.94 ,$90.87 ,$107.05 ,$101.10 ,$101.10 ,$101.10 ,$104.67 ,$101.10 ,$104.67 ,$104.67 ,$103.48 ,$101.10 ,$101.10 ,$101.10 ,$90.87 ,$107.05
Carle Richland Memorial Hospital,8384438,"THYROXINE, FREE (T4)",,84439,301,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8384448,SPECTROPHOTOMETRY,,84311,301,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8384460,"TRANSFERASE, ALANINE AMINO",,84460,301,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8384478,TRIGLYCERIDES,,84478,301,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8384479,THYROID HORMONE(T3) UPTAKE REF,,84479,301,$88.70 ,$88.70 ,$67.77 ,$79.83 ,$75.40 ,$75.40 ,$75.40 ,$78.06 ,$75.40 ,$78.06 ,$78.06 ,$77.17 ,$75.40 ,$75.40 ,$75.40 ,$67.77 ,$79.83
Carle Richland Memorial Hospital,8384484,"TROPONIN, QUANTITATIVE",,84484,301,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8384520,"UREA NITROGEN, QUANTITATIVE",,84520,301,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8384540,"UREA NITROGEN, URINE",,84540,301,$72.00 ,$72.00 ,$55.01 ,$64.80 ,$61.20 ,$61.20 ,$61.20 ,$63.36 ,$61.20 ,$63.36 ,$63.36 ,$62.64 ,$61.20 ,$61.20 ,$61.20 ,$55.01 ,$64.80
Carle Richland Memorial Hospital,8384560,"URIC ACID, OTHER SOURCE",,84560,301,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8384561,"URIC ACID, RANDOM URINE",,84560,301,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8384586,DRUG ASSAY -VALPROIC ACID,,80164,301,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,8384681,C-PEPTIDE REF,,84681,301,$579.03 ,$579.03 ,$442.38 ,$521.13 ,$492.18 ,$492.18 ,$492.18 ,$509.55 ,$492.18 ,$509.55 ,$509.55 ,$503.76 ,$492.18 ,$492.18 ,$492.18 ,$442.38 ,$521.13
Carle Richland Memorial Hospital,8384702,"GONADOTROPIN, CHORIONIC (HCG)",,84702,301,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,8386326,"ALPHA-1-ANTITRYPSIN, TOTAL",,82103,301,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8381248,"ALCOHOL, SERUM",,80307,301,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8384112,AMNISURE ROM,,84112,301,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,82330,"ASSAY OF CALCIUM, IONIZED",,82330,301,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,82435,ASSAY OF BLOOD CHLORIDE,,82435,301,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,82565,ASSAY OF CREATININE,,82565,301,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,82947,"ASSAY QUANTITATIVE,BLOOD GLUCOSE",,82947,301,$48.00 ,$48.00 ,$36.67 ,$43.20 ,$40.80 ,$40.80 ,$40.80 ,$42.24 ,$40.80 ,$42.24 ,$42.24 ,$41.76 ,$40.80 ,$40.80 ,$40.80 ,$36.67 ,$43.20
Carle Richland Memorial Hospital,83655,ASSAY OF LEAD,,83655,301,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,84132,ASSAY OF SERUM POTASSIUM,,84132,301,$44.00 ,$44.00 ,$33.62 ,$39.60 ,$37.40 ,$37.40 ,$37.40 ,$38.72 ,$37.40 ,$38.72 ,$38.72 ,$38.28 ,$37.40 ,$37.40 ,$37.40 ,$33.62 ,$39.60
Carle Richland Memorial Hospital,84295,ASSAY OF SERUM SODIUM,,84295,301,$44.00 ,$44.00 ,$33.62 ,$39.60 ,$37.40 ,$37.40 ,$37.40 ,$38.72 ,$37.40 ,$38.72 ,$38.72 ,$38.28 ,$37.40 ,$37.40 ,$37.40 ,$33.62 ,$39.60
Carle Richland Memorial Hospital,84520,"ASSAY UREA NITROGEN, QUAN",,84520,301,$52.00 ,$52.00 ,$39.73 ,$46.80 ,$44.20 ,$44.20 ,$44.20 ,$45.76 ,$44.20 ,$45.76 ,$45.76 ,$45.24 ,$44.20 ,$44.20 ,$44.20 ,$39.73 ,$46.80
Carle Richland Memorial Hospital,82272,"BLOOD OCCULT,BY PEROXID, FECES, 1-3 SIMULT, NON CA SCREEN",,82272,301,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,80047,BASIC METABOLIC PANEL CALCIUM IONIZED,,80047,301,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,88720,BILIRUBIN TOTAL TRANSCUTANEOUS,,88720,301,$61.00 ,$61.00 ,$46.60 ,$54.90 ,$51.85 ,$51.85 ,$51.85 ,$53.68 ,$51.85 ,$53.68 ,$53.68 ,$53.07 ,$51.85 ,$51.85 ,$51.85 ,$46.60 ,$54.90
Carle Richland Memorial Hospital,G0477,"Pr Drug Test(s), Prsmp, Any Nm Drg Cls/dvcs/prcs Drct Optical Obs Only",,G0477,301,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,80305,DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE,,80305,301,$69.00 ,$69.00 ,$52.72 ,$62.10 ,$58.65 ,$58.65 ,$58.65 ,$60.72 ,$58.65 ,$60.72 ,$60.72 ,$60.03 ,$58.65 ,$58.65 ,$58.65 ,$52.72 ,$62.10
Carle Richland Memorial Hospital,8386703,LAB SERVICE,,86703,302,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8386735,MUMPS ANTIBODY IGG,,86735,302,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8386800,THYROGLOBULIN ANTIBODY REF,,86800,302,$118.94 ,$118.94 ,$90.87 ,$107.05 ,$101.10 ,$101.10 ,$101.10 ,$104.67 ,$101.10 ,$104.67 ,$104.67 ,$103.48 ,$101.10 ,$101.10 ,$101.10 ,$90.87 ,$107.05
Carle Richland Memorial Hospital,8386812,HLA-B27 ANTIGEN,,86812,302,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,8386923,COMPATIBILITY TEST -EACH UNIT,,86923,302,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8386988,CMV-NEGATIVE,,86644,302,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,8381455,HEPATITIS A TOTAL AB,,86708,302,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8381456,HEPATITIS B CORE TOTAL AB,,86704,302,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8381457,THYROGLOBULIN AB,,86800,302,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8381459,THYROPEROXIDASE AB,,86376,302,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8381460,CARBOHYDRATE ANTIGEN 19-9,,86301,302,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8380680,TB QUANTIFERON,,86480,302,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8381094,DIRECT BACTERIAL AG-PARTICLE AGGLUT.EACH,,86403,302,$71.00 ,$71.00 ,$54.24 ,$63.90 ,$60.35 ,$60.35 ,$60.35 ,$62.48 ,$60.35 ,$62.48 ,$62.48 ,$61.77 ,$60.35 ,$60.35 ,$60.35 ,$54.24 ,$63.90
Carle Richland Memorial Hospital,8381939,HC TB QUANTIFERON-PLUS,,86481,302,$485.00 ,$485.00 ,$370.54 ,$436.50 ,$412.25 ,$412.25 ,$412.25 ,$426.80 ,$412.25 ,$426.80 ,$426.80 ,$421.95 ,$412.25 ,$412.25 ,$412.25 ,$370.54 ,$436.50
Carle Richland Memorial Hospital,8382217,HEP C AB W/REFL HCV,,86803,302,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,8382221,HEP B CORE IGM AB,,86705,302,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382222,HEP A IGM AB,,86709,302,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8382223,RUBELLA IMMUNE,,86762,302,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8382224,VZV AB IGM,,86787,302,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8382225,HEP B SURFACE AB QN,,86317,302,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8382256,"MEASLES AB IGG,EIA",,86765,302,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8382260,QUANTIFERON(R) PL 4T,,86480,302,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,8382283,LYME AB-WB CONFIRM,,86618,302,$490.00 ,$490.00 ,$374.36 ,$441.00 ,$416.50 ,$416.50 ,$416.50 ,$431.20 ,$416.50 ,$431.20 ,$431.20 ,$426.30 ,$416.50 ,$416.50 ,$416.50 ,$374.36 ,$441.00
Carle Richland Memorial Hospital,8382288,B2-GLYCOPROTEIN,,86146,302,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8382200,"HSV1/2 IGM, W/RFL",,86695,302,$13.04 ,$13.04 ,$9.96 ,$11.74 ,$11.08 ,$11.08 ,$11.08 ,$11.48 ,$11.08 ,$11.48 ,$11.48 ,$11.34 ,$11.08 ,$11.08 ,$11.08 ,$9.96 ,$11.74
Carle Richland Memorial Hospital,8382201,"HSV1/2 IGM, W/RFL",,86696,302,$13.04 ,$13.04 ,$9.96 ,$11.74 ,$11.08 ,$11.08 ,$11.08 ,$11.48 ,$11.08 ,$11.48 ,$11.48 ,$11.34 ,$11.08 ,$11.08 ,$11.08 ,$9.96 ,$11.74
Carle Richland Memorial Hospital,8382328,CRYPTOCOCCAL ANTIGEN,,86403,302,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,8382349,"T. PALLIDIUM AB, PA, REF",,86780,302,$117.23 ,$117.23 ,$89.56 ,$105.51 ,$99.65 ,$99.65 ,$99.65 ,$103.16 ,$99.65 ,$103.16 ,$103.16 ,$101.99 ,$99.65 ,$99.65 ,$99.65 ,$89.56 ,$105.51
Carle Richland Memorial Hospital,8382297,"CRP, HIGH SENSITIVITY, REF",,86141,302,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8382353,Hc Ra Test (rf Titer),,86430,302,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8382363,"SERUM IMMUNOFIXATION, REF",,86334,302,$689.85 ,$689.85 ,$527.05 ,$620.87 ,$586.37 ,$586.37 ,$586.37 ,$607.07 ,$586.37 ,$607.07 ,$607.07 ,$600.17 ,$586.37 ,$586.37 ,$586.37 ,$527.05 ,$620.87
Carle Richland Memorial Hospital,8382376,"HEP B CORE AB, TOTAL, REF",,86704,302,$248.75 ,$248.75 ,$190.05 ,$223.88 ,$211.44 ,$211.44 ,$211.44 ,$218.90 ,$211.44 ,$218.90 ,$218.90 ,$216.41 ,$211.44 ,$211.44 ,$211.44 ,$190.05 ,$223.88
Carle Richland Memorial Hospital,8382392,"CHROMOGRANIN A, ECL",,86316,302,$140.95 ,$140.95 ,$107.69 ,$126.86 ,$119.81 ,$119.81 ,$119.81 ,$124.04 ,$119.81 ,$124.04 ,$124.04 ,$122.63 ,$119.81 ,$119.81 ,$119.81 ,$107.69 ,$126.86
Carle Richland Memorial Hospital,8382414,"IMMUNOFIX, UR",,86335,302,$20.58 ,$20.58 ,$15.72 ,$18.52 ,$17.49 ,$17.49 ,$17.49 ,$18.11 ,$17.49 ,$18.11 ,$18.11 ,$17.90 ,$17.49 ,$17.49 ,$17.49 ,$15.72 ,$18.52
Carle Richland Memorial Hospital,8382401,CA27.29 CHIRON/BAYER,,86300,302,$531.14 ,$531.14 ,$405.79 ,$478.03 ,$451.47 ,$451.47 ,$451.47 ,$467.40 ,$451.47 ,$467.40 ,$467.40 ,$462.09 ,$451.47 ,$451.47 ,$451.47 ,$405.79 ,$478.03
Carle Richland Memorial Hospital,8382351,ANTISTREPTOLYSIN O,,86060,302,$35.40 ,$35.40 ,$27.05 ,$31.86 ,$30.09 ,$30.09 ,$30.09 ,$31.15 ,$30.09 ,$31.15 ,$31.15 ,$30.80 ,$30.09 ,$30.09 ,$30.09 ,$27.05 ,$31.86
Carle Richland Memorial Hospital,8382444,ANA TITER & PATTERN REF,,86039,302,$316.03 ,$316.03 ,$241.45 ,$284.43 ,$268.63 ,$268.63 ,$268.63 ,$278.11 ,$268.63 ,$278.11 ,$278.11 ,$274.95 ,$268.63 ,$268.63 ,$268.63 ,$241.45 ,$284.43
Carle Richland Memorial Hospital,8382470,INHIBIN A,,86336,302,$83.38 ,$83.38 ,$63.70 ,$75.04 ,$70.87 ,$70.87 ,$70.87 ,$73.37 ,$70.87 ,$73.37 ,$73.37 ,$72.54 ,$70.87 ,$70.87 ,$70.87 ,$63.70 ,$75.04
Carle Richland Memorial Hospital,8382486,"PHOSPHATIDYLSERINE AB, REF",,86148,302,$30.12 ,$30.12 ,$23.01 ,$27.11 ,$25.60 ,$25.60 ,$25.60 ,$26.51 ,$25.60 ,$26.51 ,$26.51 ,$26.20 ,$25.60 ,$25.60 ,$25.60 ,$23.01 ,$27.11
Carle Richland Memorial Hospital,8382346,"CENTROMERE AB, REF",,86235,302,$29.48 ,$29.48 ,$22.52 ,$26.53 ,$25.06 ,$25.06 ,$25.06 ,$25.94 ,$25.06 ,$25.94 ,$25.94 ,$25.65 ,$25.06 ,$25.06 ,$25.06 ,$22.52 ,$26.53
Carle Richland Memorial Hospital,8382548,"LYMPHOCYTE SUBSET PANEL 4, B",,86360,302,$264.00 ,$264.00 ,$201.70 ,$237.60 ,$224.40 ,$224.40 ,$224.40 ,$232.32 ,$224.40 ,$232.32 ,$232.32 ,$229.68 ,$224.40 ,$224.40 ,$224.40 ,$201.70 ,$237.60
Carle Richland Memorial Hospital,8382568,"ALLERGEN SPECIFIC IGE, EACH, REF",,86003,302,$14.48 ,$14.48 ,$11.06 ,$13.03 ,$12.31 ,$12.31 ,$12.31 ,$12.74 ,$12.31 ,$12.74 ,$12.74 ,$12.60 ,$12.31 ,$12.31 ,$12.31 ,$11.06 ,$13.03
Carle Richland Memorial Hospital,8382604,"CPT-CARDIOLIPIN AB, EACH IG CLASS",,86147,302,$32.18 ,$32.18 ,$24.59 ,$28.96 ,$27.35 ,$27.35 ,$27.35 ,$28.32 ,$27.35 ,$28.32 ,$28.32 ,$28.00 ,$27.35 ,$27.35 ,$27.35 ,$24.59 ,$28.96
Carle Richland Memorial Hospital,8382794,"ACHR MODULATING FLOW CYTO, REF",,86255,302,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8382822,"PARANEOPLAS AUTOAB EVAL, REF",,86255,302,$15.64 ,$15.64 ,$11.95 ,$14.08 ,$13.29 ,$13.29 ,$13.29 ,$13.76 ,$13.29 ,$13.76 ,$13.76 ,$13.61 ,$13.29 ,$13.29 ,$13.29 ,$11.95 ,$14.08
Carle Richland Memorial Hospital,8382823,"ANTISTREP-O TITER, S , REF",,86060,302,$91.70 ,$91.70 ,$70.06 ,$82.53 ,$77.95 ,$77.95 ,$77.95 ,$80.70 ,$77.95 ,$80.70 ,$80.70 ,$79.78 ,$77.95 ,$77.95 ,$77.95 ,$70.06 ,$82.53
Carle Richland Memorial Hospital,8382824,HEPATITIS A IGG AB,,86708,302,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8382982,"CMV IGG AB, REF",,86644,302,$11.00 ,$11.00 ,$8.40 ,$9.90 ,$9.35 ,$9.35 ,$9.35 ,$9.68 ,$9.35 ,$9.68 ,$9.68 ,$9.57 ,$9.35 ,$9.35 ,$9.35 ,$8.40 ,$9.90
Carle Richland Memorial Hospital,8382983,"TOXOPLASMA AG, IGM, REF",,86778,302,$23.10 ,$23.10 ,$17.65 ,$20.79 ,$19.64 ,$19.64 ,$19.64 ,$20.33 ,$19.64 ,$20.33 ,$20.33 ,$20.10 ,$19.64 ,$19.64 ,$19.64 ,$17.65 ,$20.79
Carle Richland Memorial Hospital,8382984,"TOXOPLASMA AG, IGG, REF",,86777,302,$15.40 ,$15.40 ,$11.77 ,$13.86 ,$13.09 ,$13.09 ,$13.09 ,$13.55 ,$13.09 ,$13.55 ,$13.55 ,$13.40 ,$13.09 ,$13.09 ,$13.09 ,$11.77 ,$13.86
Carle Richland Memorial Hospital,8383081,"CMV IGM AB, REF",,86645,302,$15.40 ,$15.40 ,$11.77 ,$13.86 ,$13.09 ,$13.09 ,$13.09 ,$13.55 ,$13.09 ,$13.55 ,$13.55 ,$13.40 ,$13.09 ,$13.09 ,$13.09 ,$11.77 ,$13.86
Carle Richland Memorial Hospital,8386634,IMMUNOFIX CRYOGLOBULIN REF,,86334,302,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,8382165,HEPARIN DEPENDENT PLATELET ABS,,86022,302,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8382405,CYCLIC CITRUL PEPTIDE AB REF,,86200,302,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8383005,"TUMOR ANTIGEN, CA 19-9 REF",,86301,302,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,8383131,CHLAMYDIA DETECTION,,86631,302,$36.00 ,$36.00 ,$27.50 ,$32.40 ,$30.60 ,$30.60 ,$30.60 ,$31.68 ,$30.60 ,$31.68 ,$31.68 ,$31.32 ,$30.60 ,$30.60 ,$30.60 ,$27.50 ,$32.40
Carle Richland Memorial Hospital,8386020,ANTIBODY SCREENING,,86850,302,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8386021,ANTIBODY IDENTIFICATION PANEL,,86870,302,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,8386026,ANTIBODY ELUTION,,86860,302,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8386038,ANTINUCLEAR ANTIBDIES(ANA) REF,,86038,302,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,8386050,ANTINUCLEAR ANTIBODY SCREEN,,86038,302,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8386051,ANTINUCLEAR ANTIBODY PROFILE,,86039,302,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8386060,ANTISTREPTOLYSIN O (ASO) TITER,,86060,302,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8386074,MEASELS IGG AB,,86765,302,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8386138,"CRP, HIGH SENSITIVITY",,86141,302,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8386140,C-REACTIVE PROTEIN,,86140,302,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8386147,CARDIOLIPIN ANTIBODIES REF,,86147,302,$315.01 ,$315.01 ,$240.67 ,$283.51 ,$267.76 ,$267.76 ,$267.76 ,$277.21 ,$267.76 ,$277.21 ,$277.21 ,$274.06 ,$267.76 ,$267.76 ,$267.76 ,$240.67 ,$283.51
Carle Richland Memorial Hospital,8386160,"COMPLEMENT ANTIGEN, EACH COMP.",,86160,302,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8386162,COMPLEMENT C3C REF,,86160,302,$43.46 ,$43.46 ,$33.20 ,$39.11 ,$36.94 ,$36.94 ,$36.94 ,$38.24 ,$36.94 ,$38.24 ,$38.24 ,$37.81 ,$36.94 ,$36.94 ,$36.94 ,$33.20 ,$39.11
Carle Richland Memorial Hospital,8386250,DIRECT COMBS,,86880,302,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8386255,ISLET CELL ANTIBODY REF,,86341,302,$117.23 ,$117.23 ,$89.56 ,$105.51 ,$99.65 ,$99.65 ,$99.65 ,$103.16 ,$99.65 ,$103.16 ,$103.16 ,$101.99 ,$99.65 ,$99.65 ,$99.65 ,$89.56 ,$105.51
Carle Richland Memorial Hospital,8386257,MUMPS ANTIBODY REF,,86735,302,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8386281,HEPATITIS C VIRUS ANTIBODY,,86803,302,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,8386292,HEPATITIS A IGM ANTIBODY,,86709,302,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8386294,HEPATITIS B CORE IGM ANTIBODY,,86705,302,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,8386337,"TUMOR ANTIGEN, CA 15-3 REF",,86300,302,$531.14 ,$531.14 ,$405.79 ,$478.03 ,$451.47 ,$451.47 ,$451.47 ,$467.40 ,$451.47 ,$467.40 ,$467.40 ,$462.09 ,$451.47 ,$451.47 ,$451.47 ,$405.79 ,$478.03
Carle Richland Memorial Hospital,8386362,RHEUMATOID FACTOR QUANTITATIVE,,86431,302,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8386376,PEROXIDASE ANTIBODY REF,,86376,302,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8386379,NK CELLS -TOTAL COUNT,,86357,302,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8386413,MYCOPLASMA IGM AB BY EIA,,86738,302,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8386420,VARICELLA AB IGG ANTIBODY,,86787,302,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8386421,T CELLS; ABS CD4&CD8 COUNT W/R,,86360,302,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,8386422,"T CELLS, TOTAL COUNT",,86359,302,$490.00 ,$490.00 ,$374.36 ,$441.00 ,$416.50 ,$416.50 ,$416.50 ,$431.20 ,$416.50 ,$431.20 ,$431.20 ,$426.30 ,$416.50 ,$416.50 ,$416.50 ,$374.36 ,$441.00
Carle Richland Memorial Hospital,8386423,B CELLS TOTAL COUNT,,86355,302,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8386435,RUBELLA IGG SCREEN,,86762,302,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8386630,LAB SERVICE,,86696,302,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8386646,CMV IGG ANTIBODY,,86644,302,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8386647,CMV IGM ANTIBODY,,86645,302,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8386677,HELICOBACTER PYLORI ANTIBODY,,86677,302,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8386685,VZV ANTIBODY IGM BY EIA REF,,86787,302,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8386695,LAB SERVICE,,86695,302,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8381515,CBC (ITC LAB),,85027,305,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8381546,PROTHROMBIN TIME-INCUBATED,,85610,305,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8285014,HEMATOCRIT,,85014,305,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,8380992,PLATELET FUNCTION,,85576,305,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8381011,TEG COAG TIME; ACTIVATED,,85347,305,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,8381012,TEG FIBRINOGEN; ACTIVITY,,85384,305,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8381013,TEG FIBRINOLYSIS OR COAG SCRN INTERP & RPT,,85390,305,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8381014,"TEG PLATELET AGGREGATION, EA",,85576,305,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8085014,HCT,,85014,305,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,8381946,"RETICULOCYTE COUNT, AUTOMATED",,85046,305,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8382404,DRVVT CONFIRM,,85597,305,$158.03 ,$158.03 ,$120.73 ,$142.23 ,$134.33 ,$134.33 ,$134.33 ,$139.07 ,$134.33 ,$139.07 ,$139.07 ,$137.49 ,$134.33 ,$134.33 ,$134.33 ,$120.73 ,$142.23
Carle Richland Memorial Hospital,8385660,"HEMOGLOBIN S, SCRN, B REF",,85660,305,$40.00 ,$40.00 ,$30.56 ,$36.00 ,$34.00 ,$34.00 ,$34.00 ,$35.20 ,$34.00 ,$35.20 ,$35.20 ,$34.80 ,$34.00 ,$34.00 ,$34.00 ,$30.56 ,$36.00
Carle Richland Memorial Hospital,8380141,MICROHEMATOCRIT -SPUN,,85013,305,$41.00 ,$41.00 ,$31.32 ,$36.90 ,$34.85 ,$34.85 ,$34.85 ,$36.08 ,$34.85 ,$36.08 ,$36.08 ,$35.67 ,$34.85 ,$34.85 ,$34.85 ,$31.32 ,$36.90
Carle Richland Memorial Hospital,8385001,LUPUS ANTICOAGULANT,,85613,305,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8385004,AUTOMATED DIFFERENTIAL WBC,,85004,305,$83.00 ,$83.00 ,$63.41 ,$74.70 ,$70.55 ,$70.55 ,$70.55 ,$73.04 ,$70.55 ,$73.04 ,$73.04 ,$72.21 ,$70.55 ,$70.55 ,$70.55 ,$63.41 ,$74.70
Carle Richland Memorial Hospital,8385009,MAN DIFF WBC COUNT BUFFY COAT,,85009,305,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8385012,URINE EOS,,85999,305,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8385013,SPUN MICROHEMATOCRIT,,85013,305,$68.00 ,$68.00 ,$51.95 ,$61.20 ,$57.80 ,$57.80 ,$57.80 ,$59.84 ,$57.80 ,$59.84 ,$59.84 ,$59.16 ,$57.80 ,$57.80 ,$57.80 ,$51.95 ,$61.20
Carle Richland Memorial Hospital,8385016,CBC W/AUTOMATED DIFFERENTIAL,,85025,305,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8385017,CBC W/O DIFFERENTIAL,,85027,305,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8385020,RED BLOOD CELL COUNT ONLY,,85041,305,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,8385030,WHITE CELL COUNT,,85048,305,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8385042,MANUAL DIFFERENTIAL WBC COUNT,,85007,305,$73.00 ,$73.00 ,$55.77 ,$65.70 ,$62.05 ,$62.05 ,$62.05 ,$64.24 ,$62.05 ,$64.24 ,$64.24 ,$63.51 ,$62.05 ,$62.05 ,$62.05 ,$55.77 ,$65.70
Carle Richland Memorial Hospital,8385050,HEMOGLOBIN,,85018,305,$85.00 ,$85.00 ,$64.94 ,$76.50 ,$72.25 ,$72.25 ,$72.25 ,$74.80 ,$72.25 ,$74.80 ,$74.80 ,$73.95 ,$72.25 ,$72.25 ,$72.25 ,$64.94 ,$76.50
Carle Richland Memorial Hospital,8385055,HEMATOCRIT,,85014,305,$43.00 ,$43.00 ,$32.85 ,$38.70 ,$36.55 ,$36.55 ,$36.55 ,$37.84 ,$36.55 ,$37.84 ,$37.84 ,$37.41 ,$36.55 ,$36.55 ,$36.55 ,$32.85 ,$38.70
Carle Richland Memorial Hospital,8385210,CLOTTING FACTOR II,,85210,305,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8385220,CLOTTING FACTOR V,,85220,305,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8385230,CLOTTING FACTOR VII,,85230,305,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8385240,CLOTTING FACTOR VIII,,85240,305,$470.00 ,$470.00 ,$359.08 ,$423.00 ,$399.50 ,$399.50 ,$399.50 ,$413.60 ,$399.50 ,$413.60 ,$413.60 ,$408.90 ,$399.50 ,$399.50 ,$399.50 ,$359.08 ,$423.00
Carle Richland Memorial Hospital,8385246,VW FACTOR ANTIGEN REF,,85246,305,$110.08 ,$110.08 ,$84.10 ,$99.07 ,$93.57 ,$93.57 ,$93.57 ,$96.87 ,$93.57 ,$96.87 ,$96.87 ,$95.77 ,$93.57 ,$93.57 ,$93.57 ,$84.10 ,$99.07
Carle Richland Memorial Hospital,8385250,CLOTTING FACTOR IX,,85250,305,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,8385260,CLOTTING FACTOR X,,85260,305,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8385307,ANTITHROMBINE III ACTIVITY,,85300,305,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8385310,"PROTEIN C, ACTIVITY",,85303,305,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8385350,EOSINOPHIL COUNT,,85999,305,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8385375,FIBRINOGEN,,85384,305,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8385392,"D-DIMER, ULTRASENSITIVE",,85379,305,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8385540,LEUKOCYTE ALKALINE PHOSPHATASE,,85540,305,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8385595,PLATELET PROFILE,,85049,305,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8385600,PLATELET AGGREGATION,,85576,305,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8385610,PROTHROMBIN TIME,,85610,305,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8385661,SICKLE CELL SCREEN,,85660,305,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,85014,HEMATOCRIT,,85014,305,$38.00 ,$38.00 ,$29.03 ,$34.20 ,$32.30 ,$32.30 ,$32.30 ,$33.44 ,$32.30 ,$33.44 ,$33.44 ,$33.06 ,$32.30 ,$32.30 ,$32.30 ,$29.03 ,$34.20
Carle Richland Memorial Hospital,85018,HEMOGLOBIN,,85018,305,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,8387001,"SUSCEPTIBILITY, DISK DIFFUSION",,87184,306,$92.00 ,$92.00 ,$70.29 ,$82.80 ,$78.20 ,$78.20 ,$78.20 ,$80.96 ,$78.20 ,$80.96 ,$80.96 ,$80.04 ,$78.20 ,$78.20 ,$78.20 ,$70.29 ,$82.80
Carle Richland Memorial Hospital,8387003,"FUNGAL IDENTIFICATION, YEAST",,87106,306,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8387010,"TISSUE EXAM, KOH MOUNT",,87220,306,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8387017,"CONCENTRATION, INFECT AGENTS",,87015,306,$86.00 ,$86.00 ,$65.70 ,$77.40 ,$73.10 ,$73.10 ,$73.10 ,$75.68 ,$73.10 ,$75.68 ,$75.68 ,$74.82 ,$73.10 ,$73.10 ,$73.10 ,$65.70 ,$77.40
Carle Richland Memorial Hospital,8387060,UPPER RESPIRATORY CULTURE,,87070,306,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8387066,BACT CULT QUANT AEROBIC W/ISO,,87071,306,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8387067,BACT CULT QUANT ANA W/ISO,,87073,306,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8387068,BACT CULT DEF ID AEROBIC,,87077,306,$78.00 ,$78.00 ,$59.59 ,$70.20 ,$66.30 ,$66.30 ,$66.30 ,$68.64 ,$66.30 ,$68.64 ,$68.64 ,$67.86 ,$66.30 ,$66.30 ,$66.30 ,$59.59 ,$70.20
Carle Richland Memorial Hospital,8387070,BACT CULT ISOL/PRESMPTV ID OTH,,87070,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8387071,ENVIRONMENTAL CULT/BACT,,87070,306,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8387077,BACT CULT DEF ID ANAEROBIC,,87076,306,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8387081,BACT CULTURE SCREENING ONLY,,87081,306,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8387085,BACT CULTURE SCREENING ONLY,,87081,306,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8387086,UREA TEST FOR H. PYLORI,,87077,306,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8387087,VRE SCREEN,,87081,306,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8387098,"FUNGUS CULT, DERMAL",,87101,306,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,8387107,"FUNGAL IDENTIFICATION, MOLD",,87107,306,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8387120,SENSITIVITY STUDIES,,87186,306,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8387168,MACROSCOPIC EXAM -ARTHROPOD,,87168,306,$90.00 ,$90.00 ,$68.76 ,$81.00 ,$76.50 ,$76.50 ,$76.50 ,$79.20 ,$76.50 ,$79.20 ,$79.20 ,$78.30 ,$76.50 ,$76.50 ,$76.50 ,$68.76 ,$81.00
Carle Richland Memorial Hospital,8387172,PIMWORM EXAM,,87172,306,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8387177,OVA AND PARASITE EXAM,,87177,306,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8387178,"AFB ID, DNA, PROBE TECH",,87149,306,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8387179,BETA LACTAMASE DETECTION,,87185,306,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,8387183,MIN BACTERIACIDAL LEVEL,,87187,306,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8387209,SMEAR -COMPLEX STAIN,,87209,306,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8387212,"WET MOUNT, PRIMARY SOURCE",,87210,306,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8387281,PNEUMOCYSTIS CARINII IMMFL TCH,,87281,306,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8387324,CLOSTRIDIUM DIFFICILE TOXIN A,,87324,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8387328,CRYPTOSPORIDIUM ANTIGEN,,87328,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8387329,GIARDIA ANTIGEN,,87329,306,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8387338,"H.PYLORI ANTIGEN, STOOL",,87338,306,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8387350,DARK FIELD EXAM,,87164,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8387420,RESPIRATORY SYNCYTIAL VIRUS,,87807,306,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8387449,LAB SERVICE,,87899,306,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8387451,GIARDIA/CRYPTOSPORIDIUM SCREEN,,87451,306,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8387491,LABORATORY TEST,,87491,306,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8387493,C DIFF TOXIN BY PCR,,87493,306,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8387522,HCV RNA BY PCR QUANT REF,,87522,306,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8387591,LABORATORY TEST,,87591,306,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8387640,STAPH AUREUS AMP PROBE,,87640,306,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8387641,STAPH AUREUS-METHICILLN RESIST,,87641,306,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8387880,"STREPTOCOCCUS, GROUP A",,87880,306,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8396935,FUNGAL SCRAPING & INTERP,,87106,306,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8381135,ID BY NUCLEIC ACID PROBE (EACH),,87150,306,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8381454,MYCOPLASMA PNEUMONIAE DNA,,87581,306,$435.00 ,$435.00 ,$332.34 ,$391.50 ,$369.75 ,$369.75 ,$369.75 ,$382.80 ,$369.75 ,$382.80 ,$382.80 ,$378.45 ,$369.75 ,$369.75 ,$369.75 ,$332.34 ,$391.50
Carle Richland Memorial Hospital,8381467,BORDETELLA PERTUSSIS DNA,,87798,306,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,8387502,HUMAN INFLUENZA A,,87502,306,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8387503,FLU A SUBTYPES,,87503,306,$86.00 ,$86.00 ,$65.70 ,$77.40 ,$73.10 ,$73.10 ,$73.10 ,$75.68 ,$73.10 ,$75.68 ,$75.68 ,$74.82 ,$73.10 ,$73.10 ,$73.10 ,$65.70 ,$77.40
Carle Richland Memorial Hospital,8389401,"HIV-1 RNA QUANT, BY PCR",,87536,306,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8380618,RNA QUANT BY PCR,,87522,306,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8381518,RESPIRATORY PATHOGENS PANEL (ITC LAB),,87633,306,"$3,630.00 ","$3,630.00 ","$2,773.32 ","$3,267.00 ","$3,085.50 ","$3,085.50 ","$3,085.50 ","$3,194.40 ","$3,085.50 ","$3,194.40 ","$3,194.40 ","$3,158.10 ","$3,085.50 ","$3,085.50 ","$3,085.50 ","$2,773.32 ","$3,267.00 "
Carle Richland Memorial Hospital,8381517,CPT-EBOLA ZAIRE VIRUS DNA (ITC LAB),,87150,306,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8381516,MALARIA ANTIGEN (ITC LAB),,87899,306,$73.00 ,$73.00 ,$55.77 ,$65.70 ,$62.05 ,$62.05 ,$62.05 ,$64.24 ,$62.05 ,$64.24 ,$64.24 ,$63.51 ,$62.05 ,$62.05 ,$62.05 ,$55.77 ,$65.70
Carle Richland Memorial Hospital,8381595,CPT-HCVGE 87902 BILLING,,87902,306,"$1,970.00 ","$1,970.00 ","$1,505.08 ","$1,773.00 ","$1,674.50 ","$1,674.50 ","$1,674.50 ","$1,733.60 ","$1,674.50 ","$1,733.60 ","$1,733.60 ","$1,713.90 ","$1,674.50 ","$1,674.50 ","$1,674.50 ","$1,505.08 ","$1,773.00 "
Carle Richland Memorial Hospital,8381521,MALARIA ANTIGEN,,87899,306,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8380617,HIV-1 RNA,,87536,306,"$1,100.00 ","$1,100.00 ",$840.40 ,$990.00 ,$935.00 ,$935.00 ,$935.00 ,$968.00 ,$935.00 ,$968.00 ,$968.00 ,$957.00 ,$935.00 ,$935.00 ,$935.00 ,$840.40 ,$990.00
Carle Richland Memorial Hospital,8381633,TRICHOMONAS RAPID ANTIGEN TEST,,87808,306,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8381634,BACTERIAL VAGINOSIS SCREEN,,87905,306,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8380682,"CPT-AMP PROBE, EACH ORG-ADENOVIRUS",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380683,"CPT-AMP PROBE, EACH ORG-CORONAV. 229E",,87798,306,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8380684,CPT AMP PROBE EACH ORG CORONAV HKU1,,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380685,"CPT-AMP PROBE, EACH ORG-CORONAV. NL63",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380686,"CPT-AMP PROBE, EACH ORG-CORONAV. OC43",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380687,"CPT-AMP PROBE, EACH ORG-METAPNEUM",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380688,"CPT-AMP PROBE, EACH ORG-RHINO/ENTERO",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380689,"CPT-INFLUENZA A VIRUS, FIRST 2 OR SUB-TYPES",,87502,306,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8380690,"CPT-INFLUENZA A H3 VIRUS, FIRST 2 OR SUB-TYPES",,87503,306,$76.00 ,$76.00 ,$58.06 ,$68.40 ,$64.60 ,$64.60 ,$64.60 ,$66.88 ,$64.60 ,$66.88 ,$66.88 ,$66.12 ,$64.60 ,$64.60 ,$64.60 ,$58.06 ,$68.40
Carle Richland Memorial Hospital,8380691,"CPT-INFLUENZA A 2009 VIRUS, FIRST 2 OR SUB-TYPES",,87503,306,$76.00 ,$76.00 ,$58.06 ,$68.40 ,$64.60 ,$64.60 ,$64.60 ,$66.88 ,$64.60 ,$66.88 ,$66.88 ,$66.12 ,$64.60 ,$64.60 ,$64.60 ,$58.06 ,$68.40
Carle Richland Memorial Hospital,8380692,"CPT-INFLUENZA A H1 VIRUS, FIRST 2 OR SUB-TYPES",,87503,306,$76.00 ,$76.00 ,$58.06 ,$68.40 ,$64.60 ,$64.60 ,$64.60 ,$66.88 ,$64.60 ,$66.88 ,$66.88 ,$66.12 ,$64.60 ,$64.60 ,$64.60 ,$58.06 ,$68.40
Carle Richland Memorial Hospital,8380693,"CPT-AMP PROBE, EACH ORG-PIV1",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380694,"CPT-AMP PROBE, EACH ORG-PIV2",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380695,"CPT-AMP PROBE, EACH ORG-PIV3",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380696,"CPT-AMP PROBE, EACH ORG-PIV4",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380697,"CPT-AMP PROBE, EACH ORG-RSV",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380698,"CPT-AMP PROBE, EACH ORG-PERTUSSIS",,87798,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8380699,CPT-AMP PROBE-CHLAMYDIAá PNEUMONIAE,,87486,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8380991,CPT-AMP PROBE-MYCO PNEUMONIAE,,87581,306,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8381694,"CPT-MENINGITIS PANEL, CSF",,87483,306,"$2,860.00 ","$2,860.00 ","$2,185.04 ","$2,574.00 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,516.80 ","$2,431.00 ","$2,516.80 ","$2,516.80 ","$2,488.20 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,185.04 ","$2,574.00 "
Carle Richland Memorial Hospital,8381771,CRYPTOCOCCAL ANTIGEN OR TITER,,87899,306,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8381081,CPT-87798-GPP-INF. AGENT DETC. BY AMP. PROBE,,87798,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8381082,"CPT-87493-GPP-C DIFF, TOXIN GENE, AMP PROBE",,87493,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8381124,LABORATORY SERVICE,,87899,306,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8381763,"BETA STREP GROUP B BY PCR, PRENATAL",,87150,306,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8381764,"BETA STREP GROUP B BY PCR, LABOR & DELIVERY",,87653,306,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8381963,C. DIFFICILE TOXIN EIA,,87324,306,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8382215,"HIV1/2 AG/AB,4 W/RFL",,87389,306,$245.00 ,$245.00 ,$187.18 ,$220.50 ,$208.25 ,$208.25 ,$208.25 ,$215.60 ,$208.25 ,$215.60 ,$215.60 ,$213.15 ,$208.25 ,$208.25 ,$208.25 ,$187.18 ,$220.50
Carle Richland Memorial Hospital,8382218,HEP B SURF AG W/CONF,,87340,306,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8382219,"CT/GC RNA,TMA,UROGEN",,87491,306,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382220,"CT/GC RNA,TMA,UROGEN",,87591,306,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382227,OVA AND PARASITE,,87177,306,$88.00 ,$88.00 ,$67.23 ,$79.20 ,$74.80 ,$74.80 ,$74.80 ,$77.44 ,$74.80 ,$77.44 ,$77.44 ,$76.56 ,$74.80 ,$74.80 ,$74.80 ,$67.23 ,$79.20
Carle Richland Memorial Hospital,8382228,OVA AND PARASITE,,87209,306,$88.00 ,$88.00 ,$67.23 ,$79.20 ,$74.80 ,$74.80 ,$74.80 ,$77.44 ,$74.80 ,$77.44 ,$77.44 ,$76.56 ,$74.80 ,$74.80 ,$74.80 ,$67.23 ,$79.20
Carle Richland Memorial Hospital,8382213,HPV RNA HR E6/E7 TMA,,87624,306,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8382289,MYCOBACT SM CULT,,87015,306,$78.00 ,$78.00 ,$59.59 ,$70.20 ,$66.30 ,$66.30 ,$66.30 ,$68.64 ,$66.30 ,$68.64 ,$68.64 ,$67.86 ,$66.30 ,$66.30 ,$66.30 ,$59.59 ,$70.20
Carle Richland Memorial Hospital,8382305,"BETA STREP GROUP B BY PCR, PRENATAL",,87653,306,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8382307,RSV Antigen,,87420,306,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8382317,GC - BACT CULTURE SCREENING,,87070,306,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8382318,STAPH - BACT CULTURE SCREENING,,87070,306,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8382319,VRE - BACT CULTURE SCREENING,,87070,306,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8382321,CARBA NP,,87185,306,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,8382322,CAMPY ANTIGEN,,87449,306,$92.00 ,$92.00 ,$70.29 ,$82.80 ,$78.20 ,$78.20 ,$78.20 ,$80.96 ,$78.20 ,$80.96 ,$80.96 ,$80.04 ,$78.20 ,$78.20 ,$78.20 ,$70.29 ,$82.80
Carle Richland Memorial Hospital,8382327,STREP SCREEN,,87651,306,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8382339,"CANDIDASIS DETECTION, EACH, REF",,87481,306,$62.50 ,$62.50 ,$47.75 ,$56.25 ,$53.13 ,$53.13 ,$53.13 ,$55.00 ,$53.13 ,$55.00 ,$55.00 ,$54.38 ,$53.13 ,$53.13 ,$53.13 ,$47.75 ,$56.25
Carle Richland Memorial Hospital,8382304,COVID,,87635,306,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8382378,"SARS-COV-2-RNA, PCR",,87635,306,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8382393,HCV GENOTYPE LIPA(R),,87902,306,$545.42 ,$545.42 ,$416.70 ,$490.88 ,$463.61 ,$463.61 ,$463.61 ,$479.97 ,$463.61 ,$479.97 ,$479.97 ,$474.52 ,$463.61 ,$463.61 ,$463.61 ,$416.70 ,$490.88
Carle Richland Memorial Hospital,8382394,TVAG RNA QL TMA,,87661,306,$416.27 ,$416.27 ,$318.03 ,$374.64 ,$353.83 ,$353.83 ,$353.83 ,$366.32 ,$353.83 ,$366.32 ,$366.32 ,$362.15 ,$353.83 ,$353.83 ,$353.83 ,$318.03 ,$374.64
Carle Richland Memorial Hospital,8382398,"HIV-1 RNA,QN,RT PCR",,87536,306,$233.64 ,$233.64 ,$178.50 ,$210.28 ,$198.59 ,$198.59 ,$198.59 ,$205.60 ,$198.59 ,$205.60 ,$205.60 ,$203.27 ,$198.59 ,$198.59 ,$198.59 ,$178.50 ,$210.28
Carle Richland Memorial Hospital,8382468,HISTOPLASMA QN AG,,87385,306,$96.25 ,$96.25 ,$73.54 ,$86.63 ,$81.81 ,$81.81 ,$81.81 ,$84.70 ,$81.81 ,$84.70 ,$84.70 ,$83.74 ,$81.81 ,$81.81 ,$81.81 ,$73.54 ,$86.63
Carle Richland Memorial Hospital,8382535,SARS-COV-2/FLU/RSV,,0241U,306,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8383187,SARS-COV-2/FLU,,0240U,306,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8287635,SARS-COV-2 COVID-19 AMP PRB,,87635,306,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8380023,INFEC AGEN DETEC AMPLI PROBE,,U0005,306,$90.00 ,$90.00 ,$68.76 ,$81.00 ,$76.50 ,$76.50 ,$76.50 ,$79.20 ,$76.50 ,$79.20 ,$79.20 ,$78.30 ,$76.50 ,$76.50 ,$76.50 ,$68.76 ,$81.00
Carle Richland Memorial Hospital,8287651,STRA-GROUP A STREP (POC),,87651,306,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8381231,"CPT-RPP-RESPIRATORY VIRUS, PROBE, 12-25 TARGETS",,0202U,306,"$1,660.00 ","$1,660.00 ","$1,268.24 ","$1,494.00 ","$1,411.00 ","$1,411.00 ","$1,411.00 ","$1,460.80 ","$1,411.00 ","$1,460.80 ","$1,460.80 ","$1,444.20 ","$1,411.00 ","$1,411.00 ","$1,411.00 ","$1,268.24 ","$1,494.00 "
Carle Richland Memorial Hospital,8381233,CPT-HPV HIGH RISK TYPES,,87624,306,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8380240,"BETA STREP, RAPID",,87430,306,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8387015,"CONCENTRATION, CYCLOSPORA REF",,87015,306,$4.19 ,$4.19 ,$3.20 ,$3.77 ,$3.56 ,$3.56 ,$3.56 ,$3.69 ,$3.56 ,$3.69 ,$3.69 ,$3.65 ,$3.56 ,$3.56 ,$3.56 ,$3.20 ,$3.77
Carle Richland Memorial Hospital,8380766,"WEST NILE VIRUS PCR, P REF",,87798,306,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8380135,CYTOMEG DNA - QUANT,,87497,306,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8380139,INFECTIOUS AGENT DETECTION,,87427,306,$92.00 ,$92.00 ,$70.29 ,$82.80 ,$78.20 ,$78.20 ,$78.20 ,$80.96 ,$78.20 ,$80.96 ,$80.96 ,$80.04 ,$78.20 ,$78.20 ,$78.20 ,$70.29 ,$82.80
Carle Richland Memorial Hospital,8380143,ENTEROVIRUS BY PCR,,87498,306,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8380146,AMPL PROBE EA ORG,,87798,306,$425.00 ,$425.00 ,$324.70 ,$382.50 ,$361.25 ,$361.25 ,$361.25 ,$374.00 ,$361.25 ,$374.00 ,$374.00 ,$369.75 ,$361.25 ,$361.25 ,$361.25 ,$324.70 ,$382.50
Carle Richland Memorial Hospital,8380149,AMP PROB TECH EA ORGANISM,,87150,306,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8380305,MRSA AMPI PROBE,,87641,306,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8380334,FLU A PANEL BY PCR,,87798,306,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,8385560,INFECTIOUS AGENT DETECTION,,87529,306,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8386287,HEPATITIS B SURFACE ANTIGEN,,87340,306,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8386308,INFECTIOUS AGNT ANTIGN FLU A/B,,87804,306,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,8386683,HEPATITIS BE ANTIGEN REF,,87350,306,$10.70 ,$10.70 ,$8.17 ,$9.63 ,$9.10 ,$9.10 ,$9.10 ,$9.42 ,$9.10 ,$9.42 ,$9.42 ,$9.31 ,$9.10 ,$9.10 ,$9.10 ,$8.17 ,$9.63
Carle Richland Memorial Hospital,87635,SARS-COV-2 COVID-19 AMP PRB,,87635,306,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,87220,TISSUE EXAM BY KOH,,87220,306,$61.00 ,$61.00 ,$46.60 ,$54.90 ,$51.85 ,$51.85 ,$51.85 ,$53.68 ,$51.85 ,$53.68 ,$53.68 ,$53.07 ,$51.85 ,$51.85 ,$51.85 ,$46.60 ,$54.90
Carle Richland Memorial Hospital,Q0112,Potassium hydroxide preps,,Q0112,306,$55.00 ,$55.00 ,$42.02 ,$49.50 ,$46.75 ,$46.75 ,$46.75 ,$48.40 ,$46.75 ,$48.40 ,$48.40 ,$47.85 ,$46.75 ,$46.75 ,$46.75 ,$42.02 ,$49.50
Carle Richland Memorial Hospital,87880,STREP A ASSAY W/OPTIC,,87880,306,$82.00 ,$82.00 ,$62.65 ,$73.80 ,$69.70 ,$69.70 ,$69.70 ,$72.16 ,$69.70 ,$72.16 ,$72.16 ,$71.34 ,$69.70 ,$69.70 ,$69.70 ,$62.65 ,$73.80
Carle Richland Memorial Hospital,87801,"DETECT AGENT, MULT ORGS, DNA, AMP",,87801,306,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,87808,TRICHOMONAS ASSAY W/OPTIC,,87808,306,$96.00 ,$96.00 ,$73.34 ,$86.40 ,$81.60 ,$81.60 ,$81.60 ,$84.48 ,$81.60 ,$84.48 ,$84.48 ,$83.52 ,$81.60 ,$81.60 ,$81.60 ,$73.34 ,$86.40
Carle Richland Memorial Hospital,87905,INFECT AGENT ENZYMATIC ACTIVITY NON-VIRUS,,87905,306,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8389060,CRYSTAL ID BY LIGHT MICROSCOPY,,89060,309,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8387140,DRA/LEGIONELLA PNEUMOPHILA,,87300,310,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8388106,"CYTOPATH FLUIDS/WASHINGS/BRUSHINGS, SMEARS W/INTERP",,88104,310,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8388173,FNA EVA INTER-REPORT,,88173,310,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8388316,SPECIAL STAIN-FROZN SECTIN REF,,88314,310,$66.00 ,$66.00 ,$50.42 ,$59.40 ,$56.10 ,$56.10 ,$56.10 ,$58.08 ,$56.10 ,$58.08 ,$58.08 ,$57.42 ,$56.10 ,$56.10 ,$56.10 ,$50.42 ,$59.40
Carle Richland Memorial Hospital,8388400,SURGICAL PATHOLOGY LEVEL -1,,88300,310,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8388402,SURGICAL PATHOLOGY LEVEL-II,,88302,310,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8388404,SURGI-PATHO LEVEL-III,,88304,310,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8388405,SURGICALPATHOLOGY LEVEL-IV,,88305,310,$425.00 ,$425.00 ,$324.70 ,$382.50 ,$361.25 ,$361.25 ,$361.25 ,$374.00 ,$361.25 ,$374.00 ,$374.00 ,$369.75 ,$361.25 ,$361.25 ,$361.25 ,$324.70 ,$382.50
Carle Richland Memorial Hospital,8388407,SURGICL PATHOLOGY LEVEL-V,,88307,310,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8388409,SURGICAL PATHOLOGYLEVEL-VI,,88309,310,$830.00 ,$830.00 ,$634.12 ,$747.00 ,$705.50 ,$705.50 ,$705.50 ,$730.40 ,$705.50 ,$730.40 ,$730.40 ,$722.10 ,$705.50 ,$705.50 ,$705.50 ,$634.12 ,$747.00
Carle Richland Memorial Hospital,8388411,DECALCIFICATION PROCEDURE,,88311,310,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8388431,"FROZEN SECTION, 1ST TISS BLOCK",,88331,310,$320.00 ,$320.00 ,$244.48 ,$288.00 ,$272.00 ,$272.00 ,$272.00 ,$281.60 ,$272.00 ,$281.60 ,$281.60 ,$278.40 ,$272.00 ,$272.00 ,$272.00 ,$244.48 ,$288.00
Carle Richland Memorial Hospital,8388432,"FROZEN SECTION, ADL TISS BLOCK",,88332,310,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8389180,BRONCIAL SPECIMENS W/STAIN,,88162,310,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,8380293,LAB/PATH TESTING,,81220,310,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8381757,Hc Hla B27 Antigen,,81374,310,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,8381976,"BRAF GENE ANALYSIS, V600 VARIANT(S)",,81210,310,"$1,170.00 ","$1,170.00 ",$893.88 ,"$1,053.00 ",$994.50 ,$994.50 ,$994.50 ,"$1,029.60 ",$994.50 ,"$1,029.60 ","$1,029.60 ","$1,017.90 ",$994.50 ,$994.50 ,$994.50 ,$893.88 ,"$1,053.00 "
Carle Richland Memorial Hospital,8381977,MSI ANALYSIS,,81301,310,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,8382252,MATERNAL SERUM 4,,81511,310,"$1,040.00 ","$1,040.00 ",$794.56 ,$936.00 ,$884.00 ,$884.00 ,$884.00 ,$915.20 ,$884.00 ,$915.20 ,$915.20 ,$904.80 ,$884.00 ,$884.00 ,$884.00 ,$794.56 ,$936.00
Carle Richland Memorial Hospital,8382292,QNATAL(TM) ADVANCED,,81420,310,"$2,860.00 ","$2,860.00 ","$2,185.04 ","$2,574.00 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,516.80 ","$2,431.00 ","$2,516.80 ","$2,516.80 ","$2,488.20 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,185.04 ","$2,574.00 "
Carle Richland Memorial Hospital,8382369,SARS-COV-2 BY NUCLEIC ACID,,U0003,310,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8382387,FACTOR V (LEIDEN),,81241,310,$382.88 ,$382.88 ,$292.52 ,$344.59 ,$325.45 ,$325.45 ,$325.45 ,$336.93 ,$325.45 ,$336.93 ,$336.93 ,$333.11 ,$325.45 ,$325.45 ,$325.45 ,$292.52 ,$344.59
Carle Richland Memorial Hospital,8382389,PROTHROMBIN GENE,,81240,310,$240.67 ,$240.67 ,$183.87 ,$216.60 ,$204.57 ,$204.57 ,$204.57 ,$211.79 ,$204.57 ,$211.79 ,$211.79 ,$209.38 ,$204.57 ,$204.57 ,$204.57 ,$183.87 ,$216.60
Carle Richland Memorial Hospital,8382407,LIVER FIBROSIS,,81596,310,$277.20 ,$277.20 ,$211.78 ,$249.48 ,$235.62 ,$235.62 ,$235.62 ,$243.94 ,$235.62 ,$243.94 ,$243.94 ,$241.16 ,$235.62 ,$235.62 ,$235.62 ,$211.78 ,$249.48
Carle Richland Memorial Hospital,8382554,"JAK-2 V617 MUTATION, B",,81270,310,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8389006,CYTOGENETICS INTERP/REPORT,,88289,310,$246.14 ,$246.14 ,$188.05 ,$221.53 ,$209.22 ,$209.22 ,$209.22 ,$216.60 ,$209.22 ,$216.60 ,$216.60 ,$214.14 ,$209.22 ,$209.22 ,$209.22 ,$188.05 ,$221.53
Carle Richland Memorial Hospital,8382786,"BCR-ABL 1 GENE REARRANGEMENT, QUANT, PCR, B [REF]",,81206,310,$170.55 ,$170.55 ,$130.30 ,$153.50 ,$144.97 ,$144.97 ,$144.97 ,$150.08 ,$144.97 ,$150.08 ,$150.08 ,$148.38 ,$144.97 ,$144.97 ,$144.97 ,$130.30 ,$153.50
Carle Richland Memorial Hospital,8382788,"P190 BCR ABL1, B [REF]",,81207,310,$118.00 ,$118.00 ,$90.15 ,$106.20 ,$100.30 ,$100.30 ,$100.30 ,$103.84 ,$100.30 ,$103.84 ,$103.84 ,$102.66 ,$100.30 ,$100.30 ,$100.30 ,$90.15 ,$106.20
Carle Richland Memorial Hospital,8382789,"P210 BCR ABL1, B [REF]",,81206,310,$114.05 ,$114.05 ,$87.13 ,$102.65 ,$96.94 ,$96.94 ,$96.94 ,$100.36 ,$96.94 ,$100.36 ,$100.36 ,$99.22 ,$96.94 ,$96.94 ,$96.94 ,$87.13 ,$102.65
Carle Richland Memorial Hospital,8382194,"IGH GENE REARRANGE AMP METH, REF",,81261,310,$202.54 ,$202.54 ,$154.74 ,$182.29 ,$172.16 ,$172.16 ,$172.16 ,$178.24 ,$172.16 ,$178.24 ,$178.24 ,$176.21 ,$172.16 ,$172.16 ,$172.16 ,$154.74 ,$182.29
Carle Richland Memorial Hospital,8382193,"IGK REARRANGEABN CLONAL POP, REF",,81264,310,$176.70 ,$176.70 ,$135.00 ,$159.03 ,$150.20 ,$150.20 ,$150.20 ,$155.50 ,$150.20 ,$155.50 ,$155.50 ,$153.73 ,$150.20 ,$150.20 ,$150.20 ,$135.00 ,$159.03
Carle Richland Memorial Hospital,8383116,SARS-COV-2/FLU A/ FLU B PCR,,87636,310,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,8381232,"CPT-GPP-GI PATHOGEN, PROBE, 12-25 TARGETS",,0097U,310,"$2,990.00 ","$2,990.00 ","$2,284.36 ","$2,691.00 ","$2,541.50 ","$2,541.50 ","$2,541.50 ","$2,631.20 ","$2,541.50 ","$2,631.20 ","$2,631.20 ","$2,601.30 ","$2,541.50 ","$2,541.50 ","$2,541.50 ","$2,284.36 ","$2,691.00 "
Carle Richland Memorial Hospital,Q0111,Wet mounts/ w preparations,,Q0111,310,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8388108,"CYTOPATHOLOGY, CONCENTRATION T",,88108,311,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8388109,CHROMOSOME ANALYSIS REF,,88262,311,$246.14 ,$246.14 ,$188.05 ,$221.53 ,$209.22 ,$209.22 ,$209.22 ,$216.60 ,$209.22 ,$216.60 ,$216.60 ,$214.14 ,$209.22 ,$209.22 ,$209.22 ,$188.05 ,$221.53
Carle Richland Memorial Hospital,8388112,CYTO LIQUID-BASED MONO LAYER,,88112,311,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8388142,DX CYTO PATH-ML CX /VAG,,88142,311,$29.00 ,$29.00 ,$22.16 ,$26.10 ,$24.65 ,$24.65 ,$24.65 ,$25.52 ,$24.65 ,$25.52 ,$25.52 ,$25.23 ,$24.65 ,$24.65 ,$24.65 ,$22.16 ,$26.10
Carle Richland Memorial Hospital,8388145,TOUCH PREP CYTOLOGY,,88161,311,$78.00 ,$78.00 ,$59.59 ,$70.20 ,$66.30 ,$66.30 ,$66.30 ,$68.64 ,$66.30 ,$68.64 ,$68.64 ,$67.86 ,$66.30 ,$66.30 ,$66.30 ,$59.59 ,$70.20
Carle Richland Memorial Hospital,8388233,TISSUE CULTURE -SKIN BIOPSY RF,,88233,311,$187.95 ,$187.95 ,$143.59 ,$169.16 ,$159.76 ,$159.76 ,$159.76 ,$165.40 ,$159.76 ,$165.40 ,$165.40 ,$163.52 ,$159.76 ,$159.76 ,$159.76 ,$143.59 ,$169.16
Carle Richland Memorial Hospital,8388268,CHROM ANALYSIS W/BANDING REF,,88262,311,$187.96 ,$187.96 ,$143.60 ,$169.16 ,$159.77 ,$159.77 ,$159.77 ,$165.40 ,$159.77 ,$165.40 ,$165.40 ,$163.53 ,$159.77 ,$159.77 ,$159.77 ,$143.60 ,$169.16
Carle Richland Memorial Hospital,8389007,CYTO/MOLE GENETICS INTER REF,,88291,311,$187.96 ,$187.96 ,$143.60 ,$169.16 ,$159.77 ,$159.77 ,$159.77 ,$165.40 ,$159.77 ,$165.40 ,$165.40 ,$163.53 ,$159.77 ,$159.77 ,$159.77 ,$143.60 ,$169.16
Carle Richland Memorial Hospital,8382335,"CYTOPATHOLOGY, SCREENING THIN PREP, REF",,88175,311,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8382560,"CYTOGENETICS, 100-300, REF",,88275,311,$25.12 ,$25.12 ,$19.19 ,$22.61 ,$21.35 ,$21.35 ,$21.35 ,$22.11 ,$21.35 ,$22.11 ,$22.11 ,$21.85 ,$21.35 ,$21.35 ,$21.35 ,$19.19 ,$22.61
Carle Richland Memorial Hospital,8382561,"CYTOGENETICS DNA PROBE, REF",,88271,311,$60.03 ,$60.03 ,$45.86 ,$54.03 ,$51.03 ,$51.03 ,$51.03 ,$52.83 ,$51.03 ,$52.83 ,$52.83 ,$52.23 ,$51.03 ,$51.03 ,$51.03 ,$45.86 ,$54.03
Carle Richland Memorial Hospital,8382567,"FISH, CML/ALL, BCR/ABL TRANSLOCATION 9,22",,88275,311,$106.66 ,$106.66 ,$81.49 ,$95.99 ,$90.66 ,$90.66 ,$90.66 ,$93.86 ,$90.66 ,$93.86 ,$93.86 ,$92.79 ,$90.66 ,$90.66 ,$90.66 ,$81.49 ,$95.99
Carle Richland Memorial Hospital,8382566,CPT-MOLECULAR CYTOGENETICS PROBE,,88271,311,$106.67 ,$106.67 ,$81.50 ,$96.00 ,$90.67 ,$90.67 ,$90.67 ,$93.87 ,$90.67 ,$93.87 ,$93.87 ,$92.80 ,$90.67 ,$90.67 ,$90.67 ,$81.50 ,$96.00
Carle Richland Memorial Hospital,8382599,"PAROXYSMAL NOCTURNAL HEMOGLOBINURIA INTERP W/FLAER, B [REF]",,88187,311,$112.00 ,$112.00 ,$85.57 ,$100.80 ,$95.20 ,$95.20 ,$95.20 ,$98.56 ,$95.20 ,$98.56 ,$98.56 ,$97.44 ,$95.20 ,$95.20 ,$95.20 ,$85.57 ,$100.80
Carle Richland Memorial Hospital,8382793,"PAROXYSMAL NOCTURNAL HEMOGLOBINURIA VIAB W/FLAER, B [REF]",,88184,311,$112.00 ,$112.00 ,$85.57 ,$100.80 ,$95.20 ,$95.20 ,$95.20 ,$98.56 ,$95.20 ,$98.56 ,$98.56 ,$97.44 ,$95.20 ,$95.20 ,$95.20 ,$85.57 ,$100.80
Carle Richland Memorial Hospital,8382602,"PAROXYSMAL NOCTURNAL HEMOGLOBINURIA EA ADD MARK W/FLAER, B [REF]",,88185,311,$112.00 ,$112.00 ,$85.57 ,$100.80 ,$95.20 ,$95.20 ,$95.20 ,$98.56 ,$95.20 ,$98.56 ,$98.56 ,$97.44 ,$95.20 ,$95.20 ,$95.20 ,$85.57 ,$100.80
Carle Richland Memorial Hospital,8383870,TISSUE CULTURE REF,,88230,311,$246.14 ,$246.14 ,$188.05 ,$221.53 ,$209.22 ,$209.22 ,$209.22 ,$216.60 ,$209.22 ,$216.60 ,$216.60 ,$214.14 ,$209.22 ,$209.22 ,$209.22 ,$188.05 ,$221.53
Carle Richland Memorial Hospital,8386096,"DIAG CYTOL-ML; AUTO, MNL RESCN",,88175,311,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8388312,SPECIAL STAINS -GROUP I,,88312,312,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8388313,SPECIAL STAINS -GROUP II,,88313,312,$430.00 ,$430.00 ,$328.52 ,$387.00 ,$365.50 ,$365.50 ,$365.50 ,$378.40 ,$365.50 ,$378.40 ,$378.40 ,$374.10 ,$365.50 ,$365.50 ,$365.50 ,$328.52 ,$387.00
Carle Richland Memorial Hospital,8388334,INTRAOPERATIVE PATHOLOGY EXAM,,88334,312,$75.00 ,$75.00 ,$57.30 ,$67.50 ,$63.75 ,$63.75 ,$63.75 ,$66.00 ,$63.75 ,$66.00 ,$66.00 ,$65.25 ,$63.75 ,$63.75 ,$63.75 ,$57.30 ,$67.50
Carle Richland Memorial Hospital,8388381,MICRODISSECTION MANUAL,,88381,312,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8388413,SPECIAL STAINS -GROUP II,,88313,312,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8388442,IMMUNOCHEM ANTIBODY,,88342,312,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,8388341,IHC EA ADDTL SINGLE AB STAIN PROCEDURE,,88341,312,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8381196,"PROSTATE NEEDLE BX SPECIMENS, ANY METHOD",,G0416,314,"$1,060.00 ","$1,060.00 ",$809.84 ,$954.00 ,$901.00 ,$901.00 ,$901.00 ,$932.80 ,$901.00 ,$932.80 ,$932.80 ,$922.20 ,$901.00 ,$901.00 ,$901.00 ,$809.84 ,$954.00
Carle Richland Memorial Hospital,8473525,HIP ARTHROGRAPHY S&I,,73525,320,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8477081,"DEXA,BONE DENSITY, 1 OR > SITE, APNDCLR SKELTN",,77081,320,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8470328,TMJ XRAYS -UNILATERAL,,70328,320,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8474740,HYSTEROSALPINGOGRAPHY S & I,,74740,320,$920.00 ,$920.00 ,$702.88 ,$828.00 ,$782.00 ,$782.00 ,$782.00 ,$809.60 ,$782.00 ,$809.60 ,$809.60 ,$800.40 ,$782.00 ,$782.00 ,$782.00 ,$702.88 ,$828.00
Carle Richland Memorial Hospital,8473615,ANKLE ARTHROGRAPHY S&I,,73615,320,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8472202,SACROILIAC JOINTS 3 OR MORE VIEWS,,72202,320,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,8477073,BONE LENGTH STUDIES,,77073,320,$405.00 ,$405.00 ,$309.42 ,$364.50 ,$344.25 ,$344.25 ,$344.25 ,$356.40 ,$344.25 ,$356.40 ,$356.40 ,$352.35 ,$344.25 ,$344.25 ,$344.25 ,$309.42 ,$364.50
Carle Richland Memorial Hospital,8472081,CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW,,72081,320,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,8472082,CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW,,72082,320,"$1,080.00 ","$1,080.00 ",$825.12 ,$972.00 ,$918.00 ,$918.00 ,$918.00 ,$950.40 ,$918.00 ,$950.40 ,$950.40 ,$939.60 ,$918.00 ,$918.00 ,$918.00 ,$825.12 ,$972.00
Carle Richland Memorial Hospital,8473501,CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,,73501,320,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,8473502,CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,,73502,320,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,8473503,CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS,,73503,320,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,8473521,CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,,73521,320,"$1,310.00 ","$1,310.00 ","$1,000.84 ","$1,179.00 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,152.80 ","$1,113.50 ","$1,152.80 ","$1,152.80 ","$1,139.70 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,000.84 ","$1,179.00 "
Carle Richland Memorial Hospital,8473522,CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,,73522,320,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,8473523,CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS,,73523,320,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,8473551,CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW,,73551,320,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,8473552,CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,,73552,320,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,8470030,EYE/ORBIT XRAY,,70030,320,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8470130,X-RAY MASTOIDS 3+ VW,,70130,320,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,8471045,RADIOLOGIC EXAM CHEST SINGLE VIEW,,71045,320,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,8471046,RADIOLOGIC EXAM CHEST 2 VIEWS,,71046,320,$450.00 ,$450.00 ,$343.80 ,$405.00 ,$382.50 ,$382.50 ,$382.50 ,$396.00 ,$382.50 ,$396.00 ,$396.00 ,$391.50 ,$382.50 ,$382.50 ,$382.50 ,$343.80 ,$405.00
Carle Richland Memorial Hospital,8471047,RADIOLOGIC EXAM CHEST 3 VIEWS,,71047,320,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8471048,RADIOLOGIC EXAM CHEST 4+ VIEWS,,71048,320,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,8474018,RADIOLOGIC EXAM ABDOMEN 1 VIEW,,74018,320,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8474019,RADIOLOGIC EXAM ABDOMEN 2 VIEWS,,74019,320,$930.00 ,$930.00 ,$710.52 ,$837.00 ,$790.50 ,$790.50 ,$790.50 ,$818.40 ,$790.50 ,$818.40 ,$818.40 ,$809.10 ,$790.50 ,$790.50 ,$790.50 ,$710.52 ,$837.00
Carle Richland Memorial Hospital,8474021,RADIOLOGIC EXAM ABDOMEN 3+ VIEWS,,74021,320,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8473085,ARTHROGRAM OF ELBOW,,73085,320,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8447531,NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS,,47531,320,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8427096,GD SI JOINT INJECTION,,27096,320,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,8447501,GD CHOLANG T-TBE INJ,,47505,320,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,8447532,GD CHOLANG-IVC 7,,47532,320,"$1,160.00 ","$1,160.00 ",$886.24 ,"$1,044.00 ",$986.00 ,$986.00 ,$986.00 ,"$1,020.80 ",$986.00 ,"$1,020.80 ","$1,020.80 ","$1,009.20 ",$986.00 ,$986.00 ,$986.00 ,$886.24 ,"$1,044.00 "
Carle Richland Memorial Hospital,8450435,GD GB TUBE CHANGE,,50435,320,"$4,600.00 ","$4,600.00 ","$3,514.40 ","$4,140.00 ","$3,910.00 ","$3,910.00 ","$3,910.00 ","$4,048.00 ","$3,910.00 ","$4,048.00 ","$4,048.00 ","$4,002.00 ","$3,910.00 ","$3,910.00 ","$3,910.00 ","$3,514.40 ","$4,140.00 "
Carle Richland Memorial Hospital,8470380,GD SALIVA GLAND/DUCT,,70380,320,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,8475984,GD KIDNEY NEPHRO TUBE PLACEMENT,,75984,320,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,8477053,MAMMOGRAPHY DUCTOGRAM SINGLE,,77053,320,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8477054,MAMMOGRAPHY DUCTOGRAM MULTIPLE,,77054,320,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8470100,MANDIBLE XRAYS <4 VIEWS,,70100,320,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,8470110,MANDIBLE XRAYS 4/> VIEWS,,70110,320,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,8470140,FACIAL BONES XRAYS <3 VIEWS,,70140,320,$435.00 ,$435.00 ,$332.34 ,$391.50 ,$369.75 ,$369.75 ,$369.75 ,$382.80 ,$369.75 ,$382.80 ,$382.80 ,$378.45 ,$369.75 ,$369.75 ,$369.75 ,$332.34 ,$391.50
Carle Richland Memorial Hospital,8470150,FACIAL BONES XRAYS 3/> VIEWS,,70150,320,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,8470160,NASAL BONES XRAYS 3/> VIEWS,,70160,320,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8470190,OPTIC FORAMINA XRAYS,,70190,320,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,8470200,ORBITS XRAYS 4/> VIEWS,,70200,320,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8470210,SINUS/PARANASAL XRAYS <3 VIEWS,,70210,320,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,8470220,SINUS/PARANASAL XRAYS 3/> VWS,,70220,320,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8470240,SELLA TURCICA XRAYS,,70240,320,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8470250,SKULL XRAYS <4 VIEWS,,70250,320,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8477071,MANUAL APPL STRESS JOINT RADIOGRAPHY,,77071,320,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8470260,SKULL XRAYS 4/> VIEWS,,70260,320,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,8470330,TMJ XRAYS -BILATERAL,,70330,320,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,8470360,NECK TISSUE XRAY,,70360,320,"$1,020.00 ","$1,020.00 ",$779.28 ,$918.00 ,$867.00 ,$867.00 ,$867.00 ,$897.60 ,$867.00 ,$897.60 ,$897.60 ,$887.40 ,$867.00 ,$867.00 ,$867.00 ,$779.28 ,$918.00
Carle Richland Memorial Hospital,8476145,MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT,,76145,320,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8471020,CHEST XRAY PA & LATERAL VIEWS,,71020,320,$450.00 ,$450.00 ,$343.80 ,$405.00 ,$382.50 ,$382.50 ,$382.50 ,$396.00 ,$382.50 ,$396.00 ,$396.00 ,$391.50 ,$382.50 ,$382.50 ,$382.50 ,$343.80 ,$405.00
Carle Richland Memorial Hospital,8471100,RIB XRAY UNILATERAL 2 VIEWS,,71100,320,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8471101,RIB XRAY UNI W/PA CHEST 3/> VW,,71101,320,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8471110,RIB XRAYS BILATERAL 3 VIEWS,,71110,320,"$1,040.00 ","$1,040.00 ",$794.56 ,$936.00 ,$884.00 ,$884.00 ,$884.00 ,$915.20 ,$884.00 ,$915.20 ,$915.20 ,$904.80 ,$884.00 ,$884.00 ,$884.00 ,$794.56 ,$936.00
Carle Richland Memorial Hospital,8471111,RIB XRAY BIL W/PA CHEST 4/>VWS,,71111,320,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,8471120,STERNUM XRAYS 2/> VIEWS,,71120,320,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8471130,STERNOCLAVICULAR XRAYS 3/> VWS,,71130,320,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8472020,SPINE XRAY SINGLE VIEW,,72020,320,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8472040,CERVICAL SPINE XRAYS 2-3 VIEWS,,72040,320,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8472050,CERVICAL SPINE XRAYS 4/> VIEWS,,72050,320,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,8472052,CERV SPINE XRAYS W/OBL/FLX/EXT,,72052,320,"$1,210.00 ","$1,210.00 ",$924.44 ,"$1,089.00 ","$1,028.50 ","$1,028.50 ","$1,028.50 ","$1,064.80 ","$1,028.50 ","$1,064.80 ","$1,064.80 ","$1,052.70 ","$1,028.50 ","$1,028.50 ","$1,028.50 ",$924.44 ,"$1,089.00 "
Carle Richland Memorial Hospital,8472070,THORACIC SPINE XRAYS 2 VIEWS,,72070,320,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8472072,THORACIC SPINE XRAYS 3 VIEWS,,72072,320,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,8472074,THORACIC SPINE XRAYS 4/> VIEWS,,72074,320,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,8472080,THORACOLUMBAR XRAYS 2 VIEWS,,72080,320,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8472100,LUMBOSACRAL XRAYS 2-3 VIEWS,,72100,320,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8472110,LUMBOSACRAL XRAYS 4/> VIEWS,,72110,320,"$1,100.00 ","$1,100.00 ",$840.40 ,$990.00 ,$935.00 ,$935.00 ,$935.00 ,$968.00 ,$935.00 ,$968.00 ,$968.00 ,$957.00 ,$935.00 ,$935.00 ,$935.00 ,$840.40 ,$990.00
Carle Richland Memorial Hospital,8472114,LUMBOSACRAL XRAYS W/BENDING VW,,72114,320,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,8472120,LUMBOSACRAL BENDING VIEWS ONLY,,72120,320,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8472170,PELVIS XRAYS 1-2 VIEWS,,72170,320,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8472190,PELVIS XRAYS 3/> VIEWS,,72190,320,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,8472200,SACROILIAC JOINTS XRAYS <3 VWS,,72200,320,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,8472220,SACRUM & COCCYX XRAYS 2/> VWS,,72220,320,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,8472240,MYELOGRAM - CERVICAL SPINE S&I,,72240,320,"$2,270.00 ","$2,270.00 ","$1,734.28 ","$2,043.00 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,997.60 ","$1,929.50 ","$1,997.60 ","$1,997.60 ","$1,974.90 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,734.28 ","$2,043.00 "
Carle Richland Memorial Hospital,8472255,MYELOGRAM -THORACIC SPINE S&I,,72255,320,"$2,270.00 ","$2,270.00 ","$1,734.28 ","$2,043.00 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,997.60 ","$1,929.50 ","$1,997.60 ","$1,997.60 ","$1,974.90 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,734.28 ","$2,043.00 "
Carle Richland Memorial Hospital,8472265,MYELOGRAM -LUMBAR SPINE S&I,,72265,320,"$2,270.00 ","$2,270.00 ","$1,734.28 ","$2,043.00 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,997.60 ","$1,929.50 ","$1,997.60 ","$1,997.60 ","$1,974.90 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,734.28 ","$2,043.00 "
Carle Richland Memorial Hospital,8473000,CLAVICLE XRAYS,,73000,320,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,8473010,SCAPULA XRAYS,,73010,320,$800.00 ,$800.00 ,$611.20 ,$720.00 ,$680.00 ,$680.00 ,$680.00 ,$704.00 ,$680.00 ,$704.00 ,$704.00 ,$696.00 ,$680.00 ,$680.00 ,$680.00 ,$611.20 ,$720.00
Carle Richland Memorial Hospital,8473020,SHOULDER XRAY 1 VIEW,,73020,320,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,8473030,SHOULDER XRAYS 2/> VIEWS,,73030,320,$750.00 ,$750.00 ,$573.00 ,$675.00 ,$637.50 ,$637.50 ,$637.50 ,$660.00 ,$637.50 ,$660.00 ,$660.00 ,$652.50 ,$637.50 ,$637.50 ,$637.50 ,$573.00 ,$675.00
Carle Richland Memorial Hospital,8473040,ARTHROGRAM -SHOULDER S&I,,73040,320,"$1,100.00 ","$1,100.00 ",$840.40 ,$990.00 ,$935.00 ,$935.00 ,$935.00 ,$968.00 ,$935.00 ,$968.00 ,$968.00 ,$957.00 ,$935.00 ,$935.00 ,$935.00 ,$840.40 ,$990.00
Carle Richland Memorial Hospital,8473050,A-C JOINT XRAYS BILAT W/WO WTS,,73050,320,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,8473060,HUMERUS XRAYS 2/> VIEWS,,73060,320,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,8473070,ELBOW XRAYS 2 VIEWS,,73070,320,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,8473080,ELBOW XRAYS 3/> VIEWS,,73080,320,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,8473090,FOREARM XRAYS 2 VIEWS,,73090,320,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8473092,ARM XRAY INFANT 2/> VIEWS,,73092,320,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8473100,WRIST XRAYS 2 VIEWS,,73100,320,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,8473110,WRIST XRAYS 3/> VIEWS,,73110,320,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8473120,HAND XRAYS 2 VIEWS,,73120,320,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8473130,HAND XRAYS 3/> VIEWS,,73130,320,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8473140,FINGER(S) XRAYS 2/> VIEWS,,73140,320,$430.00 ,$430.00 ,$328.52 ,$387.00 ,$365.50 ,$365.50 ,$365.50 ,$378.40 ,$365.50 ,$378.40 ,$378.40 ,$374.10 ,$365.50 ,$365.50 ,$365.50 ,$328.52 ,$387.00
Carle Richland Memorial Hospital,8473560,KNEE XRAYS 1-2 VIEWS,,73560,320,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8473562,KNEE XRAYS 3 VIEWS,,73562,320,$750.00 ,$750.00 ,$573.00 ,$675.00 ,$637.50 ,$637.50 ,$637.50 ,$660.00 ,$637.50 ,$660.00 ,$660.00 ,$652.50 ,$637.50 ,$637.50 ,$637.50 ,$573.00 ,$675.00
Carle Richland Memorial Hospital,8473564,KNEE XRAYS 4/> VIEWS,,73564,320,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8473565,KNEES XRAY AP STANDING,,73565,320,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8473590,LOWER LEG XRAYS 2 VIEWS,,73590,320,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8473592,LEG XRAY INFANT 2/> VIEWS,,73592,320,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8473600,ANKLE XRAYS 2 VIEWS,,73600,320,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,8473610,ANKLE XRAYS 3/> VIEWS,,73610,320,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8473620,FOOT XRAYS 2 VIEWS,,73620,320,$430.00 ,$430.00 ,$328.52 ,$387.00 ,$365.50 ,$365.50 ,$365.50 ,$378.40 ,$365.50 ,$378.40 ,$378.40 ,$374.10 ,$365.50 ,$365.50 ,$365.50 ,$328.52 ,$387.00
Carle Richland Memorial Hospital,8473630,FOOT XRAYS 3/> VIEWS,,73630,320,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8473650,HEEL XRAYS 2/> VIEWS,,73650,320,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8473660,TOE(S) XRAYS 2/> VIEWS,,73660,320,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,8474020,ABDOMEN XRAYS -COMPLETE STUDY,,74020,320,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8474022,ABDOMEN XRAYS W/PA CHEST XRAY,,74022,320,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8474220,ESOPHAGUS XRAYS,,74220,320,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,8474230,SWALLOWING FUNCTION XRAY,,74230,320,"$1,300.00 ","$1,300.00 ",$993.20 ,"$1,170.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ","$1,144.00 ","$1,105.00 ","$1,144.00 ","$1,144.00 ","$1,131.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ",$993.20 ,"$1,170.00 "
Carle Richland Memorial Hospital,8474240,UPPER GI (STOMACH) XRAYS,,74240,320,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,8474245,UPPER GI W/SML INTESTINE XRAYS,,74245,320,"$2,190.00 ","$2,190.00 ","$1,673.16 ","$1,971.00 ","$1,861.50 ","$1,861.50 ","$1,861.50 ","$1,927.20 ","$1,861.50 ","$1,927.20 ","$1,927.20 ","$1,905.30 ","$1,861.50 ","$1,861.50 ","$1,861.50 ","$1,673.16 ","$1,971.00 "
Carle Richland Memorial Hospital,8474246,UPPER GI XRAYS W/AIR CONTRAST,,74246,320,"$1,100.00 ","$1,100.00 ",$840.40 ,$990.00 ,$935.00 ,$935.00 ,$935.00 ,$968.00 ,$935.00 ,$968.00 ,$968.00 ,$957.00 ,$935.00 ,$935.00 ,$935.00 ,$840.40 ,$990.00
Carle Richland Memorial Hospital,8474250,SMALL INTESTINE XRAYS,,74250,320,"$1,530.00 ","$1,530.00 ","$1,168.92 ","$1,377.00 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,346.40 ","$1,300.50 ","$1,346.40 ","$1,346.40 ","$1,331.10 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,168.92 ","$1,377.00 "
Carle Richland Memorial Hospital,8474251,SMALL INTESTINE XRAYS -EC TUBE,,74251,320,"$2,190.00 ","$2,190.00 ","$1,673.16 ","$1,971.00 ","$1,861.50 ","$1,861.50 ","$1,861.50 ","$1,927.20 ","$1,861.50 ","$1,927.20 ","$1,927.20 ","$1,905.30 ","$1,861.50 ","$1,861.50 ","$1,861.50 ","$1,673.16 ","$1,971.00 "
Carle Richland Memorial Hospital,8474270,RAD EXAM COLON CONTRAST ENEMA,,74270,320,"$1,070.00 ","$1,070.00 ",$817.48 ,$963.00 ,$909.50 ,$909.50 ,$909.50 ,$941.60 ,$909.50 ,$941.60 ,$941.60 ,$930.90 ,$909.50 ,$909.50 ,$909.50 ,$817.48 ,$963.00
Carle Richland Memorial Hospital,8474280,COLON XRAYS W/AIR CONTRAST,,74280,320,"$1,330.00 ","$1,330.00 ","$1,016.12 ","$1,197.00 ","$1,130.50 ","$1,130.50 ","$1,130.50 ","$1,170.40 ","$1,130.50 ","$1,170.40 ","$1,170.40 ","$1,157.10 ","$1,130.50 ","$1,130.50 ","$1,130.50 ","$1,016.12 ","$1,197.00 "
Carle Richland Memorial Hospital,8474300,CHOLANGIOGRPHY -INTRAOPERATIVE,,74300,320,"$1,640.00 ","$1,640.00 ","$1,252.96 ","$1,476.00 ","$1,394.00 ","$1,394.00 ","$1,394.00 ","$1,443.20 ","$1,394.00 ","$1,443.20 ","$1,443.20 ","$1,426.80 ","$1,394.00 ","$1,394.00 ","$1,394.00 ","$1,252.96 ","$1,476.00 "
Carle Richland Memorial Hospital,8474400,IVP (INTRAVENOUS PYELOGRAM),,74400,320,"$1,280.00 ","$1,280.00 ",$977.92 ,"$1,152.00 ","$1,088.00 ","$1,088.00 ","$1,088.00 ","$1,126.40 ","$1,088.00 ","$1,126.40 ","$1,126.40 ","$1,113.60 ","$1,088.00 ","$1,088.00 ","$1,088.00 ",$977.92 ,"$1,152.00 "
Carle Richland Memorial Hospital,8474420,PYELOGRAPHY RETROGRADE,,74420,320,"$1,390.00 ","$1,390.00 ","$1,061.96 ","$1,251.00 ","$1,181.50 ","$1,181.50 ","$1,181.50 ","$1,223.20 ","$1,181.50 ","$1,223.20 ","$1,223.20 ","$1,209.30 ","$1,181.50 ","$1,181.50 ","$1,181.50 ","$1,061.96 ","$1,251.00 "
Carle Richland Memorial Hospital,8474425,PYELOGRAPHY ANTEGRADE,,74425,320,"$1,010.00 ","$1,010.00 ",$771.64 ,$909.00 ,$858.50 ,$858.50 ,$858.50 ,$888.80 ,$858.50 ,$888.80 ,$888.80 ,$878.70 ,$858.50 ,$858.50 ,$858.50 ,$771.64 ,$909.00
Carle Richland Memorial Hospital,8474430,CYSTOGRAPHY S&I (MIN 3 VIEWS),,74430,320,"$1,240.00 ","$1,240.00 ",$947.36 ,"$1,116.00 ","$1,054.00 ","$1,054.00 ","$1,054.00 ","$1,091.20 ","$1,054.00 ","$1,091.20 ","$1,091.20 ","$1,078.80 ","$1,054.00 ","$1,054.00 ","$1,054.00 ",$947.36 ,"$1,116.00 "
Carle Richland Memorial Hospital,8474450,URETHROCYSTOGRAPHY S&I,,74450,320,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8474455,URETHROCYSTOGRAPHY VOIDING S&I,,74455,320,"$1,350.00 ","$1,350.00 ","$1,031.40 ","$1,215.00 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,188.00 ","$1,147.50 ","$1,188.00 ","$1,188.00 ","$1,174.50 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,031.40 ","$1,215.00 "
Carle Richland Memorial Hospital,8474480,INTR CATH/STNT URETER S&I,,74480,320,"$2,090.00 ","$2,090.00 ","$1,596.76 ","$1,881.00 ","$1,776.50 ","$1,776.50 ","$1,776.50 ","$1,839.20 ","$1,776.50 ","$1,839.20 ","$1,839.20 ","$1,818.30 ","$1,776.50 ","$1,776.50 ","$1,776.50 ","$1,596.76 ","$1,881.00 "
Carle Richland Memorial Hospital,8474485,DILAT NEPHRSTMY/URETER/URETHRA,,74485,320,"$2,090.00 ","$2,090.00 ","$1,596.76 ","$1,881.00 ","$1,776.50 ","$1,776.50 ","$1,776.50 ","$1,839.20 ","$1,776.50 ","$1,839.20 ","$1,839.20 ","$1,818.30 ","$1,776.50 ","$1,776.50 ","$1,776.50 ","$1,596.76 ","$1,881.00 "
Carle Richland Memorial Hospital,8475820,VENOGRAPHY UNI EXTREMITY S&I,,75820,320,"$1,690.00 ","$1,690.00 ","$1,291.16 ","$1,521.00 ","$1,436.50 ","$1,436.50 ","$1,436.50 ","$1,487.20 ","$1,436.50 ","$1,487.20 ","$1,487.20 ","$1,470.30 ","$1,436.50 ","$1,436.50 ","$1,436.50 ","$1,291.16 ","$1,521.00 "
Carle Richland Memorial Hospital,8475822,VENOGRAPHY BILAT EXTREMITY S&I,,75822,320,"$2,540.00 ","$2,540.00 ","$1,940.56 ","$2,286.00 ","$2,159.00 ","$2,159.00 ","$2,159.00 ","$2,235.20 ","$2,159.00 ","$2,235.20 ","$2,235.20 ","$2,209.80 ","$2,159.00 ","$2,159.00 ","$2,159.00 ","$1,940.56 ","$2,286.00 "
Carle Richland Memorial Hospital,8475989,GUIDANCE FOR DRAINAGE PROC S&I,,75989,320,"$1,840.00 ","$1,840.00 ","$1,405.76 ","$1,656.00 ","$1,564.00 ","$1,564.00 ","$1,564.00 ","$1,619.20 ","$1,564.00 ","$1,619.20 ","$1,619.20 ","$1,600.80 ","$1,564.00 ","$1,564.00 ","$1,564.00 ","$1,405.76 ","$1,656.00 "
Carle Richland Memorial Hospital,8476000,FLUOROSCOPY UP TO 1 HR,,76000,320,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8476001,FLUOROSCOPY >1 HOUR,,76001,320,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8476010,NOSE-RECTUM 1 VIEW FB -CHILD,,76010,320,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8476080,FISTULA/SINUS TRACT STUDY S&I,,76080,320,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8476098,XRAY EXAM BREAST SURGICAL SPEC,,76098,320,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8476100,XRAY SNGL BODY PLANE SCTN,,76100,320,"$1,700.00 ","$1,700.00 ","$1,298.80 ","$1,530.00 ","$1,445.00 ","$1,445.00 ","$1,445.00 ","$1,496.00 ","$1,445.00 ","$1,496.00 ","$1,496.00 ","$1,479.00 ","$1,445.00 ","$1,445.00 ","$1,445.00 ","$1,298.80 ","$1,530.00 "
Carle Richland Memorial Hospital,8477001,FLUORO GDNC CNTRL VN ACC DVC,,77001,320,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,8477002,FLUORO GUIDNC ASP/BX/DRAINAGE,,77002,320,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,8477003,FLUORO SPINE/PARASP DX/TX,,77003,320,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,8477072,BONE AGE XRAY STUDY,,77072,320,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,8477075,OSSEOUS SURVEY COMPLETE,,77075,320,"$2,000.00 ","$2,000.00 ","$1,528.00 ","$1,800.00 ","$1,700.00 ","$1,700.00 ","$1,700.00 ","$1,760.00 ","$1,700.00 ","$1,760.00 ","$1,760.00 ","$1,740.00 ","$1,700.00 ","$1,700.00 ","$1,700.00 ","$1,528.00 ","$1,800.00 "
Carle Richland Memorial Hospital,8477077,JOINT SURVEY 1/MORE JOINTS,,77077,320,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8477080,DUAL ENERGY BONE DENSITOMETRY,,77080,320,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8477085,"DEXA, BONE DENSITY, AXIAL SKELETON",,77085,320,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8477086,"DEXA, VERTEBRAL FX ASSESSMENT",,77086,320,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8471023,GD CHST 1V W FLUOR,,71023,324,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,96401,"CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM",,96401,331,$320.00 ,$320.00 ,$244.48 ,$288.00 ,$272.00 ,$272.00 ,$272.00 ,$281.60 ,$272.00 ,$281.60 ,$281.60 ,$278.40 ,$272.00 ,$272.00 ,$272.00 ,$244.48 ,$288.00
Carle Richland Memorial Hospital,96402,CHEMOTHER HORMON ANTINEOPL SUB-Q/IM,,96402,331,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8478582,PULM VENT AND PERFUSION IMAGING,,78582,340,"$1,960.00 ","$1,960.00 ","$1,497.44 ","$1,764.00 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,724.80 ","$1,666.00 ","$1,724.80 ","$1,724.80 ","$1,705.20 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,497.44 ","$1,764.00 "
Carle Richland Memorial Hospital,8478226,HEPATOBILIARY SYST IMAGING W/GLBLDR,,78226,340,"$2,490.00 ","$2,490.00 ","$1,902.36 ","$2,241.00 ","$2,116.50 ","$2,116.50 ","$2,116.50 ","$2,191.20 ","$2,116.50 ","$2,191.20 ","$2,191.20 ","$2,166.30 ","$2,116.50 ","$2,116.50 ","$2,116.50 ","$1,902.36 ","$2,241.00 "
Carle Richland Memorial Hospital,8478227,HEPATOBILIARY SYST IMGNG W/GLBLDR W/RX,,78227,340,"$2,490.00 ","$2,490.00 ","$1,902.36 ","$2,241.00 ","$2,116.50 ","$2,116.50 ","$2,116.50 ","$2,191.20 ","$2,116.50 ","$2,191.20 ","$2,191.20 ","$2,166.30 ","$2,116.50 ","$2,116.50 ","$2,116.50 ","$1,902.36 ","$2,241.00 "
Carle Richland Memorial Hospital,8478800,TUMOR LOCALIZATION LIMITED AREA,,78800,340,"$2,610.00 ","$2,610.00 ","$1,994.04 ","$2,349.00 ","$2,218.50 ","$2,218.50 ","$2,218.50 ","$2,296.80 ","$2,218.50 ","$2,296.80 ","$2,296.80 ","$2,270.70 ","$2,218.50 ","$2,218.50 ","$2,218.50 ","$1,994.04 ","$2,349.00 "
Carle Richland Memorial Hospital,8478012,THYROID UPTAKE MEASUREMENT,,78012,340,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,8478013,THYROID IMAGING W/BLOOD FLOW,,78013,340,"$1,140.00 ","$1,140.00 ",$870.96 ,"$1,026.00 ",$969.00 ,$969.00 ,$969.00 ,"$1,003.20 ",$969.00 ,"$1,003.20 ","$1,003.20 ",$991.80 ,$969.00 ,$969.00 ,$969.00 ,$870.96 ,"$1,026.00 "
Carle Richland Memorial Hospital,8478014,THYROID IMAGING W/BLOOD FLOW,,78014,340,"$2,630.00 ","$2,630.00 ","$2,009.32 ","$2,367.00 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,314.40 ","$2,235.50 ","$2,314.40 ","$2,314.40 ","$2,288.10 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,009.32 ","$2,367.00 "
Carle Richland Memorial Hospital,8478206,LIVER IMAGING (SPECT); W/VASCULAR FLOW,,78206,340,"$1,310.00 ","$1,310.00 ","$1,000.84 ","$1,179.00 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,152.80 ","$1,113.50 ","$1,152.80 ","$1,152.80 ","$1,139.70 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,000.84 ","$1,179.00 "
Carle Richland Memorial Hospital,8478597,QUANT DIFF PULM PRFSN STUDY,,78597,340,"$1,090.00 ","$1,090.00 ",$832.76 ,$981.00 ,$926.50 ,$926.50 ,$926.50 ,$959.20 ,$926.50 ,$959.20 ,$959.20 ,$948.30 ,$926.50 ,$926.50 ,$926.50 ,$832.76 ,$981.00
Carle Richland Memorial Hospital,8478830,RP LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMAGING,,78830,340,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,8478201,LIVER IMAGING STATIC,,78201,340,"$1,600.00 ","$1,600.00 ","$1,222.40 ","$1,440.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,408.00 ","$1,360.00 ","$1,408.00 ","$1,408.00 ","$1,392.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,222.40 ","$1,440.00 "
Carle Richland Memorial Hospital,8478205,LIVER IMAGING (SPECT),,78205,340,"$1,310.00 ","$1,310.00 ","$1,000.84 ","$1,179.00 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,152.80 ","$1,113.50 ","$1,152.80 ","$1,152.80 ","$1,139.70 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,000.84 ","$1,179.00 "
Carle Richland Memorial Hospital,8478215,LIVER & SPLEEN IMAGING;STATIC,,78215,340,"$1,520.00 ","$1,520.00 ","$1,161.28 ","$1,368.00 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,337.60 ","$1,292.00 ","$1,337.60 ","$1,337.60 ","$1,322.40 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,161.28 ","$1,368.00 "
Carle Richland Memorial Hospital,8478262,GASTROESOPHAGEAL REFLUX STUDY,,78262,340,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,8478264,GASTRIC EMPTYING STUDY,,78264,340,"$1,990.00 ","$1,990.00 ","$1,520.36 ","$1,791.00 ","$1,691.50 ","$1,691.50 ","$1,691.50 ","$1,751.20 ","$1,691.50 ","$1,751.20 ","$1,751.20 ","$1,731.30 ","$1,691.50 ","$1,691.50 ","$1,691.50 ","$1,520.36 ","$1,791.00 "
Carle Richland Memorial Hospital,8478278,GI BLOOD LOSS IMAGING,,78278,340,"$2,420.00 ","$2,420.00 ","$1,848.88 ","$2,178.00 ","$2,057.00 ","$2,057.00 ","$2,057.00 ","$2,129.60 ","$2,057.00 ","$2,129.60 ","$2,129.60 ","$2,105.40 ","$2,057.00 ","$2,057.00 ","$2,057.00 ","$1,848.88 ","$2,178.00 "
Carle Richland Memorial Hospital,8478300,BONE/JOINT IMAGING -LTD AREA,,78300,340,"$1,480.00 ","$1,480.00 ","$1,130.72 ","$1,332.00 ","$1,258.00 ","$1,258.00 ","$1,258.00 ","$1,302.40 ","$1,258.00 ","$1,302.40 ","$1,302.40 ","$1,287.60 ","$1,258.00 ","$1,258.00 ","$1,258.00 ","$1,130.72 ","$1,332.00 "
Carle Richland Memorial Hospital,8478305,BONE/JOINT IMAGING -MULT AREAS,,78305,340,"$2,240.00 ","$2,240.00 ","$1,711.36 ","$2,016.00 ","$1,904.00 ","$1,904.00 ","$1,904.00 ","$1,971.20 ","$1,904.00 ","$1,971.20 ","$1,971.20 ","$1,948.80 ","$1,904.00 ","$1,904.00 ","$1,904.00 ","$1,711.36 ","$2,016.00 "
Carle Richland Memorial Hospital,8478306,BONE/JOINT IMAGING -WHOLE BODY,,78306,340,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,8478466,MYOCAR IMAGING INFARCT AVID PL,,78466,340,"$1,520.00 ","$1,520.00 ","$1,161.28 ","$1,368.00 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,337.60 ","$1,292.00 ","$1,337.60 ","$1,337.60 ","$1,322.40 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,161.28 ","$1,368.00 "
Carle Richland Memorial Hospital,8478472,CARDIAC GATED BLOOD POOL IMAGN,,78472,340,"$2,300.00 ","$2,300.00 ","$1,757.20 ","$2,070.00 ","$1,955.00 ","$1,955.00 ","$1,955.00 ","$2,024.00 ","$1,955.00 ","$2,024.00 ","$2,024.00 ","$2,001.00 ","$1,955.00 ","$1,955.00 ","$1,955.00 ","$1,757.20 ","$2,070.00 "
Carle Richland Memorial Hospital,8478580,LUNG PERFUSION IMAGING,,78580,340,"$2,560.00 ","$2,560.00 ","$1,955.84 ","$2,304.00 ","$2,176.00 ","$2,176.00 ","$2,176.00 ","$2,252.80 ","$2,176.00 ","$2,252.80 ","$2,252.80 ","$2,227.20 ","$2,176.00 ","$2,176.00 ","$2,176.00 ","$1,955.84 ","$2,304.00 "
Carle Richland Memorial Hospital,8478605,BRAIN IMAGING COMPLETE STATIC,,78605,340,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,8478740,URETERAL REFLUX STDY W/RADIOPH,,78740,340,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,8478801,TUMOR LOCALIZATION MULT AREAS,,78801,340,"$2,780.00 ","$2,780.00 ","$2,123.92 ","$2,502.00 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,446.40 ","$2,363.00 ","$2,446.40 ","$2,446.40 ","$2,418.60 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,123.92 ","$2,502.00 "
Carle Richland Memorial Hospital,8478630,CSF FLUID SCAN CISTERNOGRAPHY,,78630,341,"$3,820.00 ","$3,820.00 ","$2,918.48 ","$3,438.00 ","$3,247.00 ","$3,247.00 ","$3,247.00 ","$3,361.60 ","$3,247.00 ","$3,361.60 ","$3,361.60 ","$3,323.40 ","$3,247.00 ","$3,247.00 ","$3,247.00 ","$2,918.48 ","$3,438.00 "
Carle Richland Memorial Hospital,8478804,TUMOR LOCALIZATION WHOLE BODY MULT DAY IMAGING,,78804,341,"$2,620.00 ","$2,620.00 ","$2,001.68 ","$2,358.00 ","$2,227.00 ","$2,227.00 ","$2,227.00 ","$2,305.60 ","$2,227.00 ","$2,305.60 ","$2,305.60 ","$2,279.40 ","$2,227.00 ","$2,227.00 ","$2,227.00 ","$2,001.68 ","$2,358.00 "
Carle Richland Memorial Hospital,8478018,WHOLE BODY IMAGING,,78018,341,"$2,800.00 ","$2,800.00 ","$2,139.20 ","$2,520.00 ","$2,380.00 ","$2,380.00 ","$2,380.00 ","$2,464.00 ","$2,380.00 ","$2,464.00 ","$2,464.00 ","$2,436.00 ","$2,380.00 ","$2,380.00 ","$2,380.00 ","$2,139.20 ","$2,520.00 "
Carle Richland Memorial Hospital,8478070,PARATHYROID IMAGING,,78070,341,"$1,980.00 ","$1,980.00 ","$1,512.72 ","$1,782.00 ","$1,683.00 ","$1,683.00 ","$1,683.00 ","$1,742.40 ","$1,683.00 ","$1,742.40 ","$1,742.40 ","$1,722.60 ","$1,683.00 ","$1,683.00 ","$1,683.00 ","$1,512.72 ","$1,782.00 "
Carle Richland Memorial Hospital,8478195,LYMPHOSCINTIGRAPHY,,78195,341,"$1,040.00 ","$1,040.00 ",$794.56 ,$936.00 ,$884.00 ,$884.00 ,$884.00 ,$915.20 ,$884.00 ,$915.20 ,$915.20 ,$904.80 ,$884.00 ,$884.00 ,$884.00 ,$794.56 ,$936.00
Carle Richland Memorial Hospital,8478290,INTESTINE IMAGING (MECKEL'S),,78290,341,"$2,730.00 ","$2,730.00 ","$2,085.72 ","$2,457.00 ","$2,320.50 ","$2,320.50 ","$2,320.50 ","$2,402.40 ","$2,320.50 ","$2,402.40 ","$2,402.40 ","$2,375.10 ","$2,320.50 ","$2,320.50 ","$2,320.50 ","$2,085.72 ","$2,457.00 "
Carle Richland Memorial Hospital,8478315,BONE/JOINT IMAGING -3 PHASE,,78315,341,"$2,270.00 ","$2,270.00 ","$1,734.28 ","$2,043.00 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,997.60 ","$1,929.50 ","$1,997.60 ","$1,997.60 ","$1,974.90 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,734.28 ","$2,043.00 "
Carle Richland Memorial Hospital,8478320,BONE/JOINT IMAGING(SPECT),,78320,341,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,8478451,HT MUSCLE IMAGE SPECT SINGLE,,78451,341,"$1,490.00 ","$1,490.00 ","$1,138.36 ","$1,341.00 ","$1,266.50 ","$1,266.50 ","$1,266.50 ","$1,311.20 ","$1,266.50 ","$1,311.20 ","$1,311.20 ","$1,296.30 ","$1,266.50 ","$1,266.50 ","$1,266.50 ","$1,138.36 ","$1,341.00 "
Carle Richland Memorial Hospital,8478452,HT MUSCLE IMAGE SPECT MULT,,78452,341,"$6,570.00 ","$6,570.00 ","$5,019.48 ","$5,913.00 ","$5,584.50 ","$5,584.50 ","$5,584.50 ","$5,781.60 ","$5,584.50 ","$5,781.60 ","$5,781.60 ","$5,715.90 ","$5,584.50 ","$5,584.50 ","$5,584.50 ","$5,019.48 ","$5,913.00 "
Carle Richland Memorial Hospital,8478454,HT MUSC IMAGE PLANAR MULT,,78454,341,"$4,430.00 ","$4,430.00 ","$3,384.52 ","$3,987.00 ","$3,765.50 ","$3,765.50 ","$3,765.50 ","$3,898.40 ","$3,765.50 ","$3,898.40 ","$3,898.40 ","$3,854.10 ","$3,765.50 ","$3,765.50 ","$3,765.50 ","$3,384.52 ","$3,987.00 "
Carle Richland Memorial Hospital,8478700,KIDNEY IMAGING,,78700,341,"$2,860.00 ","$2,860.00 ","$2,185.04 ","$2,574.00 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,516.80 ","$2,431.00 ","$2,516.80 ","$2,516.80 ","$2,488.20 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,185.04 ","$2,574.00 "
Carle Richland Memorial Hospital,8478707,KIDNEY IMAGING W/FLOW W/O PHRM,,78707,341,"$1,670.00 ","$1,670.00 ","$1,275.88 ","$1,503.00 ","$1,419.50 ","$1,419.50 ","$1,419.50 ","$1,469.60 ","$1,419.50 ","$1,469.60 ","$1,469.60 ","$1,452.90 ","$1,419.50 ","$1,419.50 ","$1,419.50 ","$1,275.88 ","$1,503.00 "
Carle Richland Memorial Hospital,8478708,KIDNEY IMAGING W/FLOW & PHARM,,78708,341,"$2,000.00 ","$2,000.00 ","$1,528.00 ","$1,800.00 ","$1,700.00 ","$1,700.00 ","$1,700.00 ","$1,760.00 ","$1,700.00 ","$1,760.00 ","$1,760.00 ","$1,740.00 ","$1,700.00 ","$1,700.00 ","$1,700.00 ","$1,528.00 ","$1,800.00 "
Carle Richland Memorial Hospital,8478709,KIDNEY IMAGING W/FLOW W/WO PHA,,78709,341,"$2,590.00 ","$2,590.00 ","$1,978.76 ","$2,331.00 ","$2,201.50 ","$2,201.50 ","$2,201.50 ","$2,279.20 ","$2,201.50 ","$2,279.20 ","$2,279.20 ","$2,253.30 ","$2,201.50 ","$2,201.50 ","$2,201.50 ","$1,978.76 ","$2,331.00 "
Carle Richland Memorial Hospital,8478802,TUMOR IMAGING WHOLE BODY,,78802,341,"$1,410.00 ","$1,410.00 ","$1,077.24 ","$1,269.00 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,240.80 ","$1,198.50 ","$1,240.80 ","$1,240.80 ","$1,226.70 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,077.24 ","$1,269.00 "
Carle Richland Memorial Hospital,8478803,TUMOR LOCALIZATION SPECT,,78803,341,"$1,410.00 ","$1,410.00 ","$1,077.24 ","$1,269.00 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,240.80 ","$1,198.50 ","$1,240.80 ","$1,240.80 ","$1,226.70 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,077.24 ","$1,269.00 "
Carle Richland Memorial Hospital,8479005,RAD THERAPY ORAL ADMINISTRATN,,79005,342,"$1,750.00 ","$1,750.00 ","$1,337.00 ","$1,575.00 ","$1,487.50 ","$1,487.50 ","$1,487.50 ","$1,540.00 ","$1,487.50 ","$1,540.00 ","$1,540.00 ","$1,522.50 ","$1,487.50 ","$1,487.50 ","$1,487.50 ","$1,337.00 ","$1,575.00 "
Carle Richland Memorial Hospital,8419502,TC 99M TETROFOSMIN UP TO 40MCI,,A9502,343,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8419503,TC 99M MEDRONATE UP TO 30MCI,,A9503,343,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8419512,TC 99M PERTECHNETATE PER MCI,,A9512,343,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8429512,TC 99M PERTECHNETATE PER MCI,,A9512,343,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8419516,I-123 SODIUM IODIDE CAP 100UCI,,A9516,343,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8419521,TC 99M EXAMETAZIME UP TO 25MCI,,A9521,343,"$3,160.00 ","$3,160.00 ","$2,414.24 ","$2,844.00 ","$2,686.00 ","$2,686.00 ","$2,686.00 ","$2,780.80 ","$2,686.00 ","$2,780.80 ","$2,780.80 ","$2,749.20 ","$2,686.00 ","$2,686.00 ","$2,686.00 ","$2,414.24 ","$2,844.00 "
Carle Richland Memorial Hospital,8419537,TC 99M MEBROFENIN UP TO 15MCI,,A9537,343,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8409538,TC 99M PYROPHOSPHATE UP TO 25 MCI,,A9538,343,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,8419540,Tc 99m Maa Up To 10mci Stdy Ds,,A9540,343,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8419541,TC 99M SUPFUR COLLOID EA 20MCI,,A9541,343,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,8429541,TC 99M SUPFUR COLLOID EA 20MCI,,A9541,343,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,8409556,GALLIUM PER MCI,,A9556,343,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8419556,"FDG 2-(F-18) , UP TO 45 MCI",,A9556,343,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8419558,XENON XE-133 GAS PER 10MCI,,A9558,343,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8409508,MIBG PER DOSE,,A9508,343,"$5,240.00 ","$5,240.00 ","$4,003.36 ","$4,716.00 ","$4,454.00 ","$4,454.00 ","$4,454.00 ","$4,611.20 ","$4,454.00 ","$4,611.20 ","$4,611.20 ","$4,558.80 ","$4,454.00 ","$4,454.00 ","$4,454.00 ","$4,003.36 ","$4,716.00 "
Carle Richland Memorial Hospital,8419508,131 IOBENGUANE SULFATE,,A9508,343,"$5,240.00 ","$5,240.00 ","$4,003.36 ","$4,716.00 ","$4,454.00 ","$4,454.00 ","$4,454.00 ","$4,611.20 ","$4,454.00 ","$4,611.20 ","$4,611.20 ","$4,558.80 ","$4,454.00 ","$4,454.00 ","$4,454.00 ","$4,003.36 ","$4,716.00 "
Carle Richland Memorial Hospital,8409588,AXUMIN EA 1 MCI,,A9588,343,"$2,010.00 ","$2,010.00 ","$1,535.64 ","$1,809.00 ","$1,708.50 ","$1,708.50 ","$1,708.50 ","$1,768.80 ","$1,708.50 ","$1,768.80 ","$1,768.80 ","$1,748.70 ","$1,708.50 ","$1,708.50 ","$1,708.50 ","$1,535.64 ","$1,809.00 "
Carle Richland Memorial Hospital,8409500,TC 99M SESTAMIBI UP TO 40MCI,,A9500,343,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,8409502,TC 99M TETROFOSMIN UP TO 40MCI,,A9502,343,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8409503,TC 99M MEDRONATE UP TO 30MCI,,A9503,343,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8409505,THALLIUM -PER MILLICURIE,,A9505,343,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8409512,TC 99M PERTECHNETATE PER MCI,,A9512,343,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8409516,I-123 SODIUM IODIDE CAP 100UCI,,A9516,343,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8409521,TC 99M EXAMETAZIME UP TO 25MCI,,A9521,343,"$3,160.00 ","$3,160.00 ","$2,414.24 ","$2,844.00 ","$2,686.00 ","$2,686.00 ","$2,686.00 ","$2,780.80 ","$2,686.00 ","$2,780.80 ","$2,780.80 ","$2,749.20 ","$2,686.00 ","$2,686.00 ","$2,686.00 ","$2,414.24 ","$2,844.00 "
Carle Richland Memorial Hospital,8409537,TC 99M MEBROFENIN UP TO 15MCI,,A9537,343,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8409540,99M MAA UP TO 10MCI STDY DS,,A9540,343,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8409541,TC 99M SUPFUR COLLOID EA 20MCI,,A9541,343,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,8409552,F-18 FDG PER DOSE UP TO 45MCI,,A9552,343,"$1,220.00 ","$1,220.00 ",$932.08 ,"$1,098.00 ","$1,037.00 ","$1,037.00 ","$1,037.00 ","$1,073.60 ","$1,037.00 ","$1,073.60 ","$1,073.60 ","$1,061.40 ","$1,037.00 ","$1,037.00 ","$1,037.00 ",$932.08 ,"$1,098.00 "
Carle Richland Memorial Hospital,8409558,XENON XE-133 GAS PER 10MCI,,A9558,343,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8409560,TC 99M LABELED RBC'S PER 30MCI,,A9560,343,$475.00 ,$475.00 ,$362.90 ,$427.50 ,$403.75 ,$403.75 ,$403.75 ,$418.00 ,$403.75 ,$418.00 ,$418.00 ,$413.25 ,$403.75 ,$403.75 ,$403.75 ,$362.90 ,$427.50
Carle Richland Memorial Hospital,8409562,TC 99M MERTIATIDE UP TO 15MCI,,A9562,343,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,8409569,CERETEC AUTO WBCS/STUDY DOSE,,A9569,343,"$11,070.00 ","$11,070.00 ","$8,457.48 ","$9,963.00 ","$9,409.50 ","$9,409.50 ","$9,409.50 ","$9,741.60 ","$9,409.50 ","$9,741.60 ","$9,741.60 ","$9,630.90 ","$9,409.50 ","$9,409.50 ","$9,409.50 ","$8,457.48 ","$9,963.00 "
Carle Richland Memorial Hospital,8409592,"COPPER CU-64, DOTATATE, DIAGNOSTIC, 1 MILLICURIE",,A9592,343,"$16,650.00 ","$16,650.00 ","$12,720.60 ","$14,985.00 ","$14,152.50 ","$14,152.50 ","$14,152.50 ","$14,652.00 ","$14,152.50 ","$14,652.00 ","$14,652.00 ","$14,485.50 ","$14,152.50 ","$14,152.50 ","$14,152.50 ","$12,720.60 ","$14,985.00 "
Carle Richland Memorial Hospital,8474174,CT ANGIOGRAPHY ABD & PELVIS W/CONTRAST,,74174,350,"$4,220.00 ","$4,220.00 ","$3,224.08 ","$3,798.00 ","$3,587.00 ","$3,587.00 ","$3,587.00 ","$3,713.60 ","$3,587.00 ","$3,713.60 ","$3,713.60 ","$3,671.40 ","$3,587.00 ","$3,587.00 ","$3,587.00 ","$3,224.08 ","$3,798.00 "
Carle Richland Memorial Hospital,8470492,CT SOFT TISSUE NECK W/ & W/O CONTRAST,,70492,350,"$3,960.00 ","$3,960.00 ","$3,025.44 ","$3,564.00 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,484.80 ","$3,366.00 ","$3,484.80 ","$3,484.80 ","$3,445.20 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,025.44 ","$3,564.00 "
Carle Richland Memorial Hospital,8470488,CT MAXILLOFACIAL W/O & W/ CONTRAST,,70488,350,"$2,990.00 ","$2,990.00 ","$2,284.36 ","$2,691.00 ","$2,541.50 ","$2,541.50 ","$2,541.50 ","$2,631.20 ","$2,541.50 ","$2,631.20 ","$2,631.20 ","$2,601.30 ","$2,541.50 ","$2,541.50 ","$2,541.50 ","$2,284.36 ","$2,691.00 "
Carle Richland Memorial Hospital,8400297,LDCT FOR LUNG SCREENING,,G0297,350,"$2,860.00 ","$2,860.00 ","$2,185.04 ","$2,574.00 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,516.80 ","$2,431.00 ","$2,516.80 ","$2,516.80 ","$2,488.20 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,185.04 ","$2,574.00 "
Carle Richland Memorial Hospital,8474176,CT ABD & PELVIS W/O CONTRAST,,74176,350,"$4,540.00 ","$4,540.00 ","$3,468.56 ","$4,086.00 ","$3,859.00 ","$3,859.00 ","$3,859.00 ","$3,995.20 ","$3,859.00 ","$3,995.20 ","$3,995.20 ","$3,949.80 ","$3,859.00 ","$3,859.00 ","$3,859.00 ","$3,468.56 ","$4,086.00 "
Carle Richland Memorial Hospital,8474177,CT ABD & PELVIS W/ CONTRAST,,74177,350,"$7,350.00 ","$7,350.00 ","$5,615.40 ","$6,615.00 ","$6,247.50 ","$6,247.50 ","$6,247.50 ","$6,468.00 ","$6,247.50 ","$6,468.00 ","$6,468.00 ","$6,394.50 ","$6,247.50 ","$6,247.50 ","$6,247.50 ","$5,615.40 ","$6,615.00 "
Carle Richland Memorial Hospital,8474178,CT ABD & PELVIS W/ & W/O CONTRAST,,74178,350,"$8,080.00 ","$8,080.00 ","$6,173.12 ","$7,272.00 ","$6,868.00 ","$6,868.00 ","$6,868.00 ","$7,110.40 ","$6,868.00 ","$7,110.40 ","$7,110.40 ","$7,029.60 ","$6,868.00 ","$6,868.00 ","$6,868.00 ","$6,173.12 ","$7,272.00 "
Carle Richland Memorial Hospital,8473202,CT UPPR EXT W/O & W/ CONTRAST,,73202,350,"$3,290.00 ","$3,290.00 ","$2,513.56 ","$2,961.00 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,895.20 ","$2,796.50 ","$2,895.20 ","$2,895.20 ","$2,862.30 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,513.56 ","$2,961.00 "
Carle Richland Memorial Hospital,8473702,CT LOWER EXTREMITY W/ WO CONTRAST,,73702,350,"$3,290.00 ","$3,290.00 ","$2,513.56 ","$2,961.00 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,895.20 ","$2,796.50 ","$2,895.20 ","$2,895.20 ","$2,862.30 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,513.56 ","$2,961.00 "
Carle Richland Memorial Hospital,8470450,CT HEAD/BRAIN W/O CONTRAST,,70450,350,"$2,260.00 ","$2,260.00 ","$1,726.64 ","$2,034.00 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,988.80 ","$1,921.00 ","$1,988.80 ","$1,988.80 ","$1,966.20 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,726.64 ","$2,034.00 "
Carle Richland Memorial Hospital,8471271,COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-,,71271,350,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,8470460,CT HEAD/BRAIN W/CONTRAST,,70460,350,"$3,330.00 ","$3,330.00 ","$2,544.12 ","$2,997.00 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,930.40 ","$2,830.50 ","$2,930.40 ","$2,930.40 ","$2,897.10 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,544.12 ","$2,997.00 "
Carle Richland Memorial Hospital,8470470,CT HEAD/BRAIN W/O & W/CONTRAST,,70470,350,"$3,960.00 ","$3,960.00 ","$3,025.44 ","$3,564.00 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,484.80 ","$3,366.00 ","$3,484.80 ","$3,484.80 ","$3,445.20 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,025.44 ","$3,564.00 "
Carle Richland Memorial Hospital,8470480,CT ORB/PIT/PF/IAC W/O CONTRAST,,70480,350,"$1,920.00 ","$1,920.00 ","$1,466.88 ","$1,728.00 ","$1,632.00 ","$1,632.00 ","$1,632.00 ","$1,689.60 ","$1,632.00 ","$1,689.60 ","$1,689.60 ","$1,670.40 ","$1,632.00 ","$1,632.00 ","$1,632.00 ","$1,466.88 ","$1,728.00 "
Carle Richland Memorial Hospital,8470481,CT ORB/PIT/PF/IAC W/CONTRAST,,70481,350,"$2,650.00 ","$2,650.00 ","$2,024.60 ","$2,385.00 ","$2,252.50 ","$2,252.50 ","$2,252.50 ","$2,332.00 ","$2,252.50 ","$2,332.00 ","$2,332.00 ","$2,305.50 ","$2,252.50 ","$2,252.50 ","$2,252.50 ","$2,024.60 ","$2,385.00 "
Carle Richland Memorial Hospital,8470482,CT ORB/PIT/PF/IAC W/O&W/CNTRST,,70482,350,"$2,870.00 ","$2,870.00 ","$2,192.68 ","$2,583.00 ","$2,439.50 ","$2,439.50 ","$2,439.50 ","$2,525.60 ","$2,439.50 ","$2,525.60 ","$2,525.60 ","$2,496.90 ","$2,439.50 ","$2,439.50 ","$2,439.50 ","$2,192.68 ","$2,583.00 "
Carle Richland Memorial Hospital,8470486,CT MAXILLOFACIAL W/O CONTRAST,,70486,350,"$2,380.00 ","$2,380.00 ","$1,818.32 ","$2,142.00 ","$2,023.00 ","$2,023.00 ","$2,023.00 ","$2,094.40 ","$2,023.00 ","$2,094.40 ","$2,094.40 ","$2,070.60 ","$2,023.00 ","$2,023.00 ","$2,023.00 ","$1,818.32 ","$2,142.00 "
Carle Richland Memorial Hospital,8470487,CT MAXILLOFACIAL W/CONTRAST,,70487,350,"$2,810.00 ","$2,810.00 ","$2,146.84 ","$2,529.00 ","$2,388.50 ","$2,388.50 ","$2,388.50 ","$2,472.80 ","$2,388.50 ","$2,472.80 ","$2,472.80 ","$2,444.70 ","$2,388.50 ","$2,388.50 ","$2,388.50 ","$2,146.84 ","$2,529.00 "
Carle Richland Memorial Hospital,8470490,CT SOFT TISSUE NECK W/O CNTRST,,70490,350,"$3,640.00 ","$3,640.00 ","$2,780.96 ","$3,276.00 ","$3,094.00 ","$3,094.00 ","$3,094.00 ","$3,203.20 ","$3,094.00 ","$3,203.20 ","$3,203.20 ","$3,166.80 ","$3,094.00 ","$3,094.00 ","$3,094.00 ","$2,780.96 ","$3,276.00 "
Carle Richland Memorial Hospital,8470491,CT SOFT TISSUE NECK W/CONTRAST,,70491,350,"$3,940.00 ","$3,940.00 ","$3,010.16 ","$3,546.00 ","$3,349.00 ","$3,349.00 ","$3,349.00 ","$3,467.20 ","$3,349.00 ","$3,467.20 ","$3,467.20 ","$3,427.80 ","$3,349.00 ","$3,349.00 ","$3,349.00 ","$3,010.16 ","$3,546.00 "
Carle Richland Memorial Hospital,8470496,CT ANGIOGRAPHY -HEAD,,70496,350,"$3,870.00 ","$3,870.00 ","$2,956.68 ","$3,483.00 ","$3,289.50 ","$3,289.50 ","$3,289.50 ","$3,405.60 ","$3,289.50 ","$3,405.60 ","$3,405.60 ","$3,366.90 ","$3,289.50 ","$3,289.50 ","$3,289.50 ","$2,956.68 ","$3,483.00 "
Carle Richland Memorial Hospital,8470498,CT ANGIOGRAPHY -NECK,,70498,350,"$3,380.00 ","$3,380.00 ","$2,582.32 ","$3,042.00 ","$2,873.00 ","$2,873.00 ","$2,873.00 ","$2,974.40 ","$2,873.00 ","$2,974.40 ","$2,974.40 ","$2,940.60 ","$2,873.00 ","$2,873.00 ","$2,873.00 ","$2,582.32 ","$3,042.00 "
Carle Richland Memorial Hospital,8471250,CT CHEST W/O CONTRAST,,71250,350,"$2,860.00 ","$2,860.00 ","$2,185.04 ","$2,574.00 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,516.80 ","$2,431.00 ","$2,516.80 ","$2,516.80 ","$2,488.20 ","$2,431.00 ","$2,431.00 ","$2,431.00 ","$2,185.04 ","$2,574.00 "
Carle Richland Memorial Hospital,8471260,CT CHEST W/CONTRAST,,71260,350,"$3,610.00 ","$3,610.00 ","$2,758.04 ","$3,249.00 ","$3,068.50 ","$3,068.50 ","$3,068.50 ","$3,176.80 ","$3,068.50 ","$3,176.80 ","$3,176.80 ","$3,140.70 ","$3,068.50 ","$3,068.50 ","$3,068.50 ","$2,758.04 ","$3,249.00 "
Carle Richland Memorial Hospital,8471270,CT CHEST W & W/O CONTRAST,,71270,350,"$3,960.00 ","$3,960.00 ","$3,025.44 ","$3,564.00 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,484.80 ","$3,366.00 ","$3,484.80 ","$3,484.80 ","$3,445.20 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,025.44 ","$3,564.00 "
Carle Richland Memorial Hospital,8471275,CT ANGIOGRAPHY -CHEST,,71275,350,"$3,230.00 ","$3,230.00 ","$2,467.72 ","$2,907.00 ","$2,745.50 ","$2,745.50 ","$2,745.50 ","$2,842.40 ","$2,745.50 ","$2,842.40 ","$2,842.40 ","$2,810.10 ","$2,745.50 ","$2,745.50 ","$2,745.50 ","$2,467.72 ","$2,907.00 "
Carle Richland Memorial Hospital,8472125,CT CERVICAL SPINE W/O CONTRAST,,72125,350,"$3,640.00 ","$3,640.00 ","$2,780.96 ","$3,276.00 ","$3,094.00 ","$3,094.00 ","$3,094.00 ","$3,203.20 ","$3,094.00 ","$3,203.20 ","$3,203.20 ","$3,166.80 ","$3,094.00 ","$3,094.00 ","$3,094.00 ","$2,780.96 ","$3,276.00 "
Carle Richland Memorial Hospital,8472126,CT CERVICAL SPINE W/CONTRAST,,72126,350,"$4,060.00 ","$4,060.00 ","$3,101.84 ","$3,654.00 ","$3,451.00 ","$3,451.00 ","$3,451.00 ","$3,572.80 ","$3,451.00 ","$3,572.80 ","$3,572.80 ","$3,532.20 ","$3,451.00 ","$3,451.00 ","$3,451.00 ","$3,101.84 ","$3,654.00 "
Carle Richland Memorial Hospital,8472128,CT THORACIC SPINE W/O CONTRAST,,72128,350,"$3,040.00 ","$3,040.00 ","$2,322.56 ","$2,736.00 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,675.20 ","$2,584.00 ","$2,675.20 ","$2,675.20 ","$2,644.80 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,322.56 ","$2,736.00 "
Carle Richland Memorial Hospital,8472129,CT THORACIC SPINE W/CONTRAST,,72129,350,"$3,040.00 ","$3,040.00 ","$2,322.56 ","$2,736.00 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,675.20 ","$2,584.00 ","$2,675.20 ","$2,675.20 ","$2,644.80 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,322.56 ","$2,736.00 "
Carle Richland Memorial Hospital,8472131,CT LUMBAR SPINE W/O CONTRAST,,72131,350,"$2,050.00 ","$2,050.00 ","$1,566.20 ","$1,845.00 ","$1,742.50 ","$1,742.50 ","$1,742.50 ","$1,804.00 ","$1,742.50 ","$1,804.00 ","$1,804.00 ","$1,783.50 ","$1,742.50 ","$1,742.50 ","$1,742.50 ","$1,566.20 ","$1,845.00 "
Carle Richland Memorial Hospital,8472132,CT LUMBAR SPINE W/CONTRAST,,72132,350,"$3,440.00 ","$3,440.00 ","$2,628.16 ","$3,096.00 ","$2,924.00 ","$2,924.00 ","$2,924.00 ","$3,027.20 ","$2,924.00 ","$3,027.20 ","$3,027.20 ","$2,992.80 ","$2,924.00 ","$2,924.00 ","$2,924.00 ","$2,628.16 ","$3,096.00 "
Carle Richland Memorial Hospital,8472133,CT LUMBAR SPINE W/O & W/CNTRST,,72133,350,"$3,960.00 ","$3,960.00 ","$3,025.44 ","$3,564.00 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,484.80 ","$3,366.00 ","$3,484.80 ","$3,484.80 ","$3,445.20 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,025.44 ","$3,564.00 "
Carle Richland Memorial Hospital,8472191,CT ANGIOGRAPHY PELVIS,,72191,350,"$3,750.00 ","$3,750.00 ","$2,865.00 ","$3,375.00 ","$3,187.50 ","$3,187.50 ","$3,187.50 ","$3,300.00 ","$3,187.50 ","$3,300.00 ","$3,300.00 ","$3,262.50 ","$3,187.50 ","$3,187.50 ","$3,187.50 ","$2,865.00 ","$3,375.00 "
Carle Richland Memorial Hospital,8472192,CT PELVIS W/O CONTRAST,,72192,350,"$2,900.00 ","$2,900.00 ","$2,215.60 ","$2,610.00 ","$2,465.00 ","$2,465.00 ","$2,465.00 ","$2,552.00 ","$2,465.00 ","$2,552.00 ","$2,552.00 ","$2,523.00 ","$2,465.00 ","$2,465.00 ","$2,465.00 ","$2,215.60 ","$2,610.00 "
Carle Richland Memorial Hospital,8472193,CT PELVIS W/CONTRAST,,72193,350,"$3,290.00 ","$3,290.00 ","$2,513.56 ","$2,961.00 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,895.20 ","$2,796.50 ","$2,895.20 ","$2,895.20 ","$2,862.30 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,513.56 ","$2,961.00 "
Carle Richland Memorial Hospital,8472194,CT PELVIS W/O & W/CONTRAST,,72194,350,"$3,480.00 ","$3,480.00 ","$2,658.72 ","$3,132.00 ","$2,958.00 ","$2,958.00 ","$2,958.00 ","$3,062.40 ","$2,958.00 ","$3,062.40 ","$3,062.40 ","$3,027.60 ","$2,958.00 ","$2,958.00 ","$2,958.00 ","$2,658.72 ","$3,132.00 "
Carle Richland Memorial Hospital,8473200,CT UPPER EXTREMITY W/O CONTRST,,73200,350,"$1,960.00 ","$1,960.00 ","$1,497.44 ","$1,764.00 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,724.80 ","$1,666.00 ","$1,724.80 ","$1,724.80 ","$1,705.20 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,497.44 ","$1,764.00 "
Carle Richland Memorial Hospital,8473201,CT UPPER EXTREMITY W/CONTRAST,,73201,350,"$3,040.00 ","$3,040.00 ","$2,322.56 ","$2,736.00 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,675.20 ","$2,584.00 ","$2,675.20 ","$2,675.20 ","$2,644.80 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,322.56 ","$2,736.00 "
Carle Richland Memorial Hospital,8473206,CT ANGIOGRAPHY UPPER EXTRMITY,,73206,350,"$2,730.00 ","$2,730.00 ","$2,085.72 ","$2,457.00 ","$2,320.50 ","$2,320.50 ","$2,320.50 ","$2,402.40 ","$2,320.50 ","$2,402.40 ","$2,402.40 ","$2,375.10 ","$2,320.50 ","$2,320.50 ","$2,320.50 ","$2,085.72 ","$2,457.00 "
Carle Richland Memorial Hospital,8473700,CT LOWER EXTREMITY W/O CONTRST,,73700,350,"$2,610.00 ","$2,610.00 ","$1,994.04 ","$2,349.00 ","$2,218.50 ","$2,218.50 ","$2,218.50 ","$2,296.80 ","$2,218.50 ","$2,296.80 ","$2,296.80 ","$2,270.70 ","$2,218.50 ","$2,218.50 ","$2,218.50 ","$1,994.04 ","$2,349.00 "
Carle Richland Memorial Hospital,8473701,CT LOWER EXTREMITY W/CONTRAST,,73701,350,"$3,040.00 ","$3,040.00 ","$2,322.56 ","$2,736.00 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,675.20 ","$2,584.00 ","$2,675.20 ","$2,675.20 ","$2,644.80 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,322.56 ","$2,736.00 "
Carle Richland Memorial Hospital,8473706,CT ANGIOGRAPHY LWR EXT W/CONTRAST,,73706,350,"$3,020.00 ","$3,020.00 ","$2,307.28 ","$2,718.00 ","$2,567.00 ","$2,567.00 ","$2,567.00 ","$2,657.60 ","$2,567.00 ","$2,657.60 ","$2,657.60 ","$2,627.40 ","$2,567.00 ","$2,567.00 ","$2,567.00 ","$2,307.28 ","$2,718.00 "
Carle Richland Memorial Hospital,8474150,CT ABDOMEN W/O CONTRAST,,74150,350,"$3,080.00 ","$3,080.00 ","$2,353.12 ","$2,772.00 ","$2,618.00 ","$2,618.00 ","$2,618.00 ","$2,710.40 ","$2,618.00 ","$2,710.40 ","$2,710.40 ","$2,679.60 ","$2,618.00 ","$2,618.00 ","$2,618.00 ","$2,353.12 ","$2,772.00 "
Carle Richland Memorial Hospital,8474160,CT ABDOMEN W/CONTRAST,,74160,350,"$3,960.00 ","$3,960.00 ","$3,025.44 ","$3,564.00 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,484.80 ","$3,366.00 ","$3,484.80 ","$3,484.80 ","$3,445.20 ","$3,366.00 ","$3,366.00 ","$3,366.00 ","$3,025.44 ","$3,564.00 "
Carle Richland Memorial Hospital,8474170,CT ABDOMEN W&W/O CONTRAST,,74170,350,"$4,350.00 ","$4,350.00 ","$3,323.40 ","$3,915.00 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,828.00 ","$3,697.50 ","$3,828.00 ","$3,828.00 ","$3,784.50 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,323.40 ","$3,915.00 "
Carle Richland Memorial Hospital,8474175,CT ANGIOGRAPHY ABDOMEN W/CONTRAST,,74175,350,"$3,870.00 ","$3,870.00 ","$2,956.68 ","$3,483.00 ","$3,289.50 ","$3,289.50 ","$3,289.50 ","$3,405.60 ","$3,289.50 ","$3,405.60 ","$3,405.60 ","$3,366.90 ","$3,289.50 ","$3,289.50 ","$3,289.50 ","$2,956.68 ","$3,483.00 "
Carle Richland Memorial Hospital,8475571,CT HRT W/O DYE W/CA TEST,,75571,350,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8475635,CT ANGIO ABD AORTA & RUNOFF,,75635,350,"$3,560.00 ","$3,560.00 ","$2,719.84 ","$3,204.00 ","$3,026.00 ","$3,026.00 ","$3,026.00 ","$3,132.80 ","$3,026.00 ","$3,132.80 ","$3,132.80 ","$3,097.20 ","$3,026.00 ","$3,026.00 ","$3,026.00 ","$2,719.84 ","$3,204.00 "
Carle Richland Memorial Hospital,8476376,3D RENDERING W/O POST-PROCESS,,76376,350,"$1,240.00 ","$1,240.00 ",$947.36 ,"$1,116.00 ","$1,054.00 ","$1,054.00 ","$1,054.00 ","$1,091.20 ","$1,054.00 ","$1,091.20 ","$1,091.20 ","$1,078.80 ","$1,054.00 ","$1,054.00 ","$1,054.00 ",$947.36 ,"$1,116.00 "
Carle Richland Memorial Hospital,8476377,3D RENDERING W/POST-PROCESSING,,76377,350,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,8476380,CT LIMITED/LOCALIZED FOLLOW-UP,,76380,350,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8477012,CT GUIDANCE NEEDLE PLCMNT S&I,,77012,350,"$2,610.00 ","$2,610.00 ","$1,994.04 ","$2,349.00 ","$2,218.50 ","$2,218.50 ","$2,218.50 ","$2,296.80 ","$2,218.50 ","$2,296.80 ","$2,296.80 ","$2,270.70 ","$2,218.50 ","$2,218.50 ","$2,218.50 ","$1,994.04 ","$2,349.00 "
Carle Richland Memorial Hospital,8100050,OR L1 BASE OPERATING ROOM CHARGE,,,360,"$1,210.00 ","$1,210.00 ",$924.44 ,"$1,089.00 ","$1,028.50 ","$1,028.50 ","$1,028.50 ","$1,064.80 ","$1,028.50 ","$1,064.80 ","$1,064.80 ","$1,052.70 ","$1,028.50 ","$1,028.50 ","$1,028.50 ",$924.44 ,"$1,089.00 "
Carle Richland Memorial Hospital,8100075,LASER LITHOTRIPSY,,,360,"$9,640.00 ","$9,640.00 ","$7,364.96 ","$8,676.00 ","$8,194.00 ","$8,194.00 ","$8,194.00 ","$8,483.20 ","$8,194.00 ","$8,483.20 ","$8,483.20 ","$8,386.80 ","$8,194.00 ","$8,194.00 ","$8,194.00 ","$7,364.96 ","$8,676.00 "
Carle Richland Memorial Hospital,8105050,OR L1 PER MIN OPERATING ROOM CHARGE,,,360,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8102050,OR L2 BASE OPERATING ROOM CHARGE,,,360,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,8106050,OR L2 PER MIN OPERATING ROOM CHARGE,,,360,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8103050,OR L3 BASE OPERATING ROOM CHARGE,,,360,"$1,020.00 ","$1,020.00 ",$779.28 ,$918.00 ,$867.00 ,$867.00 ,$867.00 ,$897.60 ,$867.00 ,$897.60 ,$897.60 ,$887.40 ,$867.00 ,$867.00 ,$867.00 ,$779.28 ,$918.00
Carle Richland Memorial Hospital,8107050,OR L3 PER MIN OPERATING ROOM CHARGE,,,360,$82.00 ,$82.00 ,$62.65 ,$73.80 ,$69.70 ,$69.70 ,$69.70 ,$72.16 ,$69.70 ,$72.16 ,$72.16 ,$71.34 ,$69.70 ,$69.70 ,$69.70 ,$62.65 ,$73.80
Carle Richland Memorial Hospital,8104050,OR L4 BASE OPERATING ROOM CHARGE,,,360,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,8108050,OR L4 PER MIN OPERATING ROOM CHARGE,,,360,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,8431622,GD BRONCHOSCOPY W/FLUOROSCOPY,,31622,360,"$2,350.00 ","$2,350.00 ","$1,795.40 ","$2,115.00 ","$1,997.50 ","$1,997.50 ","$1,997.50 ","$2,068.00 ","$1,997.50 ","$2,068.00 ","$2,068.00 ","$2,044.50 ","$1,997.50 ","$1,997.50 ","$1,997.50 ","$1,795.40 ","$2,115.00 "
Carle Richland Memorial Hospital,8028851,RMVL PERCT RT HEART VENTRICULAR ASSIST DEVICE,,,360,"$3,200.00 ","$3,200.00 ","$2,444.80 ","$2,880.00 ","$2,720.00 ","$2,720.00 ","$2,720.00 ","$2,816.00 ","$2,720.00 ","$2,816.00 ","$2,816.00 ","$2,784.00 ","$2,720.00 ","$2,720.00 ","$2,720.00 ","$2,444.80 ","$2,880.00 "
Carle Richland Memorial Hospital,8023014,PICC INSERTION,,,361,"$2,280.00 ","$2,280.00 ","$1,741.92 ","$2,052.00 ","$1,938.00 ","$1,938.00 ","$1,938.00 ","$2,006.40 ","$1,938.00 ","$2,006.40 ","$2,006.40 ","$1,983.60 ","$1,938.00 ","$1,938.00 ","$1,938.00 ","$1,741.92 ","$2,052.00 "
Carle Richland Memorial Hospital,8026600,ARTERIAL BLOOD COLLECTION,,36600,361,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8419030,MAMMOGRAPHY DUCT INJECTION,,19030,361,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8447500,GD CHOLANG IVC INJ,,47500,361,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,8460300,US THYROID CYST ASP,,60300,361,"$1,350.00 ","$1,350.00 ","$1,031.40 ","$1,215.00 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,188.00 ","$1,147.50 ","$1,188.00 ","$1,188.00 ","$1,174.50 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,031.40 ","$1,215.00 "
Carle Richland Memorial Hospital,8020030,PICC LINE ADDL ATTEMPT,,,361,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8020032,MIDLINE INSERTION,,36410,361,"$1,880.00 ","$1,880.00 ","$1,436.32 ","$1,692.00 ","$1,598.00 ","$1,598.00 ","$1,598.00 ","$1,654.40 ","$1,598.00 ","$1,654.40 ","$1,654.40 ","$1,635.60 ","$1,598.00 ","$1,598.00 ","$1,598.00 ","$1,436.32 ","$1,692.00 "
Carle Richland Memorial Hospital,8020033,LVL 2 NRV INJECTIONS,,,361,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8972408,CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,,32408,361,"$3,040.00 ","$3,040.00 ","$2,322.56 ","$2,736.00 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,675.20 ","$2,584.00 ","$2,675.20 ","$2,675.20 ","$2,644.80 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,322.56 ","$2,736.00 "
Carle Richland Memorial Hospital,8973741,TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD,,33741,361,"$7,600.00 ","$7,600.00 ","$5,806.40 ","$6,840.00 ","$6,460.00 ","$6,460.00 ","$6,460.00 ","$6,688.00 ","$6,460.00 ","$6,688.00 ","$6,688.00 ","$6,612.00 ","$6,460.00 ","$6,460.00 ","$6,460.00 ","$5,806.40 ","$6,840.00 "
Carle Richland Memorial Hospital,8973745,TIS CRTJ ST CONGENITAL CARDIAC ANOMAL 1ST SHUNT,,33745,361,"$6,650.00 ","$6,650.00 ","$5,080.60 ","$5,985.00 ","$5,652.50 ","$5,652.50 ","$5,652.50 ","$5,852.00 ","$5,652.50 ","$5,852.00 ","$5,852.00 ","$5,785.50 ","$5,652.50 ","$5,652.50 ","$5,652.50 ","$5,080.60 ","$5,985.00 "
Carle Richland Memorial Hospital,8973746,TIS CRTJ ST CONGENITAL CARDIAC ANOMAL EA ADDL,,33746,361,"$3,330.00 ","$3,330.00 ","$2,544.12 ","$2,997.00 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,930.40 ","$2,830.50 ","$2,930.40 ","$2,930.40 ","$2,897.10 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,544.12 ","$2,997.00 "
Carle Richland Memorial Hospital,8973995,INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY,,33995,361,"$3,800.00 ","$3,800.00 ","$2,903.20 ","$3,420.00 ","$3,230.00 ","$3,230.00 ","$3,230.00 ","$3,344.00 ","$3,230.00 ","$3,344.00 ","$3,344.00 ","$3,306.00 ","$3,230.00 ","$3,230.00 ","$3,230.00 ","$2,903.20 ","$3,420.00 "
Carle Richland Memorial Hospital,8973997,REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ,,33997,361,"$4,560.00 ","$4,560.00 ","$3,483.84 ","$4,104.00 ","$3,876.00 ","$3,876.00 ","$3,876.00 ","$4,012.80 ","$3,876.00 ","$4,012.80 ","$4,012.80 ","$3,967.20 ","$3,876.00 ","$3,876.00 ","$3,876.00 ","$3,483.84 ","$4,104.00 "
Carle Richland Memorial Hospital,8020037,WOUND EXPLORATION,,,361,"$3,780.00 ","$3,780.00 ","$2,887.92 ","$3,402.00 ","$3,213.00 ","$3,213.00 ","$3,213.00 ","$3,326.40 ","$3,213.00 ","$3,326.40 ","$3,326.40 ","$3,288.60 ","$3,213.00 ","$3,213.00 ","$3,213.00 ","$2,887.92 ","$3,402.00 "
Carle Richland Memorial Hospital,8025900,REDUCTION RECTAL PROLAPSE,,,361,"$1,790.00 ","$1,790.00 ","$1,367.56 ","$1,611.00 ","$1,521.50 ","$1,521.50 ","$1,521.50 ","$1,575.20 ","$1,521.50 ","$1,575.20 ","$1,575.20 ","$1,557.30 ","$1,521.50 ","$1,521.50 ","$1,521.50 ","$1,367.56 ","$1,611.00 "
Carle Richland Memorial Hospital,8020038,"ARTHROCENTESIS, ASP/INJ JOINT/BURSA W/O US GUIDE",,,361,"$1,100.00 ","$1,100.00 ",$840.40 ,$990.00 ,$935.00 ,$935.00 ,$935.00 ,$968.00 ,$935.00 ,$968.00 ,$968.00 ,$957.00 ,$935.00 ,$935.00 ,$935.00 ,$840.40 ,$990.00
Carle Richland Memorial Hospital,8023006,THORACENTESIS/PARACENTESIS,,,361,"$1,150.00 ","$1,150.00 ",$878.60 ,"$1,035.00 ",$977.50 ,$977.50 ,$977.50 ,"$1,012.00 ",$977.50 ,"$1,012.00 ","$1,012.00 ","$1,000.50 ",$977.50 ,$977.50 ,$977.50 ,$878.60 ,"$1,035.00 "
Carle Richland Memorial Hospital,8100041,QUANTA THULIUM LASER,,,369,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8899151,"MOD SED SAME PHYS/QHP, PT <5YRS, INITL 15 MIN",,99151,370,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,8899152,"MOD SED SAME PHYS/QHP, PT 5YRS OR >, INITL 15 MIN",,99152,370,$440.00 ,$440.00 ,$336.16 ,$396.00 ,$374.00 ,$374.00 ,$374.00 ,$387.20 ,$374.00 ,$387.20 ,$387.20 ,$382.80 ,$374.00 ,$374.00 ,$374.00 ,$336.16 ,$396.00
Carle Richland Memorial Hospital,8899153,"MOD SED SAME PHYS/QHP, EA ADD 15 MIN",,99153,370,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8380975,AUTOLOGOUS L-P RED BLOOD CELLS,,P9016,390,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8380976,FRESH FROZEN PLASMA PER UNIT,,P9059,390,$66.00 ,$66.00 ,$50.42 ,$59.40 ,$56.10 ,$56.10 ,$56.10 ,$58.08 ,$56.10 ,$58.08 ,$58.08 ,$57.42 ,$56.10 ,$56.10 ,$56.10 ,$50.42 ,$59.40
Carle Richland Memorial Hospital,8386002,CRYO-POOR PLASMA,,P9044,390,$66.00 ,$66.00 ,$50.42 ,$59.40 ,$56.10 ,$56.10 ,$56.10 ,$58.08 ,$56.10 ,$58.08 ,$58.08 ,$57.42 ,$56.10 ,$56.10 ,$56.10 ,$50.42 ,$59.40
Carle Richland Memorial Hospital,8386007,LP SINGLE DONOR PLATELETS PHER,,P9035,390,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8386012,LP IRRAD SNGL DONOR PLTLTS PHR,,P9037,390,$620.00 ,$620.00 ,$473.68 ,$558.00 ,$527.00 ,$527.00 ,$527.00 ,$545.60 ,$527.00 ,$545.60 ,$545.60 ,$539.40 ,$527.00 ,$527.00 ,$527.00 ,$473.68 ,$558.00
Carle Richland Memorial Hospital,8386017,NEONATAL WHOLE BLOOD,,86999,390,$425.00 ,$425.00 ,$324.70 ,$382.50 ,$361.25 ,$361.25 ,$361.25 ,$374.00 ,$361.25 ,$374.00 ,$374.00 ,$369.75 ,$361.25 ,$361.25 ,$361.25 ,$324.70 ,$382.50
Carle Richland Memorial Hospital,8386033,IRRAD LEUKOCYTES REDUCED RBC'S,,P9040,390,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,8386102,LEUKO-REDUCED RED BLOOD CELLS,,P9016,390,$245.00 ,$245.00 ,$187.18 ,$220.50 ,$208.25 ,$208.25 ,$208.25 ,$215.60 ,$208.25 ,$215.60 ,$215.60 ,$213.15 ,$208.25 ,$208.25 ,$208.25 ,$187.18 ,$220.50
Carle Richland Memorial Hospital,8386201,CRYOPRECIPITATE PER UNIT,,P9012,390,$70.00 ,$70.00 ,$53.48 ,$63.00 ,$59.50 ,$59.50 ,$59.50 ,$61.60 ,$59.50 ,$61.60 ,$61.60 ,$60.90 ,$59.50 ,$59.50 ,$59.50 ,$53.48 ,$63.00
Carle Richland Memorial Hospital,8386890,AUTOLOGOUS BLOOD COLL & STORG,,86890,390,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,8388008,AUTOLOGOUS DONOR PACKED RBC'S,,P9021,390,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8380314,CRYO AHF 5 UNIT POOL,,P9012,390,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8026430,ADMINISTER TRANSFUSION,,,391,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,8336430,ADMINISTER TRANSFUSION,,36430,391,"$1,340.00 ","$1,340.00 ","$1,023.76 ","$1,206.00 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,179.20 ","$1,139.00 ","$1,179.20 ","$1,179.20 ","$1,165.80 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,023.76 ","$1,206.00 "
Carle Richland Memorial Hospital,8400279,BREAST TOMOSYNTHESIS UNILATERAL OR BILATERAL,,G0279,401,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8477065,DIAGNOSTIC MAMMOGRAPHY UNILAT W/CAD,,77065,401,$475.00 ,$475.00 ,$362.90 ,$427.50 ,$403.75 ,$403.75 ,$403.75 ,$418.00 ,$403.75 ,$418.00 ,$418.00 ,$413.25 ,$403.75 ,$403.75 ,$403.75 ,$362.90 ,$427.50
Carle Richland Memorial Hospital,8477066,DIAGNOSTIC MAMMOGRAPHY BILAT W/CAD,,77066,401,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8477051,CAD DIAGNOSTIC MAMMOGRAPHY,,77051,401,$65.00 ,$65.00 ,$49.66 ,$58.50 ,$55.25 ,$55.25 ,$55.25 ,$57.20 ,$55.25 ,$57.20 ,$57.20 ,$56.55 ,$55.25 ,$55.25 ,$55.25 ,$49.66 ,$58.50
Carle Richland Memorial Hospital,8477061,DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,,G0279,401,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8477062,DIGITAL BREAST TOMOSYNTHESIS BILATERAL,,G0279,401,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8476886,"US INFANT HIPS, LIMITED, STATIC",,76886,402,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8476937,US GUIDED VASC ACCESS,,76937,402,$485.00 ,$485.00 ,$370.54 ,$436.50 ,$412.25 ,$412.25 ,$412.25 ,$426.80 ,$412.25 ,$426.80 ,$426.80 ,$421.95 ,$412.25 ,$412.25 ,$412.25 ,$370.54 ,$436.50
Carle Richland Memorial Hospital,8476706,US ABD AORTA REAL TIME SCREEN STUDY AAA,,76706,402,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,8455876,US PROSTATE FIDUCIARY MARKER PLACEMENT,,55876,402,"$2,780.00 ","$2,780.00 ","$2,123.92 ","$2,502.00 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,446.40 ","$2,363.00 ","$2,446.40 ","$2,446.40 ","$2,418.60 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,123.92 ","$2,502.00 "
Carle Richland Memorial Hospital,8876642,US BREAST UNILATERAL LIMITED,,76642,402,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,8476800,ULTRASOUND SPINAL CANAL/CONTENTS,,76800,402,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,8476506,ECHOENCEPHALOGRAPHY,,76506,402,$920.00 ,$920.00 ,$702.88 ,$828.00 ,$782.00 ,$782.00 ,$782.00 ,$809.60 ,$782.00 ,$809.60 ,$809.60 ,$800.40 ,$782.00 ,$782.00 ,$782.00 ,$702.88 ,$828.00
Carle Richland Memorial Hospital,8476536,ULTRASOUND -THYROID,,76536,402,"$1,240.00 ","$1,240.00 ",$947.36 ,"$1,116.00 ","$1,054.00 ","$1,054.00 ","$1,054.00 ","$1,091.20 ","$1,054.00 ","$1,091.20 ","$1,091.20 ","$1,078.80 ","$1,054.00 ","$1,054.00 ","$1,054.00 ",$947.36 ,"$1,116.00 "
Carle Richland Memorial Hospital,8476604,ULTRASOUND -CHEST,,76604,402,"$1,150.00 ","$1,150.00 ",$878.60 ,"$1,035.00 ",$977.50 ,$977.50 ,$977.50 ,"$1,012.00 ",$977.50 ,"$1,012.00 ","$1,012.00 ","$1,000.50 ",$977.50 ,$977.50 ,$977.50 ,$878.60 ,"$1,035.00 "
Carle Richland Memorial Hospital,8476700,ULTRASOUND ABDMNL COMPLETE W/O CONTRAST,,76700,402,"$1,900.00 ","$1,900.00 ","$1,451.60 ","$1,710.00 ","$1,615.00 ","$1,615.00 ","$1,615.00 ","$1,672.00 ","$1,615.00 ","$1,672.00 ","$1,672.00 ","$1,653.00 ","$1,615.00 ","$1,615.00 ","$1,615.00 ","$1,451.60 ","$1,710.00 "
Carle Richland Memorial Hospital,8476705,ULTRASOUND ABDMNL LIMITED W/O CONTRAST,,76705,402,"$1,150.00 ","$1,150.00 ",$878.60 ,"$1,035.00 ",$977.50 ,$977.50 ,$977.50 ,"$1,012.00 ",$977.50 ,"$1,012.00 ","$1,012.00 ","$1,000.50 ",$977.50 ,$977.50 ,$977.50 ,$878.60 ,"$1,035.00 "
Carle Richland Memorial Hospital,8476770,ULTRASOUND RETRPRTNL COMPLETE,,76770,402,"$1,240.00 ","$1,240.00 ",$947.36 ,"$1,116.00 ","$1,054.00 ","$1,054.00 ","$1,054.00 ","$1,091.20 ","$1,054.00 ","$1,091.20 ","$1,091.20 ","$1,078.80 ","$1,054.00 ","$1,054.00 ","$1,054.00 ",$947.36 ,"$1,116.00 "
Carle Richland Memorial Hospital,8476775,ULTRASOUND RETRPRTNL LIMITED,,76775,402,$920.00 ,$920.00 ,$702.88 ,$828.00 ,$782.00 ,$782.00 ,$782.00 ,$809.60 ,$782.00 ,$809.60 ,$809.60 ,$800.40 ,$782.00 ,$782.00 ,$782.00 ,$702.88 ,$828.00
Carle Richland Memorial Hospital,8476801,ROUTINE OB SONO <14 WKS,,76801,402,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,8476802,OB SONO ADNL GESTATION,,76802,402,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,8476805,ROUTINE SCRN OB SONO > 14 WKS,,76805,402,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,8476810,RTN OB SONO > 14 WK MULT GEST,,76810,402,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,8476811,HIGH RISK OB SONO SINGLE OR 1RST GEST,,76811,402,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,8476812,HIGH RISK OB SONO MULT GEST,,76812,402,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,8476815,OB SONO LIMITED,,76815,402,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8476816,OB SONO FOLLOW-UP TRANSABD,,76816,402,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8476817,OB SONO TRANSVAGINAL,,76817,402,"$1,530.00 ","$1,530.00 ","$1,168.92 ","$1,377.00 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,346.40 ","$1,300.50 ","$1,346.40 ","$1,346.40 ","$1,331.10 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,168.92 ","$1,377.00 "
Carle Richland Memorial Hospital,8476818,FETAL BIOPHYSICAL PROFILE W/NS,,76818,402,"$1,230.00 ","$1,230.00 ",$939.72 ,"$1,107.00 ","$1,045.50 ","$1,045.50 ","$1,045.50 ","$1,082.40 ","$1,045.50 ","$1,082.40 ","$1,082.40 ","$1,070.10 ","$1,045.50 ","$1,045.50 ","$1,045.50 ",$939.72 ,"$1,107.00 "
Carle Richland Memorial Hospital,8476819,FETAL BIOPH PROF W/O STRESS/NS,,76819,402,"$1,280.00 ","$1,280.00 ",$977.92 ,"$1,152.00 ","$1,088.00 ","$1,088.00 ","$1,088.00 ","$1,126.40 ","$1,088.00 ","$1,126.40 ","$1,126.40 ","$1,113.60 ","$1,088.00 ","$1,088.00 ","$1,088.00 ",$977.92 ,"$1,152.00 "
Carle Richland Memorial Hospital,8476820,DOPPLER -FETAL UMBILICAL ARTRY,,76820,402,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8476821,DOPPLER MID CEREBRAL ARTERY,,76821,402,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,8476830,ULTRASOUND TRANSVAGINAL,,76830,402,"$1,530.00 ","$1,530.00 ","$1,168.92 ","$1,377.00 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,346.40 ","$1,300.50 ","$1,346.40 ","$1,346.40 ","$1,331.10 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,168.92 ","$1,377.00 "
Carle Richland Memorial Hospital,8476856,ULTRASOUND PELVIS COMPLETE,,76856,402,"$1,380.00 ","$1,380.00 ","$1,054.32 ","$1,242.00 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,214.40 ","$1,173.00 ","$1,214.40 ","$1,214.40 ","$1,200.60 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,054.32 ","$1,242.00 "
Carle Richland Memorial Hospital,8476857,ULTRASOUND PELVIS LIMITED,,76857,402,"$1,070.00 ","$1,070.00 ",$817.48 ,$963.00 ,$909.50 ,$909.50 ,$909.50 ,$941.60 ,$909.50 ,$941.60 ,$941.60 ,$930.90 ,$909.50 ,$909.50 ,$909.50 ,$817.48 ,$963.00
Carle Richland Memorial Hospital,8476870,ULTRASOUNDSCROTUM,,76870,402,"$1,290.00 ","$1,290.00 ",$985.56 ,"$1,161.00 ","$1,096.50 ","$1,096.50 ","$1,096.50 ","$1,135.20 ","$1,096.50 ","$1,135.20 ","$1,135.20 ","$1,122.30 ","$1,096.50 ","$1,096.50 ","$1,096.50 ",$985.56 ,"$1,161.00 "
Carle Richland Memorial Hospital,8476872,ULTRASOUND PROSTATE,,76872,402,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,8476942,ULTRASND GUIDANCE ASP/BX/DRAIN,,76942,402,"$1,030.00 ","$1,030.00 ",$786.92 ,$927.00 ,$875.50 ,$875.50 ,$875.50 ,$906.40 ,$875.50 ,$906.40 ,$906.40 ,$896.10 ,$875.50 ,$875.50 ,$875.50 ,$786.92 ,$927.00
Carle Richland Memorial Hospital,8476946,ULTRASOUND GUIDANCE FOR AMNIO,,76946,402,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,8476998,ULTRASOUND GUIDANCE -INTRAOP,,76998,402,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,8476999,ULTRASOUND -SOFT TISSUE BACK,,76999,402,$520.00 ,$520.00 ,$397.28 ,$468.00 ,$442.00 ,$442.00 ,$442.00 ,$457.60 ,$442.00 ,$457.60 ,$457.60 ,$452.40 ,$442.00 ,$442.00 ,$442.00 ,$397.28 ,$468.00
Carle Richland Memorial Hospital,8476641,US BREAST UNILATERAL COMPLETE,,76641,402,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,8476642,US BREAST UNILATERAL LIMITED,,76642,402,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,8476882,ULTRASOUND EXTREMITY LIMITED,,76882,402,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8476883,ULTRASOUND EXTREMITY COMPLETE,,76881,402,"$1,030.00 ","$1,030.00 ",$786.92 ,$927.00 ,$875.50 ,$875.50 ,$875.50 ,$906.40 ,$875.50 ,$906.40 ,$906.40 ,$896.10 ,$875.50 ,$875.50 ,$875.50 ,$786.92 ,$927.00
Carle Richland Memorial Hospital,8400202,SCREENING MAMMOGRAPHY -DIGITAL,,G0202,403,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8477067,SCREENING MAMMOGRAPHY BILAT W/CAD,,77067,403,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,8477052,CAD SCREENING MAMMOGRAPHY,,77052,403,$65.00 ,$65.00 ,$49.66 ,$58.50 ,$55.25 ,$55.25 ,$55.25 ,$57.20 ,$55.25 ,$57.20 ,$57.20 ,$56.55 ,$55.25 ,$55.25 ,$55.25 ,$49.66 ,$58.50
Carle Richland Memorial Hospital,8477063,SCREENING DIGITAL BREAST TOMOSYNTHESIS BILATERAL,,77063,403,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8478815,PET SCAN SKULL BASE TO MIDTHIGH,,78815,404,"$9,370.00 ","$9,370.00 ","$7,158.68 ","$8,433.00 ","$7,964.50 ","$7,964.50 ","$7,964.50 ","$8,245.60 ","$7,964.50 ","$8,245.60 ","$8,245.60 ","$8,151.90 ","$7,964.50 ","$7,964.50 ","$7,964.50 ","$7,158.68 ","$8,433.00 "
Carle Richland Memorial Hospital,8478816,PET/CT SCAN WHOLE BODY,,78816,404,"$9,370.00 ","$9,370.00 ","$7,158.68 ","$8,433.00 ","$7,964.50 ","$7,964.50 ","$7,964.50 ","$8,245.60 ","$7,964.50 ","$8,245.60 ","$8,245.60 ","$8,151.90 ","$7,964.50 ","$7,964.50 ","$7,964.50 ","$7,158.68 ","$8,433.00 "
Carle Richland Memorial Hospital,8652950,CPR,,92950,410,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,8654002,VENT / PER DAY,,94002,410,"$2,700.00 ","$2,700.00 ","$2,062.80 ","$2,430.00 ","$2,295.00 ","$2,295.00 ","$2,295.00 ","$2,376.00 ","$2,295.00 ","$2,376.00 ","$2,376.00 ","$2,349.00 ","$2,295.00 ","$2,295.00 ","$2,295.00 ","$2,062.80 ","$2,430.00 "
Carle Richland Memorial Hospital,8651002,VENT MANAGEMENT -HOURLY,,94002,410,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8654640,NEBULIZER TREATMENT,,94640,410,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8651664,NEBULIZER TREAT-OUT,,94664,410,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8652667,"MANIP CHEST WALL - WITH DVC, INITIAL TXMNT",,94667,410,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8650004,AEROSOL / PER DAY,,94799,410,$800.00 ,$800.00 ,$611.20 ,$720.00 ,$680.00 ,$680.00 ,$680.00 ,$704.00 ,$680.00 ,$704.00 ,$704.00 ,$696.00 ,$680.00 ,$680.00 ,$680.00 ,$611.20 ,$720.00
Carle Richland Memorial Hospital,8650007,BEDSIDE SPIROMETRY-LAP,,94010,410,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8650008,BI PAP / PER DAY,,94660,410,"$2,340.00 ","$2,340.00 ","$1,787.76 ","$2,106.00 ","$1,989.00 ","$1,989.00 ","$1,989.00 ","$2,059.20 ","$1,989.00 ","$2,059.20 ","$2,059.20 ","$2,035.80 ","$1,989.00 ","$1,989.00 ","$1,989.00 ","$1,787.76 ","$2,106.00 "
Carle Richland Memorial Hospital,8650016,CHEST PHYSIOTHERAPY,,94669,410,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8650020,CPAP / PER DAY,,94660,410,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,8650026,INTRAPULMONARY PERCUSSIVE VENT-INITIAL,,94667,410,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8650029,IS INSTRUCT,,94799,410,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8650033,MDI TREATMENT,,94640,410,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8650042,NEO OXYGEN / PER DAY,,94799,410,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8650044,NEO TCM -EAR OXIMETRY/PER DAY,,,410,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,8650064,SPUTUM INDUCTION,,94640,410,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8650065,TCM -EAR OXIMETRY/PER DAY,,94761,410,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,8652668,"MANIP CHEST WALL - WITH DVC, SUBSQ TXMNT",,94668,410,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8651720,NASOTRACHEAL ASPIRATION,,31720,410,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8654003,MECH. VENTILATOR SUBSEQUENT DAY,,94003,410,"$2,200.00 ","$2,200.00 ","$1,680.80 ","$1,980.00 ","$1,870.00 ","$1,870.00 ","$1,870.00 ","$1,936.00 ","$1,870.00 ","$1,936.00 ","$1,936.00 ","$1,914.00 ","$1,870.00 ","$1,870.00 ","$1,870.00 ","$1,680.80 ","$1,980.00 "
Carle Richland Memorial Hospital,8654644,CONTINUOUS NEB FIRST HOUR,,94644,410,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8654645,CONTINUOUS NEB EACH ADD HOUR,,94645,410,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,94640,PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,,94640,410,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8620007,DRIVERS EVALUATION,,,420,$345.00 ,$345.00 ,$263.58 ,$310.50 ,$293.25 ,$293.25 ,$293.25 ,$303.60 ,$293.25 ,$303.60 ,$303.60 ,$300.15 ,$293.25 ,$293.25 ,$293.25 ,$263.58 ,$310.50
Carle Richland Memorial Hospital,8617012,PELVIC & CERVICAL TRACTION,,97012,420,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8617016,COMPRESSION PUMP,,97016,420,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8617018,PARAFFIN,,97018,420,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8617022,DRY WHIRLPOOL,,97022,420,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8611022,LIQUID WHIRLPOOL,,97022,420,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8617032,15' EMS 1:1,,97032,420,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8617033,15' IONTO 1:1,,97033,420,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8617035,15' ULTRASOUND 1:1,,97035,420,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8617110,15' INDIVIDUAL THERAPY-OFFSITE,,97110,420,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8611110,15' INDIVIDUAL THERAPY-ONSITE,,97110,420,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8612110,15' THERAPEUTIC EXERCISE,,97110,420,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8617112,15' NEUROMUSCULAR RE-EDUCATION,,97112,420,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8617113,15' AQUATIC THERAPY,,97113,420,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8617116,15' GAIT TRAINING,,97116,420,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8617139,THERAPEUTIC PROCEDURE,,97139,420,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8617140,15' MANUAL THERAPY,,97140,420,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8617150,15' GROUP THERAPY,,97150,420,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8619150,"GROUP PT 8""-30""",,97150,420,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8617530,15' FUNCT THERAPY ACTIVITY,,97530,420,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8617535,15' ADL TRAINING,,97535,420,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,8617537,15' WORK & COMMUNITY RE-ENTRY,,97537,420,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8617542,15' WHEELCHAIR MGMT TRAINING,,97542,420,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8617545,WORK CONDITIONING INITIAL 2 HR,,97545,420,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,8617546,WORK CONDITIONING ADDTL HR,,97546,420,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,8617597,SELECTIVE DEBRIDEMNT < 20SQ CM,,97597,420,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8617598,SELECTIVE DEBRDEMNT > 20 SQ CM,,97598,420,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8617750,FUNCTIONAL CAPACITY EVALUATION,,97750,420,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8611750,FUNCTIONAL TESTS & MEASURES,,97750,420,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8617760,"ORTHOTIC MGMNT & TRAINING 15""",,97760,420,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8617761,PROSTHETIC TRAINING 15',,97761,420,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8611499,15' IFSP DEVELOPMENT-ONSITE,,99499,420,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8610281,ELECTRICAL STIM FOR ULCERS,,G0281,420,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8610283,ELECTRICAL STIMULATION,,G0283,420,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8619581,APPLY MULTI-LAY CMPRSSN; LEG (BELOW KNEE) INCL ANKLE/FT,,29581,420,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8619366,"PT CHG TEAM CONF WITH PT/FAMILY PRSNT, EA 30 MIN",,99366,420,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8617763,ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN,,97763,420,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8617014,ELECTRIC STIMULATION THERAPY,,97014,420,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8610023,E-I EVAL/ASSESS - ONSITE 15 MIN,,96112,420,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,8610024,E-I EVAL/ASSESS - OFFSITE 15 MIN,,96112,420,$64.00 ,$64.00 ,$48.90 ,$57.60 ,$54.40 ,$54.40 ,$54.40 ,$56.32 ,$54.40 ,$56.32 ,$56.32 ,$55.68 ,$54.40 ,$54.40 ,$54.40 ,$48.90 ,$57.60
Carle Richland Memorial Hospital,8610025,PT EVAL - MOD COMPLEXITY,,97162,420,$375.00 ,$375.00 ,$286.50 ,$337.50 ,$318.75 ,$318.75 ,$318.75 ,$330.00 ,$318.75 ,$330.00 ,$330.00 ,$326.25 ,$318.75 ,$318.75 ,$318.75 ,$286.50 ,$337.50
Carle Richland Memorial Hospital,8610026,PT EVAL - HIGH COMPLEXITY,,97163,420,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8655992,CANALITH REPOSITIONING,,95992,420,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8697161,PT EVAL LOW COMPLEXITY,,97161,424,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8697162,PT EVAL MODERATE COMPLEXITY (0-30 MINUTES),,97162,424,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8615000,PT EVAL MODERATE COMPLEXITY (31-60 MINUTES),,97162,424,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8615001,PT EVAL MODERATE COMPLEXITY (61-90 MINUTES),,97162,424,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8697163,PT EVAL HIGH COMPLEXITY (0-30 MINUTES),,97163,424,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8615002,PT EVAL HIGH COMPLEXITY (31-60 MINUTES),,97163,424,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8615003,PT EVAL HIGH COMPLEXITY 61-90 MINUTES),,97163,424,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8697164,PT RE-EVALUATION,,97164,424,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8620008,DRIVERS EVALUATION,,,430,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8620281,ELECTRICAL STIM FOR ULCERS,,G0281,430,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8627018,PARAFFIN,,97018,430,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8627022,DRY WHIRLPOOL,,97022,430,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8621022,LIQUID WHIRLPOOL,,97022,430,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8627033,15' IONTO 1:1,,97033,430,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8627035,15' ULTRASOUND 1:1,,97035,430,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8627110,15' THERAPEUTIC EXERCISE,,97110,430,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8622110,15' THERAPEUTIC EXERCISE,,97110,430,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8627112,15' NEUROMUSCULAR RE-EDUCATION,,97112,430,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8627140,15' MANUAL THERAPY,,97140,430,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8627150,15' GROUP THERAPY,,97150,430,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8622150,GROUP OT 31'-45',,97150,430,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8621530,15' INDIVIDUAL THERAPY-ONSITE,,97530,430,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8622530,15' INDIVIDUAL THERAPY-OFFSITE,,97530,430,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8627530,15' FUNCT THERAPY ACTIVITY,,97530,430,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8627533,15' SENSORY INTEGRATION,,97533,430,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,8627535,15' ADL TRAINING,,97535,430,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,8627537,15' WORK & COMMUNITY RE-ENTRY,,97537,430,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8627542,15' WHEELCHAIR MGMT TRAINING,,97542,430,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8627545,WORK CONDITIONING INITIAL 2 HR,,97545,430,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,8627546,WORK CONDITIONING ADDTL HR,,97546,430,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,8627597,SELECTIVE DEBRIDEMNT < 20SQ CM,,97597,430,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,8627598,SELECTIVE DEBRIDEMNT > 20SQ CM,,97598,430,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8627750,FUNCTIONAL CAPACITY EVALUATION,,97750,430,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8621750,FUNCTIONAL TESTS & MEASURES,,97750,430,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8627760,"ORTHOTIC MGMNT & TRAINING 15""",,97760,430,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8627761,"PROSTHETIC TRAINING 15""",,97761,430,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8629499,15' IFSP DEVELOPMENT-ONSITE,,99499,430,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8629366,"OT CHG TEAM CONF WITH PT/FAMILY PRSNT, EA 30 MIN",,99366,430,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8627127,THERAPEUTIC IVNTJ W/FOCUS ON COGNITIVE FUNCTION,,97127,430,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8627763,ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN,,97763,430,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8627014,ELECTRIC STIMULATION THERAPY,,97014,430,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,8620044,E-I EVAL/ASSESS ONSITE 15 MIN,,96112,430,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,8620045,E-I EVAL/ASSESS OFFSITE 15 MIN,,96112,430,$64.00 ,$64.00 ,$48.90 ,$57.60 ,$54.40 ,$54.40 ,$54.40 ,$56.32 ,$54.40 ,$56.32 ,$56.32 ,$55.68 ,$54.40 ,$54.40 ,$54.40 ,$48.90 ,$57.60
Carle Richland Memorial Hospital,8620046,OT EVAL - MOD COMPLEXITY,,97166,430,$375.00 ,$375.00 ,$286.50 ,$337.50 ,$318.75 ,$318.75 ,$318.75 ,$330.00 ,$318.75 ,$330.00 ,$330.00 ,$326.25 ,$318.75 ,$318.75 ,$318.75 ,$286.50 ,$337.50
Carle Richland Memorial Hospital,8620047,OT EVAL - HIGH COMPLEXITY,,97167,430,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8620515,COGNITIVE TREATMENT 15 MIN,,G0515,430,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8627129,THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES,,97129,430,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8697165,OT EVAL LOW COMPLEXITY,,97165,434,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8679166,OT EVAL MODERATE COMPLEXITY (0-30 MINUTES),,97166,434,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8697167,OT EVAL HIGH COMPLEXITY (0-30 MINUTES),,97167,434,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8625002,OT EVAL HIGH COMPLEXITY (31-60 MINUTES),,97167,434,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8697168,OT RE-EVAL,,97168,434,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8625003,OT EVAL HIGH COMPLEXITY (61-90 MINUTES),,97167,434,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8625008,OT EVAL MODERATE COMPLEXITY (31-60 MINUTES),,97166,434,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8625009,OT EVAL MODERATE COMPLEXITY (61-90 MINUTES),,97166,434,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8616105,APHASIA TEST,,96105,440,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8631579,"SP 8-30"" LARYNGOSCPY W/STROBOSCPY",,31579,440,"$1,780.00 ","$1,780.00 ","$1,359.92 ","$1,602.00 ","$1,513.00 ","$1,513.00 ","$1,513.00 ","$1,566.40 ","$1,513.00 ","$1,566.40 ","$1,566.40 ","$1,548.60 ","$1,513.00 ","$1,513.00 ","$1,513.00 ","$1,359.92 ","$1,602.00 "
Carle Richland Memorial Hospital,8632579,"SP 31-60"" LARYNGOSCPY W/STRBOSCPY",,31579,440,"$2,080.00 ","$2,080.00 ","$1,589.12 ","$1,872.00 ","$1,768.00 ","$1,768.00 ","$1,768.00 ","$1,830.40 ","$1,768.00 ","$1,830.40 ","$1,830.40 ","$1,809.60 ","$1,768.00 ","$1,768.00 ","$1,768.00 ","$1,589.12 ","$1,872.00 "
Carle Richland Memorial Hospital,8632507,8-15' SPEECH TREATMENT,,92507,440,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8631507,16-30' SPEECH TREATMENT,,92507,440,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8633507,"SPEECH/AUDIO TREATMENT 16-29""",,92507,440,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8634507,15' SLP A/R SERVICES-ONSITE,,92507,440,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8635507,15' INDIVIDUAL THERAPY-ONSITE,,92507,440,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,8636507,15' SLP A/R SERVICES-OFFSITE,,92507,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8637507,15' INDIVIDUAL THERAPY-OFFSITE,,92507,440,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8638507,31-45' SPEECH TREATMENT,,92507,440,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8639507,46-60' SPEECH TREATMENT,,92507,440,$405.00 ,$405.00 ,$309.42 ,$364.50 ,$344.25 ,$344.25 ,$344.25 ,$356.40 ,$344.25 ,$356.40 ,$356.40 ,$352.35 ,$344.25 ,$344.25 ,$344.25 ,$309.42 ,$364.50
Carle Richland Memorial Hospital,8631557,"45-59"" SPEECH/AUDIO TREATMENT",,92507,440,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,8631657,31'-60' SPEECH TREATMENT,,92507,440,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8631757,61-75' SPEECH TREATMENT,,92507,440,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8631857,"60-74"" SPEECH/AUDIO TREATMENT",,92507,440,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,8631957,SP 31'-60' TREATMENT FOR FEEDING,,92507,440,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8632107,76-90' SPEECH TREATMENT,,92507,440,$690.00 ,$690.00 ,$527.16 ,$621.00 ,$586.50 ,$586.50 ,$586.50 ,$607.20 ,$586.50 ,$607.20 ,$607.20 ,$600.30 ,$586.50 ,$586.50 ,$586.50 ,$527.16 ,$621.00
Carle Richland Memorial Hospital,8632207,"75-89"" SPEECH/AUDIO TREATMENT",,92507,440,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,8632307,"61-90"" SPEECH/AUDIO TREATMENT",,92507,440,$800.00 ,$800.00 ,$611.20 ,$720.00 ,$680.00 ,$680.00 ,$680.00 ,$704.00 ,$680.00 ,$704.00 ,$704.00 ,$696.00 ,$680.00 ,$680.00 ,$680.00 ,$611.20 ,$720.00
Carle Richland Memorial Hospital,8632407,"SPEECH TREATMENT > 90""",,92507,440,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,8632907,"91-120"" SPEECH TREATMENT",,92507,440,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,8633158,"105-119"" GROUP SPEECH",,92508,440,"$1,220.00 ","$1,220.00 ",$932.08 ,"$1,098.00 ","$1,037.00 ","$1,037.00 ","$1,037.00 ","$1,073.60 ","$1,037.00 ","$1,073.60 ","$1,073.60 ","$1,061.40 ","$1,037.00 ","$1,037.00 ","$1,037.00 ",$932.08 ,"$1,098.00 "
Carle Richland Memorial Hospital,8633258,"105-119"" GROUP SPEECH",,92508,440,"$1,220.00 ","$1,220.00 ",$932.08 ,"$1,098.00 ","$1,037.00 ","$1,037.00 ","$1,037.00 ","$1,073.60 ","$1,037.00 ","$1,073.60 ","$1,073.60 ","$1,061.40 ","$1,037.00 ","$1,037.00 ","$1,037.00 ",$932.08 ,"$1,098.00 "
Carle Richland Memorial Hospital,8633058,"106-120""GROUP SPEECH",,92508,440,"$1,160.00 ","$1,160.00 ",$886.24 ,"$1,044.00 ",$986.00 ,$986.00 ,$986.00 ,"$1,020.80 ",$986.00 ,"$1,020.80 ","$1,020.80 ","$1,009.20 ",$986.00 ,$986.00 ,$986.00 ,$886.24 ,"$1,044.00 "
Carle Richland Memorial Hospital,8635508,15' GROUP A/R SERVICES,,92508,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8636508,15' GROUP SLP A/R SERVICES,,92508,440,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8638508,15' GROUP SLP A/R SERVICES,,92508,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8632508,15' GROUP THPY SPEECH/LANGUAGE,,92508,440,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8631758,"30-44"" GROUP SPEECH",,92508,440,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8634508,31'-45' GROUP SPEECH,,92508,440,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8631658,"31-45"" GROUP SPEECH",,92508,440,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8631558,"45""-60"" GROUP SPEECH",,92508,440,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8632358,"45-59"" GROUP SPEECH",,92508,440,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8639508,46'-60' GROUP SPEECH,,92508,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8632258,46-60' GROUP SPEECH,,92508,440,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8632158,"46-60"" GROUP SPEECH",,92508,440,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8631958,"60""-120"" GROUP SPEECH",,92508,440,$450.00 ,$450.00 ,$343.80 ,$405.00 ,$382.50 ,$382.50 ,$382.50 ,$396.00 ,$382.50 ,$396.00 ,$396.00 ,$391.50 ,$382.50 ,$382.50 ,$382.50 ,$343.80 ,$405.00
Carle Richland Memorial Hospital,8632558,"60-74"" GROUP SPEECH",,92508,440,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,8631858,61'-120' GROUP SPEECH,,92508,440,$405.00 ,$405.00 ,$309.42 ,$364.50 ,$344.25 ,$344.25 ,$344.25 ,$356.40 ,$344.25 ,$356.40 ,$356.40 ,$352.35 ,$344.25 ,$344.25 ,$344.25 ,$309.42 ,$364.50
Carle Richland Memorial Hospital,8632458,"61-75"" GROUP SPEECH",,92508,440,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8632758,"75-89"" GROUP SPEECH",,92508,440,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,8632658,"76-90"" GROUP SPEECH",,92508,440,$830.00 ,$830.00 ,$634.12 ,$747.00 ,$705.50 ,$705.50 ,$705.50 ,$730.40 ,$705.50 ,$730.40 ,$730.40 ,$722.10 ,$705.50 ,$705.50 ,$705.50 ,$634.12 ,$747.00
Carle Richland Memorial Hospital,8633508,8'-30' GROUP SPEECH,,92508,440,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8632958,"90-104"" GROUP SPEECH",,92508,440,"$1,040.00 ","$1,040.00 ",$794.56 ,$936.00 ,$884.00 ,$884.00 ,$884.00 ,$915.20 ,$884.00 ,$915.20 ,$915.20 ,$904.80 ,$884.00 ,$884.00 ,$884.00 ,$794.56 ,$936.00
Carle Richland Memorial Hospital,8632858,"91-105"" GROUP SPEECH",,92508,440,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,8637508,GROUP SPEECH,,92508,440,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8633458,"GROUP SPEECH > 120""",,92508,440,"$1,300.00 ","$1,300.00 ",$993.20 ,"$1,170.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ","$1,144.00 ","$1,105.00 ","$1,144.00 ","$1,144.00 ","$1,131.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ",$993.20 ,"$1,170.00 "
Carle Richland Memorial Hospital,8633358,"GROUP SPEECH 120""",,92508,440,"$1,380.00 ","$1,380.00 ","$1,054.32 ","$1,242.00 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,214.40 ","$1,173.00 ","$1,214.40 ","$1,214.40 ","$1,200.60 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,054.32 ","$1,242.00 "
Carle Richland Memorial Hospital,8631508,GROUP SPEECH 8-15',,92508,440,$83.00 ,$83.00 ,$63.41 ,$74.70 ,$70.55 ,$70.55 ,$70.55 ,$73.04 ,$70.55 ,$73.04 ,$73.04 ,$72.21 ,$70.55 ,$70.55 ,$70.55 ,$63.41 ,$74.70
Carle Richland Memorial Hospital,8632520,8'-30' LARYNGEAL FUNCTN STUDY,,92520,440,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8631520,31'-60' LARYNGEAL FUNCTN STUDY,,92520,440,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8632526,16'-30' TREATMENT FOR FEEDING,,92526,440,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8626105,APHASIA TEST,,96105,440,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8631526,31'-60' TREATMENT FOR FEEDING,,92526,440,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,8633526,61'-120' TREATMENT FOR FEEDING,,92526,440,$920.00 ,$920.00 ,$702.88 ,$828.00 ,$782.00 ,$782.00 ,$782.00 ,$809.60 ,$782.00 ,$809.60 ,$809.60 ,$800.40 ,$782.00 ,$782.00 ,$782.00 ,$702.88 ,$828.00
Carle Richland Memorial Hospital,8632597,8'-60' VOICE PROSTHESIS EVAL,,92597,440,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,8633597,61'-120' VOICE PROSTHESIS EVAL,,92597,440,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,8632607,8'-30' AUGMENTATIVE COMM EVAL,,92607,440,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8633607,1ST HR EVAL SPEECH GN AC DVC,,92607,440,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,8632608,"ADL 30"" EVAL SPEECH GN AC DVC",,92608,440,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8632609,TX SVCS SPEECH GN DVC PROG&MOD,,92609,440,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8632610,16'-30' SWALLOW/ORAL FUNC EVAL,,92610,440,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8631610,31'-45' SWALLOW/ORAL FUNC EVAL,,92610,440,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,8632611,31'-45' RADIO-OPAQUE SWAL EVAL,,92611,440,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,8633611,46'-60' RADIO-OPAQUE SWAL EVAL,,92611,440,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,8632612,8'-30' FIBEROPTIC SWALLOW EVAL,,92612,440,$620.00 ,$620.00 ,$473.68 ,$558.00 ,$527.00 ,$527.00 ,$527.00 ,$545.60 ,$527.00 ,$545.60 ,$545.60 ,$539.40 ,$527.00 ,$527.00 ,$527.00 ,$473.68 ,$558.00
Carle Richland Memorial Hospital,8633612,31'-60'FIBEROPTIC SWALLOW EVAL,,92612,440,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8632626,15' SLP A/R ASSESSMENT-ONSITE,,92626,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8633626,15' SLP A/R ASSESSMENT-OFFSITE,,92626,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8634626,AUDITORY REHAB EVAL 1 HR,,92626,440,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8632627,"AUDITORY REHAB EVAL ADNL 15""",,92627,440,$86.00 ,$86.00 ,$65.70 ,$77.40 ,$73.10 ,$73.10 ,$73.10 ,$75.68 ,$73.10 ,$75.68 ,$75.68 ,$74.82 ,$73.10 ,$73.10 ,$73.10 ,$65.70 ,$77.40
Carle Richland Memorial Hospital,8633630,"16-29"" AUD REHAB PRE-LING",,92630,440,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8632630,"8-15"" AUD REHAB PRE-LING",,92630,440,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8634630,"8 - 30"" AUD REHAB PRE-LING",,92630,440,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8635630,"30-44"" AUD REHAB PRE-LING",,92630,440,$390.00 ,$390.00 ,$297.96 ,$351.00 ,$331.50 ,$331.50 ,$331.50 ,$343.20 ,$331.50 ,$343.20 ,$343.20 ,$339.30 ,$331.50 ,$331.50 ,$331.50 ,$297.96 ,$351.00
Carle Richland Memorial Hospital,8636630,"45-59"" AUD REHAB PRE-LING",,92630,440,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8637630,"31 - 60"" AUD REHAB PRE-LING",,92630,440,$500.00 ,$500.00 ,$382.00 ,$450.00 ,$425.00 ,$425.00 ,$425.00 ,$440.00 ,$425.00 ,$440.00 ,$440.00 ,$435.00 ,$425.00 ,$425.00 ,$425.00 ,$382.00 ,$450.00
Carle Richland Memorial Hospital,8638630,"60-74"" AUD REHAB PRE-LING",,92630,440,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,8639630,"75-89"" AUD REHAB PRE-LING",,92630,440,$830.00 ,$830.00 ,$634.12 ,$747.00 ,$705.50 ,$705.50 ,$705.50 ,$730.40 ,$705.50 ,$730.40 ,$730.40 ,$722.10 ,$705.50 ,$705.50 ,$705.50 ,$634.12 ,$747.00
Carle Richland Memorial Hospital,8631660,"61 - 90"" AUD REHAB PRE-LING",,92630,440,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,8631760,"90"" AUD REHAB PRE-LING",,92630,440,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,8631860,"8 - 30"" AUD REHAB POST-LING",,92633,440,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8631960,"31 - 60"" AUD REHAB POST-LING",,92633,440,$500.00 ,$500.00 ,$382.00 ,$450.00 ,$425.00 ,$425.00 ,$425.00 ,$440.00 ,$425.00 ,$440.00 ,$440.00 ,$435.00 ,$425.00 ,$425.00 ,$425.00 ,$382.00 ,$450.00
Carle Richland Memorial Hospital,8632160,"61 - 90"" AUD REHAB POST-LING",,92633,440,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,8635000,EQUIPMENT REPAIR SVC CHARGE,,92700,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8636000,SCHOOL STAFFING/CONSULT<100 MI,,92700,440,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,8636001,SCHOOL STAFFING/CONSULT>100 MI,,92700,440,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,8636105,15'-30' APHASIA TEST,,96105,440,$420.00 ,$420.00 ,$320.88 ,$378.00 ,$357.00 ,$357.00 ,$357.00 ,$369.60 ,$357.00 ,$369.60 ,$369.60 ,$365.40 ,$357.00 ,$357.00 ,$357.00 ,$320.88 ,$378.00
Carle Richland Memorial Hospital,8636205,31'-60' APHASIA TEST,,96105,440,$420.00 ,$420.00 ,$320.88 ,$378.00 ,$357.00 ,$357.00 ,$357.00 ,$369.60 ,$357.00 ,$369.60 ,$369.60 ,$365.40 ,$357.00 ,$357.00 ,$357.00 ,$320.88 ,$378.00
Carle Richland Memorial Hospital,8636111,15' EVALUATION-ONSITE,,96111,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8636112,15' EVALUATION-OFFSITE,,96111,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8636125,"60"" COGNITIVE PERFORMANCE TEST",,96125,440,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,8637032,"15"" SP EMS 1:1",,97032,440,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8637110,SP TX EXERCISE - ORAL MOTOR ACT,,97110,440,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8637112,SP NEUROMUSCULAR RE-EDUCATION,,97112,440,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8637139,THERAPEUTIC PROCEDURE,,97139,440,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8637530,SP INSTRUCT COMP SWALLOWING TECHN,,97530,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8637533,SP SENSORY INTEGRATION TECHNIQUES,,97533,440,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8637535,SP 15' ADL TRAINING,,97535,440,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8637537,SP 15' WORK & COMMUNITY RE-ENTRY,,97537,440,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8637750,"SP 15"" PHYSICAL PERF TEST/MEAS.",,97750,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8637755,"SP 15"" ASSISTIVE TECH ASSESSMENT",,97755,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8637000,15' IFSP DEVELOPMENT-ONSITE,,99499,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8637001,"IFSP DEVELOPMENT-ONSITE 15""",,99499,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8637002,15' IFSP DEVELOPMEMT-OFFSITE,,99499,440,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8637003,15' IFSP DEVELOPMENT-OFFSITE,,99499,440,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8637004,15' SLPA/R IFSP DVLPMNT-ONSITE,,99499,440,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8637005,15' A/R IFSP DVLPMNT-ONSITE,,99499,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8637006,15' SLPA/R IFSP DVLPMT-OFFSITE,,99499,440,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8637007,15' A/R IFSP DVLPMNT-OFFSITE,,99499,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8637008,15' IFSP DEVELOPMENT-ONSITE,,99499,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8637030,15' INDIVIDUAL SVC COORDINATIN,,T1017,440,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,8637031,15' IFSP DEVELOPMENT-ONSITE,,T1024,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8637034,15' GRP FAM TRAINING & SUPPORT,,T1027,440,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8637035,15' GROUP DT,,T1027,440,$81.00 ,$81.00 ,$61.88 ,$72.90 ,$68.85 ,$68.85 ,$68.85 ,$71.28 ,$68.85 ,$71.28 ,$71.28 ,$70.47 ,$68.85 ,$68.85 ,$68.85 ,$61.88 ,$72.90
Carle Richland Memorial Hospital,8637036,15' FAM TRAIN/SUPPORT-ONSITE,,T1027,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8637037,15' FAM TRAIN/SUPPORT-OFFSITE,,T1027,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8637038,15' INDIVIDUAL DT-ONSITE,,T1027,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8637039,15' INDIVIDUAL DT-OFFSITE,,T1027,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8637041,HEARING AID ASSESSMENT,,V5010,440,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8637042,"15"" SPEECH THERAPY/HLTHY KIDS",,W7088,440,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8637043,"15"" SPEECH EVAL/HEALTHY KIDS",,W7968,440,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8637050,15' ASSESSMENT-ONSITE,,W8730,440,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,8637051,15' ASSESSMENT-OFFSITE,,W8731,440,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,8637052,15' ASSESSMENT-ONSITE,,W8758,440,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,8637053,15' ASSESSMENT-OFFSITE,,W8759,440,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,8637132,15' IFSP DEVELOPMENT-OFFSITE,,T1024,440,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8632517,"SPEECH TREATMENT > 90""",,92507,440,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,8739366,"SLP CHG TEAM CONF WITH PT/FAMILY PRSNT, EA 30 MIN",,99366,440,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8630507,8'-30' SPEECH TREATMENT,,92507,440,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8630523,15' EVALUATION-ONSITE,,92523,440,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8639366,"SLP CHG TEAM CONF WITH PT/FAMILY PRSNT, EA 30 MIN",,99366,440,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,8639368,"SLP CHG TEAM CONF W/O PT/FAMILY PRSNT, EA 30 MIN",,99368,440,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,8637127,THERAPEUTIC IVNTJ W/FOCUS ON COGNITIVE FUNCTION,,97127,440,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8632521,SPEECH FLUENCY 8-60,,92521,440,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8632522,SOUND PRODUCTION 8-60,,92522,440,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,8632523,LANGUAGE COMP 8-60,,92523,440,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8632525,LANGUAGE COMP 60-120,,92523,440,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8632524,Voice/Resonance,,92524,440,$425.00 ,$425.00 ,$324.70 ,$382.50 ,$361.25 ,$361.25 ,$361.25 ,$374.00 ,$361.25 ,$374.00 ,$374.00 ,$369.75 ,$361.25 ,$361.25 ,$361.25 ,$324.70 ,$382.50
Carle Richland Memorial Hospital,8726125,COGNITIVE EVAL,,96125,440,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,8632605,EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR,,92605,440,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,8632618,EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN,,92618,440,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8632606,"THER SRVC(S),NON-SPEECH GEN DEV, W/PROG",,92606,440,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8630000,SPEECH EVAL/ASSESSMENT SPEECH FLUENCY ON/LOC CODE 11,,92521,440,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8630001,SPEECH EVAL/ASSESSMENT SPEECH FLUENCY OFF/LOC CODE 12,,92521,440,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8630002,SPEECH EVAL/ASSESSMENT SPEECH FLUENCY OFF/LOC CODE 99,,92521,440,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8630003,SPEECH THERAPY SERVICES ON/LOC CODE 11,,92507,440,$86.00 ,$86.00 ,$65.70 ,$77.40 ,$73.10 ,$73.10 ,$73.10 ,$75.68 ,$73.10 ,$75.68 ,$75.68 ,$74.82 ,$73.10 ,$73.10 ,$73.10 ,$65.70 ,$77.40
Carle Richland Memorial Hospital,8630004,SPEECH THERAPY SERVICES OFF/LOC CODE 12,,92507,440,$86.00 ,$86.00 ,$65.70 ,$77.40 ,$73.10 ,$73.10 ,$73.10 ,$75.68 ,$73.10 ,$75.68 ,$75.68 ,$74.82 ,$73.10 ,$73.10 ,$73.10 ,$65.70 ,$77.40
Carle Richland Memorial Hospital,8630005,SPEECH THERAPY SERVICES OFF/LOC CODE 99,,92507,440,$86.00 ,$86.00 ,$65.70 ,$77.40 ,$73.10 ,$73.10 ,$73.10 ,$75.68 ,$73.10 ,$75.68 ,$75.68 ,$74.82 ,$73.10 ,$73.10 ,$73.10 ,$65.70 ,$77.40
Carle Richland Memorial Hospital,8630006,SPEECH IFSP MTG/DEV ON/LOC CODE 11,,99499,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8630007,SPEECH IFSP MTG/DEV OFF/LOC CODE 12,,99499,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8630008,SPEECH IFSP MTG/DEV OFF/LOC CODE 99,,99499,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8630009,SPEECH EVAL/ASSESSMENT SOUND PRODUCTION ON/LOC CODE 11,,92522,440,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8630010,SPEECH EVAL/ASSESSMENT SOUND PRODUCTION OFF/LOC CODE 12,,92522,440,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8630011,SPEECH EVAL/ASSESSMENT SOUND PRODUCTION OFF/LOC CODE 99,,92522,440,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8630012,SP EVAL/ASSESS SOUND PROD W/ LANG COMP AND EXPRESS ON/LOC CODE 11,,92523,440,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8630013,SP EVAL/ASSESS SOUND PROD W/ LANG COMP AND EXPRESS OFF/LOC CODE 12,,92523,440,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8630014,SP EVAL/ASSESS SOUND PROD W/ LANG COMP AND EXPRESS OFF/LOC CODE 99,,92523,440,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8630015,SPEECH EVAL/ASSESSMENT BEHAVIORAL/VOICE RESONANCE ON/LOC CODE 11,,92524,440,$345.00 ,$345.00 ,$263.58 ,$310.50 ,$293.25 ,$293.25 ,$293.25 ,$303.60 ,$293.25 ,$303.60 ,$303.60 ,$300.15 ,$293.25 ,$293.25 ,$293.25 ,$263.58 ,$310.50
Carle Richland Memorial Hospital,8630016,SPEECH EVAL/ASSESSMENT BEHAVIORAL/VOICE RESONANCE OFF/LOC CODE 12,,92524,440,$345.00 ,$345.00 ,$263.58 ,$310.50 ,$293.25 ,$293.25 ,$293.25 ,$303.60 ,$293.25 ,$303.60 ,$303.60 ,$300.15 ,$293.25 ,$293.25 ,$293.25 ,$263.58 ,$310.50
Carle Richland Memorial Hospital,8630017,SPEECH EVAL/ASSESSMENT BEHAVIORAL/VOICE RESONANCE OFF/LOC CODE 99,,92524,440,$345.00 ,$345.00 ,$263.58 ,$310.50 ,$293.25 ,$293.25 ,$293.25 ,$303.60 ,$293.25 ,$303.60 ,$303.60 ,$300.15 ,$293.25 ,$293.25 ,$293.25 ,$263.58 ,$310.50
Carle Richland Memorial Hospital,8630018,SPEECH EVAL/ASSESSMENT SWALLOW ON/LOC CODE 11,,92610,440,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8630019,SPEECH EVAL/ASSESSMENT SWALLOW OFF/LOC CODE 12,,92610,440,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8630020,SPEECH EVAL/ASSESSMENT SWALLOW OFF/LOC CODE 99,,92610,440,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8633610,"0-15""' SWALLOW/ORAL FUNC EVAL",,92610,440,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8634610,"46""-60' SWALLOW/ORAL FUNC EVAL",,92610,440,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8634526,"0-15"" TREATMENT FOR FEEDING",,92526,440,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8630022,DSCC SPEECH THERAPY TREATMENT - 15 MIN,,92507,440,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,8630023,EVAL OF SPEECH FLUENCY 15 MIN,,92521,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8630030,E-I EVAL/ASSESS - ONSITE 15 MIN (SS W/L),,92522,440,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,8630024,EVAL OF SPEECH SOUND PRODUCTION 15 MIN,,92522,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8630025,EVAL SPEECH PROD W LANGUAGE COMP 15MIN,,92523,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8630029,BEHAV & QUAL ANALYSIS OF VOICE 15 MIN,,92524,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8630026,EVAL OF VOICE PROSTHETIC,,92597,440,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8630027,EVALUATE SWALLOWING FUNCTION,,92610,440,$520.00 ,$520.00 ,$397.28 ,$468.00 ,$442.00 ,$442.00 ,$442.00 ,$457.60 ,$442.00 ,$457.60 ,$457.60 ,$452.40 ,$442.00 ,$442.00 ,$442.00 ,$397.28 ,$468.00
Carle Richland Memorial Hospital,8630028,MOTION FLUDROSCOPY/SWALLOW,,92611,440,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8630515,COGNITIVE TREATMENT 15 MIN,,G0515,440,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8637129,THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES,,97129,440,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8637130,THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES,,97130,440,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8630021,TREATMENT OF SPEECH & LANGUAGE 15MIN,,92507,441,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8896361,HYDRATION IV INFUSN EA ADNL HR,,96361,450,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8896360,HYDRATION IV INFUSN UP TO 1HR,,96360,450,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8896365,IV INFUSION -UP TO 1HR,,96365,450,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8896366,IV INFUSION -EA ADNL HR,,96366,450,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8800235,RMVL FOREIGN BODY FINGER,,,450,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,8851798,US BLADDER CAPACITY,,51798,450,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8896367,IV INFUSION SEQ -UP TO 1HR,,96367,450,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,8800256,TXMNT WOUND DEHISCENCE,,,450,"$1,250.00 ","$1,250.00 ",$955.00 ,"$1,125.00 ","$1,062.50 ","$1,062.50 ","$1,062.50 ","$1,100.00 ","$1,062.50 ","$1,100.00 ","$1,100.00 ","$1,087.50 ","$1,062.50 ","$1,062.50 ","$1,062.50 ",$955.00 ,"$1,125.00 "
Carle Richland Memorial Hospital,8800237,"INCISION & RMVL FOREIGN BODY, SIMPLE",,,450,$800.00 ,$800.00 ,$611.20 ,$720.00 ,$680.00 ,$680.00 ,$680.00 ,$704.00 ,$680.00 ,$704.00 ,$704.00 ,$696.00 ,$680.00 ,$680.00 ,$680.00 ,$611.20 ,$720.00
Carle Richland Memorial Hospital,8836680,PLCMNT IO ACCESS,,,450,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,8864402,INJ ANES AGENT FACIAL NRV,,,450,"$1,860.00 ","$1,860.00 ","$1,421.04 ","$1,674.00 ","$1,581.00 ","$1,581.00 ","$1,581.00 ","$1,636.80 ","$1,581.00 ","$1,636.80 ","$1,636.80 ","$1,618.20 ","$1,581.00 ","$1,581.00 ","$1,581.00 ","$1,421.04 ","$1,674.00 "
Carle Richland Memorial Hospital,8862273,INJ EPIDRL BLD OR CLT PATCH,,,450,"$1,580.00 ","$1,580.00 ","$1,207.12 ","$1,422.00 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,390.40 ","$1,343.00 ","$1,390.40 ","$1,390.40 ","$1,374.60 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,207.12 ","$1,422.00 "
Carle Richland Memorial Hospital,8099281,OB EMERGENCY ROOM LEVEL 1,,99281,450,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8099282,OB EMERGENCY ROOM LEVEL 2,,99282,450,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8099283,OB EMERGENCY ROOM LEVEL 3,,99283,450,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,8099284,OB EMERGENCY ROOM LEVEL 4,,99284,450,"$1,380.00 ","$1,380.00 ","$1,054.32 ","$1,242.00 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,214.40 ","$1,173.00 ","$1,214.40 ","$1,214.40 ","$1,200.60 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,054.32 ","$1,242.00 "
Carle Richland Memorial Hospital,8099285,OB EMERGENCY ROOM LEVEL 5,,99285,450,"$1,990.00 ","$1,990.00 ","$1,520.36 ","$1,791.00 ","$1,691.50 ","$1,691.50 ","$1,691.50 ","$1,751.20 ","$1,691.50 ","$1,751.20 ","$1,751.20 ","$1,731.30 ","$1,691.50 ","$1,691.50 ","$1,691.50 ","$1,520.36 ","$1,791.00 "
Carle Richland Memorial Hospital,8099291,OB EMERGENCY ROOM LEVEL 6,,99291,450,"$3,150.00 ","$3,150.00 ","$2,406.60 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$2,677.50 ","$2,772.00 ","$2,677.50 ","$2,772.00 ","$2,772.00 ","$2,740.50 ","$2,677.50 ","$2,677.50 ","$2,677.50 ","$2,406.60 ","$2,835.00 "
Carle Richland Memorial Hospital,8812001,SIMPLE SKIN REPAIR,,,450,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8800252,CHANGE CYSTOSTOMY TUBE,,,450,$645.00 ,$645.00 ,$492.78 ,$580.50 ,$548.25 ,$548.25 ,$548.25 ,$567.60 ,$548.25 ,$567.60 ,$567.60 ,$561.15 ,$548.25 ,$548.25 ,$548.25 ,$492.78 ,$580.50
Carle Richland Memorial Hospital,8896368,IV INFUSION CONCURRENT,,96368,450,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8836591,COLLECTN BLOOD SPCMN FROM VAD,,,450,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8800260,INJ ANES AGENT NRV,,,450,"$1,620.00 ","$1,620.00 ","$1,237.68 ","$1,458.00 ","$1,377.00 ","$1,377.00 ","$1,377.00 ","$1,425.60 ","$1,377.00 ","$1,425.60 ","$1,425.60 ","$1,409.40 ","$1,377.00 ","$1,377.00 ","$1,377.00 ","$1,237.68 ","$1,458.00 "
Carle Richland Memorial Hospital,8896372,INJECTION -SUBCUTAN/INTRAMUSC,,96372,450,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8801680,DERMABOND CLOSURE,,,450,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,8843753,LAVAGE GASTRIC,,43753,450,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,8899292,CRITICAL CARE EACH ADD 30 MINUTES,,99292,450,$690.00 ,$690.00 ,$527.16 ,$621.00 ,$586.50 ,$586.50 ,$586.50 ,$607.20 ,$586.50 ,$607.20 ,$607.20 ,$600.30 ,$586.50 ,$586.50 ,$586.50 ,$527.16 ,$621.00
Carle Richland Memorial Hospital,8896374,IV PUSH -SINGLE/INITIAL,,96374,450,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8896375,IV PUSH -EA ADNL NEW DRUG,,96375,450,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8809803,HC HOSPITAL OUTPT CLINIC VISIT SPECIMEN COLLECTION,,C9803,450,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,8896376,IV PUSH -EA ADNL SAME DRUG,,96376,450,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8846600,ANOSCOPY,,,450,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8899281,EMERGENCY ROOM LEVEL 1,,99281,450,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8899282,EMERGENCY ROOM LEVEL 2,,99282,450,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8800288,SKIN TISSUE PROC NOS,,,450,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,8899283,EMERGENCY ROOM LEVEL 3,,99283,450,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,8899284,EMERGENCY ROOM LEVEL 4,,99284,450,"$1,380.00 ","$1,380.00 ","$1,054.32 ","$1,242.00 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,214.40 ","$1,173.00 ","$1,214.40 ","$1,214.40 ","$1,200.60 ","$1,173.00 ","$1,173.00 ","$1,173.00 ","$1,054.32 ","$1,242.00 "
Carle Richland Memorial Hospital,8899285,EMERGENCY ROOM LEVEL 5,,99285,450,"$1,990.00 ","$1,990.00 ","$1,520.36 ","$1,791.00 ","$1,691.50 ","$1,691.50 ","$1,691.50 ","$1,751.20 ","$1,691.50 ","$1,751.20 ","$1,751.20 ","$1,731.30 ","$1,691.50 ","$1,691.50 ","$1,691.50 ","$1,520.36 ","$1,791.00 "
Carle Richland Memorial Hospital,8899291,EMERGENCY ROOM LEVEL 6,,99291,450,"$3,150.00 ","$3,150.00 ","$2,406.60 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$2,677.50 ","$2,772.00 ","$2,677.50 ","$2,772.00 ","$2,772.00 ","$2,740.50 ","$2,677.50 ","$2,677.50 ","$2,677.50 ","$2,406.60 ","$2,835.00 "
Carle Richland Memorial Hospital,8800200,FOLEY INSERTION,,51702,450,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8800204,STRAIGHT CATH INSERTION,,51701,450,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8800205,URINARY CATHETER INSERTION,,51702,450,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,8800214,EARWAX OR FOREIGN BODY REMOVAL,,,450,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,8800215,JOINT OR BONE REDUCTIONS,,,450,$320.00 ,$320.00 ,$244.48 ,$288.00 ,$272.00 ,$272.00 ,$272.00 ,$281.60 ,$272.00 ,$281.60 ,$281.60 ,$278.40 ,$272.00 ,$272.00 ,$272.00 ,$244.48 ,$288.00
Carle Richland Memorial Hospital,8800217,APP OF SPLINTS AND CASTS,,,450,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,8800218,NAIL PROCEDURES,,,450,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,8800221,LACERATION RPR W SUTURE/STAPLE,,,450,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,8800222,APP OF BURN DRESSINGS,,,450,$375.00 ,$375.00 ,$286.50 ,$337.50 ,$318.75 ,$318.75 ,$318.75 ,$330.00 ,$318.75 ,$330.00 ,$330.00 ,$326.25 ,$318.75 ,$318.75 ,$318.75 ,$286.50 ,$337.50
Carle Richland Memorial Hospital,8800223,CONTROL OF NOSEBLEED,,,450,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,8800224,BLADDER IRRIGATION,,51700,450,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8800225,INCISION AND DRAINAGE,,,450,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8800226,WOUND DEBRIDEMENT,,,450,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,8800227,NEEDLE ASPIRATION - JOINT,,,450,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8800230,INTUBATION -ENDOTRACHEAL EMERG,,,450,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,8800231,SPINAL PUNCTURE,,,450,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,8800232,CHANGE/FIX G / J TUBE,,,450,$930.00 ,$930.00 ,$710.52 ,$837.00 ,$790.50 ,$790.50 ,$790.50 ,$818.40 ,$790.50 ,$818.40 ,$818.40 ,$809.10 ,$790.50 ,$790.50 ,$790.50 ,$710.52 ,$837.00
Carle Richland Memorial Hospital,8800239,THORACENTESIS/PARACENTESIS,,,450,"$1,370.00 ","$1,370.00 ","$1,046.68 ","$1,233.00 ","$1,164.50 ","$1,164.50 ","$1,164.50 ","$1,205.60 ","$1,164.50 ","$1,205.60 ","$1,205.60 ","$1,191.90 ","$1,164.50 ","$1,164.50 ","$1,164.50 ","$1,046.68 ","$1,233.00 "
Carle Richland Memorial Hospital,8800241,NG TUBE REPLACEMENT,,,450,"$1,400.00 ","$1,400.00 ","$1,069.60 ","$1,260.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,232.00 ","$1,190.00 ","$1,232.00 ","$1,232.00 ","$1,218.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,069.60 ","$1,260.00 "
Carle Richland Memorial Hospital,8800242,CARDIOVERSION,,,450,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,8800244,CENTRAL LINE INSERTION,,,450,"$1,610.00 ","$1,610.00 ","$1,230.04 ","$1,449.00 ","$1,368.50 ","$1,368.50 ","$1,368.50 ","$1,416.80 ","$1,368.50 ","$1,416.80 ","$1,416.80 ","$1,400.70 ","$1,368.50 ","$1,368.50 ","$1,368.50 ","$1,230.04 ","$1,449.00 "
Carle Richland Memorial Hospital,8854220,IRRIGATION FOR PRIAPISM,,,450,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8892950,RESUSCITATION TEAM,,92950,450,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,8654664,AEROSOL INHALATION DEMO OR EVA,,94664,460,$52.00 ,$52.00 ,$39.73 ,$46.80 ,$44.20 ,$44.20 ,$44.20 ,$45.76 ,$44.20 ,$45.76 ,$45.76 ,$45.24 ,$44.20 ,$44.20 ,$44.20 ,$39.73 ,$46.80
Carle Richland Memorial Hospital,8651760,EAROX- TCM CHECK,,94760,460,$89.00 ,$89.00 ,$68.00 ,$80.10 ,$75.65 ,$75.65 ,$75.65 ,$78.32 ,$75.65 ,$78.32 ,$78.32 ,$77.43 ,$75.65 ,$75.65 ,$75.65 ,$68.00 ,$80.10
Carle Richland Memorial Hospital,8654760,"PULSE OXIMETRY, SINGLE DETERM",,94760,460,$89.00 ,$89.00 ,$68.00 ,$80.10 ,$75.65 ,$75.65 ,$75.65 ,$78.32 ,$75.65 ,$78.32 ,$78.32 ,$77.43 ,$75.65 ,$75.65 ,$75.65 ,$68.00 ,$80.10
Carle Richland Memorial Hospital,8650023,END TIDAL CO2 MONITORING/DAILY,,94799,460,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,8650052,OXYGEN PER DAY,,94799,460,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8650072,VENT TRANSP-IN 30M,,,460,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8020004,CAR SEAT/BED TESTING; 1RST 60 MIN,,94780,460,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8020005,CAR SEAT/BED TESTING; EACH ADTNL 30 MIN,,94781,460,$79.00 ,$79.00 ,$60.36 ,$71.10 ,$67.15 ,$67.15 ,$67.15 ,$69.52 ,$67.15 ,$69.52 ,$69.52 ,$68.73 ,$67.15 ,$67.15 ,$67.15 ,$60.36 ,$71.10
Carle Richland Memorial Hospital,8654618,PULMONARY STRESS TESTING,,94618,460,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,8650078,EMPLOYER REQUIRED PULMONARY FUNCTION,,94010,460,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8654010,F.V.C. WITHOUT DILATOR,,94010,460,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8654060,F.V.C. PRE AND POST DILATOR,,94060,460,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8654200,MVV,,94200,460,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8654726,PLETHYSMOGRAPHY,,94726,460,$710.00 ,$710.00 ,$542.44 ,$639.00 ,$603.50 ,$603.50 ,$603.50 ,$624.80 ,$603.50 ,$624.80 ,$624.80 ,$617.70 ,$603.50 ,$603.50 ,$603.50 ,$542.44 ,$639.00
Carle Richland Memorial Hospital,8654727,LUNG VOLUMES BY GAS,,94727,460,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8654729,CO DIFF CAPACITY,,94729,460,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,8655012,FENO TESTING,,95012,460,$76.00 ,$76.00 ,$58.06 ,$68.40 ,$64.60 ,$64.60 ,$64.60 ,$66.88 ,$64.60 ,$66.88 ,$66.88 ,$66.12 ,$64.60 ,$64.60 ,$64.60 ,$58.06 ,$68.40
Carle Richland Memorial Hospital,94664,"DEMO &/OR EVAL,PT USE,AEROSOL DEVICE",,94664,460,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,94760,NONINVASV OXYGEN SATUR;SINGLE,,94760,460,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,94761,"NONINVASV OXYGEN SATUR,MULTIPLE",,94761,460,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,8642570,ACOUSTIC IMMITTANCE TESTING,,92570,470,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8642593,HEARING AID TEST-BINAURAL,,92593,470,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8642594,ELECTROACOUSTIC EVAL-MONO,,92594,470,$88.00 ,$88.00 ,$67.23 ,$79.20 ,$74.80 ,$74.80 ,$74.80 ,$77.44 ,$74.80 ,$77.44 ,$77.44 ,$76.56 ,$74.80 ,$74.80 ,$74.80 ,$67.23 ,$79.20
Carle Richland Memorial Hospital,8649015,HEARING SCREENING,,V5008,470,$82.00 ,$82.00 ,$62.65 ,$73.80 ,$69.70 ,$69.70 ,$69.70 ,$72.16 ,$69.70 ,$72.16 ,$72.16 ,$71.34 ,$69.70 ,$69.70 ,$69.70 ,$62.65 ,$73.80
Carle Richland Memorial Hospital,8649016,HEARING AID ASSESSMENT,,V5010,470,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8649017,HEARNG AID DISPNSNG - BINAURAL 1,,V5160,470,$800.00 ,$800.00 ,$611.20 ,$720.00 ,$680.00 ,$680.00 ,$680.00 ,$704.00 ,$680.00 ,$704.00 ,$704.00 ,$696.00 ,$680.00 ,$680.00 ,$680.00 ,$611.20 ,$720.00
Carle Richland Memorial Hospital,8649019,HEARNG AID DISPNSNG - MONAURAL 1,,V5241,470,$690.00 ,$690.00 ,$527.16 ,$621.00 ,$586.50 ,$586.50 ,$586.50 ,$607.20 ,$586.50 ,$607.20 ,$607.20 ,$600.30 ,$586.50 ,$586.50 ,$586.50 ,$527.16 ,$621.00
Carle Richland Memorial Hospital,8642595,ELECTROACOUSTIC EVAL-BIN,,92595,470,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8642552,PURE TONE AUDIOMETRY AIR ONLY,,92552,471,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8642553,PURE TONE AUDIOMETRY AIR&BONE,,92553,471,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8642555,SPEECH AUDIOMETRY THRESHOLD,,92555,471,$88.00 ,$88.00 ,$67.23 ,$79.20 ,$74.80 ,$74.80 ,$74.80 ,$77.44 ,$74.80 ,$77.44 ,$77.44 ,$76.56 ,$74.80 ,$74.80 ,$74.80 ,$67.23 ,$79.20
Carle Richland Memorial Hospital,8642556,SPCH AUDIO THRESHLD W/SP RECOG,,92556,471,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8643557,TYMPANOMETRY -IMPEDANCE,,92567,471,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8642568,ACOUSTIC REFLEX TEST,,92568,471,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8652585,AUDITORY EVOKD RESPNSE: COMPLT,,92585,471,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8642586,AUDITORY EVOKD RESPNSE: LIMITD,,92586,471,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,8642587,OTOACOUSTIC EMISSION TEST,,92587,471,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,8642590,HEARING AID EVAL/SELECT-MONO,,92590,471,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8642591,HEARING AID EVAL/SELECT-BIN,,92591,471,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8642592,HEARING AID TEST-MONAURAL,,92592,471,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8642579,VISUAL REINFORCEMENT AUDIO,,92579,471,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8642582,CONDITIONING PLAY AUDIOMETRY,,92582,471,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8649620,"AUDITORY FUNCTION, 60 MIN",,92620,471,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,8649621,EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN,,92621,471,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8645557,60' COMPREHENSIVE AUDIOMETRY,,92557,471,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,8022585,AUDITORY EVOKD RESPNSE: COMPLT,,92585,471,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8645014,HEARING AID REPAIR/MODIF,,V5014,471,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8645011,"HEARING AID, FITTING/ORIENT/CHECK",,V5011,471,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8642565,"STENGER TEST, PURE TONE",,92565,471,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8645299,HEARING SERVICE,,V5299,471,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8642625,TINNITUS ASSESSMENT,,92625,471,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8642551,"PURE TONE HEARING TEST, AIR",,92551,471,$82.00 ,$82.00 ,$62.65 ,$73.80 ,$69.70 ,$69.70 ,$69.70 ,$72.16 ,$69.70 ,$72.16 ,$72.16 ,$71.34 ,$69.70 ,$69.70 ,$69.70 ,$62.65 ,$73.80
Carle Richland Memorial Hospital,8642572,STAGGERED SPONDAIC WORD TEST,,92572,471,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,8642576,SYNTHETIC SENTENCE TEST,,92576,471,$47.00 ,$47.00 ,$35.91 ,$42.30 ,$39.95 ,$39.95 ,$39.95 ,$41.36 ,$39.95 ,$41.36 ,$41.36 ,$40.89 ,$39.95 ,$39.95 ,$39.95 ,$35.91 ,$42.30
Carle Richland Memorial Hospital,8642563,TONE DECAY HEARING TEST,,92563,471,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,8022558,EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYSIS,,92558,471,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8642650,AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS,,92650,471,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8642651,AEP HEARING STATUS DETER BROADBAND STIMULI I&R,,92651,471,$75.00 ,$75.00 ,$57.30 ,$67.50 ,$63.75 ,$63.75 ,$63.75 ,$66.00 ,$63.75 ,$66.00 ,$66.00 ,$65.25 ,$63.75 ,$63.75 ,$63.75 ,$57.30 ,$67.50
Carle Richland Memorial Hospital,8642652,AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,,92652,471,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8642653,AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,,92653,471,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8642558,EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYSIS,,92558,471,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,92567,TYMPANOMETRY,,92567,471,$100.00 ,$100.00 ,$76.40 ,$90.00 ,$85.00 ,$85.00 ,$85.00 ,$88.00 ,$85.00 ,$88.00 ,$88.00 ,$87.00 ,$85.00 ,$85.00 ,$85.00 ,$76.40 ,$90.00
Carle Richland Memorial Hospital,8637040,HEARING SCREENING,,V5008,472,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8400009,"TTE W/DOPPLER, COMPLETE W/ CONTRAST",,C8929,480,"$3,490.00 ","$3,490.00 ","$2,666.36 ","$3,141.00 ","$2,966.50 ","$2,966.50 ","$2,966.50 ","$3,071.20 ","$2,966.50 ","$3,071.20 ","$3,071.20 ","$3,036.30 ","$2,966.50 ","$2,966.50 ","$2,966.50 ","$2,666.36 ","$3,141.00 "
Carle Richland Memorial Hospital,8400011,"ECHO REAL-TIME, LIMITED W/ CONTRAST",,93308,480,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,8022960,CARDIOVERSION,,92960,480,"$1,600.00 ","$1,600.00 ","$1,222.40 ","$1,440.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,408.00 ","$1,360.00 ","$1,408.00 ","$1,408.00 ","$1,392.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,222.40 ","$1,440.00 "
Carle Richland Memorial Hospital,8492960,ELECTIVE CARDIO VERSION,,92960,480,"$1,600.00 ","$1,600.00 ","$1,222.40 ","$1,440.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,408.00 ","$1,360.00 ","$1,408.00 ","$1,408.00 ","$1,392.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,222.40 ","$1,440.00 "
Carle Richland Memorial Hospital,8493306,"TTE W/DOPPLER, COMPLETE W/O CONTRAST",,93306,480,"$3,280.00 ","$3,280.00 ","$2,505.92 ","$2,952.00 ","$2,788.00 ","$2,788.00 ","$2,788.00 ","$2,886.40 ","$2,788.00 ","$2,886.40 ","$2,886.40 ","$2,853.60 ","$2,788.00 ","$2,788.00 ","$2,788.00 ","$2,505.92 ","$2,952.00 "
Carle Richland Memorial Hospital,8493308,"ECHO REAL-TIME, LIMITED W/O CONTRAST",,93308,480,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,8493312,ECHO REAL TIME TRANSESOPH W/O CONTRAST,,93312,480,"$4,190.00 ","$4,190.00 ","$3,201.16 ","$3,771.00 ","$3,561.50 ","$3,561.50 ","$3,561.50 ","$3,687.20 ","$3,561.50 ","$3,687.20 ","$3,687.20 ","$3,645.30 ","$3,561.50 ","$3,561.50 ","$3,561.50 ","$3,201.16 ","$3,771.00 "
Carle Richland Memorial Hospital,8493320,DOPPLER ECHOCARDIO GRAPHY,,93320,480,"$1,010.00 ","$1,010.00 ",$771.64 ,$909.00 ,$858.50 ,$858.50 ,$858.50 ,$888.80 ,$858.50 ,$888.80 ,$888.80 ,$878.70 ,$858.50 ,$858.50 ,$858.50 ,$771.64 ,$909.00
Carle Richland Memorial Hospital,8493321,"DOPPLER ECHO, LIMITED",,93321,480,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8493325,DOPPLER VELOCITY MAPPING,,93325,480,"$1,010.00 ","$1,010.00 ",$771.64 ,$909.00 ,$858.50 ,$858.50 ,$858.50 ,$888.80 ,$858.50 ,$888.80 ,$888.80 ,$878.70 ,$858.50 ,$858.50 ,$858.50 ,$771.64 ,$909.00
Carle Richland Memorial Hospital,8293017,"CARDIAC STRESS TST,TRACING ONLY",,93017,482,"$1,280.00 ","$1,280.00 ",$977.92 ,"$1,152.00 ","$1,088.00 ","$1,088.00 ","$1,088.00 ","$1,126.40 ","$1,088.00 ","$1,126.40 ","$1,126.40 ","$1,113.60 ","$1,088.00 ","$1,088.00 ","$1,088.00 ",$977.92 ,"$1,152.00 "
Carle Richland Memorial Hospital,8493017,CV STRESS TEST TRACING ONLY,,93017,482,"$1,280.00 ","$1,280.00 ",$977.92 ,"$1,152.00 ","$1,088.00 ","$1,088.00 ","$1,088.00 ","$1,126.40 ","$1,088.00 ","$1,126.40 ","$1,126.40 ","$1,113.60 ","$1,088.00 ","$1,088.00 ","$1,088.00 ",$977.92 ,"$1,152.00 "
Carle Richland Memorial Hospital,8100016,YAG LASER,,,490,"$1,210.00 ","$1,210.00 ",$924.44 ,"$1,089.00 ","$1,028.50 ","$1,028.50 ","$1,028.50 ","$1,064.80 ","$1,028.50 ","$1,064.80 ","$1,064.80 ","$1,052.70 ","$1,028.50 ","$1,028.50 ","$1,028.50 ",$924.44 ,"$1,089.00 "
Carle Richland Memorial Hospital,8262322,INJ DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN,,62322,510,"$1,090.00 ","$1,090.00 ",$832.76 ,$981.00 ,$926.50 ,$926.50 ,$926.50 ,$959.20 ,$926.50 ,$959.20 ,$959.20 ,$948.30 ,$926.50 ,$926.50 ,$926.50 ,$832.76 ,$981.00
Carle Richland Memorial Hospital,8202960,EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD,,0296T,510,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,8816372,INJECTION -SUBCUTAN/INTRAMUSC,,96372,510,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8209803,HOSPITAL OUTPT CLINIC VISIT SPECIMEN COLLECTION,,C9803,510,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,8230468,RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT,,30468,510,"$6,530.00 ","$6,530.00 ","$4,988.92 ","$5,877.00 ","$5,550.50 ","$5,550.50 ","$5,550.50 ","$5,746.40 ","$5,550.50 ","$5,746.40 ","$5,746.40 ","$5,681.10 ","$5,550.50 ","$5,550.50 ","$5,550.50 ","$4,988.92 ","$5,877.00 "
Carle Richland Memorial Hospital,8257465,COMPUTER-AIDED MAPG CERVIX UTERI DRG COLPOSCOPY,,57465,510,"$1,430.00 ","$1,430.00 ","$1,092.52 ","$1,287.00 ","$1,215.50 ","$1,215.50 ","$1,215.50 ","$1,258.40 ","$1,215.50 ","$1,258.40 ","$1,258.40 ","$1,244.10 ","$1,215.50 ","$1,215.50 ","$1,215.50 ","$1,092.52 ","$1,287.00 "
Carle Richland Memorial Hospital,8269705,SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI,,69705,510,"$4,640.00 ","$4,640.00 ","$3,544.96 ","$4,176.00 ","$3,944.00 ","$3,944.00 ","$3,944.00 ","$4,083.20 ","$3,944.00 ","$4,083.20 ","$4,083.20 ","$4,036.80 ","$3,944.00 ","$3,944.00 ","$3,944.00 ","$3,544.96 ","$4,176.00 "
Carle Richland Memorial Hospital,8269706,SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI,,69706,510,"$4,640.00 ","$4,640.00 ","$3,544.96 ","$4,176.00 ","$3,944.00 ","$3,944.00 ","$3,944.00 ","$4,083.20 ","$3,944.00 ","$4,083.20 ","$4,083.20 ","$4,036.80 ","$3,944.00 ","$3,944.00 ","$3,944.00 ","$3,544.96 ","$4,176.00 "
Carle Richland Memorial Hospital,8276145,MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT,,76145,510,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,8292229,IMG RETINA DETCJ/MNTR DS POC AUTO A/R UNI/BI,,92229,510,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8292517,CERVICAL VEMP TESTING W/I&R,,92517,510,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8292518,OCULAR VEMP TESTING W/I&R,,92518,510,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,8292519,CERVICAL & OCULAR VEMP TESTING W/I&R,,92519,510,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,8292650,AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS,,92650,510,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8292651,AEP HEARING STATUS DETER BROADBAND STIMULI I&R,,92651,510,$75.00 ,$75.00 ,$57.30 ,$67.50 ,$63.75 ,$63.75 ,$63.75 ,$66.00 ,$63.75 ,$66.00 ,$66.00 ,$65.25 ,$63.75 ,$63.75 ,$63.75 ,$57.30 ,$67.50
Carle Richland Memorial Hospital,8292652,AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,,92652,510,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8292653,AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,,92653,510,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,8294619,XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG,,94619,510,$38.00 ,$38.00 ,$29.03 ,$34.20 ,$32.30 ,$32.30 ,$32.30 ,$33.44 ,$32.30 ,$33.44 ,$33.44 ,$33.06 ,$32.30 ,$32.30 ,$32.30 ,$29.03 ,$34.20
Carle Richland Memorial Hospital,8299417,PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN,,99417,510,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,8299439,CHRONIC CARE MANAGEMENT SERVICES EA ADDL 20 MIN,,99439,510,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,8232408,CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,,32408,510,"$3,040.00 ","$3,040.00 ","$2,322.56 ","$2,736.00 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,675.20 ","$2,584.00 ","$2,675.20 ","$2,675.20 ","$2,644.80 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,322.56 ","$2,736.00 "
Carle Richland Memorial Hospital,8233741,TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD,,33741,510,"$7,600.00 ","$7,600.00 ","$5,806.40 ","$6,840.00 ","$6,460.00 ","$6,460.00 ","$6,460.00 ","$6,688.00 ","$6,460.00 ","$6,688.00 ","$6,688.00 ","$6,612.00 ","$6,460.00 ","$6,460.00 ","$6,460.00 ","$5,806.40 ","$6,840.00 "
Carle Richland Memorial Hospital,8233745,TIS CRTJ ST CONGENITAL CARDIAC ANOMAL 1ST SHUNT,,33745,510,"$6,650.00 ","$6,650.00 ","$5,080.60 ","$5,985.00 ","$5,652.50 ","$5,652.50 ","$5,652.50 ","$5,852.00 ","$5,652.50 ","$5,852.00 ","$5,852.00 ","$5,785.50 ","$5,652.50 ","$5,652.50 ","$5,652.50 ","$5,080.60 ","$5,985.00 "
Carle Richland Memorial Hospital,8233746,TIS CRTJ ST CONGENITAL CARDIAC ANOMAL EA ADDL,,33746,510,"$3,330.00 ","$3,330.00 ","$2,544.12 ","$2,997.00 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,930.40 ","$2,830.50 ","$2,930.40 ","$2,930.40 ","$2,897.10 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,544.12 ","$2,997.00 "
Carle Richland Memorial Hospital,8233995,INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY,,33995,510,"$3,800.00 ","$3,800.00 ","$2,903.20 ","$3,420.00 ","$3,230.00 ","$3,230.00 ","$3,230.00 ","$3,344.00 ","$3,230.00 ","$3,344.00 ","$3,344.00 ","$3,306.00 ","$3,230.00 ","$3,230.00 ","$3,230.00 ","$2,903.20 ","$3,420.00 "
Carle Richland Memorial Hospital,8233997,REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ,,33997,510,"$2,380.00 ","$2,380.00 ","$1,818.32 ","$2,142.00 ","$2,023.00 ","$2,023.00 ","$2,023.00 ","$2,094.40 ","$2,023.00 ","$2,094.40 ","$2,094.40 ","$2,070.60 ","$2,023.00 ","$2,023.00 ","$2,023.00 ","$1,818.32 ","$2,142.00 "
Carle Richland Memorial Hospital,8255880,TRANSRECTAL ABLTJ MAL PRST8 TISSUE HIFU W/US,,55880,510,"$4,880.00 ","$4,880.00 ","$3,728.32 ","$4,392.00 ","$4,148.00 ","$4,148.00 ","$4,148.00 ","$4,294.40 ","$4,148.00 ","$4,294.40 ","$4,294.40 ","$4,245.60 ","$4,148.00 ","$4,148.00 ","$4,148.00 ","$3,728.32 ","$4,392.00 "
Carle Richland Memorial Hospital,8293242,EXTERNAL ECG REC>48HR<7D RECORDING,,93242,510,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8293243,EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT,,93243,510,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8293246,EXTERNAL ECG REC>7D<15D RECORDING,,93246,510,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,8293247,EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT,,93247,510,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,8222120,PROLONG OUTPT/OFFICE VIS,,G2212,510,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,95146,"ANTIGEN RX SERV,INSECT,2 VENOMS",,95146,510,$96.00 ,$96.00 ,$73.34 ,$86.40 ,$81.60 ,$81.60 ,$81.60 ,$84.48 ,$81.60 ,$84.48 ,$84.48 ,$83.52 ,$81.60 ,$81.60 ,$81.60 ,$73.34 ,$86.40
Carle Richland Memorial Hospital,99411,"PREVENT COUNSEL,GROUP,30 MIN",,99411,510,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,96523,IRRIG IMPLANTED DRUG DELIVERY DEVICE,,96523,510,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,0500F,INITIAL PRENATAL CARE VISIT,,0500F,510,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,0502F,SUBSEQUENT PRENATAL CARE,,0502F,510,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,0503F,POSTPARTUM CARE VISIT,,0503F,510,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,25075,EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM,,25075,521,"$2,680.00 ","$2,680.00 ","$2,047.52 ","$2,412.00 ","$2,278.00 ","$2,278.00 ","$2,278.00 ","$2,358.40 ","$2,278.00 ","$2,358.40 ","$2,358.40 ","$2,331.60 ","$2,278.00 ","$2,278.00 ","$2,278.00 ","$2,047.52 ","$2,412.00 "
Carle Richland Memorial Hospital,25076,EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM,,25076,521,"$4,350.00 ","$4,350.00 ","$3,323.40 ","$3,915.00 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,828.00 ","$3,697.50 ","$3,828.00 ","$3,828.00 ","$3,784.50 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,323.40 ","$3,915.00 "
Carle Richland Memorial Hospital,25077,RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM,,25077,521,"$7,510.00 ","$7,510.00 ","$5,737.64 ","$6,759.00 ","$6,383.50 ","$6,383.50 ","$6,383.50 ","$6,608.80 ","$6,383.50 ","$6,608.80 ","$6,608.80 ","$6,533.70 ","$6,383.50 ","$6,383.50 ","$6,383.50 ","$5,737.64 ","$6,759.00 "
Carle Richland Memorial Hospital,20611,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US,,20611,521,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,99490,CHRONIC CARE MANAGEMENT SERVICES 1ST 20 MIN,,99490,521,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,99497,ADVANCE CARE PLANNING FIRST 30 MINS,,99497,521,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,10004,FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL,,10004,521,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,10005,FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION,,10005,521,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,10006,FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL,,10006,521,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,10007,FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION,,10007,521,"$1,110.00 ","$1,110.00 ",$848.04 ,$999.00 ,$943.50 ,$943.50 ,$943.50 ,$976.80 ,$943.50 ,$976.80 ,$976.80 ,$965.70 ,$943.50 ,$943.50 ,$943.50 ,$848.04 ,$999.00
Carle Richland Memorial Hospital,10008,FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL,,10008,521,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,10009,FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION,,10009,521,"$1,400.00 ","$1,400.00 ","$1,069.60 ","$1,260.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,232.00 ","$1,190.00 ","$1,232.00 ","$1,232.00 ","$1,218.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,069.60 ","$1,260.00 "
Carle Richland Memorial Hospital,10010,FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL,,10010,521,$980.00 ,$980.00 ,$748.72 ,$882.00 ,$833.00 ,$833.00 ,$833.00 ,$862.40 ,$833.00 ,$862.40 ,$862.40 ,$852.60 ,$833.00 ,$833.00 ,$833.00 ,$748.72 ,$882.00
Carle Richland Memorial Hospital,10011,FINE NEEDLE ASPIRATION BX W/MR GDN 1ST LESION,,10011,521,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,10012,FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL,,10012,521,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,11102,TANGENTIAL BIOPSY SKIN SINGLE LESION,,11102,521,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,11103,TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,,11103,521,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,11104,PUNCH BIOPSY SKIN SINGLE LESION,,11104,521,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,11105,PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,,11105,521,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,11106,INCISIONAL BIOPSY SKIN SINGLE LESION,,11106,521,$470.00 ,$470.00 ,$359.08 ,$423.00 ,$399.50 ,$399.50 ,$399.50 ,$413.60 ,$399.50 ,$413.60 ,$413.60 ,$408.90 ,$399.50 ,$399.50 ,$399.50 ,$359.08 ,$423.00
Carle Richland Memorial Hospital,11107,INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,,11107,521,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,43762,PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC,,43762,521,$930.00 ,$930.00 ,$710.52 ,$837.00 ,$790.50 ,$790.50 ,$790.50 ,$818.40 ,$790.50 ,$818.40 ,$818.40 ,$809.10 ,$790.50 ,$790.50 ,$790.50 ,$710.52 ,$837.00
Carle Richland Memorial Hospital,43763,PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC,,43763,521,"$1,730.00 ","$1,730.00 ","$1,321.72 ","$1,557.00 ","$1,470.50 ","$1,470.50 ","$1,470.50 ","$1,522.40 ","$1,470.50 ","$1,522.40 ","$1,522.40 ","$1,505.10 ","$1,470.50 ","$1,470.50 ","$1,470.50 ","$1,321.72 ","$1,557.00 "
Carle Richland Memorial Hospital,25500,CLOSED RX RADIAL SHAFT FX,,25500,521,"$1,480.00 ","$1,480.00 ","$1,130.72 ","$1,332.00 ","$1,258.00 ","$1,258.00 ","$1,258.00 ","$1,302.40 ","$1,258.00 ","$1,302.40 ","$1,302.40 ","$1,287.60 ","$1,258.00 ","$1,258.00 ","$1,258.00 ","$1,130.72 ","$1,332.00 "
Carle Richland Memorial Hospital,25600,CLOSED RX DIST RAD/ULNA FX,,25600,521,"$1,580.00 ","$1,580.00 ","$1,207.12 ","$1,422.00 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,390.40 ","$1,343.00 ","$1,390.40 ","$1,390.40 ","$1,374.60 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,207.12 ","$1,422.00 "
Carle Richland Memorial Hospital,26010,"DRAIN FINGER ABSCESS,SIMPLE",,26010,521,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,26115,EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM,,26115,521,"$3,000.00 ","$3,000.00 ","$2,292.00 ","$2,700.00 ","$2,550.00 ","$2,550.00 ","$2,550.00 ","$2,640.00 ","$2,550.00 ","$2,640.00 ","$2,640.00 ","$2,610.00 ","$2,550.00 ","$2,550.00 ","$2,550.00 ","$2,292.00 ","$2,700.00 "
Carle Richland Memorial Hospital,26116,EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM,,26116,521,"$3,810.00 ","$3,810.00 ","$2,910.84 ","$3,429.00 ","$3,238.50 ","$3,238.50 ","$3,238.50 ","$3,352.80 ","$3,238.50 ","$3,352.80 ","$3,352.80 ","$3,314.70 ","$3,238.50 ","$3,238.50 ","$3,238.50 ","$2,910.84 ","$3,429.00 "
Carle Richland Memorial Hospital,26117,RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM,,26117,521,"$6,140.00 ","$6,140.00 ","$4,690.96 ","$5,526.00 ","$5,219.00 ","$5,219.00 ","$5,219.00 ","$5,403.20 ","$5,219.00 ","$5,403.20 ","$5,403.20 ","$5,341.80 ","$5,219.00 ","$5,219.00 ","$5,219.00 ","$4,690.96 ","$5,526.00 "
Carle Richland Memorial Hospital,26600,CLOSED RX METACARPAL FX,,26600,521,"$1,300.00 ","$1,300.00 ",$993.20 ,"$1,170.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ","$1,144.00 ","$1,105.00 ","$1,144.00 ","$1,144.00 ","$1,131.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ",$993.20 ,"$1,170.00 "
Carle Richland Memorial Hospital,26720,CLOSE RX PROX/MID FING SHFT FX,,26720,521,$990.00 ,$990.00 ,$756.36 ,$891.00 ,$841.50 ,$841.50 ,$841.50 ,$871.20 ,$841.50 ,$871.20 ,$871.20 ,$861.30 ,$841.50 ,$841.50 ,$841.50 ,$756.36 ,$891.00
Carle Richland Memorial Hospital,26740,CLOSE RX FINGR ARTICULAR FX,,26740,521,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,26750,CLOSE RX DIST FINGR FX,,26750,521,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,26770,CLOSED RX IP JT DISLOCATION,,26770,521,"$1,400.00 ","$1,400.00 ","$1,069.60 ","$1,260.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,232.00 ","$1,190.00 ","$1,232.00 ","$1,232.00 ","$1,218.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,069.60 ","$1,260.00 "
Carle Richland Memorial Hospital,26775,"CLOSED RX IP JT DISLOCATION,ANESTH",,26775,521,"$1,930.00 ","$1,930.00 ","$1,474.52 ","$1,737.00 ","$1,640.50 ","$1,640.50 ","$1,640.50 ","$1,698.40 ","$1,640.50 ","$1,698.40 ","$1,698.40 ","$1,679.10 ","$1,640.50 ","$1,640.50 ","$1,640.50 ","$1,474.52 ","$1,737.00 "
Carle Richland Memorial Hospital,27047,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM,,27047,521,"$3,210.00 ","$3,210.00 ","$2,452.44 ","$2,889.00 ","$2,728.50 ","$2,728.50 ","$2,728.50 ","$2,824.80 ","$2,728.50 ","$2,824.80 ","$2,824.80 ","$2,792.70 ","$2,728.50 ","$2,728.50 ","$2,728.50 ","$2,452.44 ","$2,889.00 "
Carle Richland Memorial Hospital,27048,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM,,27048,521,"$4,180.00 ","$4,180.00 ","$3,193.52 ","$3,762.00 ","$3,553.00 ","$3,553.00 ","$3,553.00 ","$3,678.40 ","$3,553.00 ","$3,678.40 ","$3,678.40 ","$3,636.60 ","$3,553.00 ","$3,553.00 ","$3,553.00 ","$3,193.52 ","$3,762.00 "
Carle Richland Memorial Hospital,27049,RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM,,27049,521,"$11,460.00 ","$11,460.00 ","$8,755.44 ","$10,314.00 ","$9,741.00 ","$9,741.00 ","$9,741.00 ","$10,084.80 ","$9,741.00 ","$10,084.80 ","$10,084.80 ","$9,970.20 ","$9,741.00 ","$9,741.00 ","$9,741.00 ","$8,755.44 ","$10,314.00 "
Carle Richland Memorial Hospital,27220,CLOSED RX ACETABULAR FX,,27220,521,"$3,410.00 ","$3,410.00 ","$2,605.24 ","$3,069.00 ","$2,898.50 ","$2,898.50 ","$2,898.50 ","$3,000.80 ","$2,898.50 ","$3,000.80 ","$3,000.80 ","$2,966.70 ","$2,898.50 ","$2,898.50 ","$2,898.50 ","$2,605.24 ","$3,069.00 "
Carle Richland Memorial Hospital,27238,CLOSED RX INTER/SUBTROCH FEMUR FX,,27238,521,"$2,630.00 ","$2,630.00 ","$2,009.32 ","$2,367.00 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,314.40 ","$2,235.50 ","$2,314.40 ","$2,314.40 ","$2,288.10 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,009.32 ","$2,367.00 "
Carle Richland Memorial Hospital,27327,EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM,,27327,521,"$2,570.00 ","$2,570.00 ","$1,963.48 ","$2,313.00 ","$2,184.50 ","$2,184.50 ","$2,184.50 ","$2,261.60 ","$2,184.50 ","$2,261.60 ","$2,261.60 ","$2,235.90 ","$2,184.50 ","$2,184.50 ","$2,184.50 ","$1,963.48 ","$2,313.00 "
Carle Richland Memorial Hospital,27328,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM,,27328,521,"$3,580.00 ","$3,580.00 ","$2,735.12 ","$3,222.00 ","$3,043.00 ","$3,043.00 ","$3,043.00 ","$3,150.40 ","$3,043.00 ","$3,150.40 ","$3,150.40 ","$3,114.60 ","$3,043.00 ","$3,043.00 ","$3,043.00 ","$2,735.12 ","$3,222.00 "
Carle Richland Memorial Hospital,27329,RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM,,27329,521,"$9,670.00 ","$9,670.00 ","$7,387.88 ","$8,703.00 ","$8,219.50 ","$8,219.50 ","$8,219.50 ","$8,509.60 ","$8,219.50 ","$8,509.60 ","$8,509.60 ","$8,412.90 ","$8,219.50 ","$8,219.50 ","$8,219.50 ","$7,387.88 ","$8,703.00 "
Carle Richland Memorial Hospital,27500,CLOSED RX FEMUR SHAFT FX,,27500,521,"$3,530.00 ","$3,530.00 ","$2,696.92 ","$3,177.00 ","$3,000.50 ","$3,000.50 ","$3,000.50 ","$3,106.40 ","$3,000.50 ","$3,106.40 ","$3,106.40 ","$3,071.10 ","$3,000.50 ","$3,000.50 ","$3,000.50 ","$2,696.92 ","$3,177.00 "
Carle Richland Memorial Hospital,27501,CLOSED RX CONDYLAR FX,,27501,521,"$3,850.00 ","$3,850.00 ","$2,941.40 ","$3,465.00 ","$3,272.50 ","$3,272.50 ","$3,272.50 ","$3,388.00 ","$3,272.50 ","$3,388.00 ","$3,388.00 ","$3,349.50 ","$3,272.50 ","$3,272.50 ","$3,272.50 ","$2,941.40 ","$3,465.00 "
Carle Richland Memorial Hospital,27520,CLOSED RX PATELLA FX,,27520,521,"$1,870.00 ","$1,870.00 ","$1,428.68 ","$1,683.00 ","$1,589.50 ","$1,589.50 ","$1,589.50 ","$1,645.60 ","$1,589.50 ","$1,645.60 ","$1,645.60 ","$1,626.90 ","$1,589.50 ","$1,589.50 ","$1,589.50 ","$1,428.68 ","$1,683.00 "
Carle Richland Memorial Hospital,27530,CLOSED RX TIBIAL PLATEAU FX,,27530,521,"$2,260.00 ","$2,260.00 ","$1,726.64 ","$2,034.00 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,988.80 ","$1,921.00 ","$1,988.80 ","$1,988.80 ","$1,966.20 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,726.64 ","$2,034.00 "
Carle Richland Memorial Hospital,27615,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM,,27615,521,"$7,870.00 ","$7,870.00 ","$6,012.68 ","$7,083.00 ","$6,689.50 ","$6,689.50 ","$6,689.50 ","$6,925.60 ","$6,689.50 ","$6,925.60 ","$6,925.60 ","$6,846.90 ","$6,689.50 ","$6,689.50 ","$6,689.50 ","$6,012.68 ","$7,083.00 "
Carle Richland Memorial Hospital,27618,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM,,27618,521,"$2,550.00 ","$2,550.00 ","$1,948.20 ","$2,295.00 ","$2,167.50 ","$2,167.50 ","$2,167.50 ","$2,244.00 ","$2,167.50 ","$2,244.00 ","$2,244.00 ","$2,218.50 ","$2,167.50 ","$2,167.50 ","$2,167.50 ","$1,948.20 ","$2,295.00 "
Carle Richland Memorial Hospital,27619,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <3CM,,27619,521,"$3,470.00 ","$3,470.00 ","$2,651.08 ","$3,123.00 ","$2,949.50 ","$2,949.50 ","$2,949.50 ","$3,053.60 ","$2,949.50 ","$3,053.60 ","$3,053.60 ","$3,018.90 ","$2,949.50 ","$2,949.50 ","$2,949.50 ","$2,651.08 ","$3,123.00 "
Carle Richland Memorial Hospital,27750,CLOSED RX TIBIA SHAFT FX,,27750,521,"$1,960.00 ","$1,960.00 ","$1,497.44 ","$1,764.00 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,724.80 ","$1,666.00 ","$1,724.80 ","$1,724.80 ","$1,705.20 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,497.44 ","$1,764.00 "
Carle Richland Memorial Hospital,27760,CLOSED RX MED MALLEOLUS FX,,27760,521,"$1,740.00 ","$1,740.00 ","$1,329.36 ","$1,566.00 ","$1,479.00 ","$1,479.00 ","$1,479.00 ","$1,531.20 ","$1,479.00 ","$1,531.20 ","$1,531.20 ","$1,513.80 ","$1,479.00 ","$1,479.00 ","$1,479.00 ","$1,329.36 ","$1,566.00 "
Carle Richland Memorial Hospital,27786,CLOSED RX DIST FIBULA FX,,27786,521,"$1,570.00 ","$1,570.00 ","$1,199.48 ","$1,413.00 ","$1,334.50 ","$1,334.50 ","$1,334.50 ","$1,381.60 ","$1,334.50 ","$1,381.60 ","$1,381.60 ","$1,365.90 ","$1,334.50 ","$1,334.50 ","$1,334.50 ","$1,199.48 ","$1,413.00 "
Carle Richland Memorial Hospital,28043,EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM,,28043,521,"$1,800.00 ","$1,800.00 ","$1,375.20 ","$1,620.00 ","$1,530.00 ","$1,530.00 ","$1,530.00 ","$1,584.00 ","$1,530.00 ","$1,584.00 ","$1,584.00 ","$1,566.00 ","$1,530.00 ","$1,530.00 ","$1,530.00 ","$1,375.20 ","$1,620.00 "
Carle Richland Memorial Hospital,28045,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM,,28045,521,"$2,380.00 ","$2,380.00 ","$1,818.32 ","$2,142.00 ","$2,023.00 ","$2,023.00 ","$2,023.00 ","$2,094.40 ","$2,023.00 ","$2,094.40 ","$2,094.40 ","$2,070.60 ","$2,023.00 ","$2,023.00 ","$2,023.00 ","$1,818.32 ","$2,142.00 "
Carle Richland Memorial Hospital,28046,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM,,28046,521,"$6,080.00 ","$6,080.00 ","$4,645.12 ","$5,472.00 ","$5,168.00 ","$5,168.00 ","$5,168.00 ","$5,350.40 ","$5,168.00 ","$5,350.40 ","$5,350.40 ","$5,289.60 ","$5,168.00 ","$5,168.00 ","$5,168.00 ","$4,645.12 ","$5,472.00 "
Carle Richland Memorial Hospital,28400,CLOSED RX HEEL FX,,28400,521,"$1,610.00 ","$1,610.00 ","$1,230.04 ","$1,449.00 ","$1,368.50 ","$1,368.50 ","$1,368.50 ","$1,416.80 ","$1,368.50 ","$1,416.80 ","$1,416.80 ","$1,400.70 ","$1,368.50 ","$1,368.50 ","$1,368.50 ","$1,230.04 ","$1,449.00 "
Carle Richland Memorial Hospital,28470,CLOSED RX METATARSAL FX,,28470,521,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,28490,CLOSED RX BIG TOE FRACTURE,,28490,521,$710.00 ,$710.00 ,$542.44 ,$639.00 ,$603.50 ,$603.50 ,$603.50 ,$624.80 ,$603.50 ,$624.80 ,$624.80 ,$617.70 ,$603.50 ,$603.50 ,$603.50 ,$542.44 ,$639.00
Carle Richland Memorial Hospital,28510,CLOSED RX TOE FX,,28510,521,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,28515,"CLOSED RX TOE FX,MANIPULATN",,28515,521,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,28665,"CLOSED RX I-P JT,TOE DISLOC,ANESTH",,28665,521,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,29065,APPLY LONG ARM CAST,,29065,521,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,29075,APPLY FOREARM CAST,,29075,521,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,29085,APPLY HAND/WRIST CAST,,29085,521,$450.00 ,$450.00 ,$343.80 ,$405.00 ,$382.50 ,$382.50 ,$382.50 ,$396.00 ,$382.50 ,$396.00 ,$396.00 ,$391.50 ,$382.50 ,$382.50 ,$382.50 ,$343.80 ,$405.00
Carle Richland Memorial Hospital,29105,APPLY LONG ARM SPLINT,,29105,521,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,29125,"APPLY FOREARM SPLINT,STATIC",,29125,521,$320.00 ,$320.00 ,$244.48 ,$288.00 ,$272.00 ,$272.00 ,$272.00 ,$281.60 ,$272.00 ,$281.60 ,$281.60 ,$278.40 ,$272.00 ,$272.00 ,$272.00 ,$244.48 ,$288.00
Carle Richland Memorial Hospital,29126,"APPLY FOREARM SPLINT,DYNAMIC",,29126,521,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,29345,APPLY LONG LEG CAST,,29345,521,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,29355,"APPLY LONG LEG CAST,WALKER",,29355,521,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,29405,APPLY SHORT LEG CAST,,29405,521,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,29425,"APPLY SHORT LEG CAST,WALKER",,29425,521,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,29450,APPLY OF CLUBFOOT CAST,,29450,521,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,29505,APPLY LONG LEG SPLINT,,29505,521,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,29515,APPLY LOWER LEG SPLINT,,29515,521,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,29540,STRAPPING; ANKLE &/OR FOOT,,29540,521,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,29550,STRAPPING OF TOES,,29550,521,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,29580,STRAPPING UNNA BOOT,,29580,521,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,30300,REMOVE NASAL FOREIGN BODY,,30300,521,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,30901,"CTRL NOSEBLEED,ANTER,SIMPLE",,30901,521,$520.00 ,$520.00 ,$397.28 ,$468.00 ,$442.00 ,$442.00 ,$442.00 ,$457.60 ,$442.00 ,$457.60 ,$457.60 ,$452.40 ,$442.00 ,$442.00 ,$442.00 ,$397.28 ,$468.00
Carle Richland Memorial Hospital,31000,IRRIGATION MAXILLARY SINUS,,31000,521,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,31500,INSERT EMERGENCY ENDOTRACH AIRWAY,,31500,521,"$1,100.00 ","$1,100.00 ",$840.40 ,$990.00 ,$935.00 ,$935.00 ,$935.00 ,$968.00 ,$935.00 ,$968.00 ,$968.00 ,$957.00 ,$935.00 ,$935.00 ,$935.00 ,$840.40 ,$990.00
Carle Richland Memorial Hospital,31603,"TRACHEOSTOMY,EMERG,XTRACH",,31603,521,"$2,830.00 ","$2,830.00 ","$2,162.12 ","$2,547.00 ","$2,405.50 ","$2,405.50 ","$2,405.50 ","$2,490.40 ","$2,405.50 ","$2,490.40 ","$2,490.40 ","$2,462.10 ","$2,405.50 ","$2,405.50 ","$2,405.50 ","$2,162.12 ","$2,547.00 "
Carle Richland Memorial Hospital,31605,"TRACHEOSTOMY,EMERG,CRICOTHYROID",,31605,521,"$2,260.00 ","$2,260.00 ","$1,726.64 ","$2,034.00 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,988.80 ","$1,921.00 ","$1,988.80 ","$1,988.80 ","$1,966.20 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,726.64 ","$2,034.00 "
Carle Richland Memorial Hospital,31646,BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ,,31646,521,"$1,940.00 ","$1,940.00 ","$1,482.16 ","$1,746.00 ","$1,649.00 ","$1,649.00 ","$1,649.00 ","$1,707.20 ","$1,649.00 ","$1,707.20 ","$1,707.20 ","$1,687.80 ","$1,649.00 ","$1,649.00 ","$1,649.00 ","$1,482.16 ","$1,746.00 "
Carle Richland Memorial Hospital,10060,DRAIN SKIN ABSCESS SIMPLE,,10060,521,$470.00 ,$470.00 ,$359.08 ,$423.00 ,$399.50 ,$399.50 ,$399.50 ,$413.60 ,$399.50 ,$413.60 ,$413.60 ,$408.90 ,$399.50 ,$399.50 ,$399.50 ,$359.08 ,$423.00
Carle Richland Memorial Hospital,10061,DRAIN SKIN ABSCESS COMPLIC,,10061,521,$970.00 ,$970.00 ,$741.08 ,$873.00 ,$824.50 ,$824.50 ,$824.50 ,$853.60 ,$824.50 ,$853.60 ,$853.60 ,$843.90 ,$824.50 ,$824.50 ,$824.50 ,$741.08 ,$873.00
Carle Richland Memorial Hospital,10080,DRAIN PILONIDAL CYST SIMPL,,10080,521,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,10120,REMOVE FOREIGN BODY SIMPLE,,10120,521,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,10121,REMOVE FOREIGN BODY COMPLIC,,10121,521,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,10140,DRAINAGE OF HEMATOMA/FLUID,,10140,521,$750.00 ,$750.00 ,$573.00 ,$675.00 ,$637.50 ,$637.50 ,$637.50 ,$660.00 ,$637.50 ,$660.00 ,$660.00 ,$652.50 ,$637.50 ,$637.50 ,$637.50 ,$573.00 ,$675.00
Carle Richland Memorial Hospital,10160,PUNCTURE DRAINAGE OF LESION,,10160,521,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,10180,"COMPLEX DRAINAGE, WOUND",,10180,521,"$1,340.00 ","$1,340.00 ","$1,023.76 ","$1,206.00 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,179.20 ","$1,139.00 ","$1,179.20 ","$1,179.20 ","$1,165.80 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,023.76 ","$1,206.00 "
Carle Richland Memorial Hospital,11000,"DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA",,11000,521,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,11042,"Pr Debridement, Skin, Sub-q Tissue",,11042,521,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,11043,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE",,11043,521,"$1,300.00 ","$1,300.00 ",$993.20 ,"$1,170.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ","$1,144.00 ","$1,105.00 ","$1,144.00 ","$1,144.00 ","$1,131.00 ","$1,105.00 ","$1,105.00 ","$1,105.00 ",$993.20 ,"$1,170.00 "
Carle Richland Memorial Hospital,11044,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE",,11044,521,"$2,020.00 ","$2,020.00 ","$1,543.28 ","$1,818.00 ","$1,717.00 ","$1,717.00 ","$1,717.00 ","$1,777.60 ","$1,717.00 ","$1,777.60 ","$1,777.60 ","$1,757.40 ","$1,717.00 ","$1,717.00 ","$1,717.00 ","$1,543.28 ","$1,818.00 "
Carle Richland Memorial Hospital,11100,BIOPSY OF SKIN LESION,,11100,521,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,11200,"REMOVAL OF SKIN TAGS, UP TO 15",,11200,521,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,11201,"REMOVAL OF SKIN TAGS, EACH ADD 10",,11201,521,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,11300,"SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG",,11300,521,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,11301,"SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG",,11301,521,$375.00 ,$375.00 ,$286.50 ,$337.50 ,$318.75 ,$318.75 ,$318.75 ,$330.00 ,$318.75 ,$330.00 ,$330.00 ,$326.25 ,$318.75 ,$318.75 ,$318.75 ,$286.50 ,$337.50
Carle Richland Memorial Hospital,11302,"SHAV SKIN LES 1.1-2.0 CM TRUNK,ARM,LEG",,11302,521,$435.00 ,$435.00 ,$332.34 ,$391.50 ,$369.75 ,$369.75 ,$369.75 ,$382.80 ,$369.75 ,$382.80 ,$382.80 ,$378.45 ,$369.75 ,$369.75 ,$369.75 ,$332.34 ,$391.50
Carle Richland Memorial Hospital,11303,"SHAV SKIN LES >2.1 CM TRUNK,ARM,LEG",,11303,521,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,11305,SHAV SKIN LES <0.5 CM REMAINDER BODY,,11305,521,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,11306,SHAV SKIN LES 0.6-1.0 CM REMAINDER BODY,,11306,521,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,11307,SHAV SKIN LES 1.1-2.0 CM REMAINDER BODY,,11307,521,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,11308,SHAV SKIN LES >2.1 CM REMAINDER BODY,,11308,521,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,11310,"SHAV SKIN LES <0.5 CM FACE,FACIAL",,11310,521,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,11311,"SHAV SKIN LES 0.6-1.0 CM FACE,FACIAL",,11311,521,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,11312,"SHAV SKIN LES 1.1-2.0 CM FACE,FACIAL",,11312,521,$490.00 ,$490.00 ,$374.36 ,$441.00 ,$416.50 ,$416.50 ,$416.50 ,$431.20 ,$416.50 ,$431.20 ,$431.20 ,$426.30 ,$416.50 ,$416.50 ,$416.50 ,$374.36 ,$441.00
Carle Richland Memorial Hospital,11400,"EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG",,11400,521,$500.00 ,$500.00 ,$382.00 ,$450.00 ,$425.00 ,$425.00 ,$425.00 ,$440.00 ,$425.00 ,$440.00 ,$440.00 ,$435.00 ,$425.00 ,$425.00 ,$425.00 ,$382.00 ,$450.00
Carle Richland Memorial Hospital,36400,VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN,,36400,521,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,11401,"EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG",,11401,521,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,36410,VNPNXR 3 YEARS/> PHYS/QHP SKILL,,36410,521,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,36430,BLOOD TRANSFUSION SERVICE,,36430,521,$435.00 ,$435.00 ,$332.34 ,$391.50 ,$369.75 ,$369.75 ,$369.75 ,$382.80 ,$369.75 ,$382.80 ,$382.80 ,$378.45 ,$369.75 ,$369.75 ,$369.75 ,$332.34 ,$391.50
Carle Richland Memorial Hospital,11402,"EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG",,11402,521,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,36620,"INSERT CATH,ART,PERCUT,SHORTTERM",,36620,521,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,11403,"EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG",,11403,521,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,11404,"EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG",,11404,521,"$1,060.00 ","$1,060.00 ",$809.84 ,$954.00 ,$901.00 ,$901.00 ,$901.00 ,$932.80 ,$901.00 ,$932.80 ,$932.80 ,$922.20 ,$901.00 ,$901.00 ,$901.00 ,$809.84 ,$954.00
Carle Richland Memorial Hospital,11406,"EXC SKIN BENIG >4 CM TRUNK,ARM,LEG",,11406,521,"$1,520.00 ","$1,520.00 ","$1,161.28 ","$1,368.00 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,337.60 ","$1,292.00 ","$1,337.60 ","$1,337.60 ","$1,322.40 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,161.28 ","$1,368.00 "
Carle Richland Memorial Hospital,11420,EXC SKIN BENIG <0.5 CM REMAINDER BODY,,11420,521,$520.00 ,$520.00 ,$397.28 ,$468.00 ,$442.00 ,$442.00 ,$442.00 ,$457.60 ,$442.00 ,$457.60 ,$457.60 ,$452.40 ,$442.00 ,$442.00 ,$442.00 ,$397.28 ,$468.00
Carle Richland Memorial Hospital,11421,EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,,11421,521,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,11422,EXC SKIN BENIG 1.1-2 CM REMAINDR BODY,,11422,521,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,11423,EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,,11423,521,$980.00 ,$980.00 ,$748.72 ,$882.00 ,$833.00 ,$833.00 ,$833.00 ,$862.40 ,$833.00 ,$862.40 ,$862.40 ,$852.60 ,$833.00 ,$833.00 ,$833.00 ,$748.72 ,$882.00
Carle Richland Memorial Hospital,11424,EXC SKIN BENIG 3.1-4 CM REMAINDR BODY,,11424,521,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,39000,"Pr Mediastinotomy, Cerv Approach",,39000,521,"$4,280.00 ","$4,280.00 ","$3,269.92 ","$3,852.00 ","$3,638.00 ","$3,638.00 ","$3,638.00 ","$3,766.40 ","$3,638.00 ","$3,766.40 ","$3,766.40 ","$3,723.60 ","$3,638.00 ","$3,638.00 ","$3,638.00 ","$3,269.92 ","$3,852.00 "
Carle Richland Memorial Hospital,11426,EXC SKIN BENIG >4 CM REMAINDR BODY,,11426,521,"$1,680.00 ","$1,680.00 ","$1,283.52 ","$1,512.00 ","$1,428.00 ","$1,428.00 ","$1,428.00 ","$1,478.40 ","$1,428.00 ","$1,478.40 ","$1,478.40 ","$1,461.60 ","$1,428.00 ","$1,428.00 ","$1,428.00 ","$1,283.52 ","$1,512.00 "
Carle Richland Memorial Hospital,11440,"EXC SKIN BENIG <0.5 CM FACE,FACIAL",,11440,521,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,11441,"EXC SKIN BENIG 0.6-1 CM FACE,FACIAL",,11441,521,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,11442,"EXC SKIN BENIG 1.1-2 CM FACE,FACIAL",,11442,521,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,11443,"EXC SKIN BENIG 2.1-3 CM FACE,FACIAL",,11443,521,"$1,110.00 ","$1,110.00 ",$848.04 ,$999.00 ,$943.50 ,$943.50 ,$943.50 ,$976.80 ,$943.50 ,$976.80 ,$976.80 ,$965.70 ,$943.50 ,$943.50 ,$943.50 ,$848.04 ,$999.00
Carle Richland Memorial Hospital,41010,INCISION OF TONGUE FOLD,,41010,521,$980.00 ,$980.00 ,$748.72 ,$882.00 ,$833.00 ,$833.00 ,$833.00 ,$862.40 ,$833.00 ,$862.40 ,$862.40 ,$852.60 ,$833.00 ,$833.00 ,$833.00 ,$748.72 ,$882.00
Carle Richland Memorial Hospital,11444,"EXC SKIN BENIG 3.1- 4 CM FACE,FACIAL",,11444,521,"$1,340.00 ","$1,340.00 ","$1,023.76 ","$1,206.00 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,179.20 ","$1,139.00 ","$1,179.20 ","$1,179.20 ","$1,165.80 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,023.76 ","$1,206.00 "
Carle Richland Memorial Hospital,11446,"EXC SKIN BENIG >4 CM FACE,FACIAL",,11446,521,"$2,240.00 ","$2,240.00 ","$1,711.36 ","$2,016.00 ","$1,904.00 ","$1,904.00 ","$1,904.00 ","$1,971.20 ","$1,904.00 ","$1,971.20 ","$1,971.20 ","$1,948.80 ","$1,904.00 ","$1,904.00 ","$1,904.00 ","$1,711.36 ","$2,016.00 "
Carle Richland Memorial Hospital,11600,"EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG",,11600,521,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,11601,"EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG",,11601,521,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,11602,"EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG",,11602,521,$990.00 ,$990.00 ,$756.36 ,$891.00 ,$841.50 ,$841.50 ,$841.50 ,$871.20 ,$841.50 ,$871.20 ,$871.20 ,$861.30 ,$841.50 ,$841.50 ,$841.50 ,$756.36 ,$891.00
Carle Richland Memorial Hospital,11603,"EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG",,11603,521,"$1,130.00 ","$1,130.00 ",$863.32 ,"$1,017.00 ",$960.50 ,$960.50 ,$960.50 ,$994.40 ,$960.50 ,$994.40 ,$994.40 ,$983.10 ,$960.50 ,$960.50 ,$960.50 ,$863.32 ,"$1,017.00 "
Carle Richland Memorial Hospital,11604,"EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG",,11604,521,"$1,420.00 ","$1,420.00 ","$1,084.88 ","$1,278.00 ","$1,207.00 ","$1,207.00 ","$1,207.00 ","$1,249.60 ","$1,207.00 ","$1,249.60 ","$1,249.60 ","$1,235.40 ","$1,207.00 ","$1,207.00 ","$1,207.00 ","$1,084.88 ","$1,278.00 "
Carle Richland Memorial Hospital,11606,"EXC SKIN MALIG >4 CM TRUNK,ARM,LEG",,11606,521,"$1,920.00 ","$1,920.00 ","$1,466.88 ","$1,728.00 ","$1,632.00 ","$1,632.00 ","$1,632.00 ","$1,689.60 ","$1,632.00 ","$1,689.60 ","$1,689.60 ","$1,670.40 ","$1,632.00 ","$1,632.00 ","$1,632.00 ","$1,466.88 ","$1,728.00 "
Carle Richland Memorial Hospital,11620,EXC SKIN MALIG <0.5 CM REMAINDER BODY,,11620,521,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,11621,EXC SKIN MALIG 0.6-1 CM REMAINDR BODY,,11621,521,$920.00 ,$920.00 ,$702.88 ,$828.00 ,$782.00 ,$782.00 ,$782.00 ,$809.60 ,$782.00 ,$809.60 ,$809.60 ,$800.40 ,$782.00 ,$782.00 ,$782.00 ,$702.88 ,$828.00
Carle Richland Memorial Hospital,43235,ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,,43235,521,"$1,510.00 ","$1,510.00 ","$1,153.64 ","$1,359.00 ","$1,283.50 ","$1,283.50 ","$1,283.50 ","$1,328.80 ","$1,283.50 ","$1,328.80 ","$1,328.80 ","$1,313.70 ","$1,283.50 ","$1,283.50 ","$1,283.50 ","$1,153.64 ","$1,359.00 "
Carle Richland Memorial Hospital,43239,EDG TRANSORAL BIOPSY SINGLE/MULTIPLE,,43239,521,"$2,230.00 ","$2,230.00 ","$1,703.72 ","$2,007.00 ","$1,895.50 ","$1,895.50 ","$1,895.50 ","$1,962.40 ","$1,895.50 ","$1,962.40 ","$1,962.40 ","$1,940.10 ","$1,895.50 ","$1,895.50 ","$1,895.50 ","$1,703.72 ","$2,007.00 "
Carle Richland Memorial Hospital,11622,EXC SKIN MALIG 1.1-2 CM REMAINDR BODY,,11622,521,"$1,110.00 ","$1,110.00 ",$848.04 ,$999.00 ,$943.50 ,$943.50 ,$943.50 ,$976.80 ,$943.50 ,$976.80 ,$976.80 ,$965.70 ,$943.50 ,$943.50 ,$943.50 ,$848.04 ,$999.00
Carle Richland Memorial Hospital,43249,EDG BALLOON DILATION ESOPHAGUS <30 MM DIAM,,43249,521,"$2,230.00 ","$2,230.00 ","$1,703.72 ","$2,007.00 ","$1,895.50 ","$1,895.50 ","$1,895.50 ","$1,962.40 ","$1,895.50 ","$1,962.40 ","$1,962.40 ","$1,940.10 ","$1,895.50 ","$1,895.50 ","$1,895.50 ","$1,703.72 ","$2,007.00 "
Carle Richland Memorial Hospital,11623,EXC SKIN MALIG 2.1-3 CM REMAINDR BODY,,11623,521,"$1,340.00 ","$1,340.00 ","$1,023.76 ","$1,206.00 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,179.20 ","$1,139.00 ","$1,179.20 ","$1,179.20 ","$1,165.80 ","$1,139.00 ","$1,139.00 ","$1,139.00 ","$1,023.76 ","$1,206.00 "
Carle Richland Memorial Hospital,11624,EXC SKIN MALIG 3.1-4 CM REMAINDR BODY,,11624,521,"$1,610.00 ","$1,610.00 ","$1,230.04 ","$1,449.00 ","$1,368.50 ","$1,368.50 ","$1,368.50 ","$1,416.80 ","$1,368.50 ","$1,416.80 ","$1,416.80 ","$1,400.70 ","$1,368.50 ","$1,368.50 ","$1,368.50 ","$1,230.04 ","$1,449.00 "
Carle Richland Memorial Hospital,11626,EXC SKIN MALIG >4 CM REMAINDR BODY,,11626,521,"$2,040.00 ","$2,040.00 ","$1,558.56 ","$1,836.00 ","$1,734.00 ","$1,734.00 ","$1,734.00 ","$1,795.20 ","$1,734.00 ","$1,795.20 ","$1,795.20 ","$1,774.80 ","$1,734.00 ","$1,734.00 ","$1,734.00 ","$1,558.56 ","$1,836.00 "
Carle Richland Memorial Hospital,11640,"EXC SKIN MALIG <0.5 CM FACE,FACIAL",,11640,521,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,11641,"EXC SKIN MALIG 0.6-1CM FACE,FACIAL",,11641,521,"$1,140.00 ","$1,140.00 ",$870.96 ,"$1,026.00 ",$969.00 ,$969.00 ,$969.00 ,"$1,003.20 ",$969.00 ,"$1,003.20 ","$1,003.20 ",$991.80 ,$969.00 ,$969.00 ,$969.00 ,$870.96 ,"$1,026.00 "
Carle Richland Memorial Hospital,11642,"EXC SKIN MALIG 1.1-2 CM FACE,FACIAL",,11642,521,"$1,310.00 ","$1,310.00 ","$1,000.84 ","$1,179.00 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,152.80 ","$1,113.50 ","$1,152.80 ","$1,152.80 ","$1,139.70 ","$1,113.50 ","$1,113.50 ","$1,113.50 ","$1,000.84 ","$1,179.00 "
Carle Richland Memorial Hospital,11643,"EXC SKIN MALIG 2.1-3 CM FACE,FACIAL",,11643,521,"$1,530.00 ","$1,530.00 ","$1,168.92 ","$1,377.00 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,346.40 ","$1,300.50 ","$1,346.40 ","$1,346.40 ","$1,331.10 ","$1,300.50 ","$1,300.50 ","$1,300.50 ","$1,168.92 ","$1,377.00 "
Carle Richland Memorial Hospital,11644,"EXC SKIN MALIG 3.1-4 CM FACE,FACIAL",,11644,521,"$1,870.00 ","$1,870.00 ","$1,428.68 ","$1,683.00 ","$1,589.50 ","$1,589.50 ","$1,589.50 ","$1,645.60 ","$1,589.50 ","$1,645.60 ","$1,645.60 ","$1,626.90 ","$1,589.50 ","$1,589.50 ","$1,589.50 ","$1,428.68 ","$1,683.00 "
Carle Richland Memorial Hospital,11646,"EXC SKIN MALIG >4 CM FACE,FACIAL",,11646,521,"$2,510.00 ","$2,510.00 ","$1,917.64 ","$2,259.00 ","$2,133.50 ","$2,133.50 ","$2,133.50 ","$2,208.80 ","$2,133.50 ","$2,208.80 ","$2,208.80 ","$2,183.70 ","$2,133.50 ","$2,133.50 ","$2,133.50 ","$1,917.64 ","$2,259.00 "
Carle Richland Memorial Hospital,11730,REMOVAL OF NAIL PLATE,,11730,521,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,11732,REMOVE ADDITIONAL NAIL PLATE,,11732,521,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,11740,DRAIN BLOOD FROM UNDER NAIL,,11740,521,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,11750,REMOVAL OF NAIL BED,,11750,521,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,11765,"EXCISION OF NAIL FOLD, TOE",,11765,521,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,45330,SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD,,45330,521,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,45331,"SIGMOIDOSCOPY,BIOPSY",,45331,521,"$1,080.00 ","$1,080.00 ",$825.12 ,$972.00 ,$918.00 ,$918.00 ,$918.00 ,$950.40 ,$918.00 ,$950.40 ,$950.40 ,$939.60 ,$918.00 ,$918.00 ,$918.00 ,$825.12 ,$972.00
Carle Richland Memorial Hospital,45378,COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD,,45378,521,"$2,470.00 ","$2,470.00 ","$1,887.08 ","$2,223.00 ","$2,099.50 ","$2,099.50 ","$2,099.50 ","$2,173.60 ","$2,099.50 ","$2,173.60 ","$2,173.60 ","$2,148.90 ","$2,099.50 ","$2,099.50 ","$2,099.50 ","$1,887.08 ","$2,223.00 "
Carle Richland Memorial Hospital,45380,COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,,45380,521,"$2,950.00 ","$2,950.00 ","$2,253.80 ","$2,655.00 ","$2,507.50 ","$2,507.50 ","$2,507.50 ","$2,596.00 ","$2,507.50 ","$2,596.00 ","$2,596.00 ","$2,566.50 ","$2,507.50 ","$2,507.50 ","$2,507.50 ","$2,253.80 ","$2,655.00 "
Carle Richland Memorial Hospital,45385,COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ,,45385,521,"$3,330.00 ","$3,330.00 ","$2,544.12 ","$2,997.00 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,930.40 ","$2,830.50 ","$2,930.40 ","$2,930.40 ","$2,897.10 ","$2,830.50 ","$2,830.50 ","$2,830.50 ","$2,544.12 ","$2,997.00 "
Carle Richland Memorial Hospital,11900,"INJECTION INTO SKIN LESIONS, UP TO 7",,11900,521,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,11901,"INJECTION INTO SKIN LESIONS, 8 OR MORE",,11901,521,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,46050,"I&D PERIANAL ABSCESS,SUPERFICIAL",,46050,521,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,46083,INCISE EXTERNAL HEMORRHOID,,46083,521,$710.00 ,$710.00 ,$542.44 ,$639.00 ,$603.50 ,$603.50 ,$603.50 ,$624.80 ,$603.50 ,$624.80 ,$624.80 ,$617.70 ,$603.50 ,$603.50 ,$603.50 ,$542.44 ,$639.00
Carle Richland Memorial Hospital,11920,CORRECT SKIN COLR DEFCT <6 SQCM,,11920,521,"$1,740.00 ","$1,740.00 ","$1,329.36 ","$1,566.00 ","$1,479.00 ","$1,479.00 ","$1,479.00 ","$1,531.20 ","$1,479.00 ","$1,531.20 ","$1,531.20 ","$1,513.80 ","$1,479.00 ","$1,479.00 ","$1,479.00 ","$1,329.36 ","$1,566.00 "
Carle Richland Memorial Hospital,11921,CORRECT SKIN COLR DEFCT 6.1-20 SQCM,,11921,521,"$2,670.00 ","$2,670.00 ","$2,039.88 ","$2,403.00 ","$2,269.50 ","$2,269.50 ","$2,269.50 ","$2,349.60 ","$2,269.50 ","$2,349.60 ","$2,349.60 ","$2,322.90 ","$2,269.50 ","$2,269.50 ","$2,269.50 ","$2,039.88 ","$2,403.00 "
Carle Richland Memorial Hospital,46600,ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD,,46600,521,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,11950,FILL CONTOUR DEFCT <1CC,,11950,521,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,11951,FILL CONTOUR DEFCT 1.1-5CC,,11951,521,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,11976,REMOVAL OF CONTRACEPTIVE CAPSUL,,11976,521,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,12001,RESUPERF WND BODY <2.5CM,,12001,521,$620.00 ,$620.00 ,$473.68 ,$558.00 ,$527.00 ,$527.00 ,$527.00 ,$545.60 ,$527.00 ,$545.60 ,$545.60 ,$539.40 ,$527.00 ,$527.00 ,$527.00 ,$473.68 ,$558.00
Carle Richland Memorial Hospital,12002,RESUP NPTERF WND BODY 2.6-7.5 CM,,12002,521,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,12004,RESUPERF WND BODY 7.6-12.5 CM,,12004,521,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,12005,RESUPERF WND BODY 12.6-20 CM,,12005,521,"$1,090.00 ","$1,090.00 ",$832.76 ,$981.00 ,$926.50 ,$926.50 ,$926.50 ,$959.20 ,$926.50 ,$959.20 ,$959.20 ,$948.30 ,$926.50 ,$926.50 ,$926.50 ,$832.76 ,$981.00
Carle Richland Memorial Hospital,12006,RESUPERF WND BODY 20.1-30 CM,,12006,521,"$1,330.00 ","$1,330.00 ","$1,016.12 ","$1,197.00 ","$1,130.50 ","$1,130.50 ","$1,130.50 ","$1,170.40 ","$1,130.50 ","$1,170.40 ","$1,170.40 ","$1,157.10 ","$1,130.50 ","$1,130.50 ","$1,130.50 ","$1,016.12 ","$1,197.00 "
Carle Richland Memorial Hospital,12007,RESUPERF WND BODY >30 CM,,12007,521,"$1,520.00 ","$1,520.00 ","$1,161.28 ","$1,368.00 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,337.60 ","$1,292.00 ","$1,337.60 ","$1,337.60 ","$1,322.40 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,161.28 ","$1,368.00 "
Carle Richland Memorial Hospital,12011,RESUPERF WND FACE <2.5 CM,,12011,521,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,12013,RESUPERF WND FACE 2.6-5 CM,,12013,521,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,12014,RESUPERF WND FACE 5.1-7.5 CM,,12014,521,"$1,020.00 ","$1,020.00 ",$779.28 ,$918.00 ,$867.00 ,$867.00 ,$867.00 ,$897.60 ,$867.00 ,$897.60 ,$897.60 ,$887.40 ,$867.00 ,$867.00 ,$867.00 ,$779.28 ,$918.00
Carle Richland Memorial Hospital,12015,RESUPERF WND FACE 7.6-12.5 CM,,12015,521,"$1,250.00 ","$1,250.00 ",$955.00 ,"$1,125.00 ","$1,062.50 ","$1,062.50 ","$1,062.50 ","$1,100.00 ","$1,062.50 ","$1,100.00 ","$1,100.00 ","$1,087.50 ","$1,062.50 ","$1,062.50 ","$1,062.50 ",$955.00 ,"$1,125.00 "
Carle Richland Memorial Hospital,12016,RESUPERF WND FACE 12.6-20 CM,,12016,521,"$1,580.00 ","$1,580.00 ","$1,207.12 ","$1,422.00 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,390.40 ","$1,343.00 ","$1,390.40 ","$1,390.40 ","$1,374.60 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,207.12 ","$1,422.00 "
Carle Richland Memorial Hospital,12017,RESUPERF WND FACE 20.1-30 CM,,12017,521,"$2,000.00 ","$2,000.00 ","$1,528.00 ","$1,800.00 ","$1,700.00 ","$1,700.00 ","$1,700.00 ","$1,760.00 ","$1,700.00 ","$1,760.00 ","$1,760.00 ","$1,740.00 ","$1,700.00 ","$1,700.00 ","$1,700.00 ","$1,528.00 ","$1,800.00 "
Carle Richland Memorial Hospital,12018,RESUPERF WND FACE >30 CM,,12018,521,"$2,580.00 ","$2,580.00 ","$1,971.12 ","$2,322.00 ","$2,193.00 ","$2,193.00 ","$2,193.00 ","$2,270.40 ","$2,193.00 ","$2,270.40 ","$2,270.40 ","$2,244.60 ","$2,193.00 ","$2,193.00 ","$2,193.00 ","$1,971.12 ","$2,322.00 "
Carle Richland Memorial Hospital,12031,"LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM",,12031,521,$800.00 ,$800.00 ,$611.20 ,$720.00 ,$680.00 ,$680.00 ,$680.00 ,$704.00 ,$680.00 ,$704.00 ,$704.00 ,$696.00 ,$680.00 ,$680.00 ,$680.00 ,$611.20 ,$720.00
Carle Richland Memorial Hospital,12032,"LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM",,12032,521,"$1,020.00 ","$1,020.00 ",$779.28 ,$918.00 ,$867.00 ,$867.00 ,$867.00 ,$897.60 ,$867.00 ,$897.60 ,$897.60 ,$887.40 ,$867.00 ,$867.00 ,$867.00 ,$779.28 ,$918.00
Carle Richland Memorial Hospital,12034,"LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM",,12034,521,"$1,230.00 ","$1,230.00 ",$939.72 ,"$1,107.00 ","$1,045.50 ","$1,045.50 ","$1,045.50 ","$1,082.40 ","$1,045.50 ","$1,082.40 ","$1,082.40 ","$1,070.10 ","$1,045.50 ","$1,045.50 ","$1,045.50 ",$939.72 ,"$1,107.00 "
Carle Richland Memorial Hospital,12035,"LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM",,12035,521,"$1,680.00 ","$1,680.00 ","$1,283.52 ","$1,512.00 ","$1,428.00 ","$1,428.00 ","$1,428.00 ","$1,478.40 ","$1,428.00 ","$1,478.40 ","$1,478.40 ","$1,461.60 ","$1,428.00 ","$1,428.00 ","$1,428.00 ","$1,283.52 ","$1,512.00 "
Carle Richland Memorial Hospital,12036,"LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM",,12036,521,"$1,950.00 ","$1,950.00 ","$1,489.80 ","$1,755.00 ","$1,657.50 ","$1,657.50 ","$1,657.50 ","$1,716.00 ","$1,657.50 ","$1,716.00 ","$1,716.00 ","$1,696.50 ","$1,657.50 ","$1,657.50 ","$1,657.50 ","$1,489.80 ","$1,755.00 "
Carle Richland Memorial Hospital,51700,IRRIGATION OF BLADDER,,51700,521,$420.00 ,$420.00 ,$320.88 ,$378.00 ,$357.00 ,$357.00 ,$357.00 ,$369.60 ,$357.00 ,$369.60 ,$369.60 ,$365.40 ,$357.00 ,$357.00 ,$357.00 ,$320.88 ,$378.00
Carle Richland Memorial Hospital,12037,"LAYR CLOS WND TRUNK,ARM,LEG >30 CM",,12037,521,"$2,350.00 ","$2,350.00 ","$1,795.40 ","$2,115.00 ","$1,997.50 ","$1,997.50 ","$1,997.50 ","$2,068.00 ","$1,997.50 ","$2,068.00 ","$2,068.00 ","$2,044.50 ","$1,997.50 ","$1,997.50 ","$1,997.50 ","$1,795.40 ","$2,115.00 "
Carle Richland Memorial Hospital,51741,COMPLEX UROFLOWMETRY,,51741,521,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,12041,LAYR CLOS WND REST BODY <2.5 CM,,12041,521,$970.00 ,$970.00 ,$741.08 ,$873.00 ,$824.50 ,$824.50 ,$824.50 ,$853.60 ,$824.50 ,$853.60 ,$853.60 ,$843.90 ,$824.50 ,$824.50 ,$824.50 ,$741.08 ,$873.00
Carle Richland Memorial Hospital,12042,LAYR CLOS WND REST BODY 2.6-7.5 CM,,12042,521,"$1,140.00 ","$1,140.00 ",$870.96 ,"$1,026.00 ",$969.00 ,$969.00 ,$969.00 ,"$1,003.20 ",$969.00 ,"$1,003.20 ","$1,003.20 ",$991.80 ,$969.00 ,$969.00 ,$969.00 ,$870.96 ,"$1,026.00 "
Carle Richland Memorial Hospital,52000,CYSTOURETHROSCOPY,,52000,521,"$1,050.00 ","$1,050.00 ",$802.20 ,$945.00 ,$892.50 ,$892.50 ,$892.50 ,$924.00 ,$892.50 ,$924.00 ,$924.00 ,$913.50 ,$892.50 ,$892.50 ,$892.50 ,$802.20 ,$945.00
Carle Richland Memorial Hospital,12044,LAYR CLOS WND REST BODY 7.6-12.5 CM,,12044,521,"$1,450.00 ","$1,450.00 ","$1,107.80 ","$1,305.00 ","$1,232.50 ","$1,232.50 ","$1,232.50 ","$1,276.00 ","$1,232.50 ","$1,276.00 ","$1,276.00 ","$1,261.50 ","$1,232.50 ","$1,232.50 ","$1,232.50 ","$1,107.80 ","$1,305.00 "
Carle Richland Memorial Hospital,12045,LAYR CLOS WND REST BODY 12.6-20 CM,,12045,521,"$1,670.00 ","$1,670.00 ","$1,275.88 ","$1,503.00 ","$1,419.50 ","$1,419.50 ","$1,419.50 ","$1,469.60 ","$1,419.50 ","$1,469.60 ","$1,469.60 ","$1,452.90 ","$1,419.50 ","$1,419.50 ","$1,419.50 ","$1,275.88 ","$1,503.00 "
Carle Richland Memorial Hospital,12046,LAYR CLOS WND REST BODY 20.1-30 CM,,12046,521,"$2,180.00 ","$2,180.00 ","$1,665.52 ","$1,962.00 ","$1,853.00 ","$1,853.00 ","$1,853.00 ","$1,918.40 ","$1,853.00 ","$1,918.40 ","$1,918.40 ","$1,896.60 ","$1,853.00 ","$1,853.00 ","$1,853.00 ","$1,665.52 ","$1,962.00 "
Carle Richland Memorial Hospital,12047,LAYR CLOS WND REST BODY >30 CM,,12047,521,"$2,260.00 ","$2,260.00 ","$1,726.64 ","$2,034.00 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,988.80 ","$1,921.00 ","$1,988.80 ","$1,988.80 ","$1,966.20 ","$1,921.00 ","$1,921.00 ","$1,921.00 ","$1,726.64 ","$2,034.00 "
Carle Richland Memorial Hospital,12051,"LAYR CLOS WND FACE,FACIAL <2.5 CM",,12051,521,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,12052,"LAYR CLOS WND FACE,FACIAL 2.5-5 CM",,12052,521,"$1,240.00 ","$1,240.00 ",$947.36 ,"$1,116.00 ","$1,054.00 ","$1,054.00 ","$1,054.00 ","$1,091.20 ","$1,054.00 ","$1,091.20 ","$1,091.20 ","$1,078.80 ","$1,054.00 ","$1,054.00 ","$1,054.00 ",$947.36 ,"$1,116.00 "
Carle Richland Memorial Hospital,12053,"LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM",,12053,521,"$1,520.00 ","$1,520.00 ","$1,161.28 ","$1,368.00 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,337.60 ","$1,292.00 ","$1,337.60 ","$1,337.60 ","$1,322.40 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,161.28 ","$1,368.00 "
Carle Richland Memorial Hospital,12054,"LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM",,12054,521,"$1,800.00 ","$1,800.00 ","$1,375.20 ","$1,620.00 ","$1,530.00 ","$1,530.00 ","$1,530.00 ","$1,584.00 ","$1,530.00 ","$1,584.00 ","$1,584.00 ","$1,566.00 ","$1,530.00 ","$1,530.00 ","$1,530.00 ","$1,375.20 ","$1,620.00 "
Carle Richland Memorial Hospital,12055,"LAYR CLOS WND FACE,FACIAL 12.6-20 CM",,12055,521,"$2,250.00 ","$2,250.00 ","$1,719.00 ","$2,025.00 ","$1,912.50 ","$1,912.50 ","$1,912.50 ","$1,980.00 ","$1,912.50 ","$1,980.00 ","$1,980.00 ","$1,957.50 ","$1,912.50 ","$1,912.50 ","$1,912.50 ","$1,719.00 ","$2,025.00 "
Carle Richland Memorial Hospital,54050,"DESTR PENIS LESN,SIMPL,CHEMICAL",,54050,521,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,54056,"DESTR PENIS LESN,SIMPL,CRYOSURG",,54056,521,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,12056,"LAYR CLOS WND FACE,FACIAL 20.1-30 CM",,12056,521,"$2,830.00 ","$2,830.00 ","$2,162.12 ","$2,547.00 ","$2,405.50 ","$2,405.50 ","$2,405.50 ","$2,490.40 ","$2,405.50 ","$2,490.40 ","$2,490.40 ","$2,462.10 ","$2,405.50 ","$2,405.50 ","$2,405.50 ","$2,162.12 ","$2,547.00 "
Carle Richland Memorial Hospital,54150,"CIRCUMCISION,CLAMP,NEWBORN",,54150,521,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,12057,"LAYR CLOS WND FACE,FACIAL >30 CM",,12057,521,"$3,020.00 ","$3,020.00 ","$2,307.28 ","$2,718.00 ","$2,567.00 ","$2,567.00 ","$2,567.00 ","$2,657.60 ","$2,567.00 ","$2,657.60 ","$2,657.60 ","$2,627.40 ","$2,567.00 ","$2,567.00 ","$2,567.00 ","$2,307.28 ","$2,718.00 "
Carle Richland Memorial Hospital,54160,"CIRCUMCISION,OTHR,NEWBORN",,54160,521,"$1,110.00 ","$1,110.00 ",$848.04 ,$999.00 ,$943.50 ,$943.50 ,$943.50 ,$976.80 ,$943.50 ,$976.80 ,$976.80 ,$965.70 ,$943.50 ,$943.50 ,$943.50 ,$848.04 ,$999.00
Carle Richland Memorial Hospital,13100,RECMPL WND TRUNK 1.1-2.5 CM,,13100,521,"$1,080.00 ","$1,080.00 ",$825.12 ,$972.00 ,$918.00 ,$918.00 ,$918.00 ,$950.40 ,$918.00 ,$950.40 ,$950.40 ,$939.60 ,$918.00 ,$918.00 ,$918.00 ,$825.12 ,$972.00
Carle Richland Memorial Hospital,13101,RECMPL WND TRUNK 2.6-7.5 CM,,13101,521,"$1,510.00 ","$1,510.00 ","$1,153.64 ","$1,359.00 ","$1,283.50 ","$1,283.50 ","$1,283.50 ","$1,328.80 ","$1,283.50 ","$1,328.80 ","$1,328.80 ","$1,313.70 ","$1,283.50 ","$1,283.50 ","$1,283.50 ","$1,153.64 ","$1,359.00 "
Carle Richland Memorial Hospital,13120,"RECMPL WND SCALP,EXTR 1.1-2.5 CM",,13120,521,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,13121,"RECMPL WND SCALP,EXTR 2.6-7.5 CM",,13121,521,"$1,870.00 ","$1,870.00 ","$1,428.68 ","$1,683.00 ","$1,589.50 ","$1,589.50 ","$1,589.50 ","$1,645.60 ","$1,589.50 ","$1,645.60 ","$1,645.60 ","$1,626.90 ","$1,589.50 ","$1,589.50 ","$1,589.50 ","$1,428.68 ","$1,683.00 "
Carle Richland Memorial Hospital,13131,"RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM",,13131,521,"$1,580.00 ","$1,580.00 ","$1,207.12 ","$1,422.00 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,390.40 ","$1,343.00 ","$1,390.40 ","$1,390.40 ","$1,374.60 ","$1,343.00 ","$1,343.00 ","$1,343.00 ","$1,207.12 ","$1,422.00 "
Carle Richland Memorial Hospital,13132,"RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM",,13132,521,"$2,400.00 ","$2,400.00 ","$1,833.60 ","$2,160.00 ","$2,040.00 ","$2,040.00 ","$2,040.00 ","$2,112.00 ","$2,040.00 ","$2,112.00 ","$2,112.00 ","$2,088.00 ","$2,040.00 ","$2,040.00 ","$2,040.00 ","$1,833.60 ","$2,160.00 "
Carle Richland Memorial Hospital,13151,"RECMPL WND LID,NOS,EAR 1.1-2.5 CM",,13151,521,"$1,900.00 ","$1,900.00 ","$1,451.60 ","$1,710.00 ","$1,615.00 ","$1,615.00 ","$1,615.00 ","$1,672.00 ","$1,615.00 ","$1,672.00 ","$1,672.00 ","$1,653.00 ","$1,615.00 ","$1,615.00 ","$1,615.00 ","$1,451.60 ","$1,710.00 "
Carle Richland Memorial Hospital,55250,REMOVAL OF SPERM DUCT(S),,55250,521,"$1,640.00 ","$1,640.00 ","$1,252.96 ","$1,476.00 ","$1,394.00 ","$1,394.00 ","$1,394.00 ","$1,443.20 ","$1,394.00 ","$1,443.20 ","$1,443.20 ","$1,426.80 ","$1,394.00 ","$1,394.00 ","$1,394.00 ","$1,252.96 ","$1,476.00 "
Carle Richland Memorial Hospital,13152,"RECMPL WND LID,NOS,EAR 2.5-7.5 CM",,13152,521,"$3,060.00 ","$3,060.00 ","$2,337.84 ","$2,754.00 ","$2,601.00 ","$2,601.00 ","$2,601.00 ","$2,692.80 ","$2,601.00 ","$2,692.80 ","$2,692.80 ","$2,662.20 ","$2,601.00 ","$2,601.00 ","$2,601.00 ","$2,337.84 ","$2,754.00 "
Carle Richland Memorial Hospital,56405,I&D OF VULVA/PERINEUM ABSCESS,,56405,521,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,56420,I&D BARTHOLIN GLAND ABSCESS,,56420,521,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,56441,LYSIS OF LABIAL LESION(S),,56441,521,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,56501,"DESTRUCTION,LESION(S),VULVA,SIMPLE",,56501,521,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,56515,"DESTRUCTION,LESION(S),VULVA;EXTENSIVE",,56515,521,"$1,730.00 ","$1,730.00 ","$1,321.72 ","$1,557.00 ","$1,470.50 ","$1,470.50 ","$1,470.50 ","$1,522.40 ","$1,470.50 ","$1,522.40 ","$1,522.40 ","$1,505.10 ","$1,470.50 ","$1,470.50 ","$1,470.50 ","$1,321.72 ","$1,557.00 "
Carle Richland Memorial Hospital,56605,"BIOPSY VULVA/PERINEUM,ONE LESN",,56605,521,$620.00 ,$620.00 ,$473.68 ,$558.00 ,$527.00 ,$527.00 ,$527.00 ,$545.60 ,$527.00 ,$545.60 ,$545.60 ,$539.40 ,$527.00 ,$527.00 ,$527.00 ,$473.68 ,$558.00
Carle Richland Memorial Hospital,56606,"BX,VULVA/PERINEUM,ADDL LESION",,56606,521,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,14020,"ADJ TISS XFER SCALP,EXTREM <10 SQCM",,14020,521,"$3,210.00 ","$3,210.00 ","$2,452.44 ","$2,889.00 ","$2,728.50 ","$2,728.50 ","$2,728.50 ","$2,824.80 ","$2,728.50 ","$2,824.80 ","$2,824.80 ","$2,792.70 ","$2,728.50 ","$2,728.50 ","$2,728.50 ","$2,452.44 ","$2,889.00 "
Carle Richland Memorial Hospital,57061,"DESTRUCT,VAGINAL LESION(S),SIMPLE",,57061,521,"$1,280.00 ","$1,280.00 ",$977.92 ,"$1,152.00 ","$1,088.00 ","$1,088.00 ","$1,088.00 ","$1,126.40 ","$1,088.00 ","$1,126.40 ","$1,126.40 ","$1,113.60 ","$1,088.00 ","$1,088.00 ","$1,088.00 ",$977.92 ,"$1,152.00 "
Carle Richland Memorial Hospital,57100,"BIOPSY OF VAGINA,SIMPLE",,57100,521,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,14021,"ADJ TISS XFER SCALP,EXTREM 10.1-30 SQCM",,14021,521,"$4,020.00 ","$4,020.00 ","$3,071.28 ","$3,618.00 ","$3,417.00 ","$3,417.00 ","$3,417.00 ","$3,537.60 ","$3,417.00 ","$3,537.60 ","$3,537.60 ","$3,497.40 ","$3,417.00 ","$3,417.00 ","$3,417.00 ","$3,071.28 ","$3,618.00 "
Carle Richland Memorial Hospital,57160,FIT/INSERT INTRAVAG SUPPORT DEVICE,,57160,521,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,57170,FITTING OF DIAPHRAGM/CAP,,57170,521,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,14040,"ADJ TISS XFER HEAD,FAC,HAND <10 SQCM",,14040,521,"$3,730.00 ","$3,730.00 ","$2,849.72 ","$3,357.00 ","$3,170.50 ","$3,170.50 ","$3,170.50 ","$3,282.40 ","$3,170.50 ","$3,282.40 ","$3,282.40 ","$3,245.10 ","$3,170.50 ","$3,170.50 ","$3,170.50 ","$2,849.72 ","$3,357.00 "
Carle Richland Memorial Hospital,14041,"ADJ TISS XFER HEAD,FAC,HAND 10.1-30 SQCM",,14041,521,"$4,520.00 ","$4,520.00 ","$3,453.28 ","$4,068.00 ","$3,842.00 ","$3,842.00 ","$3,842.00 ","$3,977.60 ","$3,842.00 ","$3,977.60 ","$3,977.60 ","$3,932.40 ","$3,842.00 ","$3,842.00 ","$3,842.00 ","$3,453.28 ","$4,068.00 "
Carle Richland Memorial Hospital,14060,"ADJ TISS XFER LID,NOS,EAR <10 SQCM",,14060,521,"$3,880.00 ","$3,880.00 ","$2,964.32 ","$3,492.00 ","$3,298.00 ","$3,298.00 ","$3,298.00 ","$3,414.40 ","$3,298.00 ","$3,414.40 ","$3,414.40 ","$3,375.60 ","$3,298.00 ","$3,298.00 ","$3,298.00 ","$2,964.32 ","$3,492.00 "
Carle Richland Memorial Hospital,57452,"COLPOSCOPY,CERVIX W/ADJ VAGINA",,57452,521,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,57454,"COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG",,57454,521,$970.00 ,$970.00 ,$741.08 ,$873.00 ,$824.50 ,$824.50 ,$824.50 ,$853.60 ,$824.50 ,$853.60 ,$853.60 ,$843.90 ,$824.50 ,$824.50 ,$824.50 ,$741.08 ,$873.00
Carle Richland Memorial Hospital,57500,"BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION",,57500,521,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,57505,ENDOCERVICAL CURETTAGE,,57505,521,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,14061,"ADJ TISS XFER LID,NOS,EAR 10.1-30 SQCM",,14061,521,"$5,280.00 ","$5,280.00 ","$4,033.92 ","$4,752.00 ","$4,488.00 ","$4,488.00 ","$4,488.00 ","$4,646.40 ","$4,488.00 ","$4,646.40 ","$4,646.40 ","$4,593.60 ","$4,488.00 ","$4,488.00 ","$4,488.00 ","$4,033.92 ","$4,752.00 "
Carle Richland Memorial Hospital,57511,CRYOCAUTERY OF CERVIX,,57511,521,$830.00 ,$830.00 ,$634.12 ,$747.00 ,$705.50 ,$705.50 ,$705.50 ,$730.40 ,$705.50 ,$730.40 ,$730.40 ,$722.10 ,$705.50 ,$705.50 ,$705.50 ,$634.12 ,$747.00
Carle Richland Memorial Hospital,57522,"CONIZATION CERVIX,LOOP ELECTRD",,57522,521,"$2,110.00 ","$2,110.00 ","$1,612.04 ","$1,899.00 ","$1,793.50 ","$1,793.50 ","$1,793.50 ","$1,856.80 ","$1,793.50 ","$1,856.80 ","$1,856.80 ","$1,835.70 ","$1,793.50 ","$1,793.50 ","$1,793.50 ","$1,612.04 ","$1,899.00 "
Carle Richland Memorial Hospital,57800,DILATION OF CERVICAL CANAL,,57800,521,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,58100,BIOPSY OF UTERUS LINING,,58100,521,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,58300,INSERT INTRAUTERINE DEVICE,,58300,521,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,58301,REMOVE INTRAUTERINE DEVICE,,58301,521,$485.00 ,$485.00 ,$370.54 ,$436.50 ,$412.25 ,$412.25 ,$412.25 ,$426.80 ,$412.25 ,$426.80 ,$426.80 ,$421.95 ,$412.25 ,$412.25 ,$412.25 ,$370.54 ,$436.50
Carle Richland Memorial Hospital,58321,"ARTIF INSEMINATION,INTRA-CERVICAL",,58321,521,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,58322,"ARTIF INSEMINATION,INTRA-UTERINE",,58322,521,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,58323,SPERM WASHING FOR ARTIF INSEM,,58323,521,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,58340,CATH/INJECT HYSTEROSALPINGOGRAM,,58340,521,$920.00 ,$920.00 ,$702.88 ,$828.00 ,$782.00 ,$782.00 ,$782.00 ,$809.60 ,$782.00 ,$809.60 ,$809.60 ,$800.40 ,$782.00 ,$782.00 ,$782.00 ,$702.88 ,$828.00
Carle Richland Memorial Hospital,58605,"LIGATE FALLOPIAN TUBE,POSTPARTUM",,58605,521,"$3,320.00 ","$3,320.00 ","$2,536.48 ","$2,988.00 ","$2,822.00 ","$2,822.00 ","$2,822.00 ","$2,921.60 ","$2,822.00 ","$2,921.60 ","$2,921.60 ","$2,888.40 ","$2,822.00 ","$2,822.00 ","$2,822.00 ","$2,536.48 ","$2,988.00 "
Carle Richland Memorial Hospital,58611,"LIGATION,FALLOPIAN TUBE W/C-SECTION",,58611,521,"$1,520.00 ","$1,520.00 ","$1,161.28 ","$1,368.00 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,337.60 ","$1,292.00 ","$1,337.60 ","$1,337.60 ","$1,322.40 ","$1,292.00 ","$1,292.00 ","$1,292.00 ","$1,161.28 ","$1,368.00 "
Carle Richland Memorial Hospital,59000,"AMNIOCENTESIS,DIAGNOSTIC",,59000,521,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,59020,FETAL CONTRACTN STRESS TEST,,59020,521,$490.00 ,$490.00 ,$374.36 ,$441.00 ,$416.50 ,$416.50 ,$416.50 ,$431.20 ,$416.50 ,$431.20 ,$431.20 ,$426.30 ,$416.50 ,$416.50 ,$416.50 ,$374.36 ,$441.00
Carle Richland Memorial Hospital,59025,FETAL NON-STRESS TEST,,59025,521,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,59160,D&C AFTER DELIVERY,,59160,521,"$1,710.00 ","$1,710.00 ","$1,306.44 ","$1,539.00 ","$1,453.50 ","$1,453.50 ","$1,453.50 ","$1,504.80 ","$1,453.50 ","$1,504.80 ","$1,504.80 ","$1,487.70 ","$1,453.50 ","$1,453.50 ","$1,453.50 ","$1,306.44 ","$1,539.00 "
Carle Richland Memorial Hospital,15220,"FULL THICK GRFT SCALP,ARM,LEG <20SQC",,15220,521,"$4,830.00 ","$4,830.00 ","$3,690.12 ","$4,347.00 ","$4,105.50 ","$4,105.50 ","$4,105.50 ","$4,250.40 ","$4,105.50 ","$4,250.40 ","$4,250.40 ","$4,202.10 ","$4,105.50 ","$4,105.50 ","$4,105.50 ","$3,690.12 ","$4,347.00 "
Carle Richland Memorial Hospital,59200,INSERT CERVICAL DILATOR,,59200,521,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,59320,"REVISION CERVIX W PREG,VAG APPRCH",,59320,521,"$1,890.00 ","$1,890.00 ","$1,443.96 ","$1,701.00 ","$1,606.50 ","$1,606.50 ","$1,606.50 ","$1,663.20 ","$1,606.50 ","$1,663.20 ","$1,663.20 ","$1,644.30 ","$1,606.50 ","$1,606.50 ","$1,606.50 ","$1,443.96 ","$1,701.00 "
Carle Richland Memorial Hospital,59400,"FULL ROUT OBSTE CARE,VAGINAL DELIV",,59400,521,"$7,400.00 ","$7,400.00 ","$5,653.60 ","$6,660.00 ","$6,290.00 ","$6,290.00 ","$6,290.00 ","$6,512.00 ","$6,290.00 ","$6,512.00 ","$6,512.00 ","$6,438.00 ","$6,290.00 ","$6,290.00 ","$6,290.00 ","$5,653.60 ","$6,660.00 "
Carle Richland Memorial Hospital,59409,"OBSTETRICAL CARE,VAG DELIV ONLY",,59409,521,"$3,880.00 ","$3,880.00 ","$2,964.32 ","$3,492.00 ","$3,298.00 ","$3,298.00 ","$3,298.00 ","$3,414.40 ","$3,298.00 ","$3,414.40 ","$3,414.40 ","$3,375.60 ","$3,298.00 ","$3,298.00 ","$3,298.00 ","$2,964.32 ","$3,492.00 "
Carle Richland Memorial Hospital,59410,"OBSTE CARE,VAG DELIV+POSTPARTUM",,59410,521,"$4,750.00 ","$4,750.00 ","$3,629.00 ","$4,275.00 ","$4,037.50 ","$4,037.50 ","$4,037.50 ","$4,180.00 ","$4,037.50 ","$4,180.00 ","$4,180.00 ","$4,132.50 ","$4,037.50 ","$4,037.50 ","$4,037.50 ","$3,629.00 ","$4,275.00 "
Carle Richland Memorial Hospital,59412,ANTEPARTUM HEAD MANIPULATION,,59412,521,"$1,130.00 ","$1,130.00 ",$863.32 ,"$1,017.00 ",$960.50 ,$960.50 ,$960.50 ,$994.40 ,$960.50 ,$994.40 ,$994.40 ,$983.10 ,$960.50 ,$960.50 ,$960.50 ,$863.32 ,"$1,017.00 "
Carle Richland Memorial Hospital,59414,DELIVER PLACENTA,,59414,521,$990.00 ,$990.00 ,$756.36 ,$891.00 ,$841.50 ,$841.50 ,$841.50 ,$871.20 ,$841.50 ,$871.20 ,$871.20 ,$861.30 ,$841.50 ,$841.50 ,$841.50 ,$756.36 ,$891.00
Carle Richland Memorial Hospital,15221,"FULL THICK GRFT SCALP,ARM ADD 20 SQCM",,15221,521,"$1,110.00 ","$1,110.00 ",$848.04 ,$999.00 ,$943.50 ,$943.50 ,$943.50 ,$976.80 ,$943.50 ,$976.80 ,$976.80 ,$965.70 ,$943.50 ,$943.50 ,$943.50 ,$848.04 ,$999.00
Carle Richland Memorial Hospital,59425,"ANTEPARTUM CARE ONLY, 4-6 VISITS",,59425,521,"$1,290.00 ","$1,290.00 ",$985.56 ,"$1,161.00 ","$1,096.50 ","$1,096.50 ","$1,096.50 ","$1,135.20 ","$1,096.50 ","$1,135.20 ","$1,135.20 ","$1,122.30 ","$1,096.50 ","$1,096.50 ","$1,096.50 ",$985.56 ,"$1,161.00 "
Carle Richland Memorial Hospital,59426,"ANTEPARTUM CARE ONLY, >7 VISITS",,59426,521,"$3,140.00 ","$3,140.00 ","$2,398.96 ","$2,826.00 ","$2,669.00 ","$2,669.00 ","$2,669.00 ","$2,763.20 ","$2,669.00 ","$2,763.20 ","$2,763.20 ","$2,731.80 ","$2,669.00 ","$2,669.00 ","$2,669.00 ","$2,398.96 ","$2,826.00 "
Carle Richland Memorial Hospital,59430,CARE AFTER DELIVERY ONLY,,59430,521,$500.00 ,$500.00 ,$382.00 ,$450.00 ,$425.00 ,$425.00 ,$425.00 ,$440.00 ,$425.00 ,$440.00 ,$440.00 ,$435.00 ,$425.00 ,$425.00 ,$425.00 ,$382.00 ,$450.00
Carle Richland Memorial Hospital,59510,"FULL ROUT OBSTE CARE,CESAREAN DELIV",,59510,521,"$8,630.00 ","$8,630.00 ","$6,593.32 ","$7,767.00 ","$7,335.50 ","$7,335.50 ","$7,335.50 ","$7,594.40 ","$7,335.50 ","$7,594.40 ","$7,594.40 ","$7,508.10 ","$7,335.50 ","$7,335.50 ","$7,335.50 ","$6,593.32 ","$7,767.00 "
Carle Richland Memorial Hospital,59514,CESAREAN DELIVERY ONLY,,59514,521,"$4,700.00 ","$4,700.00 ","$3,590.80 ","$4,230.00 ","$3,995.00 ","$3,995.00 ","$3,995.00 ","$4,136.00 ","$3,995.00 ","$4,136.00 ","$4,136.00 ","$4,089.00 ","$3,995.00 ","$3,995.00 ","$3,995.00 ","$3,590.80 ","$4,230.00 "
Carle Richland Memorial Hospital,59515,CESAREAN DELIVERY+POSTPARTUM CARE,,59515,521,"$5,610.00 ","$5,610.00 ","$4,286.04 ","$5,049.00 ","$4,768.50 ","$4,768.50 ","$4,768.50 ","$4,936.80 ","$4,768.50 ","$4,936.80 ","$4,936.80 ","$4,880.70 ","$4,768.50 ","$4,768.50 ","$4,768.50 ","$4,286.04 ","$5,049.00 "
Carle Richland Memorial Hospital,59525,REMOVE UTERUS AFTER CESAREAN,,59525,521,"$3,360.00 ","$3,360.00 ","$2,567.04 ","$3,024.00 ","$2,856.00 ","$2,856.00 ","$2,856.00 ","$2,956.80 ","$2,856.00 ","$2,956.80 ","$2,956.80 ","$2,923.20 ","$2,856.00 ","$2,856.00 ","$2,856.00 ","$2,567.04 ","$3,024.00 "
Carle Richland Memorial Hospital,59610,"ROUT OB CARE,VAG DELIV,PREV C-SEC",,59610,521,"$8,260.00 ","$8,260.00 ","$6,310.64 ","$7,434.00 ","$7,021.00 ","$7,021.00 ","$7,021.00 ","$7,268.80 ","$7,021.00 ","$7,268.80 ","$7,268.80 ","$7,186.20 ","$7,021.00 ","$7,021.00 ","$7,021.00 ","$6,310.64 ","$7,434.00 "
Carle Richland Memorial Hospital,59614,"VAG DELIV+POSTPARTUM CARE,PREV C-SEC",,59614,521,"$5,330.00 ","$5,330.00 ","$4,072.12 ","$4,797.00 ","$4,530.50 ","$4,530.50 ","$4,530.50 ","$4,690.40 ","$4,530.50 ","$4,690.40 ","$4,690.40 ","$4,637.10 ","$4,530.50 ","$4,530.50 ","$4,530.50 ","$4,072.12 ","$4,797.00 "
Carle Richland Memorial Hospital,15240,"FULL THICK GRFT HEAD,FAC,HAND <20SQC",,15240,521,"$5,440.00 ","$5,440.00 ","$4,156.16 ","$4,896.00 ","$4,624.00 ","$4,624.00 ","$4,624.00 ","$4,787.20 ","$4,624.00 ","$4,787.20 ","$4,787.20 ","$4,732.80 ","$4,624.00 ","$4,624.00 ","$4,624.00 ","$4,156.16 ","$4,896.00 "
Carle Richland Memorial Hospital,59618,"ROUT OB CARE,C-SEC,PREV C-SEC",,59618,521,"$9,520.00 ","$9,520.00 ","$7,273.28 ","$8,568.00 ","$8,092.00 ","$8,092.00 ","$8,092.00 ","$8,377.60 ","$8,092.00 ","$8,377.60 ","$8,377.60 ","$8,282.40 ","$8,092.00 ","$8,092.00 ","$8,092.00 ","$7,273.28 ","$8,568.00 "
Carle Richland Memorial Hospital,59622,"C-SEC+POSTPARTUM CARE,PREV C-SEC",,59622,521,"$6,480.00 ","$6,480.00 ","$4,950.72 ","$5,832.00 ","$5,508.00 ","$5,508.00 ","$5,508.00 ","$5,702.40 ","$5,508.00 ","$5,702.40 ","$5,702.40 ","$5,637.60 ","$5,508.00 ","$5,508.00 ","$5,508.00 ","$4,950.72 ","$5,832.00 "
Carle Richland Memorial Hospital,59812,SURG RX INCOMPLETE ABORTN,,59812,521,"$2,030.00 ","$2,030.00 ","$1,550.92 ","$1,827.00 ","$1,725.50 ","$1,725.50 ","$1,725.50 ","$1,786.40 ","$1,725.50 ","$1,786.40 ","$1,786.40 ","$1,766.10 ","$1,725.50 ","$1,725.50 ","$1,725.50 ","$1,550.92 ","$1,827.00 "
Carle Richland Memorial Hospital,59820,"SURG RX MISSED ABORTN,1ST TRI",,59820,521,"$2,010.00 ","$2,010.00 ","$1,535.64 ","$1,809.00 ","$1,708.50 ","$1,708.50 ","$1,708.50 ","$1,768.80 ","$1,708.50 ","$1,768.80 ","$1,768.80 ","$1,748.70 ","$1,708.50 ","$1,708.50 ","$1,708.50 ","$1,535.64 ","$1,809.00 "
Carle Richland Memorial Hospital,59821,"SURG RX MISSED ABORTN,2ND TRI",,59821,521,"$2,640.00 ","$2,640.00 ","$2,016.96 ","$2,376.00 ","$2,244.00 ","$2,244.00 ","$2,244.00 ","$2,323.20 ","$2,244.00 ","$2,323.20 ","$2,323.20 ","$2,296.80 ","$2,244.00 ","$2,244.00 ","$2,244.00 ","$2,016.96 ","$2,376.00 "
Carle Richland Memorial Hospital,15260,"FULL THICK GRFT NOS,EAR,LID <20 SQCM",,15260,521,"$5,900.00 ","$5,900.00 ","$4,507.60 ","$5,310.00 ","$5,015.00 ","$5,015.00 ","$5,015.00 ","$5,192.00 ","$5,015.00 ","$5,192.00 ","$5,192.00 ","$5,133.00 ","$5,015.00 ","$5,015.00 ","$5,015.00 ","$4,507.60 ","$5,310.00 "
Carle Richland Memorial Hospital,15261,"FULL THICK GRFT NOS,EAR,LID ADD 20SQ",,15261,521,"$1,900.00 ","$1,900.00 ","$1,451.60 ","$1,710.00 ","$1,615.00 ","$1,615.00 ","$1,615.00 ","$1,672.00 ","$1,615.00 ","$1,672.00 ","$1,672.00 ","$1,653.00 ","$1,615.00 ","$1,615.00 ","$1,615.00 ","$1,451.60 ","$1,710.00 "
Carle Richland Memorial Hospital,61070,BRAIN SHUNT TUBE/RESERV INJECTN,,61070,521,"$1,170.00 ","$1,170.00 ",$893.88 ,"$1,053.00 ",$994.50 ,$994.50 ,$994.50 ,"$1,029.60 ",$994.50 ,"$1,029.60 ","$1,029.60 ","$1,017.90 ",$994.50 ,$994.50 ,$994.50 ,$893.88 ,"$1,053.00 "
Carle Richland Memorial Hospital,61210,BURR HOLE IMPLANT CATH/DEVICE,,61210,521,"$4,960.00 ","$4,960.00 ","$3,789.44 ","$4,464.00 ","$4,216.00 ","$4,216.00 ","$4,216.00 ","$4,364.80 ","$4,216.00 ","$4,364.80 ","$4,364.80 ","$4,315.20 ","$4,216.00 ","$4,216.00 ","$4,216.00 ","$3,789.44 ","$4,464.00 "
Carle Richland Memorial Hospital,62270,"SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC",,62270,521,$830.00 ,$830.00 ,$634.12 ,$747.00 ,$705.50 ,$705.50 ,$705.50 ,$730.40 ,$705.50 ,$730.40 ,$730.40 ,$722.10 ,$705.50 ,$705.50 ,$705.50 ,$634.12 ,$747.00
Carle Richland Memorial Hospital,64405,"INJECT NERV BLCK,GREAT OCCIPTL",,64405,521,$970.00 ,$970.00 ,$741.08 ,$873.00 ,$824.50 ,$824.50 ,$824.50 ,$853.60 ,$824.50 ,$853.60 ,$853.60 ,$843.90 ,$824.50 ,$824.50 ,$824.50 ,$741.08 ,$873.00
Carle Richland Memorial Hospital,64450,"INJECT NERV BLCK,OTHR PERIPH NERV",,64450,521,$760.00 ,$760.00 ,$580.64 ,$684.00 ,$646.00 ,$646.00 ,$646.00 ,$668.80 ,$646.00 ,$668.80 ,$668.80 ,$661.20 ,$646.00 ,$646.00 ,$646.00 ,$580.64 ,$684.00
Carle Richland Memorial Hospital,64612,CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL,,64612,521,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,64721,REVISE MEDIAN N/CARPAL TUNNEL SURG,,64721,521,"$4,620.00 ","$4,620.00 ","$3,529.68 ","$4,158.00 ","$3,927.00 ","$3,927.00 ","$3,927.00 ","$4,065.60 ","$3,927.00 ","$4,065.60 ","$4,065.60 ","$4,019.40 ","$3,927.00 ","$3,927.00 ","$3,927.00 ","$3,529.68 ","$4,158.00 "
Carle Richland Memorial Hospital,65205,"REMV F.B.,EYE,SUPERF CONJUNC",,65205,521,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,65220,"REMV F.B.,EYE,CORNEA,NO SLIT",,65220,521,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,15852,"DRESSING CHANGE,NOT FOR BURN",,15852,521,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,69200,REMV EXT CANAL FOREIGN BODY,,69200,521,$475.00 ,$475.00 ,$362.90 ,$427.50 ,$403.75 ,$403.75 ,$403.75 ,$418.00 ,$403.75 ,$418.00 ,$418.00 ,$413.25 ,$403.75 ,$403.75 ,$403.75 ,$362.90 ,$427.50
Carle Richland Memorial Hospital,69210,REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,,69210,521,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,69610,REPAIR TYMPANIC MEMBRANE,,69610,521,"$1,510.00 ","$1,510.00 ","$1,153.64 ","$1,359.00 ","$1,283.50 ","$1,283.50 ","$1,283.50 ","$1,328.80 ","$1,283.50 ","$1,328.80 ","$1,328.80 ","$1,313.70 ","$1,283.50 ","$1,283.50 ","$1,283.50 ","$1,153.64 ","$1,359.00 "
Carle Richland Memorial Hospital,16000,INITIAL RX BURN(S) 1ST DEGREE,,16000,521,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,16020,DRESS/DEBRID SMALL BURN NO ANES,,16020,521,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,16025,DRESS/DEBRID MED BURN NO ANESTH,,16025,521,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,16030,DRESS/DEBRID LARGE BURN NO ANESTH,,16030,521,"$1,050.00 ","$1,050.00 ",$802.20 ,$945.00 ,$892.50 ,$892.50 ,$892.50 ,$924.00 ,$892.50 ,$924.00 ,$924.00 ,$913.50 ,$892.50 ,$892.50 ,$892.50 ,$802.20 ,$945.00
Carle Richland Memorial Hospital,17000,DESTRUCTION PREMALIGNANT LSN FIRST,,17000,521,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,17106,DESTRUC CUT/VASC <10 SQCM,,17106,521,"$1,440.00 ","$1,440.00 ","$1,100.16 ","$1,296.00 ","$1,224.00 ","$1,224.00 ","$1,224.00 ","$1,267.20 ","$1,224.00 ","$1,267.20 ","$1,267.20 ","$1,252.80 ","$1,224.00 ","$1,224.00 ","$1,224.00 ","$1,100.16 ","$1,296.00 "
Carle Richland Memorial Hospital,17107,DESTRUC CUT/VASC 10-50 SQCM,,17107,521,"$2,570.00 ","$2,570.00 ","$1,963.48 ","$2,313.00 ","$2,184.50 ","$2,184.50 ","$2,184.50 ","$2,261.60 ","$2,184.50 ","$2,261.60 ","$2,261.60 ","$2,235.90 ","$2,184.50 ","$2,184.50 ","$2,184.50 ","$1,963.48 ","$2,313.00 "
Carle Richland Memorial Hospital,17108,DESTRUC CUT/VASC >50 SQCM,,17108,521,"$3,800.00 ","$3,800.00 ","$2,903.20 ","$3,420.00 ","$3,230.00 ","$3,230.00 ","$3,230.00 ","$3,344.00 ","$3,230.00 ","$3,344.00 ","$3,344.00 ","$3,306.00 ","$3,230.00 ","$3,230.00 ","$3,230.00 ","$2,903.20 ","$3,420.00 "
Carle Richland Memorial Hospital,17110,DESTRUCTION BENIGN LESIONS UP TO 14,,17110,521,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,17250,CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,,17250,521,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,17260,"DESTR MALIG TRUNK,EXTREM <0.6 CM",,17260,521,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,17261,"DESTR MALIG TRUNK,EXTREM 0.6-1 CM",,17261,521,$475.00 ,$475.00 ,$362.90 ,$427.50 ,$403.75 ,$403.75 ,$403.75 ,$418.00 ,$403.75 ,$418.00 ,$418.00 ,$413.25 ,$403.75 ,$403.75 ,$403.75 ,$362.90 ,$427.50
Carle Richland Memorial Hospital,17262,"DESTR MALIG TRUNK,EXTREM 1.1-2 CM",,17262,521,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,17263,"DESTR MALIG TRUNK,EXTREM 2.1-3 CM",,17263,521,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,17264,"DESTR MALIG TRUNK,EXTREM 3.1-4 CM",,17264,521,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,17266,"DESTR MALIG TRUNK,EXTREM >4.0 CM",,17266,521,$980.00 ,$980.00 ,$748.72 ,$882.00 ,$833.00 ,$833.00 ,$833.00 ,$862.40 ,$833.00 ,$862.40 ,$862.40 ,$852.60 ,$833.00 ,$833.00 ,$833.00 ,$748.72 ,$882.00
Carle Richland Memorial Hospital,17270,"DESTR MALIG SCAL,NCK,HAND <0.6 CM",,17270,521,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,17271,"DESTR MALIG SCAL,NCK,HAND 0.6-1 CM",,17271,521,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,17272,"DESTR MALIG SCAL,NCK,HAND 1.1-2 CM",,17272,521,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,17273,"DESTR MALIG SCAL,NCK,HAND 2.1-3 CM",,17273,521,$830.00 ,$830.00 ,$634.12 ,$747.00 ,$705.50 ,$705.50 ,$705.50 ,$730.40 ,$705.50 ,$730.40 ,$730.40 ,$722.10 ,$705.50 ,$705.50 ,$705.50 ,$634.12 ,$747.00
Carle Richland Memorial Hospital,17274,"DESTR MALIG SCAL,NCK,HAND 3.1-4 CM",,17274,521,$930.00 ,$930.00 ,$710.52 ,$837.00 ,$790.50 ,$790.50 ,$790.50 ,$818.40 ,$790.50 ,$818.40 ,$818.40 ,$809.10 ,$790.50 ,$790.50 ,$790.50 ,$710.52 ,$837.00
Carle Richland Memorial Hospital,17276,"DESTR MALIG SCAL,NCK,HAND >4 CM",,17276,521,"$1,090.00 ","$1,090.00 ",$832.76 ,$981.00 ,$926.50 ,$926.50 ,$926.50 ,$959.20 ,$926.50 ,$959.20 ,$959.20 ,$948.30 ,$926.50 ,$926.50 ,$926.50 ,$832.76 ,$981.00
Carle Richland Memorial Hospital,17280,"DESTR MALIG FACE,NOSE,LIP <0.6 CM",,17280,521,$500.00 ,$500.00 ,$382.00 ,$450.00 ,$425.00 ,$425.00 ,$425.00 ,$440.00 ,$425.00 ,$440.00 ,$440.00 ,$435.00 ,$425.00 ,$425.00 ,$425.00 ,$382.00 ,$450.00
Carle Richland Memorial Hospital,17281,"DESTR MALIG FACE,NOSE,LIP 0.6-1 CM",,17281,521,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,17282,"DESTR MALIG FACE,NOSE,LIP 1.1-2 CM",,17282,521,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,17284,"DESTR MALIG FACE,NOSE,LIP 3.1-4 CM",,17284,521,"$1,060.00 ","$1,060.00 ",$809.84 ,$954.00 ,$901.00 ,$901.00 ,$901.00 ,$932.80 ,$901.00 ,$932.80 ,$932.80 ,$922.20 ,$901.00 ,$901.00 ,$901.00 ,$809.84 ,$954.00
Carle Richland Memorial Hospital,17286,"DESTR MALIG FACE,NOSE,LIP >4 CM",,17286,521,"$1,330.00 ","$1,330.00 ","$1,016.12 ","$1,197.00 ","$1,130.50 ","$1,130.50 ","$1,130.50 ","$1,170.40 ","$1,130.50 ","$1,170.40 ","$1,170.40 ","$1,157.10 ","$1,130.50 ","$1,130.50 ","$1,130.50 ","$1,016.12 ","$1,197.00 "
Carle Richland Memorial Hospital,17340,CRYOTHERAPY ACNE,,17340,521,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,19000,PUNC/ASPIR BREAST CYST,,19000,521,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,19001,"PUCT/ASPIR BREAST CYST,EACH ADDN",,19001,521,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,19020,EXPLO/DRAIN BREAST ABSCESS,,19020,521,"$1,910.00 ","$1,910.00 ","$1,459.24 ","$1,719.00 ","$1,623.50 ","$1,623.50 ","$1,623.50 ","$1,680.80 ","$1,623.50 ","$1,680.80 ","$1,680.80 ","$1,661.70 ","$1,623.50 ","$1,623.50 ","$1,623.50 ","$1,459.24 ","$1,719.00 "
Carle Richland Memorial Hospital,19100,"BIOPSY OF BREAST, NEEDLE CORE",,19100,521,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,92012,"EYE EXAM, EST PATIENT,INTERMED",,92012,521,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,92014,"EYE EXAM, EST PATIENT,COMPREHESV",,92014,521,$245.00 ,$245.00 ,$187.18 ,$220.50 ,$208.25 ,$208.25 ,$208.25 ,$215.60 ,$208.25 ,$215.60 ,$215.60 ,$213.15 ,$208.25 ,$208.25 ,$208.25 ,$187.18 ,$220.50
Carle Richland Memorial Hospital,92551,"PURE TONE HEARING TEST, AIR",,92551,521,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,92552,"PURE TONE AUDIOMETRY, AIR",,92552,521,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,92950,HEART/LUNG RESUSCITATION (CPR),,92950,521,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,20520,REMOVAL OF FOREIGN BODY,,20520,521,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,20550,INJECT TENDON SHEATH/LIGAMENT,,20550,521,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,95115,"IMMUNOTHERAPY, ONE INJECTION",,95115,521,$50.00 ,$50.00 ,$38.20 ,$45.00 ,$42.50 ,$42.50 ,$42.50 ,$44.00 ,$42.50 ,$44.00 ,$44.00 ,$43.50 ,$42.50 ,$42.50 ,$42.50 ,$38.20 ,$45.00
Carle Richland Memorial Hospital,95117,"IMMUNOTHERAPY, 2+ INJECTIONS",,95117,521,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,20600,ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US,,20600,521,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,20605,ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US,,20605,521,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,20610,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US,,20610,521,$390.00 ,$390.00 ,$297.96 ,$351.00 ,$331.50 ,$331.50 ,$331.50 ,$343.20 ,$331.50 ,$343.20 ,$343.20 ,$339.30 ,$331.50 ,$331.50 ,$331.50 ,$297.96 ,$351.00
Carle Richland Memorial Hospital,20650,INSERT AND REMOVE BONE PIN,,20650,521,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,99201,OFFICE OUTPATIENT NEW LEVEL 1,,99201,521,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,99202,OFFICE/OUTPATIENT NEW SF MDM,,99202,521,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,99203,OFFICE/OUTPATIENT NEW LOW MDM,,99203,521,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,99204,OFFICE/OUTPATIENT NEW MODERATE MDM,,99204,521,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,99205,OFFICE/OUTPATIENT NEW HIGH MDM,,99205,521,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,99211,OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S),,99211,521,$84.00 ,$84.00 ,$64.18 ,$75.60 ,$71.40 ,$71.40 ,$71.40 ,$73.92 ,$71.40 ,$73.92 ,$73.92 ,$73.08 ,$71.40 ,$71.40 ,$71.40 ,$64.18 ,$75.60
Carle Richland Memorial Hospital,99212,OFFICE/OUTPATIENT ESTABLISHED SF MDM,,99212,521,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,99213,OFFICE/OUTPATIENT ESTABLISHED LOW MDM,,99213,521,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,99214,OFFICE/OUTPATIENT ESTABLISHED MOD MDM,,99214,521,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,99215,OFFICE/OUTPATIENT ESTABLISHED HIGH MDM,,99215,521,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,99241,OFFICE CONSULTATION NEW/ESTAB PATIENT LEVEL 1,,99241,521,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,99242,OFFICE CONSULTATION NEW/ESTAB PATIENT LEVEL 2,,99242,521,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,99243,OFFICE CONSULTATION NEW/ESTAB PATIENT LEVEL 3,,99243,521,$435.00 ,$435.00 ,$332.34 ,$391.50 ,$369.75 ,$369.75 ,$369.75 ,$382.80 ,$369.75 ,$382.80 ,$382.80 ,$378.45 ,$369.75 ,$369.75 ,$369.75 ,$332.34 ,$391.50
Carle Richland Memorial Hospital,99244,OFFICE CONSULTATION NEW/ESTAB PATIENT LEVEL 4,,99244,521,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,99245,OFFICE CONSULTATION NEW/ESTAB PATIENT LEVEL 5,,99245,521,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,99291,"CRITICAL CARE, E/M 30-74 MINUTES",,99291,521,"$1,280.00 ","$1,280.00 ",$977.92 ,"$1,152.00 ","$1,088.00 ","$1,088.00 ","$1,088.00 ","$1,126.40 ","$1,088.00 ","$1,126.40 ","$1,126.40 ","$1,113.60 ","$1,088.00 ","$1,088.00 ","$1,088.00 ",$977.92 ,"$1,152.00 "
Carle Richland Memorial Hospital,99292,"CRITICAL CARE, ADDL 30 MIN",,99292,521,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,99354,PROLONGED SVC OUTPATIENT SETTING 1ST HOUR,,99354,521,$485.00 ,$485.00 ,$370.54 ,$436.50 ,$412.25 ,$412.25 ,$412.25 ,$426.80 ,$412.25 ,$426.80 ,$426.80 ,$421.95 ,$412.25 ,$412.25 ,$412.25 ,$370.54 ,$436.50
Carle Richland Memorial Hospital,99355,PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN,,99355,521,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,99358,PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR,,99358,521,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,99359,PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MIN,,99359,521,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,99375,SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>,,99375,521,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,99381,"PREVENTIVE VISIT,NEW,INFANT < 1 YR",,99381,521,$245.00 ,$245.00 ,$187.18 ,$220.50 ,$208.25 ,$208.25 ,$208.25 ,$215.60 ,$208.25 ,$215.60 ,$215.60 ,$213.15 ,$208.25 ,$208.25 ,$208.25 ,$187.18 ,$220.50
Carle Richland Memorial Hospital,99382,"PREVENTIVE VISIT,NEW,AGE 1-4",,99382,521,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,99383,"PREVENTIVE VISIT,NEW,AGE5-11",,99383,521,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,99384,"PREVENTIVE VISIT,NEW,12-17",,99384,521,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,99385,"PREVENTIVE VISIT,NEW,18-39",,99385,521,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,99386,"PREVENTIVE VISIT,NEW,40-64",,99386,521,$425.00 ,$425.00 ,$324.70 ,$382.50 ,$361.25 ,$361.25 ,$361.25 ,$374.00 ,$361.25 ,$374.00 ,$374.00 ,$369.75 ,$361.25 ,$361.25 ,$361.25 ,$324.70 ,$382.50
Carle Richland Memorial Hospital,99387,"PREVENTIVE VISIT,NEW,65 & OVER",,99387,521,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,99391,"PREVENTIVE VISIT,EST, INFANT < 1 YR",,99391,521,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,99392,"PREVENTIVE VISIT,EST,AGE 1-4",,99392,521,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,99393,"PREVENTIVE VISIT,EST,AGE5-11",,99393,521,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,99394,"PREVENTIVE VISIT,EST,12-17",,99394,521,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,99395,"PREVENTIVE VISIT,EST,18-39",,99395,521,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,99396,"PREVENTIVE VISIT,EST,40-64",,99396,521,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,99397,"PREVENTIVE VISIT,EST,65 & OVER",,99397,521,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,99402,"PREVENT COUNSEL,INDIV,30 MIN",,99402,521,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,99403,"PREVENT COUNSEL,INDIV,45 MIN",,99403,521,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,99450,LIFE/DISABILITY EVALUATION,,99450,521,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,99455,DISABILITY EXAM/TREATING DR,,99455,521,$325.00 ,$325.00 ,$248.30 ,$292.50 ,$276.25 ,$276.25 ,$276.25 ,$286.00 ,$276.25 ,$286.00 ,$286.00 ,$282.75 ,$276.25 ,$276.25 ,$276.25 ,$248.30 ,$292.50
Carle Richland Memorial Hospital,Q0091,Obtaining screen pap smear,,Q0091,521,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,11720,"DEBRIDEMENT OF NAIL(S), 1-5",,11720,521,$76.00 ,$76.00 ,$58.06 ,$68.40 ,$64.60 ,$64.60 ,$64.60 ,$66.88 ,$64.60 ,$66.88 ,$66.88 ,$66.12 ,$64.60 ,$64.60 ,$64.60 ,$58.06 ,$68.40
Carle Richland Memorial Hospital,11721,"DEBRIDEMENT OF NAILS, 6 OR MORE",,11721,521,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,11055,"TRIM HYPERKERATOTIC SKIN LESION, ONE",,11055,521,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,11056,"TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4",,11056,521,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,11057,"TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4",,11057,521,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,11719,TRIM NAIL(S),,11719,521,$67.00 ,$67.00 ,$51.19 ,$60.30 ,$56.95 ,$56.95 ,$56.95 ,$58.96 ,$56.95 ,$58.96 ,$58.96 ,$58.29 ,$56.95 ,$56.95 ,$56.95 ,$51.19 ,$60.30
Carle Richland Memorial Hospital,17003,DSTRCTN PREMALG 2-14 EACH,,17003,521,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,17004,DSTRCTN PREMALG 15+ LSNS,,17004,521,"$1,010.00 ","$1,010.00 ",$771.64 ,$909.00 ,$858.50 ,$858.50 ,$858.50 ,$888.80 ,$858.50 ,$888.80 ,$888.80 ,$878.70 ,$858.50 ,$858.50 ,$858.50 ,$771.64 ,$909.00
Carle Richland Memorial Hospital,17111,DESTRUCTION BENIGN LESIONS 15 OR MORE,,17111,521,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,59871,REMOVE CERCLAGE SUTURE,,59871,521,$830.00 ,$830.00 ,$634.12 ,$747.00 ,$705.50 ,$705.50 ,$705.50 ,$730.40 ,$705.50 ,$730.40 ,$730.40 ,$722.10 ,$705.50 ,$705.50 ,$705.50 ,$634.12 ,$747.00
Carle Richland Memorial Hospital,99374,SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES,,99374,521,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,99377,SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN,,99377,521,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,99378,SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/>,,99378,521,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,99379,SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN,,99379,521,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,99380,SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>,,99380,521,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,G0101,CA screen;pelvic/breast exam,,G0101,521,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,G0105,Colorectal scrn; hi risk ind,,G0105,521,"$3,340.00 ","$3,340.00 ","$2,551.76 ","$3,006.00 ","$2,839.00 ","$2,839.00 ","$2,839.00 ","$2,939.20 ","$2,839.00 ","$2,939.20 ","$2,939.20 ","$2,905.80 ","$2,839.00 ","$2,839.00 ","$2,839.00 ","$2,551.76 ","$3,006.00 "
Carle Richland Memorial Hospital,G0121,Colon ca scrn not hi rsk ind,,G0121,521,"$3,340.00 ","$3,340.00 ","$2,551.76 ","$3,006.00 ","$2,839.00 ","$2,839.00 ","$2,839.00 ","$2,939.20 ","$2,839.00 ","$2,939.20 ","$2,939.20 ","$2,905.80 ","$2,839.00 ","$2,839.00 ","$2,839.00 ","$2,551.76 ","$3,006.00 "
Carle Richland Memorial Hospital,G0127,Trim nail(s),,G0127,521,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,10021,FINE NEEDLE ASP;W/O IMAGING GUIDANCE,,10021,521,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,11980,"IMPLANT,HORMONE,SUBCUTANEOUS",,11980,521,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,11981,INSERTION DRUG IMPLANT DEVICE,,11981,521,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,11982,REMOVAL DRUG IMPLANT DEVICE,,11982,521,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,11983,REMOVAL W/ REINSERT DRUG IMPLANT DEVICE,,11983,521,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,13102,"REP,SKIN,TRUNK,CMPLX,+5 CM/<",,13102,521,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,13122,"REP,SKIN,SCALP/EXTREM+5 CM/<",,13122,521,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,13133,"REPR,FACE,GENITAL,HAND,FT+5 CMCM/<",,13133,521,$990.00 ,$990.00 ,$756.36 ,$891.00 ,$841.50 ,$841.50 ,$841.50 ,$871.20 ,$841.50 ,$871.20 ,$871.20 ,$861.30 ,$841.50 ,$841.50 ,$841.50 ,$756.36 ,$891.00
Carle Richland Memorial Hospital,13153,"REPR,EYELID,NOSE,EAR,LIP+5 CM",,13153,521,"$1,320.00 ","$1,320.00 ","$1,008.48 ","$1,188.00 ","$1,122.00 ","$1,122.00 ","$1,122.00 ","$1,161.60 ","$1,122.00 ","$1,161.60 ","$1,161.60 ","$1,148.40 ","$1,122.00 ","$1,122.00 ","$1,122.00 ","$1,008.48 ","$1,188.00 "
Carle Richland Memorial Hospital,20526,INJECT CARPAL TUNNEL,,20526,521,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,20551,INJECT TENDON ORIGIN/INSERT,,20551,521,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,20552,"INJECT TRIGGER POINT, 1 OR 2",,20552,521,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,20553,"INJECT TRIGGER POINTS, > 3",,20553,521,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,20612,ASPIRAT/INJECTION GANGLION CYST(S),,20612,521,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,21015,RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM,,21015,521,"$4,040.00 ","$4,040.00 ","$3,086.56 ","$3,636.00 ","$3,434.00 ","$3,434.00 ","$3,434.00 ","$3,555.20 ","$3,434.00 ","$3,555.20 ","$3,555.20 ","$3,514.80 ","$3,434.00 ","$3,434.00 ","$3,434.00 ","$3,086.56 ","$3,636.00 "
Carle Richland Memorial Hospital,36556,INSERT NON-TUNNEL CV CATH,,36556,521,"$1,820.00 ","$1,820.00 ","$1,390.48 ","$1,638.00 ","$1,547.00 ","$1,547.00 ","$1,547.00 ","$1,601.60 ","$1,547.00 ","$1,601.60 ","$1,601.60 ","$1,583.40 ","$1,547.00 ","$1,547.00 ","$1,547.00 ","$1,390.48 ","$1,638.00 "
Carle Richland Memorial Hospital,36569,INSERT PICC W/O SUB-Q PORT,,36569,521,"$1,890.00 ","$1,890.00 ","$1,443.96 ","$1,701.00 ","$1,606.50 ","$1,606.50 ","$1,606.50 ","$1,663.20 ","$1,606.50 ","$1,663.20 ","$1,663.20 ","$1,644.30 ","$1,606.50 ","$1,606.50 ","$1,606.50 ","$1,443.96 ","$1,701.00 "
Carle Richland Memorial Hospital,38220,DIAGNOSTIC BONE MARROW ASPIRATIONS,,38220,521,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,38221,DIAGNOSTIC BONE MARROW BIOPSIES,,38221,521,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,51701,"INSERT,NON-INDWELLING BLADDER CATHETER",,51701,521,$390.00 ,$390.00 ,$297.96 ,$351.00 ,$331.50 ,$331.50 ,$331.50 ,$343.20 ,$331.50 ,$343.20 ,$343.20 ,$339.30 ,$331.50 ,$331.50 ,$331.50 ,$297.96 ,$351.00
Carle Richland Memorial Hospital,51702,"INSERT,TEMP INDWELLING BLAD CATH,SIMPLE",,51702,521,$500.00 ,$500.00 ,$382.00 ,$450.00 ,$425.00 ,$425.00 ,$425.00 ,$440.00 ,$425.00 ,$440.00 ,$440.00 ,$435.00 ,$425.00 ,$425.00 ,$425.00 ,$382.00 ,$450.00
Carle Richland Memorial Hospital,51703,"INSERT,TEMP INDWELLING BLAD CATH,COMP",,51703,521,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,51798,"MEAS,POST-VOID RES,US,NON-IMAGING",,51798,521,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,54162,"LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS",,54162,521,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,56820,"COLPOSCOPY,VULVA",,56820,521,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,56821,"COLPOSCOPY,VULVA,W/BIOPSY(S)",,56821,521,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,57420,"COLPOSCOPY,ENTIRE VAGINA",,57420,521,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,57421,"COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)",,57421,521,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,57455,"COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX",,57455,521,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,57456,"COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG",,57456,521,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,57461,"COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP CONIZ",,57461,521,"$2,270.00 ","$2,270.00 ","$1,734.28 ","$2,043.00 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,997.60 ","$1,929.50 ","$1,997.60 ","$1,997.60 ","$1,974.90 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,734.28 ","$2,043.00 "
Carle Richland Memorial Hospital,58555,"HYSTEROSCOPY,DX,SEP PROC",,58555,521,"$2,270.00 ","$2,270.00 ","$1,734.28 ","$2,043.00 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,997.60 ","$1,929.50 ","$1,997.60 ","$1,997.60 ","$1,974.90 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,734.28 ","$2,043.00 "
Carle Richland Memorial Hospital,58558,"HYSTEROSCOPY,W/ENDO BX",,58558,521,"$3,290.00 ","$3,290.00 ","$2,513.56 ","$2,961.00 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,895.20 ","$2,796.50 ","$2,895.20 ","$2,895.20 ","$2,862.30 ","$2,796.50 ","$2,796.50 ","$2,796.50 ","$2,513.56 ","$2,961.00 "
Carle Richland Memorial Hospital,97802,"MED NUTR THER, 1ST, INDIV, EA 15 MIN",,97802,521,$88.00 ,$88.00 ,$67.23 ,$79.20 ,$74.80 ,$74.80 ,$74.80 ,$77.44 ,$74.80 ,$77.44 ,$77.44 ,$76.56 ,$74.80 ,$74.80 ,$74.80 ,$67.23 ,$79.20
Carle Richland Memorial Hospital,97803,"MED NUTR THER, SUBSQ, INDIV, EA 15 MIN",,97803,521,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,25608,"OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 2 FRAG",,25608,521,"$4,990.00 ","$4,990.00 ","$3,812.36 ","$4,491.00 ","$4,241.50 ","$4,241.50 ","$4,241.50 ","$4,391.20 ","$4,241.50 ","$4,391.20 ","$4,391.20 ","$4,341.30 ","$4,241.50 ","$4,241.50 ","$4,241.50 ","$3,812.36 ","$4,491.00 "
Carle Richland Memorial Hospital,58110,ENDOMET BIOPSY DONE W/COLPOSCOPY,,58110,521,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,58565,"HYSTEROSCOPY, STERILIZE W IMPLANTS",,58565,521,"$10,770.00 ","$10,770.00 ","$8,228.28 ","$9,693.00 ","$9,154.50 ","$9,154.50 ","$9,154.50 ","$9,477.60 ","$9,154.50 ","$9,477.60 ","$9,477.60 ","$9,369.90 ","$9,154.50 ","$9,154.50 ","$9,154.50 ","$8,228.28 ","$9,693.00 "
Carle Richland Memorial Hospital,97597,DEBRIDEMENT OPEN WOUND 20 SQ CM<,,97597,521,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,98960,"SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN",,98960,521,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,14301,"ADJ TISS XFER ANY AREA,30.1-60 SQCM",,14301,521,"$5,470.00 ","$5,470.00 ","$4,179.08 ","$4,923.00 ","$4,649.50 ","$4,649.50 ","$4,649.50 ","$4,813.60 ","$4,649.50 ","$4,813.60 ","$4,813.60 ","$4,758.90 ","$4,649.50 ","$4,649.50 ","$4,649.50 ","$4,179.08 ","$4,923.00 "
Carle Richland Memorial Hospital,14302,"ADJ TISS XFER ANY AREA,EA ADD 30.0 SQCM",,14302,521,"$1,410.00 ","$1,410.00 ","$1,077.24 ","$1,269.00 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,240.80 ","$1,198.50 ","$1,240.80 ","$1,240.80 ","$1,226.70 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,077.24 ","$1,269.00 "
Carle Richland Memorial Hospital,21011,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM,,21011,521,"$2,150.00 ","$2,150.00 ","$1,642.60 ","$1,935.00 ","$1,827.50 ","$1,827.50 ","$1,827.50 ","$1,892.00 ","$1,827.50 ","$1,892.00 ","$1,892.00 ","$1,870.50 ","$1,827.50 ","$1,827.50 ","$1,827.50 ","$1,642.60 ","$1,935.00 "
Carle Richland Memorial Hospital,21013,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL < 2CM,,21013,521,"$3,310.00 ","$3,310.00 ","$2,528.84 ","$2,979.00 ","$2,813.50 ","$2,813.50 ","$2,813.50 ","$2,912.80 ","$2,813.50 ","$2,912.80 ","$2,912.80 ","$2,879.70 ","$2,813.50 ","$2,813.50 ","$2,813.50 ","$2,528.84 ","$2,979.00 "
Carle Richland Memorial Hospital,21016,RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>,,21016,521,"$6,690.00 ","$6,690.00 ","$5,111.16 ","$6,021.00 ","$5,686.50 ","$5,686.50 ","$5,686.50 ","$5,887.20 ","$5,686.50 ","$5,887.20 ","$5,887.20 ","$5,820.30 ","$5,686.50 ","$5,686.50 ","$5,686.50 ","$5,111.16 ","$6,021.00 "
Carle Richland Memorial Hospital,21558,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>,,21558,521,"$8,890.00 ","$8,890.00 ","$6,791.96 ","$8,001.00 ","$7,556.50 ","$7,556.50 ","$7,556.50 ","$7,823.20 ","$7,556.50 ","$7,823.20 ","$7,823.20 ","$7,734.30 ","$7,556.50 ","$7,556.50 ","$7,556.50 ","$6,791.96 ","$8,001.00 "
Carle Richland Memorial Hospital,21932,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM,,21932,521,"$4,530.00 ","$4,530.00 ","$3,460.92 ","$4,077.00 ","$3,850.50 ","$3,850.50 ","$3,850.50 ","$3,986.40 ","$3,850.50 ","$3,986.40 ","$3,986.40 ","$3,941.10 ","$3,850.50 ","$3,850.50 ","$3,850.50 ","$3,460.92 ","$4,077.00 "
Carle Richland Memorial Hospital,21936,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>,,21936,521,"$10,250.00 ","$10,250.00 ","$7,831.00 ","$9,225.00 ","$8,712.50 ","$8,712.50 ","$8,712.50 ","$9,020.00 ","$8,712.50 ","$9,020.00 ","$9,020.00 ","$8,917.50 ","$8,712.50 ","$8,712.50 ","$8,712.50 ","$7,831.00 ","$9,225.00 "
Carle Richland Memorial Hospital,22902,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,,22902,521,"$2,350.00 ","$2,350.00 ","$1,795.40 ","$2,115.00 ","$1,997.50 ","$1,997.50 ","$1,997.50 ","$2,068.00 ","$1,997.50 ","$2,068.00 ","$2,068.00 ","$2,044.50 ","$1,997.50 ","$1,997.50 ","$1,997.50 ","$1,795.40 ","$2,115.00 "
Carle Richland Memorial Hospital,22904,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM,,22904,521,"$6,150.00 ","$6,150.00 ","$4,698.60 ","$5,535.00 ","$5,227.50 ","$5,227.50 ","$5,227.50 ","$5,412.00 ","$5,227.50 ","$5,412.00 ","$5,412.00 ","$5,350.50 ","$5,227.50 ","$5,227.50 ","$5,227.50 ","$4,698.60 ","$5,535.00 "
Carle Richland Memorial Hospital,22905,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>,,22905,521,"$7,350.00 ","$7,350.00 ","$5,615.40 ","$6,615.00 ","$6,247.50 ","$6,247.50 ","$6,247.50 ","$6,468.00 ","$6,247.50 ","$6,468.00 ","$6,468.00 ","$6,394.50 ","$6,247.50 ","$6,247.50 ","$6,247.50 ","$5,615.40 ","$6,615.00 "
Carle Richland Memorial Hospital,23078,RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>,,23078,521,"$10,400.00 ","$10,400.00 ","$7,945.60 ","$9,360.00 ","$8,840.00 ","$8,840.00 ","$8,840.00 ","$9,152.00 ","$8,840.00 ","$9,152.00 ","$9,152.00 ","$9,048.00 ","$8,840.00 ","$8,840.00 ","$8,840.00 ","$7,945.60 ","$9,360.00 "
Carle Richland Memorial Hospital,24079,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>,,24079,521,"$9,400.00 ","$9,400.00 ","$7,181.60 ","$8,460.00 ","$7,990.00 ","$7,990.00 ","$7,990.00 ","$8,272.00 ","$7,990.00 ","$8,272.00 ","$8,272.00 ","$8,178.00 ","$7,990.00 ","$7,990.00 ","$7,990.00 ","$7,181.60 ","$8,460.00 "
Carle Richland Memorial Hospital,25078,RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>,,25078,521,"$8,760.00 ","$8,760.00 ","$6,692.64 ","$7,884.00 ","$7,446.00 ","$7,446.00 ","$7,446.00 ","$7,708.80 ","$7,446.00 ","$7,708.80 ","$7,708.80 ","$7,621.20 ","$7,446.00 ","$7,446.00 ","$7,446.00 ","$6,692.64 ","$7,884.00 "
Carle Richland Memorial Hospital,27059,RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>,,27059,521,"$13,410.00 ","$13,410.00 ","$10,245.24 ","$12,069.00 ","$11,398.50 ","$11,398.50 ","$11,398.50 ","$11,800.80 ","$11,398.50 ","$11,800.80 ","$11,800.80 ","$11,666.70 ","$11,398.50 ","$11,398.50 ","$11,398.50 ","$10,245.24 ","$12,069.00 "
Carle Richland Memorial Hospital,27364,RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>,,27364,521,"$12,100.00 ","$12,100.00 ","$9,244.40 ","$10,890.00 ","$10,285.00 ","$10,285.00 ","$10,285.00 ","$10,648.00 ","$10,285.00 ","$10,648.00 ","$10,648.00 ","$10,527.00 ","$10,285.00 ","$10,285.00 ","$10,285.00 ","$9,244.40 ","$10,890.00 "
Carle Richland Memorial Hospital,27616,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>,,27616,521,"$9,600.00 ","$9,600.00 ","$7,334.40 ","$8,640.00 ","$8,160.00 ","$8,160.00 ","$8,160.00 ","$8,448.00 ","$8,160.00 ","$8,448.00 ","$8,448.00 ","$8,352.00 ","$8,160.00 ","$8,160.00 ","$8,160.00 ","$7,334.40 ","$8,640.00 "
Carle Richland Memorial Hospital,36591,COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,,36591,521,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,36592,COLLECT BLOOD FROM CATHETER VENOUS NOS,,36592,521,$195.00 ,$195.00 ,$148.98 ,$175.50 ,$165.75 ,$165.75 ,$165.75 ,$171.60 ,$165.75 ,$171.60 ,$171.60 ,$169.65 ,$165.75 ,$165.75 ,$165.75 ,$148.98 ,$175.50
Carle Richland Memorial Hospital,36593,DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH,,36593,521,$320.00 ,$320.00 ,$244.48 ,$288.00 ,$272.00 ,$272.00 ,$272.00 ,$281.60 ,$272.00 ,$281.60 ,$281.60 ,$278.40 ,$272.00 ,$272.00 ,$272.00 ,$244.48 ,$288.00
Carle Richland Memorial Hospital,49411,"PLACE INTERST RAD THER GUIDE, PERC,INTRAABD/INTRAPELV/RETROPER,1+",,49411,521,"$2,500.00 ","$2,500.00 ","$1,910.00 ","$2,250.00 ","$2,125.00 ","$2,125.00 ","$2,125.00 ","$2,200.00 ","$2,125.00 ","$2,200.00 ","$2,200.00 ","$2,175.00 ","$2,125.00 ","$2,125.00 ","$2,125.00 ","$1,910.00 ","$2,250.00 "
Carle Richland Memorial Hospital,51727,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,,51727,521,"$1,470.00 ","$1,470.00 ","$1,123.08 ","$1,323.00 ","$1,249.50 ","$1,249.50 ","$1,249.50 ","$1,293.60 ","$1,249.50 ","$1,293.60 ","$1,293.60 ","$1,278.90 ","$1,249.50 ","$1,249.50 ","$1,249.50 ","$1,123.08 ","$1,323.00 "
Carle Richland Memorial Hospital,64632,DESTRUCT BY NEURO AGENT; PLANTAR DIGITAL NERVE,,64632,521,$680.00 ,$680.00 ,$519.52 ,$612.00 ,$578.00 ,$578.00 ,$578.00 ,$598.40 ,$578.00 ,$598.40 ,$598.40 ,$591.60 ,$578.00 ,$578.00 ,$578.00 ,$519.52 ,$612.00
Carle Richland Memorial Hospital,96372,"INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT",,96372,521,$86.00 ,$86.00 ,$65.70 ,$77.40 ,$73.10 ,$73.10 ,$73.10 ,$75.68 ,$73.10 ,$75.68 ,$75.68 ,$74.82 ,$73.10 ,$73.10 ,$73.10 ,$65.70 ,$77.40
Carle Richland Memorial Hospital,96373,"INJECTION,THERAP/PROPH/DIAGNOST, INTRA-ARTERIAL",,96373,521,$93.00 ,$93.00 ,$71.05 ,$83.70 ,$79.05 ,$79.05 ,$79.05 ,$81.84 ,$79.05 ,$81.84 ,$81.84 ,$80.91 ,$79.05 ,$79.05 ,$79.05 ,$71.05 ,$83.70
Carle Richland Memorial Hospital,96374,"INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG",,96374,521,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,96375,"INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG",,96375,521,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,98966,NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN,,98966,521,$93.00 ,$93.00 ,$71.05 ,$83.70 ,$79.05 ,$79.05 ,$79.05 ,$81.84 ,$79.05 ,$81.84 ,$81.84 ,$80.91 ,$79.05 ,$79.05 ,$79.05 ,$71.05 ,$83.70
Carle Richland Memorial Hospital,98967,NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN,,98967,521,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,98968,NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN,,98968,521,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,99406,TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES,,99406,521,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,99407,TOBACCO USE CESSATION INTENSIVE >10 MINUTES,,99407,521,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,99408,ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN,,99408,521,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,99441,PHYS/QHP TELEPHONE EVALUATION 5-10 MIN,,99441,521,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,99442,PHYS/QHP TELEPHONE EVALUATION 11-20 MIN,,99442,521,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,99443,PHYS/QHP TELEPHONE EVALUATION 21-30 MIN,,99443,521,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,G0102,Prostate ca screening; dre,,G0102,521,$68.00 ,$68.00 ,$51.95 ,$61.20 ,$57.80 ,$57.80 ,$57.80 ,$59.84 ,$57.80 ,$59.84 ,$59.84 ,$59.16 ,$57.80 ,$57.80 ,$57.80 ,$51.95 ,$61.20
Carle Richland Memorial Hospital,G0168,Wound closure by adhesive,,G0168,521,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,G0179,MD recertification HHA PT,,G0179,521,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,G0180,MD certification HHA patient,,G0180,521,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,G0402,Initial preventive exam,,G0402,521,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,21555,EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM,,21555,521,"$2,290.00 ","$2,290.00 ","$1,749.56 ","$2,061.00 ","$1,946.50 ","$1,946.50 ","$1,946.50 ","$2,015.20 ","$1,946.50 ","$2,015.20 ","$2,015.20 ","$1,992.30 ","$1,946.50 ","$1,946.50 ","$1,946.50 ","$1,749.56 ","$2,061.00 "
Carle Richland Memorial Hospital,21556,EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL <5CM,,21556,521,"$2,960.00 ","$2,960.00 ","$2,261.44 ","$2,664.00 ","$2,516.00 ","$2,516.00 ","$2,516.00 ","$2,604.80 ","$2,516.00 ","$2,604.80 ","$2,604.80 ","$2,575.20 ","$2,516.00 ","$2,516.00 ","$2,516.00 ","$2,261.44 ","$2,664.00 "
Carle Richland Memorial Hospital,21557,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM,,21557,521,"$6,030.00 ","$6,030.00 ","$4,606.92 ","$5,427.00 ","$5,125.50 ","$5,125.50 ","$5,125.50 ","$5,306.40 ","$5,125.50 ","$5,306.40 ","$5,306.40 ","$5,246.10 ","$5,125.50 ","$5,125.50 ","$5,125.50 ","$4,606.92 ","$5,427.00 "
Carle Richland Memorial Hospital,21930,EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM,,21930,521,"$2,780.00 ","$2,780.00 ","$2,123.92 ","$2,502.00 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,446.40 ","$2,363.00 ","$2,446.40 ","$2,446.40 ","$2,418.60 ","$2,363.00 ","$2,363.00 ","$2,363.00 ","$2,123.92 ","$2,502.00 "
Carle Richland Memorial Hospital,21935,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM,,21935,521,"$7,480.00 ","$7,480.00 ","$5,714.72 ","$6,732.00 ","$6,358.00 ","$6,358.00 ","$6,358.00 ","$6,582.40 ","$6,358.00 ","$6,582.40 ","$6,582.40 ","$6,507.60 ","$6,358.00 ","$6,358.00 ","$6,358.00 ","$5,714.72 ","$6,732.00 "
Carle Richland Memorial Hospital,22900,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM,,22900,521,"$2,890.00 ","$2,890.00 ","$2,207.96 ","$2,601.00 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,543.20 ","$2,456.50 ","$2,543.20 ","$2,543.20 ","$2,514.30 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,207.96 ","$2,601.00 "
Carle Richland Memorial Hospital,23075,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM,,23075,521,"$1,960.00 ","$1,960.00 ","$1,497.44 ","$1,764.00 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,724.80 ","$1,666.00 ","$1,724.80 ","$1,724.80 ","$1,705.20 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,497.44 ","$1,764.00 "
Carle Richland Memorial Hospital,23076,EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM,,23076,521,"$3,500.00 ","$3,500.00 ","$2,674.00 ","$3,150.00 ","$2,975.00 ","$2,975.00 ","$2,975.00 ","$3,080.00 ","$2,975.00 ","$3,080.00 ","$3,080.00 ","$3,045.00 ","$2,975.00 ","$2,975.00 ","$2,975.00 ","$2,674.00 ","$3,150.00 "
Carle Richland Memorial Hospital,23077,RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM,,23077,521,"$9,050.00 ","$9,050.00 ","$6,914.20 ","$8,145.00 ","$7,692.50 ","$7,692.50 ","$7,692.50 ","$7,964.00 ","$7,692.50 ","$7,964.00 ","$7,964.00 ","$7,873.50 ","$7,692.50 ","$7,692.50 ","$7,692.50 ","$6,914.20 ","$8,145.00 "
Carle Richland Memorial Hospital,11045,"DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM",,11045,521,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,11047,"DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM",,11047,521,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,15271,APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM,,15271,521,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,15272,APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM,,15272,521,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,20527,INJECTION ENZYME PALMAR FASCIAL CORD,,20527,521,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,23500,CLOSED RX CLAVICLE FRACTURE,,23500,521,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,49082,ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE,,49082,521,$980.00 ,$980.00 ,$748.72 ,$882.00 ,$833.00 ,$833.00 ,$833.00 ,$862.40 ,$833.00 ,$862.40 ,$862.40 ,$852.60 ,$833.00 ,$833.00 ,$833.00 ,$748.72 ,$882.00
Carle Richland Memorial Hospital,49083,ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE,,49083,521,"$1,790.00 ","$1,790.00 ","$1,367.56 ","$1,611.00 ","$1,521.50 ","$1,521.50 ","$1,521.50 ","$1,575.20 ","$1,521.50 ","$1,575.20 ","$1,575.20 ","$1,557.30 ","$1,521.50 ","$1,521.50 ","$1,521.50 ","$1,367.56 ","$1,611.00 "
Carle Richland Memorial Hospital,G0438,"PPPS, initial visit",,G0438,521,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,G0439,"PPPS, subseq visit",,G0439,521,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,G0442,Annual alcohol screen 15 min,,G0442,521,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,G0443,Brief alcohol misuse counsel,,G0443,521,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,G0444,Depression screen annual,,G0444,521,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,G0447,Behavior counsel obesity 15m,,G0447,521,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,G0446,Intens behave ther cardio dx,,G0446,521,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,23600,CLOSED RX PROX HUMERUS FRACTURE,,23600,521,"$1,910.00 ","$1,910.00 ","$1,459.24 ","$1,719.00 ","$1,623.50 ","$1,623.50 ","$1,623.50 ","$1,680.80 ","$1,623.50 ","$1,680.80 ","$1,680.80 ","$1,661.70 ","$1,623.50 ","$1,623.50 ","$1,623.50 ","$1,459.24 ","$1,719.00 "
Carle Richland Memorial Hospital,23650,CLOSED RX SHLDR DISLOCATION,,23650,521,"$1,710.00 ","$1,710.00 ","$1,306.44 ","$1,539.00 ","$1,453.50 ","$1,453.50 ","$1,453.50 ","$1,504.80 ","$1,453.50 ","$1,504.80 ","$1,504.80 ","$1,487.70 ","$1,453.50 ","$1,453.50 ","$1,453.50 ","$1,306.44 ","$1,539.00 "
Carle Richland Memorial Hospital,24075,EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM,,24075,521,"$3,230.00 ","$3,230.00 ","$2,467.72 ","$2,907.00 ","$2,745.50 ","$2,745.50 ","$2,745.50 ","$2,842.40 ","$2,745.50 ","$2,842.40 ","$2,842.40 ","$2,810.10 ","$2,745.50 ","$2,745.50 ","$2,745.50 ","$2,467.72 ","$2,907.00 "
Carle Richland Memorial Hospital,24076,EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM,,24076,521,"$3,620.00 ","$3,620.00 ","$2,765.68 ","$3,258.00 ","$3,077.00 ","$3,077.00 ","$3,077.00 ","$3,185.60 ","$3,077.00 ","$3,185.60 ","$3,185.60 ","$3,149.40 ","$3,077.00 ","$3,077.00 ","$3,077.00 ","$2,765.68 ","$3,258.00 "
Carle Richland Memorial Hospital,24077,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM,,24077,521,"$6,940.00 ","$6,940.00 ","$5,302.16 ","$6,246.00 ","$5,899.00 ","$5,899.00 ","$5,899.00 ","$6,107.20 ","$5,899.00 ","$6,107.20 ","$6,107.20 ","$6,037.80 ","$5,899.00 ","$5,899.00 ","$5,899.00 ","$5,302.16 ","$6,246.00 "
Carle Richland Memorial Hospital,90833,MEDICAL SERVICE,,90833,521,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,90836,MEDICAL SERVICE,,90836,521,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,90838,MEDICAL SERVICE,,90838,521,$345.00 ,$345.00 ,$263.58 ,$310.50 ,$293.25 ,$293.25 ,$293.25 ,$303.60 ,$293.25 ,$303.60 ,$303.60 ,$300.15 ,$293.25 ,$293.25 ,$293.25 ,$263.58 ,$310.50
Carle Richland Memorial Hospital,99495,TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE,,99495,521,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,99496,TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE,,99496,521,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,69209,REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT,,69209,521,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,G0296,VISIT TO DETERM LDCT ELIG,,G0296,521,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,7999915,"Pr Special Reports, Legal Purposes",,99080,521,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,24640,"CLOSED RX RADIAL HEAD DISLOC,CHILD",,24640,521,$790.00 ,$790.00 ,$603.56 ,$711.00 ,$671.50 ,$671.50 ,$671.50 ,$695.20 ,$671.50 ,$695.20 ,$695.20 ,$687.30 ,$671.50 ,$671.50 ,$671.50 ,$603.56 ,$711.00
Carle Richland Memorial Hospital,24650,CLOSED RX RADIAL HEAD/NECK FX,,24650,521,"$1,390.00 ","$1,390.00 ","$1,061.96 ","$1,251.00 ","$1,181.50 ","$1,181.50 ","$1,181.50 ","$1,223.20 ","$1,181.50 ","$1,223.20 ","$1,223.20 ","$1,209.30 ","$1,181.50 ","$1,181.50 ","$1,181.50 ","$1,061.96 ","$1,251.00 "
Carle Richland Memorial Hospital,99341,HOME VISIT NEW PATIENT LEVEL 1,,99341,522,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,99342,HOME VISIT NEW PATIENT LEVEL 2,,99342,522,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,99343,HOME VST NEW PATIENT LEVEL 3,,99343,522,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,99344,HOME VISIT NEW PATIENT LEVEL 4,,99344,522,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,99345,HOME VISIT NEW PT LEVEL 5,,99345,522,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,99347,HOME VISIT EST PT LEVEL 1,,99347,522,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,99348,HOME VISIT EST PT LEVEL 2,,99348,522,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,99349,HOME VISIT EST PT LEVEL 3,,99349,522,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,99350,HOME VST EST PT LEVEL 4,,99350,522,$470.00 ,$470.00 ,$359.08 ,$423.00 ,$399.50 ,$399.50 ,$399.50 ,$413.60 ,$399.50 ,$413.60 ,$413.60 ,$408.90 ,$399.50 ,$399.50 ,$399.50 ,$359.08 ,$423.00
Carle Richland Memorial Hospital,99324,DOMICIL/REST HOME NEW PT VISIT LEVEL 1,,99324,522,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,99325,DOMICIL/REST HOME NEW PT VISIT LEVEL 2,,99325,522,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,99326,DOMICIL/REST HOME NEW PT LEVEL 3,,99326,522,$420.00 ,$420.00 ,$320.88 ,$378.00 ,$357.00 ,$357.00 ,$357.00 ,$369.60 ,$357.00 ,$369.60 ,$369.60 ,$365.40 ,$357.00 ,$357.00 ,$357.00 ,$320.88 ,$378.00
Carle Richland Memorial Hospital,99327,DOMICIL/REST HOME NEW PT VISIT LEVEL 4,,99327,522,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,99328,DOM/R-HOME E/M NEW PT LEVEL 5,,99328,522,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,99334,DOM/R-HOME E/M EST PT LEVEL 1,,99334,522,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,99335,DOM/R-HOME E/M EST PT LEVEL 2,,99335,522,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,99336,DOM/R-HOME E/M EST PT LEVEL 3,,99336,522,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,99337,DOM/R-HOME E/M EST PT LEVEL 4,,99337,522,$520.00 ,$520.00 ,$397.28 ,$468.00 ,$442.00 ,$442.00 ,$442.00 ,$457.60 ,$442.00 ,$457.60 ,$457.60 ,$452.40 ,$442.00 ,$442.00 ,$442.00 ,$397.28 ,$468.00
Carle Richland Memorial Hospital,99315,"NURSING FAC DISCHRGE DAY,1-30 MIN",,99315,524,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,99316,"NURSING FAC DISCHRGE DAY,MORE 30 MIN",,99316,524,$310.00 ,$310.00 ,$236.84 ,$279.00 ,$263.50 ,$263.50 ,$263.50 ,$272.80 ,$263.50 ,$272.80 ,$272.80 ,$269.70 ,$263.50 ,$263.50 ,$263.50 ,$236.84 ,$279.00
Carle Richland Memorial Hospital,99304,INITIAL NURSING FACILITY CARE/DAY LEVEL 1,,99304,524,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,99305,INITIAL NURSING FACILITY CARE/DAY LEVEL 2,,99305,524,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,99306,INITIAL NURSING FACILITY CARE/DAY LEVEL 3,,99306,524,$430.00 ,$430.00 ,$328.52 ,$387.00 ,$365.50 ,$365.50 ,$365.50 ,$378.40 ,$365.50 ,$378.40 ,$378.40 ,$374.10 ,$365.50 ,$365.50 ,$365.50 ,$328.52 ,$387.00
Carle Richland Memorial Hospital,99307,SBSQ NURSING FACILITY CARE/DAY LEVEL 1,,99307,524,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,99308,SBSQ NURSING FACIL CARE/DAY LEVEL 2,,99308,524,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,99309,SBSQ NURSING FACIL CARE/DAY LEVEL 3,,99309,524,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,99310,SBSQ NURS FACIL CARE/DAY LEVEL 4,,99310,524,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,99318,E/M ANNUAL NURSING FACILITY ASSESS,,99318,524,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,98925,"OSTEOPATHIC MANIP,1-2 BODY REGN",,98925,530,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,98926,"OSTEOPATHIC MANIP,3-4 BODY REGN",,98926,530,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,98927,"OSTEOPATHIC MANIP,5-6 BODY REGN",,98927,530,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,98928,"OSTEOPATHIC MANIP,7-8 BODY REGN",,98928,530,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,98929,"OSTEOPATHIC MANIP,9-10 BODY REGN",,98929,530,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,8470336,MRI TMJ,,70336,610,"$3,830.00 ","$3,830.00 ","$2,926.12 ","$3,447.00 ","$3,255.50 ","$3,255.50 ","$3,255.50 ","$3,370.40 ","$3,255.50 ","$3,370.40 ","$3,370.40 ","$3,332.10 ","$3,255.50 ","$3,255.50 ","$3,255.50 ","$2,926.12 ","$3,447.00 "
Carle Richland Memorial Hospital,8473219,MRI UPPER EXTREMITY W/CNTRST,,73219,610,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8408906,MRI BREAST W/CONTRAST,,C8906,610,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8408907,MRI BREAST W/O CONTRAST,,C8907,610,"$2,310.00 ","$2,310.00 ","$1,764.84 ","$2,079.00 ","$1,963.50 ","$1,963.50 ","$1,963.50 ","$2,032.80 ","$1,963.50 ","$2,032.80 ","$2,032.80 ","$2,009.70 ","$1,963.50 ","$1,963.50 ","$1,963.50 ","$1,764.84 ","$2,079.00 "
Carle Richland Memorial Hospital,8408900,MRA ABDOMEN W CONTRAST,,C8900,610,"$3,460.00 ","$3,460.00 ","$2,643.44 ","$3,114.00 ","$2,941.00 ","$2,941.00 ","$2,941.00 ","$3,044.80 ","$2,941.00 ","$3,044.80 ","$3,044.80 ","$3,010.20 ","$2,941.00 ","$2,941.00 ","$2,941.00 ","$2,643.44 ","$3,114.00 "
Carle Richland Memorial Hospital,8408901,MRA ABDOMEN W/O CONTRAST,,C8901,610,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8408902,MRA - ABDOMEN W/O & W/CONTRAST,,C8902,610,"$4,060.00 ","$4,060.00 ","$3,101.84 ","$3,654.00 ","$3,451.00 ","$3,451.00 ","$3,451.00 ","$3,572.80 ","$3,451.00 ","$3,572.80 ","$3,572.80 ","$3,532.20 ","$3,451.00 ","$3,451.00 ","$3,451.00 ","$3,101.84 ","$3,654.00 "
Carle Richland Memorial Hospital,8408908,MRI BREAST BILAT WO&W/CNTRST,,C8908,610,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,8408912,MRA W/CONTRAST -LWR EXTREMITY,,C8912,610,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8408913,MRA-LOWER EXTREMITY W/O CNTRST,,C8913,610,"$2,360.00 ","$2,360.00 ","$1,803.04 ","$2,124.00 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$2,076.80 ","$2,006.00 ","$2,076.80 ","$2,076.80 ","$2,053.20 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$1,803.04 ","$2,124.00 "
Carle Richland Memorial Hospital,8408914,MRA W/O & W/CONTRAST -LWR EXTREMITY,,C8914,610,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,8408918,MRA PELVIS W/CONTRAST,,C8918,610,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8408919,MRA PELVIS W/O CONTRAST,,C8919,610,"$2,360.00 ","$2,360.00 ","$1,803.04 ","$2,124.00 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$2,076.80 ","$2,006.00 ","$2,076.80 ","$2,076.80 ","$2,053.20 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$1,803.04 ","$2,124.00 "
Carle Richland Memorial Hospital,8408920,MRA PELVIS W/O & W/CONTRAST,,C8920,610,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,8408903,"MRI W/CONT, BREAST, UNI",,C8903,610,"$1,220.00 ","$1,220.00 ",$932.08 ,"$1,098.00 ","$1,037.00 ","$1,037.00 ","$1,037.00 ","$1,073.60 ","$1,037.00 ","$1,073.60 ","$1,073.60 ","$1,061.40 ","$1,037.00 ","$1,037.00 ","$1,037.00 ",$932.08 ,"$1,098.00 "
Carle Richland Memorial Hospital,8470540,MRI ORBIT/FACE/NECK W/O CNTRST,,70540,610,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8470542,MRI ORBIT/FACE/NECK W/CONTRAST,,70542,610,"$3,200.00 ","$3,200.00 ","$2,444.80 ","$2,880.00 ","$2,720.00 ","$2,720.00 ","$2,720.00 ","$2,816.00 ","$2,720.00 ","$2,816.00 ","$2,816.00 ","$2,784.00 ","$2,720.00 ","$2,720.00 ","$2,720.00 ","$2,444.80 ","$2,880.00 "
Carle Richland Memorial Hospital,8470543,MRI ORB/FACE/NECK W&W/O CNTRST,,70543,610,"$4,060.00 ","$4,060.00 ","$3,101.84 ","$3,654.00 ","$3,451.00 ","$3,451.00 ","$3,451.00 ","$3,572.80 ","$3,451.00 ","$3,572.80 ","$3,572.80 ","$3,532.20 ","$3,451.00 ","$3,451.00 ","$3,451.00 ","$3,101.84 ","$3,654.00 "
Carle Richland Memorial Hospital,8470544,MRA HEAD W/O CONTRAST,,70544,610,"$4,240.00 ","$4,240.00 ","$3,239.36 ","$3,816.00 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,731.20 ","$3,604.00 ","$3,731.20 ","$3,731.20 ","$3,688.80 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,239.36 ","$3,816.00 "
Carle Richland Memorial Hospital,8470545,MRA HEAD W/CONTRAST,,70545,610,"$4,240.00 ","$4,240.00 ","$3,239.36 ","$3,816.00 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,731.20 ","$3,604.00 ","$3,731.20 ","$3,731.20 ","$3,688.80 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,239.36 ","$3,816.00 "
Carle Richland Memorial Hospital,8470546,MRA HEAD W/O & W/CONTRAST,,70546,610,"$4,240.00 ","$4,240.00 ","$3,239.36 ","$3,816.00 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,731.20 ","$3,604.00 ","$3,731.20 ","$3,731.20 ","$3,688.80 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,239.36 ","$3,816.00 "
Carle Richland Memorial Hospital,8470547,MRA NECK W/O CONTRAST,,70547,610,"$2,890.00 ","$2,890.00 ","$2,207.96 ","$2,601.00 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,543.20 ","$2,456.50 ","$2,543.20 ","$2,543.20 ","$2,514.30 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,207.96 ","$2,601.00 "
Carle Richland Memorial Hospital,8470548,MRA NECK W/CONTRAST,,70548,610,"$4,240.00 ","$4,240.00 ","$3,239.36 ","$3,816.00 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,731.20 ","$3,604.00 ","$3,731.20 ","$3,731.20 ","$3,688.80 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,239.36 ","$3,816.00 "
Carle Richland Memorial Hospital,8470549,MRA NECK W/O & W/CONTRAST,,70549,610,"$5,020.00 ","$5,020.00 ","$3,835.28 ","$4,518.00 ","$4,267.00 ","$4,267.00 ","$4,267.00 ","$4,417.60 ","$4,267.00 ","$4,417.60 ","$4,417.60 ","$4,367.40 ","$4,267.00 ","$4,267.00 ","$4,267.00 ","$3,835.28 ","$4,518.00 "
Carle Richland Memorial Hospital,8470551,MRI BRAIN W/O CONTRAST,,70551,610,"$3,540.00 ","$3,540.00 ","$2,704.56 ","$3,186.00 ","$3,009.00 ","$3,009.00 ","$3,009.00 ","$3,115.20 ","$3,009.00 ","$3,115.20 ","$3,115.20 ","$3,079.80 ","$3,009.00 ","$3,009.00 ","$3,009.00 ","$2,704.56 ","$3,186.00 "
Carle Richland Memorial Hospital,8470552,MRI BRAIN W/CONTRAST,,70552,610,"$3,680.00 ","$3,680.00 ","$2,811.52 ","$3,312.00 ","$3,128.00 ","$3,128.00 ","$3,128.00 ","$3,238.40 ","$3,128.00 ","$3,238.40 ","$3,238.40 ","$3,201.60 ","$3,128.00 ","$3,128.00 ","$3,128.00 ","$2,811.52 ","$3,312.00 "
Carle Richland Memorial Hospital,8470553,MRI BRAIN W/O & W/CONTRAST,,70553,610,"$4,790.00 ","$4,790.00 ","$3,659.56 ","$4,311.00 ","$4,071.50 ","$4,071.50 ","$4,071.50 ","$4,215.20 ","$4,071.50 ","$4,215.20 ","$4,215.20 ","$4,167.30 ","$4,071.50 ","$4,071.50 ","$4,071.50 ","$3,659.56 ","$4,311.00 "
Carle Richland Memorial Hospital,8471550,MRI CHEST W/O CONTRAST,,71550,610,"$2,890.00 ","$2,890.00 ","$2,207.96 ","$2,601.00 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,543.20 ","$2,456.50 ","$2,543.20 ","$2,543.20 ","$2,514.30 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,207.96 ","$2,601.00 "
Carle Richland Memorial Hospital,8471551,MRI CHEST W/CONTRAST,,71551,610,"$3,830.00 ","$3,830.00 ","$2,926.12 ","$3,447.00 ","$3,255.50 ","$3,255.50 ","$3,255.50 ","$3,370.40 ","$3,255.50 ","$3,370.40 ","$3,370.40 ","$3,332.10 ","$3,255.50 ","$3,255.50 ","$3,255.50 ","$2,926.12 ","$3,447.00 "
Carle Richland Memorial Hospital,8472142,MRI C SPINE W/CONTRAST,,72142,610,"$4,950.00 ","$4,950.00 ","$3,781.80 ","$4,455.00 ","$4,207.50 ","$4,207.50 ","$4,207.50 ","$4,356.00 ","$4,207.50 ","$4,356.00 ","$4,356.00 ","$4,306.50 ","$4,207.50 ","$4,207.50 ","$4,207.50 ","$3,781.80 ","$4,455.00 "
Carle Richland Memorial Hospital,8472147,MRI T SPINE W/CONTRAST,,72147,610,"$3,810.00 ","$3,810.00 ","$2,910.84 ","$3,429.00 ","$3,238.50 ","$3,238.50 ","$3,238.50 ","$3,352.80 ","$3,238.50 ","$3,352.80 ","$3,352.80 ","$3,314.70 ","$3,238.50 ","$3,238.50 ","$3,238.50 ","$2,910.84 ","$3,429.00 "
Carle Richland Memorial Hospital,8472148,MRI L SPINE W/O CONTRAST,,72148,610,"$4,240.00 ","$4,240.00 ","$3,239.36 ","$3,816.00 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,731.20 ","$3,604.00 ","$3,731.20 ","$3,731.20 ","$3,688.80 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,239.36 ","$3,816.00 "
Carle Richland Memorial Hospital,8472149,MRI L SPINE W/CONTRAST,,72149,610,"$4,550.00 ","$4,550.00 ","$3,476.20 ","$4,095.00 ","$3,867.50 ","$3,867.50 ","$3,867.50 ","$4,004.00 ","$3,867.50 ","$4,004.00 ","$4,004.00 ","$3,958.50 ","$3,867.50 ","$3,867.50 ","$3,867.50 ","$3,476.20 ","$4,095.00 "
Carle Richland Memorial Hospital,8472156,MRI C SPINE W/O & W/CONTRAST,,72156,610,"$5,680.00 ","$5,680.00 ","$4,339.52 ","$5,112.00 ","$4,828.00 ","$4,828.00 ","$4,828.00 ","$4,998.40 ","$4,828.00 ","$4,998.40 ","$4,998.40 ","$4,941.60 ","$4,828.00 ","$4,828.00 ","$4,828.00 ","$4,339.52 ","$5,112.00 "
Carle Richland Memorial Hospital,8472157,MRI T SPINE W/O & W/CONTRAST,,72157,610,"$4,750.00 ","$4,750.00 ","$3,629.00 ","$4,275.00 ","$4,037.50 ","$4,037.50 ","$4,037.50 ","$4,180.00 ","$4,037.50 ","$4,180.00 ","$4,180.00 ","$4,132.50 ","$4,037.50 ","$4,037.50 ","$4,037.50 ","$3,629.00 ","$4,275.00 "
Carle Richland Memorial Hospital,8472158,MRI L SPINE W/O & W/CONTRAST,,72158,610,"$5,750.00 ","$5,750.00 ","$4,393.00 ","$5,175.00 ","$4,887.50 ","$4,887.50 ","$4,887.50 ","$5,060.00 ","$4,887.50 ","$5,060.00 ","$5,060.00 ","$5,002.50 ","$4,887.50 ","$4,887.50 ","$4,887.50 ","$4,393.00 ","$5,175.00 "
Carle Richland Memorial Hospital,8472195,MRI PELVIS W/O CONTRAST,,72195,610,"$1,800.00 ","$1,800.00 ","$1,375.20 ","$1,620.00 ","$1,530.00 ","$1,530.00 ","$1,530.00 ","$1,584.00 ","$1,530.00 ","$1,584.00 ","$1,584.00 ","$1,566.00 ","$1,530.00 ","$1,530.00 ","$1,530.00 ","$1,375.20 ","$1,620.00 "
Carle Richland Memorial Hospital,8472196,MRI PELVIS W/CONTRAST,,72196,610,"$4,270.00 ","$4,270.00 ","$3,262.28 ","$3,843.00 ","$3,629.50 ","$3,629.50 ","$3,629.50 ","$3,757.60 ","$3,629.50 ","$3,757.60 ","$3,757.60 ","$3,714.90 ","$3,629.50 ","$3,629.50 ","$3,629.50 ","$3,262.28 ","$3,843.00 "
Carle Richland Memorial Hospital,8472197,MRI PELVIS W/O & W/CONTRAST,,72197,610,"$5,120.00 ","$5,120.00 ","$3,911.68 ","$4,608.00 ","$4,352.00 ","$4,352.00 ","$4,352.00 ","$4,505.60 ","$4,352.00 ","$4,505.60 ","$4,505.60 ","$4,454.40 ","$4,352.00 ","$4,352.00 ","$4,352.00 ","$3,911.68 ","$4,608.00 "
Carle Richland Memorial Hospital,8473218,MRI UPPER EXTREMITY W/O CNTRST,,73218,610,"$2,830.00 ","$2,830.00 ","$2,162.12 ","$2,547.00 ","$2,405.50 ","$2,405.50 ","$2,405.50 ","$2,490.40 ","$2,405.50 ","$2,490.40 ","$2,490.40 ","$2,462.10 ","$2,405.50 ","$2,405.50 ","$2,405.50 ","$2,162.12 ","$2,547.00 "
Carle Richland Memorial Hospital,8473220,MRI UPPER EXTREMITY WO&W/CONTR,,73220,610,"$2,470.00 ","$2,470.00 ","$1,887.08 ","$2,223.00 ","$2,099.50 ","$2,099.50 ","$2,099.50 ","$2,173.60 ","$2,099.50 ","$2,173.60 ","$2,173.60 ","$2,148.90 ","$2,099.50 ","$2,099.50 ","$2,099.50 ","$1,887.08 ","$2,223.00 "
Carle Richland Memorial Hospital,8473221,MRI UPPR EXT JOINT W/O CONTRAST,,73221,610,"$4,350.00 ","$4,350.00 ","$3,323.40 ","$3,915.00 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,828.00 ","$3,697.50 ","$3,828.00 ","$3,828.00 ","$3,784.50 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,323.40 ","$3,915.00 "
Carle Richland Memorial Hospital,8473223,MRI UPPR EXT JOINT W & W/O CONTRAST,,73223,610,"$3,930.00 ","$3,930.00 ","$3,002.52 ","$3,537.00 ","$3,340.50 ","$3,340.50 ","$3,340.50 ","$3,458.40 ","$3,340.50 ","$3,458.40 ","$3,458.40 ","$3,419.10 ","$3,340.50 ","$3,340.50 ","$3,340.50 ","$3,002.52 ","$3,537.00 "
Carle Richland Memorial Hospital,8473225,MRA UPPER EXTREMITY,,73225,610,"$2,360.00 ","$2,360.00 ","$1,803.04 ","$2,124.00 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$2,076.80 ","$2,006.00 ","$2,076.80 ","$2,076.80 ","$2,053.20 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$1,803.04 ","$2,124.00 "
Carle Richland Memorial Hospital,8473718,MRI LOWER EXTREMITY W/O CNTRST,,73718,610,"$2,890.00 ","$2,890.00 ","$2,207.96 ","$2,601.00 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,543.20 ","$2,456.50 ","$2,543.20 ","$2,543.20 ","$2,514.30 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,207.96 ","$2,601.00 "
Carle Richland Memorial Hospital,8473719,MRI LOWER EXTREMITY W/CONTRAST,,73719,610,"$3,940.00 ","$3,940.00 ","$3,010.16 ","$3,546.00 ","$3,349.00 ","$3,349.00 ","$3,349.00 ","$3,467.20 ","$3,349.00 ","$3,467.20 ","$3,467.20 ","$3,427.80 ","$3,349.00 ","$3,349.00 ","$3,349.00 ","$3,010.16 ","$3,546.00 "
Carle Richland Memorial Hospital,8473720,MRI LOWER EXTREMITY WO&W/CONTR,,73720,610,"$3,830.00 ","$3,830.00 ","$2,926.12 ","$3,447.00 ","$3,255.50 ","$3,255.50 ","$3,255.50 ","$3,370.40 ","$3,255.50 ","$3,370.40 ","$3,370.40 ","$3,332.10 ","$3,255.50 ","$3,255.50 ","$3,255.50 ","$2,926.12 ","$3,447.00 "
Carle Richland Memorial Hospital,8473721,MRI LWR EXT JOINT W/O CONTRAST,,73721,610,"$2,890.00 ","$2,890.00 ","$2,207.96 ","$2,601.00 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,543.20 ","$2,456.50 ","$2,543.20 ","$2,543.20 ","$2,514.30 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,207.96 ","$2,601.00 "
Carle Richland Memorial Hospital,8473222,MRI UPPR EXT JOINT W/ CONTRAST,,73222,610,"$2,890.00 ","$2,890.00 ","$2,207.96 ","$2,601.00 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,543.20 ","$2,456.50 ","$2,543.20 ","$2,543.20 ","$2,514.30 ","$2,456.50 ","$2,456.50 ","$2,456.50 ","$2,207.96 ","$2,601.00 "
Carle Richland Memorial Hospital,8473722,MRI LWR EXT JOINT W/ONTRAST,,73722,610,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,8473723,MRI LWR EXT JOINT W & W/O CONTRAST,,73723,610,"$3,570.00 ","$3,570.00 ","$2,727.48 ","$3,213.00 ","$3,034.50 ","$3,034.50 ","$3,034.50 ","$3,141.60 ","$3,034.50 ","$3,141.60 ","$3,141.60 ","$3,105.90 ","$3,034.50 ","$3,034.50 ","$3,034.50 ","$2,727.48 ","$3,213.00 "
Carle Richland Memorial Hospital,8474181,MRI ABDOMEN W/O CONTRAST,,74181,610,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8474182,MRI ABDOMEN W/CONTRAST,,74182,610,"$3,500.00 ","$3,500.00 ","$2,674.00 ","$3,150.00 ","$2,975.00 ","$2,975.00 ","$2,975.00 ","$3,080.00 ","$2,975.00 ","$3,080.00 ","$3,080.00 ","$3,045.00 ","$2,975.00 ","$2,975.00 ","$2,975.00 ","$2,674.00 ","$3,150.00 "
Carle Richland Memorial Hospital,8474183,MRI ABDOMEN W/O & W/CONTRAST,,74183,610,"$3,690.00 ","$3,690.00 ","$2,819.16 ","$3,321.00 ","$3,136.50 ","$3,136.50 ","$3,136.50 ","$3,247.20 ","$3,136.50 ","$3,247.20 ","$3,247.20 ","$3,210.30 ","$3,136.50 ","$3,136.50 ","$3,136.50 ","$2,819.16 ","$3,321.00 "
Carle Richland Memorial Hospital,8471552,MRI CHEST WO & W CONTRAST,,71552,610,"$3,930.00 ","$3,930.00 ","$3,002.52 ","$3,537.00 ","$3,340.50 ","$3,340.50 ","$3,340.50 ","$3,458.40 ","$3,340.50 ","$3,458.40 ","$3,458.40 ","$3,419.10 ","$3,340.50 ","$3,340.50 ","$3,340.50 ","$3,002.52 ","$3,537.00 "
Carle Richland Memorial Hospital,8472141,MRI C SPINE W/O CONTRAST,,72141,612,"$4,240.00 ","$4,240.00 ","$3,239.36 ","$3,816.00 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,731.20 ","$3,604.00 ","$3,731.20 ","$3,731.20 ","$3,688.80 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,239.36 ","$3,816.00 "
Carle Richland Memorial Hospital,8472146,MRI T SPINE W/O CONTRAST,,72146,612,"$3,540.00 ","$3,540.00 ","$2,704.56 ","$3,186.00 ","$3,009.00 ","$3,009.00 ","$3,009.00 ","$3,115.20 ","$3,009.00 ","$3,115.20 ","$3,115.20 ","$3,079.80 ","$3,009.00 ","$3,009.00 ","$3,009.00 ","$2,704.56 ","$3,186.00 "
Carle Richland Memorial Hospital,8408910,MRA CHEST W/O CONTRAST,,C8910,618,"$2,360.00 ","$2,360.00 ","$1,803.04 ","$2,124.00 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$2,076.80 ","$2,006.00 ","$2,076.80 ","$2,076.80 ","$2,053.20 ","$2,006.00 ","$2,006.00 ","$2,006.00 ","$1,803.04 ","$2,124.00 "
Carle Richland Memorial Hospital,8408911,MRA CHEST WO&W/CONTRAST,,C8911,618,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,8408909,MRA CHEST W/CONTRAST,,C8909,618,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,8980010,"MFN DRUG ADD-ON, PER DOSE",,M1145,636,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,8980636,acetaZOLAMIDE 500 mg solution for injection,39822019001,J1120,636,$220.84 ,$220.84 ,$168.72 ,$198.76 ,$187.71 ,$187.71 ,$187.71 ,$194.34 ,$187.71 ,$194.34 ,$194.34 ,$192.13 ,$187.71 ,$187.71 ,$187.71 ,$168.72 ,$198.76
Carle Richland Memorial Hospital,8980636,acetylcysteine 200 mg/mL (20 %) intravenous solution,63323096330,J0132,636,$37.18 ,$37.18 ,$28.41 ,$33.46 ,$31.60 ,$31.60 ,$31.60 ,$32.72 ,$31.60 ,$32.72 ,$32.72 ,$32.35 ,$31.60 ,$31.60 ,$31.60 ,$28.41 ,$33.46
Carle Richland Memorial Hospital,8980636,acetylcysteine 200 mg/mL (20 %) solution,63323069030,J7608,636,$118.92 ,$118.92 ,$90.85 ,$107.03 ,$101.08 ,$101.08 ,$101.08 ,$104.65 ,$101.08 ,$104.65 ,$104.65 ,$103.46 ,$101.08 ,$101.08 ,$101.08 ,$90.85 ,$107.03
Carle Richland Memorial Hospital,8980636,acyclovir sodium 50 mg/mL intravenous solution,63323032514,J0133,636,$64.98 ,$64.98 ,$49.64 ,$58.48 ,$55.23 ,$55.23 ,$55.23 ,$57.18 ,$55.23 ,$57.18 ,$57.18 ,$56.53 ,$55.23 ,$55.23 ,$55.23 ,$49.64 ,$58.48
Carle Richland Memorial Hospital,8980636,adenosine 3 mg/mL intravenous solution,17478054202,,636,$46.69 ,$46.69 ,$35.67 ,$42.02 ,$39.69 ,$39.69 ,$39.69 ,$41.09 ,$39.69 ,$41.09 ,$41.09 ,$40.62 ,$39.69 ,$39.69 ,$39.69 ,$35.67 ,$42.02
Carle Richland Memorial Hospital,8980636,adenosine 3 mg/mL intravenous solution,63323065104,,636,$79.87 ,$79.87 ,$61.02 ,$71.88 ,$67.89 ,$67.89 ,$67.89 ,$70.29 ,$67.89 ,$70.29 ,$70.29 ,$69.49 ,$67.89 ,$67.89 ,$67.89 ,$61.02 ,$71.88
Carle Richland Memorial Hospital,8980636,adenosine 3 mg/mL intravenous solution,67457085400,,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,adenosine 3 mg/mL intravenous solution,67457085404,,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",68516521601,P9047,636,$324.66 ,$324.66 ,$248.04 ,$292.19 ,$275.96 ,$275.96 ,$275.96 ,$285.70 ,$275.96 ,$285.70 ,$285.70 ,$282.45 ,$275.96 ,$275.96 ,$275.96 ,$248.04 ,$292.19
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",68516521602,P9047,636,$324.66 ,$324.66 ,$248.04 ,$292.19 ,$275.96 ,$275.96 ,$275.96 ,$285.70 ,$275.96 ,$285.70 ,$285.70 ,$282.45 ,$275.96 ,$275.96 ,$275.96 ,$248.04 ,$292.19
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",68516521604,P9047,636,$324.66 ,$324.66 ,$248.04 ,$292.19 ,$275.96 ,$275.96 ,$275.96 ,$285.70 ,$275.96 ,$285.70 ,$285.70 ,$282.45 ,$275.96 ,$275.96 ,$275.96 ,$248.04 ,$292.19
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",68982064301,P9047,636,$404.40 ,$404.40 ,$308.96 ,$363.96 ,$343.74 ,$343.74 ,$343.74 ,$355.87 ,$343.74 ,$355.87 ,$355.87 ,$351.83 ,$343.74 ,$343.74 ,$343.74 ,$308.96 ,$363.96
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",68982064302,P9047,636,$404.40 ,$404.40 ,$308.96 ,$363.96 ,$343.74 ,$343.74 ,$343.74 ,$355.87 ,$343.74 ,$355.87 ,$355.87 ,$351.83 ,$343.74 ,$343.74 ,$343.74 ,$308.96 ,$363.96
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",944049302,P9047,636,$407.60 ,$407.60 ,$311.41 ,$366.84 ,$346.46 ,$346.46 ,$346.46 ,$358.69 ,$346.46 ,$358.69 ,$358.69 ,$354.61 ,$346.46 ,$346.46 ,$346.46 ,$311.41 ,$366.84
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",44206025105,P9047,636,$631.96 ,$631.96 ,$482.82 ,$568.76 ,$537.17 ,$537.17 ,$537.17 ,$556.12 ,$537.17 ,$556.12 ,$556.12 ,$549.81 ,$537.17 ,$537.17 ,$537.17 ,$482.82 ,$568.76
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",44206025110,P9047,636,$631.96 ,$631.96 ,$482.82 ,$568.76 ,$537.17 ,$537.17 ,$537.17 ,$556.12 ,$537.17 ,$556.12 ,$556.12 ,$549.81 ,$537.17 ,$537.17 ,$537.17 ,$482.82 ,$568.76
Carle Richland Memorial Hospital,8980636,"albumin, human 25 % intravenous solution",44206025191,P9047,636,"$1,260.52 ","$1,260.52 ",$963.04 ,"$1,134.47 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,109.26 ","$1,071.44 ","$1,109.26 ","$1,109.26 ","$1,096.65 ","$1,071.44 ","$1,071.44 ","$1,071.44 ",$963.04 ,"$1,134.47 "
Carle Richland Memorial Hospital,8980636,albuterol sulfate 1.25 mg/3 mL solution for nebulization,487990401,J7613,636,$9.75 ,$9.75 ,$7.45 ,$8.78 ,$8.29 ,$8.29 ,$8.29 ,$8.58 ,$8.29 ,$8.58 ,$8.58 ,$8.48 ,$8.29 ,$8.29 ,$8.29 ,$7.45 ,$8.78
Carle Richland Memorial Hospital,8980636,albuterol sulfate 2.5 mg/3 mL (0.083 %) solution for nebulization,60687039579,J7613,636,$2.90 ,$2.90 ,$2.22 ,$2.61 ,$2.47 ,$2.47 ,$2.47 ,$2.55 ,$2.47 ,$2.55 ,$2.55 ,$2.52 ,$2.47 ,$2.47 ,$2.47 ,$2.22 ,$2.61
Carle Richland Memorial Hospital,8980636,albuterol sulfate 2.5 mg/3 mL (0.083 %) solution for nebulization,60687039583,J7613,636,$2.90 ,$2.90 ,$2.22 ,$2.61 ,$2.47 ,$2.47 ,$2.47 ,$2.55 ,$2.47 ,$2.55 ,$2.55 ,$2.52 ,$2.47 ,$2.47 ,$2.47 ,$2.22 ,$2.61
Carle Richland Memorial Hospital,8980636,albuterol sulfate concentrate 5 mg/mL(0.5 %) solution for nebulization,50383074120,J7611,636,$291.06 ,$291.06 ,$222.37 ,$261.95 ,$247.40 ,$247.40 ,$247.40 ,$256.13 ,$247.40 ,$256.13 ,$256.13 ,$253.22 ,$247.40 ,$247.40 ,$247.40 ,$222.37 ,$261.95
Carle Richland Memorial Hospital,8980636,alprostadiL 500 mcg/mL injection solution,9316901,J0270,636,$793.09 ,$793.09 ,$605.92 ,$713.78 ,$674.13 ,$674.13 ,$674.13 ,$697.92 ,$674.13 ,$697.92 ,$697.92 ,$689.99 ,$674.13 ,$674.13 ,$674.13 ,$605.92 ,$713.78
Carle Richland Memorial Hospital,8980636,alprostadiL 500 mcg/mL injection solution,9316906,J0270,636,$793.09 ,$793.09 ,$605.92 ,$713.78 ,$674.13 ,$674.13 ,$674.13 ,$697.92 ,$674.13 ,$697.92 ,$697.92 ,$689.99 ,$674.13 ,$674.13 ,$674.13 ,$605.92 ,$713.78
Carle Richland Memorial Hospital,8980636,alteplase 100 mg intravenous solution,50242008527,J2997,636,$666.86 ,$666.86 ,$509.48 ,$600.17 ,$566.83 ,$566.83 ,$566.83 ,$586.84 ,$566.83 ,$586.84 ,$586.84 ,$580.17 ,$566.83 ,$566.83 ,$566.83 ,$509.48 ,$600.17
Carle Richland Memorial Hospital,8980636,alteplase 100 mg IV Solution,50242008525,J2997,636,"$24,780.54 ","$24,780.54 ","$18,932.33 ","$22,302.49 ","$21,063.46 ","$21,063.46 ","$21,063.46 ","$21,806.88 ","$21,063.46 ","$21,806.88 ","$21,806.88 ","$21,559.07 ","$21,063.46 ","$21,063.46 ","$21,063.46 ","$18,932.33 ","$22,302.49 "
Carle Richland Memorial Hospital,8980636,Alteplase 100 mg IV Solution,50242008527,J2997,636,"$24,780.54 ","$24,780.54 ","$18,932.33 ","$22,302.49 ","$21,063.46 ","$21,063.46 ","$21,063.46 ","$21,806.88 ","$21,063.46 ","$21,806.88 ","$21,806.88 ","$21,559.07 ","$21,063.46 ","$21,063.46 ","$21,063.46 ","$18,932.33 ","$22,302.49 "
Carle Richland Memorial Hospital,8980636,alteplase 2 mg intra-catheter solution,50242004164,J2997,636,$764.99 ,$764.99 ,$584.45 ,$688.49 ,$650.24 ,$650.24 ,$650.24 ,$673.19 ,$650.24 ,$673.19 ,$673.19 ,$665.54 ,$650.24 ,$650.24 ,$650.24 ,$584.45 ,$688.49
Carle Richland Memorial Hospital,8980636,amikacin 500 mg/2 mL injection solution,25021017302,J0278,636,$89.08 ,$89.08 ,$68.06 ,$80.17 ,$75.72 ,$75.72 ,$75.72 ,$78.39 ,$75.72 ,$78.39 ,$78.39 ,$77.50 ,$75.72 ,$75.72 ,$75.72 ,$68.06 ,$80.17
Carle Richland Memorial Hospital,8980636,aminophylline 250 mg/10 mL intravenous solution,409592101,J0280,636,$122.25 ,$122.25 ,$93.40 ,$110.03 ,$103.91 ,$103.91 ,$103.91 ,$107.58 ,$103.91 ,$107.58 ,$107.58 ,$106.36 ,$103.91 ,$103.91 ,$103.91 ,$93.40 ,$110.03
Carle Richland Memorial Hospital,8980636,"amiodarone 150 mg/100 mL (1.5 mg/mL) in dextrose, iso-osmotic IV",43066015010,J0282,636,$245.51 ,$245.51 ,$187.57 ,$220.96 ,$208.68 ,$208.68 ,$208.68 ,$216.05 ,$208.68 ,$216.05 ,$216.05 ,$213.59 ,$208.68 ,$208.68 ,$208.68 ,$187.57 ,$220.96
Carle Richland Memorial Hospital,8980636,amiodarone 360 mg/200 mL (1.8 mg/mL) in dextrose,43066036020,J0282,636,$357.38 ,$357.38 ,$273.04 ,$321.64 ,$303.77 ,$303.77 ,$303.77 ,$314.49 ,$303.77 ,$314.49 ,$314.49 ,$310.92 ,$303.77 ,$303.77 ,$303.77 ,$273.04 ,$321.64
Carle Richland Memorial Hospital,8980636,"amiodarone 360 mg/200 mL (1.8 mg/mL) in dextrose, iso-osmotic IV",43066036020,J0282,636,$357.38 ,$357.38 ,$273.04 ,$321.64 ,$303.77 ,$303.77 ,$303.77 ,$314.49 ,$303.77 ,$314.49 ,$314.49 ,$310.92 ,$303.77 ,$303.77 ,$303.77 ,$273.04 ,$321.64
Carle Richland Memorial Hospital,8980636,amiodarone 50 mg/mL intravenous solution,63323061603,J0282,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,amiodarone 50 mg/mL intravenous solution,67457015309,J0282,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,amiodarone 50 mg/mL intravenous solution,67457015399,J0282,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,amphotericin B 50 mg solution for injection,39822105505,J0285,636,$318.65 ,$318.65 ,$243.45 ,$286.79 ,$270.85 ,$270.85 ,$270.85 ,$280.41 ,$270.85 ,$280.41 ,$280.41 ,$277.23 ,$270.85 ,$270.85 ,$270.85 ,$243.45 ,$286.79
Carle Richland Memorial Hospital,8980636,ampicillin 1 gram solution for injection,781926185,J0290,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,ampicillin 2 gram solution for injection,44567010310,J0290,636,$111.77 ,$111.77 ,$85.39 ,$100.59 ,$95.00 ,$95.00 ,$95.00 ,$98.36 ,$95.00 ,$98.36 ,$98.36 ,$97.24 ,$95.00 ,$95.00 ,$95.00 ,$85.39 ,$100.59
Carle Richland Memorial Hospital,8980636,ampicillin 250 mg solution for injection,55150011110,J0290,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,ampicillin 500 mg solution for injection,781925078,J0290,636,$269.39 ,$269.39 ,$205.81 ,$242.45 ,$228.98 ,$228.98 ,$228.98 ,$237.06 ,$228.98 ,$237.06 ,$237.06 ,$234.37 ,$228.98 ,$228.98 ,$228.98 ,$205.81 ,$242.45
Carle Richland Memorial Hospital,8980636,ampicillin-sulbactam 1.5 gram solution for injection,641611601,J0295,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,ampicillin-sulbactam 1.5 gram solution for injection,25021014220,J0295,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,ampicillin-sulbactam 3 gram solution for injection,67457034903,J0295,636,$124.40 ,$124.40 ,$95.04 ,$111.96 ,$105.74 ,$105.74 ,$105.74 ,$109.47 ,$105.74 ,$109.47 ,$109.47 ,$108.23 ,$105.74 ,$105.74 ,$105.74 ,$95.04 ,$111.96
Carle Richland Memorial Hospital,8980636,ampicillin-sulbactam 3 gram solution for injection,49001481,J0295,636,$135.65 ,$135.65 ,$103.64 ,$122.09 ,$115.30 ,$115.30 ,$115.30 ,$119.37 ,$115.30 ,$119.37 ,$119.37 ,$118.02 ,$115.30 ,$115.30 ,$115.30 ,$103.64 ,$122.09
Carle Richland Memorial Hospital,8980636,ampicillin-sulbactam 3 gram solution for injection,49001483,J0295,636,$135.65 ,$135.65 ,$103.64 ,$122.09 ,$115.30 ,$115.30 ,$115.30 ,$119.37 ,$115.30 ,$119.37 ,$119.37 ,$118.02 ,$115.30 ,$115.30 ,$115.30 ,$103.64 ,$122.09
Carle Richland Memorial Hospital,8980636,anastrozole 1 mg tablet,60687011211,J8999,636,$11.99 ,$11.99 ,$9.16 ,$10.79 ,$10.19 ,$10.19 ,$10.19 ,$10.55 ,$10.19 ,$10.55 ,$10.55 ,$10.43 ,$10.19 ,$10.19 ,$10.19 ,$9.16 ,$10.79
Carle Richland Memorial Hospital,8980636,atropine 0.1 mg/mL injection syringe,409163010,J0461,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,atropine 0.4 mg/mL injection solution,641600601,J0461,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,atropine 0.4 mg/mL injection solution,517040125,J0461,636,$59.27 ,$59.27 ,$45.28 ,$53.34 ,$50.38 ,$50.38 ,$50.38 ,$52.16 ,$50.38 ,$52.16 ,$52.16 ,$51.56 ,$50.38 ,$50.38 ,$50.38 ,$45.28 ,$53.34
Carle Richland Memorial Hospital,8980636,atropine 1 mg/mL injection solution,517101025,J0461,636,$91.12 ,$91.12 ,$69.62 ,$82.01 ,$77.45 ,$77.45 ,$77.45 ,$80.19 ,$77.45 ,$80.19 ,$80.19 ,$79.27 ,$77.45 ,$77.45 ,$77.45 ,$69.62 ,$82.01
Carle Richland Memorial Hospital,8980636,azaCITIDine 100 mg solution for injection,43598030562,J9025,636,"$1,014.74 ","$1,014.74 ",$775.26 ,$913.27 ,$862.53 ,$862.53 ,$862.53 ,$892.97 ,$862.53 ,$892.97 ,$892.97 ,$882.82 ,$862.53 ,$862.53 ,$862.53 ,$775.26 ,$913.27
Carle Richland Memorial Hospital,8980636,azaTHIOprine 50 mg tablet,51079062001,J7500,636,$13.26 ,$13.26 ,$10.13 ,$11.93 ,$11.27 ,$11.27 ,$11.27 ,$11.67 ,$11.27 ,$11.67 ,$11.67 ,$11.54 ,$11.27 ,$11.27 ,$11.27 ,$10.13 ,$11.93
Carle Richland Memorial Hospital,8980636,azaTHIOprine 50 mg tablet,51079062006,J7500,636,$13.26 ,$13.26 ,$10.13 ,$11.93 ,$11.27 ,$11.27 ,$11.27 ,$11.67 ,$11.27 ,$11.67 ,$11.67 ,$11.54 ,$11.27 ,$11.27 ,$11.27 ,$10.13 ,$11.93
Carle Richland Memorial Hospital,8980636,azithromycin 500 mg intravenous solution,63323039814,J0456,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,BCG live 50 mg intravesical suspension,52060202,,636,$834.42 ,$834.42 ,$637.50 ,$750.98 ,$709.26 ,$709.26 ,$709.26 ,$734.29 ,$709.26 ,$734.29 ,$734.29 ,$725.95 ,$709.26 ,$709.26 ,$709.26 ,$637.50 ,$750.98
Carle Richland Memorial Hospital,8980636,benztropine 1 mg/mL injection solution,143972905,J0515,636,$212.08 ,$212.08 ,$162.03 ,$190.87 ,$180.27 ,$180.27 ,$180.27 ,$186.63 ,$180.27 ,$186.63 ,$186.63 ,$184.51 ,$180.27 ,$180.27 ,$180.27 ,$162.03 ,$190.87
Carle Richland Memorial Hospital,8980636,betamethasone acetate and sodium phos 6 mg/mL suspension for injection,517072001,J0702,636,$75.34 ,$75.34 ,$57.56 ,$67.81 ,$64.04 ,$64.04 ,$64.04 ,$66.30 ,$64.04 ,$66.30 ,$66.30 ,$65.55 ,$64.04 ,$64.04 ,$64.04 ,$57.56 ,$67.81
Carle Richland Memorial Hospital,8980636,bicalutamide 50 mg tablet,904601946,J8999,636,$68.12 ,$68.12 ,$52.04 ,$61.31 ,$57.90 ,$57.90 ,$57.90 ,$59.95 ,$57.90 ,$59.95 ,$59.95 ,$59.26 ,$57.90 ,$57.90 ,$57.90 ,$52.04 ,$61.31
Carle Richland Memorial Hospital,8980636,bosentan 125 mg tablet,66215010206,J8999,636,$409.25 ,$409.25 ,$312.67 ,$368.33 ,$347.86 ,$347.86 ,$347.86 ,$360.14 ,$347.86 ,$360.14 ,$360.14 ,$356.05 ,$347.86 ,$347.86 ,$347.86 ,$312.67 ,$368.33
Carle Richland Memorial Hospital,8980636,budesonide 0.25 mg/2 mL suspension for nebulization,69097031886,,636,$46.17 ,$46.17 ,$35.27 ,$41.55 ,$39.24 ,$39.24 ,$39.24 ,$40.63 ,$39.24 ,$40.63 ,$40.63 ,$40.17 ,$39.24 ,$39.24 ,$39.24 ,$35.27 ,$41.55
Carle Richland Memorial Hospital,8980636,budesonide 0.25 mg/2 mL suspension for nebulization,69097031887,,636,$46.17 ,$46.17 ,$35.27 ,$41.55 ,$39.24 ,$39.24 ,$39.24 ,$40.63 ,$39.24 ,$40.63 ,$40.63 ,$40.17 ,$39.24 ,$39.24 ,$39.24 ,$35.27 ,$41.55
Carle Richland Memorial Hospital,8980636,budesonide 0.5 mg/2 mL suspension for nebulization,69097031986,,636,$46.93 ,$46.93 ,$35.85 ,$42.24 ,$39.89 ,$39.89 ,$39.89 ,$41.30 ,$39.89 ,$41.30 ,$41.30 ,$40.83 ,$39.89 ,$39.89 ,$39.89 ,$35.85 ,$42.24
Carle Richland Memorial Hospital,8980636,budesonide 0.5 mg/2 mL suspension for nebulization,69097031987,,636,$46.93 ,$46.93 ,$35.85 ,$42.24 ,$39.89 ,$39.89 ,$39.89 ,$41.30 ,$39.89 ,$41.30 ,$41.30 ,$40.83 ,$39.89 ,$39.89 ,$39.89 ,$35.85 ,$42.24
Carle Richland Memorial Hospital,8980636,bupivacaine liposome(PF) 1.3 %(13.3 mg/mL) suspension for infiltration,65250026609,C9290,636,"$1,205.35 ","$1,205.35 ",$920.89 ,"$1,084.82 ","$1,024.55 ","$1,024.55 ","$1,024.55 ","$1,060.71 ","$1,024.55 ","$1,060.71 ","$1,060.71 ","$1,048.65 ","$1,024.55 ","$1,024.55 ","$1,024.55 ",$920.89 ,"$1,084.82 "
Carle Richland Memorial Hospital,8980636,buprenorphine HCL 2 mg sublingual tablet,60687048121,,636,$16.08 ,$16.08 ,$12.29 ,$14.47 ,$13.67 ,$13.67 ,$13.67 ,$14.15 ,$13.67 ,$14.15 ,$14.15 ,$13.99 ,$13.67 ,$13.67 ,$13.67 ,$12.29 ,$14.47
Carle Richland Memorial Hospital,8980636,butorphanol 2 mg/mL injection solution,409162621,J0595,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,calcium gluconate 100 mg/mL (10 %) intravenous solution,63323036019,J0610,636,$104.91 ,$104.91 ,$80.15 ,$94.42 ,$89.17 ,$89.17 ,$89.17 ,$92.32 ,$89.17 ,$92.32 ,$92.32 ,$91.27 ,$89.17 ,$89.17 ,$89.17 ,$80.15 ,$94.42
Carle Richland Memorial Hospital,8980636,ceFAZolin 1 gram intravenous solution,409258501,J0690,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,ceFAZolin 1 gram intravenous solution,409258511,J0690,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,ceFAZolin 1 gram solution for injection,143992490,J0690,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,ceFAZolin 1 gram/50 mL in dextrose (iso-osmotic) intravenous piggyback,264310311,J0690,636,$82.55 ,$82.55 ,$63.07 ,$74.30 ,$70.17 ,$70.17 ,$70.17 ,$72.64 ,$70.17 ,$72.64 ,$72.64 ,$71.82 ,$70.17 ,$70.17 ,$70.17 ,$63.07 ,$74.30
Carle Richland Memorial Hospital,8980636,ceFAZolin 2 gram/50 mL in dextrose (iso-osmotic) intravenous piggyback,264310511,J0690,636,$92.58 ,$92.58 ,$70.73 ,$83.32 ,$78.69 ,$78.69 ,$78.69 ,$81.47 ,$78.69 ,$81.47 ,$81.47 ,$80.54 ,$78.69 ,$78.69 ,$78.69 ,$70.73 ,$83.32
Carle Richland Memorial Hospital,8980636,cefepime 1 gram solution for injection,25021012166,J0692,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefepime 1 gram/50 mL in dextrose 5 % intravenous piggyback,264319311,J0692,636,$122.30 ,$122.30 ,$93.44 ,$110.07 ,$103.96 ,$103.96 ,$103.96 ,$107.62 ,$103.96 ,$107.62 ,$107.62 ,$106.40 ,$103.96 ,$103.96 ,$103.96 ,$93.44 ,$110.07
Carle Richland Memorial Hospital,8980636,cefepime 2 gram solution for injection,25021012267,J0692,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefepime 2 gram/50 mL in dextrose 5 % intravenous piggyback,264319511,J0692,636,$173.04 ,$173.04 ,$132.20 ,$155.74 ,$147.08 ,$147.08 ,$147.08 ,$152.28 ,$147.08 ,$152.28 ,$152.28 ,$150.54 ,$147.08 ,$147.08 ,$147.08 ,$132.20 ,$155.74
Carle Richland Memorial Hospital,8980636,cefOXitin 1 gram intravenous solution,25021010910,J0694,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"cefOXitin 1 gram/50 mL in dextrose, iso-osmotic intravenous piggyback",264312311,J0694,636,$117.34 ,$117.34 ,$89.65 ,$105.61 ,$99.74 ,$99.74 ,$99.74 ,$103.26 ,$99.74 ,$103.26 ,$103.26 ,$102.09 ,$99.74 ,$99.74 ,$99.74 ,$89.65 ,$105.61
Carle Richland Memorial Hospital,8980636,cefOXitin 2 gram intravenous solution,25021011020,J0694,636,$104.79 ,$104.79 ,$80.06 ,$94.31 ,$89.07 ,$89.07 ,$89.07 ,$92.22 ,$89.07 ,$92.22 ,$92.22 ,$91.17 ,$89.07 ,$89.07 ,$89.07 ,$80.06 ,$94.31
Carle Richland Memorial Hospital,8980636,cefOXitin 2 gram/50 mL in dextrose(iso-osmotic) intravenous piggyback,264312511,J0694,636,$200.77 ,$200.77 ,$153.39 ,$180.69 ,$170.65 ,$170.65 ,$170.65 ,$176.68 ,$170.65 ,$176.68 ,$176.68 ,$174.67 ,$170.65 ,$170.65 ,$170.65 ,$153.39 ,$180.69
Carle Richland Memorial Hospital,8980636,cefTAZidime 1 gram solution for injection,25021012766,J0713,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefTAZidime 2 gram solution for injection,25021012867,J0713,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefTRIAXone 1 gram solution for injection,25021010610,J0696,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefTRIAXone 1 gram solution for injection,25021010667,J0696,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefTRIAXone 1 gram/50 mL in dextrose (iso-osmot) intravenous piggyback,264315311,J0696,636,$122.30 ,$122.30 ,$93.44 ,$110.07 ,$103.96 ,$103.96 ,$103.96 ,$107.62 ,$103.96 ,$107.62 ,$107.62 ,$106.40 ,$103.96 ,$103.96 ,$103.96 ,$93.44 ,$110.07
Carle Richland Memorial Hospital,8980636,cefTRIAXone 2 gram solution for injection,44567070225,J0696,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefTRIAXone 2 gram/50 mL in dextrose (iso-osm) intravenous piggyback,264315511,J0696,636,$173.39 ,$173.39 ,$132.47 ,$156.05 ,$147.38 ,$147.38 ,$147.38 ,$152.58 ,$147.38 ,$152.58 ,$152.58 ,$150.85 ,$147.38 ,$147.38 ,$147.38 ,$132.47 ,$156.05
Carle Richland Memorial Hospital,8980636,cefTRIAXone 250 mg solution for injection,409733711,J0696,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefTRIAXone 500 mg solution for injection,409733801,J0696,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,cefuroxime sodium 1.5 gram intravenous solution,143997790,J0697,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,chlorproMAZINE 25 mg tablet,781591401,Q0161,636,$29.65 ,$29.65 ,$22.65 ,$26.69 ,$25.20 ,$25.20 ,$25.20 ,$26.09 ,$25.20 ,$26.09 ,$26.09 ,$25.80 ,$25.20 ,$25.20 ,$25.20 ,$22.65 ,$26.69
Carle Richland Memorial Hospital,8980636,chlorproMAZINE 25 mg/mL injection solution,641139835,J3230,636,$234.58 ,$234.58 ,$179.22 ,$211.12 ,$199.39 ,$199.39 ,$199.39 ,$206.43 ,$199.39 ,$206.43 ,$206.43 ,$204.08 ,$199.39 ,$199.39 ,$199.39 ,$179.22 ,$211.12
Carle Richland Memorial Hospital,8980636,ciprofloxacin 200 mg/100 mL in 5 % dextrose intravenous piggyback,36000000824,J0744,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,ciprofloxacin 400 mg/200 mL in 5 % dextrose intravenous piggyback,36000000924,J0744,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"cloNIDine (PF) 1,000 mcg/10 mL (100 mcg/mL) epidural solution",143972401,J0735,636,$296.73 ,$296.73 ,$226.70 ,$267.06 ,$252.22 ,$252.22 ,$252.22 ,$261.12 ,$252.22 ,$261.12 ,$261.12 ,$258.16 ,$252.22 ,$252.22 ,$252.22 ,$226.70 ,$267.06
Carle Richland Memorial Hospital,8980636,cocaine 4 % nasal solution,64950036204,,636,"$1,410.81 ","$1,410.81 ","$1,077.86 ","$1,269.73 ","$1,199.19 ","$1,199.19 ","$1,199.19 ","$1,241.51 ","$1,199.19 ","$1,241.51 ","$1,241.51 ","$1,227.40 ","$1,199.19 ","$1,199.19 ","$1,199.19 ","$1,077.86 ","$1,269.73 "
Carle Richland Memorial Hospital,8980636,conjugated estrogens 25 mg solution for injection,46074905,J1410,636,"$1,496.45 ","$1,496.45 ","$1,143.29 ","$1,346.81 ","$1,271.98 ","$1,271.98 ","$1,271.98 ","$1,316.88 ","$1,271.98 ","$1,316.88 ","$1,316.88 ","$1,301.91 ","$1,271.98 ","$1,271.98 ","$1,271.98 ","$1,143.29 ","$1,346.81 "
Carle Richland Memorial Hospital,8980636,copper 380 square mm intrauterine device,59365512801,J7300,636,"$3,723.05 ","$3,723.05 ","$2,844.41 ","$3,350.75 ","$3,164.59 ","$3,164.59 ","$3,164.59 ","$3,276.28 ","$3,164.59 ","$3,276.28 ","$3,276.28 ","$3,239.05 ","$3,164.59 ","$3,164.59 ","$3,164.59 ","$2,844.41 ","$3,350.75 "
Carle Richland Memorial Hospital,8980636,cosyntropin 0.25 mg solution for injection,67457022700,J0834,636,$557.14 ,$557.14 ,$425.65 ,$501.43 ,$473.57 ,$473.57 ,$473.57 ,$490.28 ,$473.57 ,$490.28 ,$490.28 ,$484.71 ,$473.57 ,$473.57 ,$473.57 ,$425.65 ,$501.43
Carle Richland Memorial Hospital,8980636,cosyntropin 0.25 mg solution for injection,67457022702,J0834,636,$557.14 ,$557.14 ,$425.65 ,$501.43 ,$473.57 ,$473.57 ,$473.57 ,$490.28 ,$473.57 ,$490.28 ,$490.28 ,$484.71 ,$473.57 ,$473.57 ,$473.57 ,$425.65 ,$501.43
Carle Richland Memorial Hospital,8980636,"cyanocobalamin (vit B-12) 1,000 mcg/mL injection solution",63323004444,J3420,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,cycloSPORINE 25 mg capsule,78024015,J7515,636,$23.97 ,$23.97 ,$18.31 ,$21.57 ,$20.37 ,$20.37 ,$20.37 ,$21.09 ,$20.37 ,$21.09 ,$21.09 ,$20.85 ,$20.37 ,$20.37 ,$20.37 ,$18.31 ,$21.57
Carle Richland Memorial Hospital,8980636,cycloSPORINE modified 25 mg capsule,93574019,J7515,636,$8.74 ,$8.74 ,$6.68 ,$7.87 ,$7.43 ,$7.43 ,$7.43 ,$7.69 ,$7.43 ,$7.69 ,$7.69 ,$7.60 ,$7.43 ,$7.43 ,$7.43 ,$6.68 ,$7.87
Carle Richland Memorial Hospital,8980636,cycloSPORINE modified 25 mg capsule,93574065,J7515,636,$8.74 ,$8.74 ,$6.68 ,$7.87 ,$7.43 ,$7.43 ,$7.43 ,$7.69 ,$7.43 ,$7.69 ,$7.69 ,$7.60 ,$7.43 ,$7.43 ,$7.43 ,$6.68 ,$7.87
Carle Richland Memorial Hospital,8980636,DAPTOmycin 500 mg intravenous solution,67919001201,J0878,636,"$2,555.26 ","$2,555.26 ","$1,952.22 ","$2,299.73 ","$2,171.97 ","$2,171.97 ","$2,171.97 ","$2,248.63 ","$2,171.97 ","$2,248.63 ","$2,248.63 ","$2,223.08 ","$2,171.97 ","$2,171.97 ","$2,171.97 ","$1,952.22 ","$2,299.73 "
Carle Richland Memorial Hospital,8980636,darbepoetin alfa 150 mcg/0.3 mL in polysorbate injection syringe,55513002701,J0881,636,"$4,927.09 ","$4,927.09 ","$3,764.30 ","$4,434.38 ","$4,188.03 ","$4,188.03 ","$4,188.03 ","$4,335.84 ","$4,188.03 ","$4,335.84 ","$4,335.84 ","$4,286.57 ","$4,188.03 ","$4,188.03 ","$4,188.03 ","$3,764.30 ","$4,434.38 "
Carle Richland Memorial Hospital,8980636,darbepoetin alfa 150 mcg/0.3 mL in polysorbate injection syringe,55513002704,J0881,636,"$4,927.09 ","$4,927.09 ","$3,764.30 ","$4,434.38 ","$4,188.03 ","$4,188.03 ","$4,188.03 ","$4,335.84 ","$4,188.03 ","$4,335.84 ","$4,335.84 ","$4,286.57 ","$4,188.03 ","$4,188.03 ","$4,188.03 ","$3,764.30 ","$4,434.38 "
Carle Richland Memorial Hospital,8980636,deferoxamine 500 mg solution for injection,52609450501,J0895,636,$125.39 ,$125.39 ,$95.80 ,$112.85 ,$106.58 ,$106.58 ,$106.58 ,$110.34 ,$106.58 ,$110.34 ,$110.34 ,$109.09 ,$106.58 ,$106.58 ,$106.58 ,$95.80 ,$112.85
Carle Richland Memorial Hospital,8980636,denosumab 120 mg/1.7 mL (70 mg/mL) subcutaneous solution,55513073001,J0897,636,"$10,584.51 ","$10,584.51 ","$8,086.57 ","$9,526.06 ","$8,996.83 ","$8,996.83 ","$8,996.83 ","$9,314.37 ","$8,996.83 ","$9,314.37 ","$9,314.37 ","$9,208.52 ","$8,996.83 ","$8,996.83 ","$8,996.83 ","$8,086.57 ","$9,526.06 "
Carle Richland Memorial Hospital,8980636,denosumab 60 mg/mL subcutaneous syringe,55513071001,J0897,636,"$5,809.96 ","$5,809.96 ","$4,438.81 ","$5,228.96 ","$4,938.47 ","$4,938.47 ","$4,938.47 ","$5,112.76 ","$4,938.47 ","$5,112.76 ","$5,112.76 ","$5,054.67 ","$4,938.47 ","$4,938.47 ","$4,938.47 ","$4,438.81 ","$5,228.96 "
Carle Richland Memorial Hospital,8980636,desmopressin 4 mcg/mL injection solution,69918089910,J2597,636,$228.46 ,$228.46 ,$174.54 ,$205.61 ,$194.19 ,$194.19 ,$194.19 ,$201.04 ,$194.19 ,$201.04 ,$201.04 ,$198.76 ,$194.19 ,$194.19 ,$194.19 ,$174.54 ,$205.61
Carle Richland Memorial Hospital,8980636,dexAMETHasone 0.5 mg tablet,54817925,J8540,636,$3.29 ,$3.29 ,$2.51 ,$2.96 ,$2.80 ,$2.80 ,$2.80 ,$2.90 ,$2.80 ,$2.90 ,$2.90 ,$2.86 ,$2.80 ,$2.80 ,$2.80 ,$2.51 ,$2.96
Carle Richland Memorial Hospital,8980636,dexAMETHasone 4 mg tablet,54817525,,636,$2.68 ,$2.68 ,$2.05 ,$2.41 ,$2.28 ,$2.28 ,$2.28 ,$2.36 ,$2.28 ,$2.36 ,$2.36 ,$2.33 ,$2.28 ,$2.28 ,$2.28 ,$2.05 ,$2.41
Carle Richland Memorial Hospital,8980636,dexAMETHasone sodium phosphate (PF) 10 mg/mL injection solution,63323050601,J1100,636,$47.12 ,$47.12 ,$36.00 ,$42.41 ,$40.05 ,$40.05 ,$40.05 ,$41.47 ,$40.05 ,$41.47 ,$41.47 ,$40.99 ,$40.05 ,$40.05 ,$40.05 ,$36.00 ,$42.41
Carle Richland Memorial Hospital,8980636,dexAMETHasone sodium phosphate 10 mg/mL injection solution,641036721,J1100,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,dexAMETHasone sodium phosphate 4 mg/mL injection solution,63323016502,J1100,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,dextrose 10 % in water (D10W) intravenous solution,409793009,J7060,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and 0.2 % sodium chloride intravenous solution,338007703,J7042,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and 0.2 % sodium chloride intravenous solution,338007704,J7042,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and 0.45 % sodium chloride intravenous solution,264761200,J7042,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and 0.45 % sodium chloride intravenous solution,338008503,J7042,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and 0.9 % sodium chloride intravenous solution,338008903,J7042,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and 0.9 % sodium chloride intravenous solution,338008904,J7042,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and lactated ringers intravenous solution,338012503,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % and lactated ringers intravenous solution,338012504,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % in water (D5W) intravenous solution,264751010,J7060,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % in water (D5W) intravenous solution,338001702,J7060,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % in water (D5W) intravenous solution,338001718,J7060,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % in water (D5W) intravenous solution,409792313,J7060,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5 % in water (D5W) intravenous solution,264751000,J7070,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5% in water (D5W) IV,264751000,J7070,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5%-lactated ringers IV,338012503,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,dextrose 5%-lactated ringers IV,338012504,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,diazePAM 5 mg/mL injection syringe,69339013632,J3360,636,$91.78 ,$91.78 ,$70.12 ,$82.60 ,$78.01 ,$78.01 ,$78.01 ,$80.77 ,$78.01 ,$80.77 ,$80.77 ,$79.85 ,$78.01 ,$78.01 ,$78.01 ,$70.12 ,$82.60
Carle Richland Memorial Hospital,8980636,dicyclomine 10 mg/mL intramuscular solution,58914008052,J0500,636,$507.38 ,$507.38 ,$387.64 ,$456.64 ,$431.27 ,$431.27 ,$431.27 ,$446.49 ,$431.27 ,$446.49 ,$446.49 ,$441.42 ,$431.27 ,$431.27 ,$431.27 ,$387.64 ,$456.64
Carle Richland Memorial Hospital,8980636,digoxin immune fab 40 mg intravenous solution,50633012011,J1162,636,"$17,409.49 ","$17,409.49 ","$13,300.85 ","$15,668.54 ","$14,798.07 ","$14,798.07 ","$14,798.07 ","$15,320.35 ","$14,798.07 ","$15,320.35 ","$15,320.35 ","$15,146.26 ","$14,798.07 ","$14,798.07 ","$14,798.07 ","$13,300.85 ","$15,668.54 "
Carle Richland Memorial Hospital,8980636,diphenhydrAMINE 50 mg/mL injection solution,63323066416,J1200,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"diphth,pertussis(acel),tetanus 2.5 Lf unit-8 mcg-5 Lf/0.5mL IM syringe",58160084243,90715,636,$96.08 ,$96.08 ,$73.41 ,$86.47 ,$81.67 ,$81.67 ,$81.67 ,$84.55 ,$81.67 ,$84.55 ,$84.55 ,$83.59 ,$81.67 ,$81.67 ,$81.67 ,$73.41 ,$86.47
Carle Richland Memorial Hospital,8980636,DOBUTamine 250 mg/20 mL (12.5 mg/mL) intravenous solution,409234401,J1250,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"DOBUTamine 500 mg/250 mL (2,000 mcg/mL) in 5 % dextrose IV",338107502,J1250,636,$283.74 ,$283.74 ,$216.78 ,$255.37 ,$241.18 ,$241.18 ,$241.18 ,$249.69 ,$241.18 ,$249.69 ,$249.69 ,$246.85 ,$241.18 ,$241.18 ,$241.18 ,$216.78 ,$255.37
Carle Richland Memorial Hospital,8980636,"DOPamine 400 mg/250 mL (1,600 mcg/mL) in 5 % dextrose intravenous soln",409780922,J1265,636,$106.23 ,$106.23 ,$81.16 ,$95.61 ,$90.30 ,$90.30 ,$90.30 ,$93.48 ,$90.30 ,$93.48 ,$93.48 ,$92.42 ,$90.30 ,$90.30 ,$90.30 ,$81.16 ,$95.61
Carle Richland Memorial Hospital,8980636,dornase alfa 1 mg/mL solution for inhalation,50242010039,J7639,636,$490.81 ,$490.81 ,$374.98 ,$441.73 ,$417.19 ,$417.19 ,$417.19 ,$431.91 ,$417.19 ,$431.91 ,$431.91 ,$427.00 ,$417.19 ,$417.19 ,$417.19 ,$374.98 ,$441.73
Carle Richland Memorial Hospital,8980636,dronabinoL 2.5 mg capsule,60687037501,Q0167,636,$29.05 ,$29.05 ,$22.19 ,$26.15 ,$24.69 ,$24.69 ,$24.69 ,$25.56 ,$24.69 ,$25.56 ,$25.56 ,$25.27 ,$24.69 ,$24.69 ,$24.69 ,$22.19 ,$26.15
Carle Richland Memorial Hospital,8980636,emtricitabine 200 mg-tenofovir disoproxil fumarate 300 mg tablet,61958070101,J8499,636,$266.07 ,$266.07 ,$203.28 ,$239.46 ,$226.16 ,$226.16 ,$226.16 ,$234.14 ,$226.16 ,$234.14 ,$234.14 ,$231.48 ,$226.16 ,$226.16 ,$226.16 ,$203.28 ,$239.46
Carle Richland Memorial Hospital,8980636,enoxaparin 100 mg/mL subcutaneous syringe,955101010,J1650,636,$152.65 ,$152.65 ,$116.62 ,$137.39 ,$129.75 ,$129.75 ,$129.75 ,$134.33 ,$129.75 ,$134.33 ,$134.33 ,$132.81 ,$129.75 ,$129.75 ,$129.75 ,$116.62 ,$137.39
Carle Richland Memorial Hospital,8980636,enoxaparin 150 mg/mL subcutaneous syringe,75291501,J1650,636,$643.88 ,$643.88 ,$491.92 ,$579.49 ,$547.30 ,$547.30 ,$547.30 ,$566.61 ,$547.30 ,$566.61 ,$566.61 ,$560.18 ,$547.30 ,$547.30 ,$547.30 ,$491.92 ,$579.49
Carle Richland Memorial Hospital,8980636,enoxaparin 30 mg/0.3 mL subcutaneous syringe,63323055993,J1650,636,$45.09 ,$45.09 ,$34.45 ,$40.58 ,$38.33 ,$38.33 ,$38.33 ,$39.68 ,$38.33 ,$39.68 ,$39.68 ,$39.23 ,$38.33 ,$38.33 ,$38.33 ,$34.45 ,$40.58
Carle Richland Memorial Hospital,8980636,enoxaparin 30 mg/0.3 mL subcutaneous syringe,75801301,J1650,636,$48.20 ,$48.20 ,$36.82 ,$43.38 ,$40.97 ,$40.97 ,$40.97 ,$42.42 ,$40.97 ,$42.42 ,$42.42 ,$41.93 ,$40.97 ,$40.97 ,$40.97 ,$36.82 ,$43.38
Carle Richland Memorial Hospital,8980636,enoxaparin 40 mg/0.4 mL subcutaneous syringe,75062040,J1650,636,$261.06 ,$261.06 ,$199.45 ,$234.95 ,$221.90 ,$221.90 ,$221.90 ,$229.73 ,$221.90 ,$229.73 ,$229.73 ,$227.12 ,$221.90 ,$221.90 ,$221.90 ,$199.45 ,$234.95
Carle Richland Memorial Hospital,8980636,enoxaparin 60 mg/0.6 mL subcutaneous syringe,75801601,J1650,636,$92.96 ,$92.96 ,$71.02 ,$83.66 ,$79.02 ,$79.02 ,$79.02 ,$81.80 ,$79.02 ,$81.80 ,$81.80 ,$80.88 ,$79.02 ,$79.02 ,$79.02 ,$71.02 ,$83.66
Carle Richland Memorial Hospital,8980636,enoxaparin 80 mg/0.8 mL subcutaneous syringe,71288041087,J1650,636,$87.21 ,$87.21 ,$66.63 ,$78.49 ,$74.13 ,$74.13 ,$74.13 ,$76.74 ,$74.13 ,$76.74 ,$76.74 ,$75.87 ,$74.13 ,$74.13 ,$74.13 ,$66.63 ,$78.49
Carle Richland Memorial Hospital,8980636,"ePHEDrine sulfate 50 mg/mL injection solution,ePHEDrine sulfate 50 mg/mL injection solution",42023021683,J3490,636,$132.46 ,$132.46 ,$101.20 ,$119.21 ,$112.59 ,$112.59 ,$112.59 ,$116.56 ,$112.59 ,$116.56 ,$116.56 ,$115.24 ,$112.59 ,$112.59 ,$112.59 ,$101.20 ,$119.21
Carle Richland Memorial Hospital,8980636,"ePHEDrine sulfate 50 mg/mL injection solution,ePHEDrine sulfate 50 mg/mL injection solution",17478041501,J3490,636,$209.11 ,$209.11 ,$159.76 ,$188.20 ,$177.74 ,$177.74 ,$177.74 ,$184.02 ,$177.74 ,$184.02 ,$184.02 ,$181.93 ,$177.74 ,$177.74 ,$177.74 ,$159.76 ,$188.20
Carle Richland Memorial Hospital,8980636,"ePHEDrine sulfate 50 mg/mL injection solution,ePHEDrine sulfate 50 mg/mL injection solution",17478041510,J3490,636,$209.11 ,$209.11 ,$159.76 ,$188.20 ,$177.74 ,$177.74 ,$177.74 ,$184.02 ,$177.74 ,$184.02 ,$184.02 ,$181.93 ,$177.74 ,$177.74 ,$177.74 ,$159.76 ,$188.20
Carle Richland Memorial Hospital,8980636,ePHEDrine sulfate 50 mg/mL intravenous solution,70121163705,J3490,636,$199.72 ,$199.72 ,$152.59 ,$179.75 ,$169.76 ,$169.76 ,$169.76 ,$175.75 ,$169.76 ,$175.75 ,$175.75 ,$173.76 ,$169.76 ,$169.76 ,$169.76 ,$152.59 ,$179.75
Carle Richland Memorial Hospital,8980636,EPINEPHrine 0.1 mg/mL injection syringe,409492120,J0171,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,EPINEPHrine 1 mg/mL (1 mL) injection solution,42023015901,J0171,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,EPINEPHrine 1 mg/mL (1 mL) injection solution,42023015925,J0171,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,EPINEPHrine HCl (PF) 1 mg/mL (1 mL) injection solution,54288010301,J0171,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"epoetin alfa 10,000 unit/mL injection solution",55513014410,J0885,636,$818.50 ,$818.50 ,$625.33 ,$736.65 ,$695.73 ,$695.73 ,$695.73 ,$720.28 ,$695.73 ,$720.28 ,$720.28 ,$712.10 ,$695.73 ,$695.73 ,$695.73 ,$625.33 ,$736.65
Carle Richland Memorial Hospital,8980636,"epoetin alfa 20,000 unit/mL injection solution",59676032000,J0885,636,"$1,469.08 ","$1,469.08 ","$1,122.38 ","$1,322.17 ","$1,248.72 ","$1,248.72 ","$1,248.72 ","$1,292.79 ","$1,248.72 ","$1,292.79 ","$1,292.79 ","$1,278.10 ","$1,248.72 ","$1,248.72 ","$1,248.72 ","$1,122.38 ","$1,322.17 "
Carle Richland Memorial Hospital,8980636,"epoetin alfa 3,000 unit/mL injection solution",55513026710,J0885,636,$315.48 ,$315.48 ,$241.03 ,$283.93 ,$268.16 ,$268.16 ,$268.16 ,$277.62 ,$268.16 ,$277.62 ,$277.62 ,$274.47 ,$268.16 ,$268.16 ,$268.16 ,$241.03 ,$283.93
Carle Richland Memorial Hospital,8980636,"epoetin alfa 4,000 unit/mL injection solution",59676030400,J0885,636,$571.12 ,$571.12 ,$436.34 ,$514.01 ,$485.45 ,$485.45 ,$485.45 ,$502.59 ,$485.45 ,$502.59 ,$502.59 ,$496.87 ,$485.45 ,$485.45 ,$485.45 ,$436.34 ,$514.01
Carle Richland Memorial Hospital,8980636,"epoetin alfa 40,000 unit/mL injection solution",59676034000,J0885,636,"$4,611.94 ","$4,611.94 ","$3,523.52 ","$4,150.75 ","$3,920.15 ","$3,920.15 ","$3,920.15 ","$4,058.51 ","$3,920.15 ","$4,058.51 ","$4,058.51 ","$4,012.39 ","$3,920.15 ","$3,920.15 ","$3,920.15 ","$3,523.52 ","$4,150.75 "
Carle Richland Memorial Hospital,8980636,eptifibatide 0.75 mg/mL intravenous solution,85113603,J1327,636,"$3,803.28 ","$3,803.28 ","$2,905.71 ","$3,422.95 ","$3,232.79 ","$3,232.79 ","$3,232.79 ","$3,346.89 ","$3,232.79 ","$3,346.89 ","$3,346.89 ","$3,308.85 ","$3,232.79 ","$3,232.79 ","$3,232.79 ","$2,905.71 ","$3,422.95 "
Carle Richland Memorial Hospital,8980636,eptifibatide 2 mg/mL intravenous solution,85117703,J1327,636,"$1,217.51 ","$1,217.51 ",$930.18 ,"$1,095.76 ","$1,034.88 ","$1,034.88 ","$1,034.88 ","$1,071.41 ","$1,034.88 ","$1,071.41 ","$1,071.41 ","$1,059.23 ","$1,034.88 ","$1,034.88 ","$1,034.88 ",$930.18 ,"$1,095.76 "
Carle Richland Memorial Hospital,8980636,ertapenem 1 gram solution for injection,44567082010,J1335,636,$840.24 ,$840.24 ,$641.94 ,$756.22 ,$714.20 ,$714.20 ,$714.20 ,$739.41 ,$714.20 ,$739.41 ,$739.41 ,$731.01 ,$714.20 ,$714.20 ,$714.20 ,$641.94 ,$756.22
Carle Richland Memorial Hospital,8980636,erythromycin lactobionate 500 mg intravenous solution,409648201,J1364,636,$521.52 ,$521.52 ,$398.44 ,$469.37 ,$443.29 ,$443.29 ,$443.29 ,$458.94 ,$443.29 ,$458.94 ,$458.94 ,$453.72 ,$443.29 ,$443.29 ,$443.29 ,$398.44 ,$469.37
Carle Richland Memorial Hospital,8980636,etonogestreL 68 mg subdermal implant,52433001,J7307,636,"$3,861.40 ","$3,861.40 ","$2,950.11 ","$3,475.26 ","$3,282.19 ","$3,282.19 ","$3,282.19 ","$3,398.03 ","$3,282.19 ","$3,398.03 ","$3,398.03 ","$3,359.42 ","$3,282.19 ","$3,282.19 ","$3,282.19 ","$2,950.11 ","$3,475.26 "
Carle Richland Memorial Hospital,8980636,fat emulsion 20 % intravenous,338051909,B4185,636,$285.42 ,$285.42 ,$218.06 ,$256.88 ,$242.61 ,$242.61 ,$242.61 ,$251.17 ,$242.61 ,$251.17 ,$251.17 ,$248.32 ,$242.61 ,$242.61 ,$242.61 ,$218.06 ,$256.88
Carle Richland Memorial Hospital,8980636,fentaNYL (PF) 50 mcg/mL injection solution,409909332,J3010,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,fentaNYL (PF) 50 mcg/mL injection solution,409909335,J3010,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,fentaNYL (PF) 50 mcg/mL injection solution,409909431,J3010,636,$145.61 ,$145.61 ,$111.25 ,$131.05 ,$123.77 ,$123.77 ,$123.77 ,$128.14 ,$123.77 ,$128.14 ,$128.14 ,$126.68 ,$123.77 ,$123.77 ,$123.77 ,$111.25 ,$131.05
Carle Richland Memorial Hospital,8980636,ferric carboxymaltose 50 mg iron/mL intravenous solution,517065001,J1439,636,"$6,825.29 ","$6,825.29 ","$5,214.52 ","$6,142.76 ","$5,801.50 ","$5,801.50 ","$5,801.50 ","$6,006.26 ","$5,801.50 ","$6,006.26 ","$6,006.26 ","$5,938.00 ","$5,801.50 ","$5,801.50 ","$5,801.50 ","$5,214.52 ","$6,142.76 "
Carle Richland Memorial Hospital,8980636,ferumoxytoL 510 mg/17 mL (30 mg/mL) intravenous solution,59338077501,,636,"$6,738.75 ","$6,738.75 ","$5,148.41 ","$6,064.88 ","$5,727.94 ","$5,727.94 ","$5,727.94 ","$5,930.10 ","$5,727.94 ","$5,930.10 ","$5,930.10 ","$5,862.71 ","$5,727.94 ","$5,727.94 ","$5,727.94 ","$5,148.41 ","$6,064.88 "
Carle Richland Memorial Hospital,8980636,filgrastim 300 mcg/0.5 mL injection syringe,55513092491,J1442,636,"$1,523.68 ","$1,523.68 ","$1,164.09 ","$1,371.31 ","$1,295.13 ","$1,295.13 ","$1,295.13 ","$1,340.84 ","$1,295.13 ","$1,340.84 ","$1,340.84 ","$1,325.60 ","$1,295.13 ","$1,295.13 ","$1,295.13 ","$1,164.09 ","$1,371.31 "
Carle Richland Memorial Hospital,8980636,filgrastim 480 mcg/0.8 mL injection syringe,55513020991,J1442,636,"$2,354.16 ","$2,354.16 ","$1,798.58 ","$2,118.74 ","$2,001.04 ","$2,001.04 ","$2,001.04 ","$2,071.66 ","$2,001.04 ","$2,071.66 ","$2,071.66 ","$2,048.12 ","$2,001.04 ","$2,001.04 ","$2,001.04 ","$1,798.58 ","$2,118.74 "
Carle Richland Memorial Hospital,8980636,flu vaccine qs 2021-22(6mos up)(PF) 60 mcg(15 mcgx4)/0.5 mL IM syringe,19515081841,90686,636,$38.67 ,$38.67 ,$29.54 ,$34.80 ,$32.87 ,$32.87 ,$32.87 ,$34.03 ,$32.87 ,$34.03 ,$34.03 ,$33.64 ,$32.87 ,$32.87 ,$32.87 ,$29.54 ,$34.80
Carle Richland Memorial Hospital,8980636,flu vaccine qs 2021-22(6mos up)(PF) 60 mcg(15 mcgx4)/0.5 mL IM syringe,19515081852,90686,636,$38.67 ,$38.67 ,$29.54 ,$34.80 ,$32.87 ,$32.87 ,$32.87 ,$34.03 ,$32.87 ,$34.03 ,$34.03 ,$33.64 ,$32.87 ,$32.87 ,$32.87 ,$29.54 ,$34.80
Carle Richland Memorial Hospital,8980636,fluconazole 200 mg/100 mL in sod. chloride (iso) intravenous piggyback,70655000210,J1450,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,fondaparinux 10 mg/0.8 mL subcutaneous solution syringe,67457058508,J1652,636,$572.28 ,$572.28 ,$437.22 ,$515.05 ,$486.44 ,$486.44 ,$486.44 ,$503.61 ,$486.44 ,$503.61 ,$503.61 ,$497.88 ,$486.44 ,$486.44 ,$486.44 ,$437.22 ,$515.05
Carle Richland Memorial Hospital,8980636,fondaparinux 2.5 mg/0.5 mL subcutaneous solution syringe,67457058210,J1652,636,$313.42 ,$313.42 ,$239.45 ,$282.08 ,$266.41 ,$266.41 ,$266.41 ,$275.81 ,$266.41 ,$275.81 ,$275.81 ,$272.68 ,$266.41 ,$266.41 ,$266.41 ,$239.45 ,$282.08
Carle Richland Memorial Hospital,8980636,fondaparinux 7.5 mg/0.6 mL subcutaneous solution syringe,67457058400,J1652,636,$572.28 ,$572.28 ,$437.22 ,$515.05 ,$486.44 ,$486.44 ,$486.44 ,$503.61 ,$486.44 ,$503.61 ,$503.61 ,$497.88 ,$486.44 ,$486.44 ,$486.44 ,$437.22 ,$515.05
Carle Richland Memorial Hospital,8980636,fondaparinux 7.5 mg/0.6 mL subcutaneous solution syringe,67457058406,J1652,636,$572.28 ,$572.28 ,$437.22 ,$515.05 ,$486.44 ,$486.44 ,$486.44 ,$503.61 ,$486.44 ,$503.61 ,$503.61 ,$497.88 ,$486.44 ,$486.44 ,$486.44 ,$437.22 ,$515.05
Carle Richland Memorial Hospital,8980636,formoterol fumarate 20 mcg/2 mL solution for nebulization,49502060561,J7606,636,$86.21 ,$86.21 ,$65.86 ,$77.59 ,$73.28 ,$73.28 ,$73.28 ,$75.86 ,$73.28 ,$75.86 ,$75.86 ,$75.00 ,$73.28 ,$73.28 ,$73.28 ,$65.86 ,$77.59
Carle Richland Memorial Hospital,8980636,formoterol fumarate 20 mcg/2 mL solution for nebulization,49502060595,J7606,636,$86.22 ,$86.22 ,$65.87 ,$77.60 ,$73.29 ,$73.29 ,$73.29 ,$75.87 ,$73.29 ,$75.87 ,$75.87 ,$75.01 ,$73.29 ,$73.29 ,$73.29 ,$65.87 ,$77.60
Carle Richland Memorial Hospital,8980636,fosphenytoin 100 mg PE/2 mL injection solution,69600125,Q2009,636,$267.78 ,$267.78 ,$204.58 ,$241.00 ,$227.61 ,$227.61 ,$227.61 ,$235.65 ,$227.61 ,$235.65 ,$235.65 ,$232.97 ,$227.61 ,$227.61 ,$227.61 ,$204.58 ,$241.00
Carle Richland Memorial Hospital,8980636,fosphenytoin 500 mg PE/10 mL injection solution,69600110,Q2009,636,$733.47 ,$733.47 ,$560.37 ,$660.12 ,$623.45 ,$623.45 ,$623.45 ,$645.45 ,$623.45 ,$645.45 ,$645.45 ,$638.12 ,$623.45 ,$623.45 ,$623.45 ,$560.37 ,$660.12
Carle Richland Memorial Hospital,8980636,furosemide 10 mg/mL injection solution,63323028003,J1940,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,furosemide 10 mg/mL injection solution,63323028005,J1940,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,furosemide 10 mg/mL injection solution,63323028026,J1940,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,furosemide 10 mg/mL injection solution,63323028036,J1940,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,gemcitabine 2 gram/52.6 mL,67457061810,,636,$642.25 ,$642.25 ,$490.68 ,$578.03 ,$545.91 ,$545.91 ,$545.91 ,$565.18 ,$545.91 ,$565.18 ,$565.18 ,$558.76 ,$545.91 ,$545.91 ,$545.91 ,$490.68 ,$578.03
Carle Richland Memorial Hospital,8980636,gemcitabine 2 gram/52.6 mL (38 mg/mL) intravenous solution,67457061810,J9201,636,$642.25 ,$642.25 ,$490.68 ,$578.03 ,$545.91 ,$545.91 ,$545.91 ,$565.18 ,$545.91 ,$565.18 ,$565.18 ,$558.76 ,$545.91 ,$545.91 ,$545.91 ,$490.68 ,$578.03
Carle Richland Memorial Hospital,8980636,gentamicin 40 mg/mL injection solution,409120703,J1580,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,gentamicin sulfate (pediatric) (PF) 20 mg/2 mL injection solution,63323017394,J1580,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"glucagon (human recombinant) 1 mg/mL solution for injection,glucagon HCL 1 mg/mL solution for injection,glucagon HCL 1 mg solution for injection,glucagon 1 mg solution for injection",63323059603,J1610,636,$838.24 ,$838.24 ,$640.42 ,$754.42 ,$712.50 ,$712.50 ,$712.50 ,$737.65 ,$712.50 ,$737.65 ,$737.65 ,$729.27 ,$712.50 ,$712.50 ,$712.50 ,$640.42 ,$754.42
Carle Richland Memorial Hospital,8980636,"glucagon (human recombinant) 1 mg/mL solution for injection,glucagon HCL 1 mg/mL solution for injection,glucagon HCL 1 mg solution for injection,glucagon 1 mg solution for injection",597026010,J1610,636,$842.86 ,$842.86 ,$643.95 ,$758.57 ,$716.43 ,$716.43 ,$716.43 ,$741.72 ,$716.43 ,$741.72 ,$741.72 ,$733.29 ,$716.43 ,$716.43 ,$716.43 ,$643.95 ,$758.57
Carle Richland Memorial Hospital,8980636,"glucagon (human recombinant) 1 mg/mL solution for injection,glucagon HCL 1 mg/mL solution for injection,glucagon HCL 1 mg solution for injection,glucagon 1 mg solution for injection",63323058282,J1610,636,"$1,297.30 ","$1,297.30 ",$991.14 ,"$1,167.57 ","$1,102.71 ","$1,102.71 ","$1,102.71 ","$1,141.62 ","$1,102.71 ","$1,141.62 ","$1,141.62 ","$1,128.65 ","$1,102.71 ","$1,102.71 ","$1,102.71 ",$991.14 ,"$1,167.57 "
Carle Richland Memorial Hospital,8980636,"glucagon (human recombinant) 1 mg/mL solution for injection,glucagon HCL 1 mg/mL solution for injection,glucagon HCL 1 mg solution for injection,glucagon 1 mg solution for injection",2803101,J1610,636,"$1,301.50 ","$1,301.50 ",$994.35 ,"$1,171.35 ","$1,106.28 ","$1,106.28 ","$1,106.28 ","$1,145.32 ","$1,106.28 ","$1,145.32 ","$1,145.32 ","$1,132.31 ","$1,106.28 ","$1,106.28 ","$1,106.28 ",$994.35 ,"$1,171.35 "
Carle Richland Memorial Hospital,8980636,golimumab 12.5 mg/mL intravenous solution,57894035001,J1602,636,"$11,243.56 ","$11,243.56 ","$8,590.08 ","$10,119.20 ","$9,557.03 ","$9,557.03 ","$9,557.03 ","$9,894.33 ","$9,557.03 ","$9,894.33 ","$9,894.33 ","$9,781.90 ","$9,557.03 ","$9,557.03 ","$9,557.03 ","$8,590.08 ","$10,119.20 "
Carle Richland Memorial Hospital,8980636,haloperidol lactate 5 mg/mL injection solution,143931901,J1630,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"heparin (porcine) 1,000 unit/mL injection solution",67457037299,J1644,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"heparin (porcine) 10,000 unit/mL injection solution",67457060202,J1644,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"heparin (porcine) 25,000 unit/250 mL (100 unit/mL) in dextrose 5 % IV",63323052374,J1644,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"heparin (porcine) 25,000 unit/250 mL in 0.45 % sodium chloride IV soln",409765062,J1644,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"heparin (porcine) 5,000 unit/mL injection solution",67457094900,J1644,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,heparin lock flush (porcine) 100 unit/mL intravenous solution,63323054501,J1642,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,heparin lock flush (porcine) 100 unit/mL intravenous solution,63323054505,J1642,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"heparin, porcine (PF) 100 unit/mL intravenous syringe",8290306424,J1642,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"heparin, porcine (PF) 100 unit/mL intravenous syringe",8290306513,J1642,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"heparin, porcine (PF) 100 unit/mL intravenous syringe",63807060055,J1642,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"hepatitis B immune globulin > 1,560 unit/5 mL intramuscular solution",59730420301,90371,636,$315.71 ,$315.71 ,$241.20 ,$284.14 ,$268.35 ,$268.35 ,$268.35 ,$277.82 ,$268.35 ,$277.82 ,$277.82 ,$274.67 ,$268.35 ,$268.35 ,$268.35 ,$241.20 ,$284.14
Carle Richland Memorial Hospital,8980636,hepatitis B immune globulin greatr than 312 unit/mL intramuscular soln,59730420201,90371,636,$360.45 ,$360.45 ,$275.38 ,$324.41 ,$306.38 ,$306.38 ,$306.38 ,$317.20 ,$306.38 ,$317.20 ,$317.20 ,$313.59 ,$306.38 ,$306.38 ,$306.38 ,$275.38 ,$324.41
Carle Richland Memorial Hospital,8980636,hepatitis B virus vaccine recomb (PF) 10 mcg/0.5 mL IM syringe,58160082043,90744,636,$56.12 ,$56.12 ,$42.88 ,$50.51 ,$47.70 ,$47.70 ,$47.70 ,$49.39 ,$47.70 ,$49.39 ,$49.39 ,$48.82 ,$47.70 ,$47.70 ,$47.70 ,$42.88 ,$50.51
Carle Richland Memorial Hospital,8980636,hepatitis B virus vaccine recomb (PF) 20 mcg/mL intramuscular syringe,58160082143,90746,636,$137.35 ,$137.35 ,$104.94 ,$123.62 ,$116.75 ,$116.75 ,$116.75 ,$120.87 ,$116.75 ,$120.87 ,$120.87 ,$119.49 ,$116.75 ,$116.75 ,$116.75 ,$104.94 ,$123.62
Carle Richland Memorial Hospital,8980636,hum prothrombin cplx (PCC) 4factor 500 unit (400-620 unit) IV solution,63833038602,,636,$36.44 ,$36.44 ,$27.84 ,$32.80 ,$30.97 ,$30.97 ,$30.97 ,$32.07 ,$30.97 ,$32.07 ,$32.07 ,$31.70 ,$30.97 ,$30.97 ,$30.97 ,$27.84 ,$32.80
Carle Richland Memorial Hospital,8980636,hum prothrombin cplx (PCC) 4factor 500 unit (400-620 unit) IV solution,63833039601,,636,$36.44 ,$36.44 ,$27.84 ,$32.80 ,$30.97 ,$30.97 ,$30.97 ,$32.07 ,$30.97 ,$32.07 ,$32.07 ,$31.70 ,$30.97 ,$30.97 ,$30.97 ,$27.84 ,$32.80
Carle Richland Memorial Hospital,8980636,"hyaluronidase, human recombinant 150 unit/mL injection solution",18657011702,J3473,636,$349.36 ,$349.36 ,$266.91 ,$314.42 ,$296.96 ,$296.96 ,$296.96 ,$307.44 ,$296.96 ,$307.44 ,$307.44 ,$303.94 ,$296.96 ,$296.96 ,$296.96 ,$266.91 ,$314.42
Carle Richland Memorial Hospital,8980636,hydrALAZINE 20 mg/mL injection solution,63323061416,J0360,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,hydrocortisone sod succinate (PF) 100 mg/2 mL solution for injection,9001103,J1720,636,$111.19 ,$111.19 ,$84.95 ,$100.07 ,$94.51 ,$94.51 ,$94.51 ,$97.85 ,$94.51 ,$97.85 ,$97.85 ,$96.74 ,$94.51 ,$94.51 ,$94.51 ,$84.95 ,$100.07
Carle Richland Memorial Hospital,8980636,hydrocortisone sod succinate (PF) 250 mg/2 mL solution for injection,9001305,J1720,636,$164.98 ,$164.98 ,$126.04 ,$148.48 ,$140.23 ,$140.23 ,$140.23 ,$145.18 ,$140.23 ,$145.18 ,$145.18 ,$143.53 ,$140.23 ,$140.23 ,$140.23 ,$126.04 ,$148.48
Carle Richland Memorial Hospital,8980636,"HYDROmorphone (PF) 1 mg/mL injection syringe,HYDROmorphone 1 mg/mL injection syringe,HYDROmorphone 1 mg/mL injection solution,HYDROmorphone (PF) 1 mg/mL injection solution",409128303,J1170,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"HYDROmorphone (PF) 4 mg/mL injection syringe,HYDROmorphone 4 mg/mL injection syringe,HYDROmorphone (PF) 4 mg/mL injection solution,HYDROmorphone 4 mg/mL injection solution",409130431,J1170,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,HYDROmorphone 1 mg/mL injection syringe,409128303,J1170,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,HYDROmorphone 2 mg/mL injection syringe,409131203,J1170,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"HYDROmorphone 2 mg/mL injection syringe,HYDROmorphone (PF) 2 mg/mL injection solution,HYDROmorphone (PF) 2 mg/mL injection syringe,HYDROmorphone 2 mg/mL injection solution",409131203,J1170,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,hydroxyurea 500 mg capsule,68084028411,J8999,636,$9.80 ,$9.80 ,$7.49 ,$8.82 ,$8.33 ,$8.33 ,$8.33 ,$8.62 ,$8.33 ,$8.62 ,$8.62 ,$8.53 ,$8.33 ,$8.33 ,$8.33 ,$7.49 ,$8.82
Carle Richland Memorial Hospital,8980636,hydrOXYzine pamoate 25 mg capsule,185067401,Q0177,636,$3.72 ,$3.72 ,$2.84 ,$3.35 ,$3.16 ,$3.16 ,$3.16 ,$3.27 ,$3.16 ,$3.27 ,$3.27 ,$3.24 ,$3.16 ,$3.16 ,$3.16 ,$2.84 ,$3.35
Carle Richland Memorial Hospital,8980636,imatinib 400 mg tablet,54024913,S0088,636,$199.71 ,$199.71 ,$152.58 ,$179.74 ,$169.75 ,$169.75 ,$169.75 ,$175.74 ,$169.75 ,$175.74 ,$175.74 ,$173.75 ,$169.75 ,$169.75 ,$169.75 ,$152.58 ,$179.74
Carle Richland Memorial Hospital,8980636,"immune glob,gamma (IgG) 10 %-gly-IgA over 50 mcg/mL injection solution",944270005,J1569,636,"$10,428.18 ","$10,428.18 ","$7,967.13 ","$9,385.36 ","$8,863.95 ","$8,863.95 ","$8,863.95 ","$9,176.80 ","$8,863.95 ","$9,176.80 ","$9,176.80 ","$9,072.52 ","$8,863.95 ","$8,863.95 ","$8,863.95 ","$7,967.13 ","$9,385.36 "
Carle Richland Memorial Hospital,8980636,"immune glob,gamma (IgG) 10 %-gly-IgA over 50 mcg/mL injection solution",944270006,J1569,636,"$20,852.97 ","$20,852.97 ","$15,931.67 ","$18,767.67 ","$17,725.02 ","$17,725.02 ","$17,725.02 ","$18,350.61 ","$17,725.02 ","$18,350.61 ","$18,350.61 ","$18,142.08 ","$17,725.02 ","$17,725.02 ","$17,725.02 ","$15,931.67 ","$18,767.67 "
Carle Richland Memorial Hospital,8980636,"immune glob,gamma (IgG) 10 %-gly-IgA over 50 mcg/mL injection solution",944270007,J1569,636,"$31,277.75 ","$31,277.75 ","$23,896.20 ","$28,149.98 ","$26,586.09 ","$26,586.09 ","$26,586.09 ","$27,524.42 ","$26,586.09 ","$27,524.42 ","$27,524.42 ","$27,211.64 ","$26,586.09 ","$26,586.09 ","$26,586.09 ","$23,896.20 ","$28,149.98 "
Carle Richland Memorial Hospital,8980636,inFLIXimab 100 mg intravenous solution,57894003001,J1745,636,"$6,594.50 ","$6,594.50 ","$5,038.20 ","$5,935.05 ","$5,605.33 ","$5,605.33 ","$5,605.33 ","$5,803.16 ","$5,605.33 ","$5,803.16 ","$5,803.16 ","$5,737.22 ","$5,605.33 ","$5,605.33 ","$5,605.33 ","$5,038.20 ","$5,935.05 "
Carle Richland Memorial Hospital,8980636,inFLIXimab-dyyb 100 mg intravenous solution,69080901,,636,"$5,355.69 ","$5,355.69 ","$4,091.75 ","$4,820.12 ","$4,552.34 ","$4,552.34 ","$4,552.34 ","$4,713.01 ","$4,552.34 ","$4,713.01 ","$4,713.01 ","$4,659.45 ","$4,552.34 ","$4,552.34 ","$4,552.34 ","$4,091.75 ","$4,820.12 "
Carle Richland Memorial Hospital,8980636,insulin glargine (U-100) 100 unit/mL subcutaneous solution,88222033,J1815,636,"$1,622.99 ","$1,622.99 ","$1,239.96 ","$1,460.69 ","$1,379.54 ","$1,379.54 ","$1,379.54 ","$1,428.23 ","$1,379.54 ","$1,428.23 ","$1,428.23 ","$1,412.00 ","$1,379.54 ","$1,379.54 ","$1,379.54 ","$1,239.96 ","$1,460.69 "
Carle Richland Memorial Hospital,8980636,insulin lispro (U-100) 100 unit/mL subcutaneous solution,2751001,J1815,636,$45.01 ,$45.01 ,$34.39 ,$40.51 ,$38.26 ,$38.26 ,$38.26 ,$39.61 ,$38.26 ,$39.61 ,$39.61 ,$39.16 ,$38.26 ,$38.26 ,$38.26 ,$34.39 ,$40.51
Carle Richland Memorial Hospital,8980636,insulin lispro (U-100) 100 unit/mL subcutaneous solution,2751017,J1815,636,$45.01 ,$45.01 ,$34.39 ,$40.51 ,$38.26 ,$38.26 ,$38.26 ,$39.61 ,$38.26 ,$39.61 ,$39.61 ,$39.16 ,$38.26 ,$38.26 ,$38.26 ,$34.39 ,$40.51
Carle Richland Memorial Hospital,8980636,insulin lispro (U-100) 100 unit/mL subcutaneous solution,2751017,J1815,636,$498.15 ,$498.15 ,$380.59 ,$448.34 ,$423.43 ,$423.43 ,$423.43 ,$438.37 ,$423.43 ,$438.37 ,$438.37 ,$433.39 ,$423.43 ,$423.43 ,$423.43 ,$380.59 ,$448.34
Carle Richland Memorial Hospital,8980636,insulin lispro (U-100) 100 unit/mL subcutaneous solution,2751001,J1815,636,"$1,573.45 ","$1,573.45 ","$1,202.12 ","$1,416.11 ","$1,337.43 ","$1,337.43 ","$1,337.43 ","$1,384.64 ","$1,337.43 ","$1,384.64 ","$1,384.64 ","$1,368.90 ","$1,337.43 ","$1,337.43 ","$1,337.43 ","$1,202.12 ","$1,416.11 "
Carle Richland Memorial Hospital,8980636,insulin lispro protamine-lispro 100 unit/mL (75-25) subcutaneous susp,2751101,J1815,636,$45.29 ,$45.29 ,$34.60 ,$40.76 ,$38.50 ,$38.50 ,$38.50 ,$39.86 ,$38.50 ,$39.86 ,$39.86 ,$39.40 ,$38.50 ,$38.50 ,$38.50 ,$34.60 ,$40.76
Carle Richland Memorial Hospital,8980636,insulin NPH isophane U-100 human 100 unit/mL subcutaneous suspension,169183411,J1815,636,$965.10 ,$965.10 ,$737.34 ,$868.59 ,$820.34 ,$820.34 ,$820.34 ,$849.29 ,$820.34 ,$849.29 ,$849.29 ,$839.64 ,$820.34 ,$820.34 ,$820.34 ,$737.34 ,$868.59
Carle Richland Memorial Hospital,8980636,insulin U-100 regular human 100 unit/mL injection solution,2821501,J1815,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,insulin U-100 regular human 100 unit/mL injection solution,2821517,J1815,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,ipratropium bromide 0.02 % solution for inhalation,487980101,J7644,636,$3.51 ,$3.51 ,$2.68 ,$3.16 ,$2.98 ,$2.98 ,$2.98 ,$3.09 ,$2.98 ,$3.09 ,$3.09 ,$3.05 ,$2.98 ,$2.98 ,$2.98 ,$2.68 ,$3.16
Carle Richland Memorial Hospital,8980636,iron dextran 50 mg/mL injection solution,23608201,J1750,636,$142.06 ,$142.06 ,$108.53 ,$127.85 ,$120.75 ,$120.75 ,$120.75 ,$125.01 ,$120.75 ,$125.01 ,$125.01 ,$123.59 ,$120.75 ,$120.75 ,$120.75 ,$108.53 ,$127.85
Carle Richland Memorial Hospital,8980636,iron sucrose 100 mg iron/5 mL intravenous solution,517234099,J1756,636,$227.01 ,$227.01 ,$173.44 ,$204.31 ,$192.96 ,$192.96 ,$192.96 ,$199.77 ,$192.96 ,$199.77 ,$199.77 ,$197.50 ,$192.96 ,$192.96 ,$192.96 ,$173.44 ,$204.31
Carle Richland Memorial Hospital,8980636,ketorolac 15 mg/mL injection solution,63323016116,J1885,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,ketorolac 30 mg/mL (1 mL) injection solution,63323016201,J1885,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,ketorolac 60 mg/2 mL intramuscular solution,63323016202,J1885,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lactated Ringers intravenous solution,409795330,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,lactated Ringers intravenous solution,990795309,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,lactated ringers IV,409795330,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,lactated ringers IV,990795309,J7120,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,letrozole 2.5 mg tablet,16729003410,J8499,636,$71.33 ,$71.33 ,$54.50 ,$64.20 ,$60.63 ,$60.63 ,$60.63 ,$62.77 ,$60.63 ,$62.77 ,$62.77 ,$62.06 ,$60.63 ,$60.63 ,$60.63 ,$54.50 ,$64.20
Carle Richland Memorial Hospital,8980636,leuprolide (6 month) 45 mg intramuscular syringe kit,74347303,J9217,636,"$29,825.90 ","$29,825.90 ","$22,786.99 ","$26,843.31 ","$25,352.02 ","$25,352.02 ","$25,352.02 ","$26,246.79 ","$25,352.02 ","$26,246.79 ","$26,246.79 ","$25,948.53 ","$25,352.02 ","$25,352.02 ","$25,352.02 ","$22,786.99 ","$26,843.31 "
Carle Richland Memorial Hospital,8980636,leuprolide 22.5 mg (3 month) intramuscular syringe kit,74334603,J9217,636,"$18,600.60 ","$18,600.60 ","$14,210.86 ","$16,740.54 ","$15,810.51 ","$15,810.51 ","$15,810.51 ","$16,368.53 ","$15,810.51 ","$16,368.53 ","$16,368.53 ","$16,182.52 ","$15,810.51 ","$15,810.51 ","$15,810.51 ","$14,210.86 ","$16,740.54 "
Carle Richland Memorial Hospital,8980636,leuprolide 30 mg (4 month) intramuscular syringe kit,74368303,J9217,636,"$24,772.56 ","$24,772.56 ","$18,926.24 ","$22,295.30 ","$21,056.68 ","$21,056.68 ","$21,056.68 ","$21,799.85 ","$21,056.68 ","$21,799.85 ","$21,799.85 ","$21,552.13 ","$21,056.68 ","$21,056.68 ","$21,056.68 ","$18,926.24 ","$22,295.30 "
Carle Richland Memorial Hospital,8980636,leuprolide 45 mg (6 month) subcutaneous syringe,62935045345,J9217,636,"$11,504.70 ","$11,504.70 ","$8,789.59 ","$10,354.23 ","$9,779.00 ","$9,779.00 ","$9,779.00 ","$10,124.14 ","$9,779.00 ","$10,124.14 ","$10,124.14 ","$10,009.09 ","$9,779.00 ","$9,779.00 ","$9,779.00 ","$8,789.59 ","$10,354.23 "
Carle Richland Memorial Hospital,8980636,leuprolide 45 mg (6 month) subcutaneous syringe,62935045444,J9217,636,"$11,504.70 ","$11,504.70 ","$8,789.59 ","$10,354.23 ","$9,779.00 ","$9,779.00 ","$9,779.00 ","$10,124.14 ","$9,779.00 ","$10,124.14 ","$10,124.14 ","$10,009.09 ","$9,779.00 ","$9,779.00 ","$9,779.00 ","$8,789.59 ","$10,354.23 "
Carle Richland Memorial Hospital,8980636,leuprolide 7.5 mg intramuscular syringe kit,74364203,J9217,636,"$7,545.43 ","$7,545.43 ","$5,764.71 ","$6,790.89 ","$6,413.62 ","$6,413.62 ","$6,413.62 ","$6,639.98 ","$6,413.62 ","$6,639.98 ","$6,639.98 ","$6,564.52 ","$6,413.62 ","$6,413.62 ","$6,413.62 ","$5,764.71 ","$6,790.89 "
Carle Richland Memorial Hospital,8980636,levalbuteroL 0.63 mg/3 mL solution for nebulization,76204080001,J7614,636,$11.65 ,$11.65 ,$8.90 ,$10.49 ,$9.90 ,$9.90 ,$9.90 ,$10.25 ,$9.90 ,$10.25 ,$10.25 ,$10.14 ,$9.90 ,$9.90 ,$9.90 ,$8.90 ,$10.49
Carle Richland Memorial Hospital,8980636,levalbuteroL 0.63 mg/3 mL solution for nebulization,76204080011,J7614,636,$11.65 ,$11.65 ,$8.90 ,$10.49 ,$9.90 ,$9.90 ,$9.90 ,$10.25 ,$9.90 ,$10.25 ,$10.25 ,$10.14 ,$9.90 ,$9.90 ,$9.90 ,$8.90 ,$10.49
Carle Richland Memorial Hospital,8980636,levalbuteroL 1.25 mg/3 mL solution for nebulization,76204090001,J7614,636,$11.65 ,$11.65 ,$8.90 ,$10.49 ,$9.90 ,$9.90 ,$9.90 ,$10.25 ,$9.90 ,$10.25 ,$10.25 ,$10.14 ,$9.90 ,$9.90 ,$9.90 ,$8.90 ,$10.49
Carle Richland Memorial Hospital,8980636,"levETIRAcetam 1,000 mg/100 mL in sodium chloride(iso-osm) IV piggyback",70860060341,J1953,636,$394.50 ,$394.50 ,$301.40 ,$355.05 ,$335.33 ,$335.33 ,$335.33 ,$347.16 ,$335.33 ,$347.16 ,$347.16 ,$343.22 ,$335.33 ,$335.33 ,$335.33 ,$301.40 ,$355.05
Carle Richland Memorial Hospital,8980636,"levETIRAcetam 1,000 mg/100 mL in sodium chloride(iso-osm) IV piggyback",70860060382,J1953,636,$394.50 ,$394.50 ,$301.40 ,$355.05 ,$335.33 ,$335.33 ,$335.33 ,$347.16 ,$335.33 ,$347.16 ,$347.16 ,$343.22 ,$335.33 ,$335.33 ,$335.33 ,$301.40 ,$355.05
Carle Richland Memorial Hospital,8980636,levETIRAcetam 500 mg/100 mL in sodium chloride (iso-osm) IV piggyback,67457025500,J1953,636,$101.18 ,$101.18 ,$77.30 ,$91.06 ,$86.00 ,$86.00 ,$86.00 ,$89.04 ,$86.00 ,$89.04 ,$89.04 ,$88.03 ,$86.00 ,$86.00 ,$86.00 ,$77.30 ,$91.06
Carle Richland Memorial Hospital,8980636,levETIRAcetam 500 mg/5 mL intravenous solution,51224001310,,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,levOCARNitine 200 mg/mL intravenous solution,54482014701,J1955,636,$266.27 ,$266.27 ,$203.43 ,$239.64 ,$226.33 ,$226.33 ,$226.33 ,$234.32 ,$226.33 ,$234.32 ,$234.32 ,$231.65 ,$226.33 ,$226.33 ,$226.33 ,$203.43 ,$239.64
Carle Richland Memorial Hospital,8980636,levoFLOXacin 250 mg/50 mL in 5 % dextrose intravenous piggyback,36000004624,J1956,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,levoFLOXacin 500 mg/100 mL in 5 % dextrose intravenous piggyback,36000004724,J1956,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,levoFLOXacin 750 mg/150 mL in 5 % dextrose intravenous piggyback,36000004824,J1956,636,$48.80 ,$48.80 ,$37.28 ,$43.92 ,$41.48 ,$41.48 ,$41.48 ,$42.94 ,$41.48 ,$42.94 ,$42.94 ,$42.46 ,$41.48 ,$41.48 ,$41.48 ,$37.28 ,$43.92
Carle Richland Memorial Hospital,8980636,levonorgestreL 1.5 mg tablet,68180085211,,636,$51.18 ,$51.18 ,$39.10 ,$46.06 ,$43.50 ,$43.50 ,$43.50 ,$45.04 ,$43.50 ,$45.04 ,$45.04 ,$44.53 ,$43.50 ,$43.50 ,$43.50 ,$39.10 ,$46.06
Carle Richland Memorial Hospital,8980636,levonorgestreL 14 mcg/24 hrs (3 yrs) 13.5 mg intrauterine device,50419042201,J7301,636,"$3,502.83 ","$3,502.83 ","$2,676.16 ","$3,152.55 ","$2,977.41 ","$2,977.41 ","$2,977.41 ","$3,082.49 ","$2,977.41 ","$3,082.49 ","$3,082.49 ","$3,047.46 ","$2,977.41 ","$2,977.41 ","$2,977.41 ","$2,676.16 ","$3,152.55 "
Carle Richland Memorial Hospital,8980636,levonorgestreL 17.5 mcg/24 hrs (5yrs) 19.5mg intrauterine device,50419042401,,636,"$4,205.14 ","$4,205.14 ","$3,212.73 ","$3,784.63 ","$3,574.37 ","$3,574.37 ","$3,574.37 ","$3,700.52 ","$3,574.37 ","$3,700.52 ","$3,700.52 ","$3,658.47 ","$3,574.37 ","$3,574.37 ","$3,574.37 ","$3,212.73 ","$3,784.63 "
Carle Richland Memorial Hospital,8980636,levonorgestreL 20 mcg/24 hours (7 yrs) 52 mg intrauterine device,50419042301,,636,"$4,205.14 ","$4,205.14 ","$3,212.73 ","$3,784.63 ","$3,574.37 ","$3,574.37 ","$3,574.37 ","$3,700.52 ","$3,574.37 ","$3,700.52 ","$3,700.52 ","$3,658.47 ","$3,574.37 ","$3,574.37 ","$3,574.37 ","$3,212.73 ","$3,784.63 "
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 10 mg/mL (1 %) injection solution,143959501,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 10 mg/mL (1 %) injection solution,63323049216,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 10 mg/mL (1 %) injection solution,63323049226,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 10 mg/mL (1 %) injection solution,63323049237,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 100 mg/5 mL (2 %) intravenous syringe,409132305,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 20 mg/mL (2 %) injection solution,63323049526,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 20 mg/mL (2 %) injection solution,63323049527,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 20 mg/mL (2 %) intravenous solution,63323020805,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 4 mg/mL (0.4 %) in 5 % dextrose intravenous solution,264959410,J2001,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 40 mg/mL (4 %) injection solution,409428301,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 40 mg/mL (4 %) injection solution,409428325,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine (PF) 5 mg/mL (0.5 %) injection solution,63323049157,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine HCL 10 mg/mL (1 %) injection solution,409427602,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine HCL 10 mg/mL (1 %) injection solution,63323020102,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine HCL 10 mg/mL (1 %) injection solution,63323048526,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine HCL 10 mg/mL (1 %) injection solution,63323048527,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine HCL 20 mg/mL (2 %) injection solution,63323048627,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,lidocaine HCL 5 mg/mL (0.5 %) injection solution,63323048457,J2001,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,linezolid in 5% dextrose in water 600 mg/300 mL intravenous piggyback,25021016987,J2020,636,$247.84 ,$247.84 ,$189.35 ,$223.06 ,$210.66 ,$210.66 ,$210.66 ,$218.10 ,$210.66 ,$218.10 ,$218.10 ,$215.62 ,$210.66 ,$210.66 ,$210.66 ,$189.35 ,$223.06
Carle Richland Memorial Hospital,8980636,"LORazepam 2 mg/mL injection solution,LORazepam 2 mg/mL injection syringe",641620725,J2060,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"LORazepam 2 mg/mL injection solution,LORazepam 2 mg/mL injection syringe",76329826101,J2060,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,magnesium sulfate 1 gram/100 mL in dextrose 5 % intravenous piggyback,63323010826,J3475,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,magnesium sulfate 2 gram/50 mL (4 %) in water intravenous piggyback,63323010626,J3475,636,$71.49 ,$71.49 ,$54.62 ,$64.34 ,$60.77 ,$60.77 ,$60.77 ,$62.91 ,$60.77 ,$62.91 ,$62.91 ,$62.20 ,$60.77 ,$60.77 ,$60.77 ,$54.62 ,$64.34
Carle Richland Memorial Hospital,8980636,magnesium sulfate 20 gram/500 mL (4 %) in water intravenous solution,409672903,J3475,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,magnesium sulfate 20 gram/500 mL (4 %) in water intravenous solution,63323010615,J3475,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,magnesium sulfate 4 gram/100 mL (4 %) in water intravenous piggyback,63323010601,J3475,636,$58.69 ,$58.69 ,$44.84 ,$52.82 ,$49.89 ,$49.89 ,$49.89 ,$51.65 ,$49.89 ,$51.65 ,$51.65 ,$51.06 ,$49.89 ,$49.89 ,$49.89 ,$44.84 ,$52.82
Carle Richland Memorial Hospital,8980636,magnesium sulfate 4 mEq/mL (50 %) injection solution,63323006401,J3475,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,magnesium sulfate 4 mEq/mL (50 %) injection solution,63323006404,J3475,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"magnesium sulfate 40 gram/1,000 mL (4 %) in water intravenous solution",409672909,J3475,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,mannitoL 20 % intravenous solution,990771513,J2150,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,mannitoL 25 % intravenous solution,409403116,J2150,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"measles,mumps,rubella vaccine live(PF)1,000-12,500TCID50/0.5 mL subcut",6468100,90707,636,$193.42 ,$193.42 ,$147.77 ,$174.08 ,$164.41 ,$164.41 ,$164.41 ,$170.21 ,$164.41 ,$170.21 ,$170.21 ,$168.28 ,$164.41 ,$164.41 ,$164.41 ,$147.77 ,$174.08
Carle Richland Memorial Hospital,8980636,medroxyPROGESTERone 150 mg/mL intramuscular suspension,548540000,J1050,636,$288.97 ,$288.97 ,$220.77 ,$260.07 ,$245.62 ,$245.62 ,$245.62 ,$254.29 ,$245.62 ,$254.29 ,$254.29 ,$251.40 ,$245.62 ,$245.62 ,$245.62 ,$220.77 ,$260.07
Carle Richland Memorial Hospital,8980636,"meperidine (PF) 100 mg/mL injection solution,meperidine (PF) 100 mg/mL injection syringe",409118069,J2175,636,$50.05 ,$50.05 ,$38.24 ,$45.05 ,$42.54 ,$42.54 ,$42.54 ,$44.04 ,$42.54 ,$44.04 ,$44.04 ,$43.54 ,$42.54 ,$42.54 ,$42.54 ,$38.24 ,$45.05
Carle Richland Memorial Hospital,8980636,"meperidine (PF) 25 mg/mL injection solution,meperidine (PF) 25 mg/mL injection syringe",409117603,J2175,636,$47.58 ,$47.58 ,$36.35 ,$42.82 ,$40.44 ,$40.44 ,$40.44 ,$41.87 ,$40.44 ,$41.87 ,$41.87 ,$41.39 ,$40.44 ,$40.44 ,$40.44 ,$36.35 ,$42.82
Carle Richland Memorial Hospital,8980636,"meperidine (PF) 50 mg/mL injection solution,meperidine (PF) 50 mg/mL injection syringe",409117803,J2175,636,$48.99 ,$48.99 ,$37.43 ,$44.09 ,$41.64 ,$41.64 ,$41.64 ,$43.11 ,$41.64 ,$43.11 ,$43.11 ,$42.62 ,$41.64 ,$41.64 ,$41.64 ,$37.43 ,$44.09
Carle Richland Memorial Hospital,8980636,"meperidine (PF) 50 mg/mL injection solution,meperidine (PF) 50 mg/mL injection syringe",409117830,J2175,636,$48.99 ,$48.99 ,$37.43 ,$44.09 ,$41.64 ,$41.64 ,$41.64 ,$43.11 ,$41.64 ,$43.11 ,$43.11 ,$42.62 ,$41.64 ,$41.64 ,$41.64 ,$37.43 ,$44.09
Carle Richland Memorial Hospital,8980636,mepivacaine 2 % injection solution,409204750,,636,$64.22 ,$64.22 ,$49.06 ,$57.80 ,$54.59 ,$54.59 ,$54.59 ,$56.51 ,$54.59 ,$56.51 ,$56.51 ,$55.87 ,$54.59 ,$54.59 ,$54.59 ,$49.06 ,$57.80
Carle Richland Memorial Hospital,8980636,meropenem 1 gram intravenous solution,63323050830,J2185,636,$174.63 ,$174.63 ,$133.42 ,$157.17 ,$148.44 ,$148.44 ,$148.44 ,$153.67 ,$148.44 ,$153.67 ,$153.67 ,$151.93 ,$148.44 ,$148.44 ,$148.44 ,$133.42 ,$157.17
Carle Richland Memorial Hospital,8980636,meropenem 1 gram/50 mL in 0.9% sodium chloride intravenous piggyback,264318511,J2185,636,$176.80 ,$176.80 ,$135.08 ,$159.12 ,$150.28 ,$150.28 ,$150.28 ,$155.58 ,$150.28 ,$155.58 ,$155.58 ,$153.82 ,$150.28 ,$150.28 ,$150.28 ,$135.08 ,$159.12
Carle Richland Memorial Hospital,8980636,meropenem 500 mg intravenous solution,63323050725,J2185,636,$76.85 ,$76.85 ,$58.71 ,$69.17 ,$65.32 ,$65.32 ,$65.32 ,$67.63 ,$65.32 ,$67.63 ,$67.63 ,$66.86 ,$65.32 ,$65.32 ,$65.32 ,$58.71 ,$69.17
Carle Richland Memorial Hospital,8980636,meropenem 500 mg/50 mL in 0.9% sodium chloride intravenous piggyback,264318311,J2185,636,$127.26 ,$127.26 ,$97.23 ,$114.53 ,$108.17 ,$108.17 ,$108.17 ,$111.99 ,$108.17 ,$111.99 ,$111.99 ,$110.72 ,$108.17 ,$108.17 ,$108.17 ,$97.23 ,$114.53
Carle Richland Memorial Hospital,8980636,methotrexate sodium 2.5 mg tablet,51079067001,J8610,636,$32.32 ,$32.32 ,$24.69 ,$29.09 ,$27.47 ,$27.47 ,$27.47 ,$28.44 ,$27.47 ,$28.44 ,$28.44 ,$28.12 ,$27.47 ,$27.47 ,$27.47 ,$24.69 ,$29.09
Carle Richland Memorial Hospital,8980636,methylene blue (antidote) 1 % (10 mg/mL) intravenous solution,17478050410,Q9968,636,"$1,175.32 ","$1,175.32 ",$897.94 ,"$1,057.79 ",$999.02 ,$999.02 ,$999.02 ,"$1,034.28 ",$999.02 ,"$1,034.28 ","$1,034.28 ","$1,022.53 ",$999.02 ,$999.02 ,$999.02 ,$897.94 ,"$1,057.79 "
Carle Richland Memorial Hospital,8980636,methylene blue (antidote) 5 mg/mL (0.5 %) intravenous solution,517037405,Q9968,636,"$1,665.36 ","$1,665.36 ","$1,272.34 ","$1,498.82 ","$1,415.56 ","$1,415.56 ","$1,415.56 ","$1,465.52 ","$1,415.56 ","$1,465.52 ","$1,465.52 ","$1,448.86 ","$1,415.56 ","$1,415.56 ","$1,415.56 ","$1,272.34 ","$1,498.82 "
Carle Richland Memorial Hospital,8980636,methylergonovine 0.2 mg/mL (1 mL) injection solution,51991014499,J2210,636,$141.40 ,$141.40 ,$108.03 ,$127.26 ,$120.19 ,$120.19 ,$120.19 ,$124.43 ,$120.19 ,$124.43 ,$124.43 ,$123.02 ,$120.19 ,$120.19 ,$120.19 ,$108.03 ,$127.26
Carle Richland Memorial Hospital,8980636,methylPREDNISolone 4 mg tablet,55289064930,J7509,636,$7.48 ,$7.48 ,$5.71 ,$6.73 ,$6.36 ,$6.36 ,$6.36 ,$6.58 ,$6.36 ,$6.58 ,$6.58 ,$6.51 ,$6.36 ,$6.36 ,$6.36 ,$5.71 ,$6.73
Carle Richland Memorial Hospital,8980636,methylPREDNISolone 4 mg tablets in a dose pack,68001000501,J7509,636,$8.99 ,$8.99 ,$6.87 ,$8.09 ,$7.64 ,$7.64 ,$7.64 ,$7.91 ,$7.64 ,$7.91 ,$7.91 ,$7.82 ,$7.64 ,$7.64 ,$7.64 ,$6.87 ,$8.09
Carle Richland Memorial Hospital,8980636,methylPREDNISolone acetate 40 mg/mL suspension for injection,703003101,J1030,636,$64.16 ,$64.16 ,$49.02 ,$57.74 ,$54.54 ,$54.54 ,$54.54 ,$56.46 ,$54.54 ,$56.46 ,$56.46 ,$55.82 ,$54.54 ,$54.54 ,$54.54 ,$49.02 ,$57.74
Carle Richland Memorial Hospital,8980636,methylPREDNISolone acetate 80 mg/mL suspension for injection,703005101,J1040,636,$103.27 ,$103.27 ,$78.90 ,$92.94 ,$87.78 ,$87.78 ,$87.78 ,$90.88 ,$87.78 ,$90.88 ,$90.88 ,$89.84 ,$87.78 ,$87.78 ,$87.78 ,$78.90 ,$92.94
Carle Richland Memorial Hospital,8980636,"methylPREDNISolone sod succ (PF) 1,000 mg/8 mL intravenous solution",9001820,J2930,636,$370.85 ,$370.85 ,$283.33 ,$333.77 ,$315.22 ,$315.22 ,$315.22 ,$326.35 ,$315.22 ,$326.35 ,$326.35 ,$322.64 ,$315.22 ,$315.22 ,$315.22 ,$283.33 ,$333.77
Carle Richland Memorial Hospital,8980636,methylPREDNISolone sod succ (PF) 125 mg/2 mL solution for injection,9004703,J2930,636,$74.44 ,$74.44 ,$56.87 ,$67.00 ,$63.27 ,$63.27 ,$63.27 ,$65.51 ,$63.27 ,$65.51 ,$65.51 ,$64.76 ,$63.27 ,$63.27 ,$63.27 ,$56.87 ,$67.00
Carle Richland Memorial Hospital,8980636,methylPREDNISolone sod succ (PF) 40 mg/mL solution for injection,9003905,J2920,636,$47.52 ,$47.52 ,$36.31 ,$42.77 ,$40.39 ,$40.39 ,$40.39 ,$41.82 ,$40.39 ,$41.82 ,$41.82 ,$41.34 ,$40.39 ,$40.39 ,$40.39 ,$36.31 ,$42.77
Carle Richland Memorial Hospital,8980636,methylPREDNISolone sod succ (PF) 500 mg/4 mL intravenous solution,9000302,J2930,636,$266.60 ,$266.60 ,$203.68 ,$239.94 ,$226.61 ,$226.61 ,$226.61 ,$234.61 ,$226.61 ,$234.61 ,$234.61 ,$231.94 ,$226.61 ,$226.61 ,$226.61 ,$203.68 ,$239.94
Carle Richland Memorial Hospital,8980636,methylPREDNISolone sodium succinate 125 mg solution for injection,63323025803,J2930,636,$84.76 ,$84.76 ,$64.76 ,$76.28 ,$72.05 ,$72.05 ,$72.05 ,$74.59 ,$72.05 ,$74.59 ,$74.59 ,$73.74 ,$72.05 ,$72.05 ,$72.05 ,$64.76 ,$76.28
Carle Richland Memorial Hospital,8980636,methylPREDNISolone sodium succinate 500 mg intravenous solution,9075801,J2930,636,$173.09 ,$173.09 ,$132.24 ,$155.78 ,$147.13 ,$147.13 ,$147.13 ,$152.32 ,$147.13 ,$152.32 ,$152.32 ,$150.59 ,$147.13 ,$147.13 ,$147.13 ,$132.24 ,$155.78
Carle Richland Memorial Hospital,8980636,metoclopramide 5 mg/mL injection solution,409341401,J2765,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,metoclopramide 5 mg/mL injection solution,409341418,J2765,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,metoclopramide 5 mg/mL injection solution,703450201,J2765,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,metoclopramide 5 mg/mL injection solution,703450204,J2765,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,metoclopramide 5 mg/mL injection solution,703450281,J2765,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,metoclopramide 5 mg/mL injection solution,703450284,J2765,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,micafungin 100 mg intravenous solution,25021019110,J2248,636,"$1,109.77 ","$1,109.77 ",$847.86 ,$998.79 ,$943.30 ,$943.30 ,$943.30 ,$976.60 ,$943.30 ,$976.60 ,$976.60 ,$965.50 ,$943.30 ,$943.30 ,$943.30 ,$847.86 ,$998.79
Carle Richland Memorial Hospital,8980636,midazolam (PF) 2 mg/2 mL (1 mg/mL) injection syringe,409230622,j2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam (PF) 5 mg/mL injection solution,55390013801,,636,$145.61 ,$145.61 ,$111.25 ,$131.05 ,$123.77 ,$123.77 ,$123.77 ,$128.14 ,$123.77 ,$128.14 ,$128.14 ,$126.68 ,$123.77 ,$123.77 ,$123.77 ,$111.25 ,$131.05
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,409258705,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,641605701,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,641605725,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,641605901,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,641605910,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,641620925,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,63323041118,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 1 mg/mL injection solution,63323041125,J2250,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,midazolam 5 mg/mL injection solution,409259603,J2250,636,$145.61 ,$145.61 ,$111.25 ,$131.05 ,$123.77 ,$123.77 ,$123.77 ,$128.14 ,$123.77 ,$128.14 ,$128.14 ,$126.68 ,$123.77 ,$123.77 ,$123.77 ,$111.25 ,$131.05
Carle Richland Memorial Hospital,8980636,midazolam 5 mg/mL injection solution,641606010,J2250,636,$145.61 ,$145.61 ,$111.25 ,$131.05 ,$123.77 ,$123.77 ,$123.77 ,$128.14 ,$123.77 ,$128.14 ,$128.14 ,$126.68 ,$123.77 ,$123.77 ,$123.77 ,$111.25 ,$131.05
Carle Richland Memorial Hospital,8980636,midazolam 5 mg/mL injection solution,641606301,J2250,636,$145.61 ,$145.61 ,$111.25 ,$131.05 ,$123.77 ,$123.77 ,$123.77 ,$128.14 ,$123.77 ,$128.14 ,$128.14 ,$126.68 ,$123.77 ,$123.77 ,$123.77 ,$111.25 ,$131.05
Carle Richland Memorial Hospital,8980636,midazolam 5 mg/mL injection solution,63323041225,J2250,636,$145.61 ,$145.61 ,$111.25 ,$131.05 ,$123.77 ,$123.77 ,$123.77 ,$128.14 ,$123.77 ,$128.14 ,$128.14 ,$126.68 ,$123.77 ,$123.77 ,$123.77 ,$111.25 ,$131.05
Carle Richland Memorial Hospital,8980636,milrinone 20 mg/100 mL(200 mcg/mL) in 5 % dextrose intravenous piggybk,143971901,J2260,636,$109.32 ,$109.32 ,$83.52 ,$98.39 ,$92.92 ,$92.92 ,$92.92 ,$96.20 ,$92.92 ,$96.20 ,$96.20 ,$95.11 ,$92.92 ,$92.92 ,$92.92 ,$83.52 ,$98.39
Carle Richland Memorial Hospital,8980636,mitoMYcin 40 mg intravenous solution,67457052040,J9280,636,"$5,129.48 ","$5,129.48 ","$3,918.92 ","$4,616.53 ","$4,360.06 ","$4,360.06 ","$4,360.06 ","$4,513.94 ","$4,360.06 ","$4,513.94 ","$4,513.94 ","$4,462.65 ","$4,360.06 ","$4,360.06 ","$4,360.06 ","$3,918.92 ","$4,616.53 "
Carle Richland Memorial Hospital,8980636,morphine (PF) 0.5 mg/mL injection solution,409381412,,636,$52.85 ,$52.85 ,$40.38 ,$47.57 ,$44.92 ,$44.92 ,$44.92 ,$46.51 ,$44.92 ,$46.51 ,$46.51 ,$45.98 ,$44.92 ,$44.92 ,$44.92 ,$40.38 ,$47.57
Carle Richland Memorial Hospital,8980636,"morphine 10 mg/mL intravenous syringe,morphine 10 mg/mL intravenous solution,morphine 10 mg/mL injection syringe",641612701,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"morphine 10 mg/mL intravenous syringe,morphine 10 mg/mL intravenous solution,morphine 10 mg/mL injection syringe",641612725,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,morphine 2 mg/mL injection syringe,76045000401,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,morphine 2 mg/mL injection syringe,76045000411,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,morphine 2 mg/mL intravenous syringe,409189003,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"morphine 2 mg/mL intravenous syringe,morphine 2 mg/mL injection syringe,morphine 2 mg/mL injection solution",409189001,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"morphine 4 mg/mL injection solution,morphine 4 mg/mL injection syringe,morphine 4 mg/mL intravenous solution, morphine 4 mg/mL intravenous syringe",409189101,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,morphine 4 mg/mL intravenous syringe,409189101,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"morphine 4 mg/mL Syringe,morphine 4 mg/mL injection solution,morphine 4 mg/mL injection syringe,morphine 4 mg/mL intravenous solution",409189101,J2270,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,mycophenolate mofetil 250 mg capsule,51079072101,J7517,636,$20.80 ,$20.80 ,$15.89 ,$18.72 ,$17.68 ,$17.68 ,$17.68 ,$18.30 ,$17.68 ,$18.30 ,$18.30 ,$18.10 ,$17.68 ,$17.68 ,$17.68 ,$15.89 ,$18.72
Carle Richland Memorial Hospital,8980636,mycophenolate mofetil 250 mg capsule,51079072120,J7517,636,$20.80 ,$20.80 ,$15.89 ,$18.72 ,$17.68 ,$17.68 ,$17.68 ,$18.30 ,$17.68 ,$18.30 ,$18.30 ,$18.10 ,$17.68 ,$17.68 ,$17.68 ,$15.89 ,$18.72
Carle Richland Memorial Hospital,8980636,nalbuphine 10 mg/mL injection solution,409146301,J2300,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,nalbuphine 20 mg/mL injection solution,409146501,J2300,636,$47.11 ,$47.11 ,$35.99 ,$42.40 ,$40.04 ,$40.04 ,$40.04 ,$41.46 ,$40.04 ,$41.46 ,$41.46 ,$40.99 ,$40.04 ,$40.04 ,$40.04 ,$35.99 ,$42.40
Carle Richland Memorial Hospital,8980636,naloxone 0.4 mg/mL injection solution,409121925,J2310,636,$85.08 ,$85.08 ,$65.00 ,$76.57 ,$72.32 ,$72.32 ,$72.32 ,$74.87 ,$72.32 ,$74.87 ,$74.87 ,$74.02 ,$72.32 ,$72.32 ,$72.32 ,$65.00 ,$76.57
Carle Richland Memorial Hospital,8980636,naloxone 0.4 mg/mL injection solution,67457059900,J2310,636,$141.47 ,$141.47 ,$108.08 ,$127.32 ,$120.25 ,$120.25 ,$120.25 ,$124.49 ,$120.25 ,$124.49 ,$124.49 ,$123.08 ,$120.25 ,$120.25 ,$120.25 ,$108.08 ,$127.32
Carle Richland Memorial Hospital,8980636,naloxone 0.4 mg/mL injection solution,67457059902,J2310,636,$141.47 ,$141.47 ,$108.08 ,$127.32 ,$120.25 ,$120.25 ,$120.25 ,$124.49 ,$120.25 ,$124.49 ,$124.49 ,$123.08 ,$120.25 ,$120.25 ,$120.25 ,$108.08 ,$127.32
Carle Richland Memorial Hospital,8980636,naloxone 1 mg/mL injection syringe,76329346901,J2310,636,$118.64 ,$118.64 ,$90.64 ,$106.78 ,$100.84 ,$100.84 ,$100.84 ,$104.40 ,$100.84 ,$104.40 ,$104.40 ,$103.22 ,$100.84 ,$100.84 ,$100.84 ,$90.64 ,$106.78
Carle Richland Memorial Hospital,8980636,neostigmine methylsulfate 1 mg/mL intravenous solution,63323041536,J2710,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,octreotide acetate 100 mcg/mL injection solution,63323037604,J2354,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,octreotide acetate 500 mcg/mL injection solution,63323037701,J2354,636,$341.94 ,$341.94 ,$261.24 ,$307.75 ,$290.65 ,$290.65 ,$290.65 ,$300.91 ,$290.65 ,$300.91 ,$300.91 ,$297.49 ,$290.65 ,$290.65 ,$290.65 ,$261.24 ,$307.75
Carle Richland Memorial Hospital,8980636,OLANZapine 10 mg intramuscular solution,781910572,S0166,636,$85.68 ,$85.68 ,$65.46 ,$77.11 ,$72.83 ,$72.83 ,$72.83 ,$75.40 ,$72.83 ,$75.40 ,$75.40 ,$74.54 ,$72.83 ,$72.83 ,$72.83 ,$65.46 ,$77.11
Carle Richland Memorial Hospital,8980636,omalizumab 150 mg subcutaneous solution,50242004062,J2357,636,"$5,003.98 ","$5,003.98 ","$3,823.04 ","$4,503.58 ","$4,253.38 ","$4,253.38 ","$4,253.38 ","$4,403.50 ","$4,253.38 ","$4,403.50 ","$4,403.50 ","$4,353.46 ","$4,253.38 ","$4,253.38 ","$4,253.38 ","$3,823.04 ","$4,503.58 "
Carle Richland Memorial Hospital,8980636,omalizumab 150 mg/mL subcutaneous syringe,50242021501,J2357,636,"$5,003.98 ","$5,003.98 ","$3,823.04 ","$4,503.58 ","$4,253.38 ","$4,253.38 ","$4,253.38 ","$4,403.50 ","$4,253.38 ","$4,403.50 ","$4,403.50 ","$4,353.46 ","$4,253.38 ","$4,253.38 ","$4,253.38 ","$3,823.04 ","$4,503.58 "
Carle Richland Memorial Hospital,8980636,onabotulinumtoxinA (cosmetic) 100 unit intramuscular solution,23923201,J0585,636,"$2,734.54 ","$2,734.54 ","$2,089.19 ","$2,461.09 ","$2,324.36 ","$2,324.36 ","$2,324.36 ","$2,406.40 ","$2,324.36 ","$2,406.40 ","$2,406.40 ","$2,379.05 ","$2,324.36 ","$2,324.36 ","$2,324.36 ","$2,089.19 ","$2,461.09 "
Carle Richland Memorial Hospital,8980636,ondansetron 4 mg disintegrating tablet,68462015740,Q0162,636,$89.05 ,$89.05 ,$68.03 ,$80.15 ,$75.69 ,$75.69 ,$75.69 ,$78.36 ,$75.69 ,$78.36 ,$78.36 ,$77.47 ,$75.69 ,$75.69 ,$75.69 ,$68.03 ,$80.15
Carle Richland Memorial Hospital,8980636,ondansetron HCl (PF) 4 mg/2 mL injection solution,23155054842,J2405,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,ondansetron HCl (PF) 4 mg/2 mL injection solution,70860077602,J2405,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,orphenadrine citrate 30 mg/mL injection solution,17478053802,J2360,636,$132.63 ,$132.63 ,$101.33 ,$119.37 ,$112.74 ,$112.74 ,$112.74 ,$116.71 ,$112.74 ,$116.71 ,$116.71 ,$115.39 ,$112.74 ,$112.74 ,$112.74 ,$101.33 ,$119.37
Carle Richland Memorial Hospital,8980636,oxytocin 10 unit/mL injection solution,42023011625,J2590,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,oxytocin 10 unit/mL injection solution,63323001206,J2590,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,oxytocin 10 unit/mL injection solution,63323001230,J2590,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,oxytocin in lactated ringers 30 unit/500 mL intravenous solution,9999501525,J2590,636,$177.54 ,$177.54 ,$135.64 ,$159.79 ,$150.91 ,$150.91 ,$150.91 ,$156.24 ,$150.91 ,$156.24 ,$156.24 ,$154.46 ,$150.91 ,$150.91 ,$150.91 ,$135.64 ,$159.79
Carle Richland Memorial Hospital,8980636,pantoprazole 40 mg intravenous solution,8092351,C9113,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,pegfilgrastim 6 mg/0.6 mL subcutaneous syringe,55513019001,,636,"$18,119.44 ","$18,119.44 ","$13,843.25 ","$16,307.50 ","$15,401.52 ","$15,401.52 ","$15,401.52 ","$15,945.11 ","$15,401.52 ","$15,945.11 ","$15,945.11 ","$15,763.91 ","$15,401.52 ","$15,401.52 ","$15,401.52 ","$13,843.25 ","$16,307.50 "
Carle Richland Memorial Hospital,8980636,"penicillin G benzathine 1,200,000 unit/2 mL intramuscular syringe",60793070102,J0561,636,$302.91 ,$302.91 ,$231.42 ,$272.62 ,$257.47 ,$257.47 ,$257.47 ,$266.56 ,$257.47 ,$266.56 ,$266.56 ,$263.53 ,$257.47 ,$257.47 ,$257.47 ,$231.42 ,$272.62
Carle Richland Memorial Hospital,8980636,penicillin G potassium 5 million unit solution for injection,49042010,J2540,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,PHENobarbital sodium 130 mg/mL injection solution,641047725,J2560,636,$388.80 ,$388.80 ,$297.04 ,$349.92 ,$330.48 ,$330.48 ,$330.48 ,$342.14 ,$330.48 ,$342.14 ,$342.14 ,$338.26 ,$330.48 ,$330.48 ,$330.48 ,$297.04 ,$349.92
Carle Richland Memorial Hospital,8980636,phenylephrine 10 mg/mL injection solution,63323075101,J2370,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,phenytoin sodium 50 mg/mL intravenous solution,641049321,J1165,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"phytonadione (vitamin K1) 1 mg/0.5 mL injection solution,phytonadione (vitamin K1) 1 mg/0.5 mL injection syringe",409915701,,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,"phytonadione (vitamin K1) 1 mg/0.5 mL injection solution,phytonadione (vitamin K1) 1 mg/0.5 mL injection syringe",76329124001,,636,$175.62 ,$175.62 ,$134.17 ,$158.06 ,$149.28 ,$149.28 ,$149.28 ,$154.55 ,$149.28 ,$154.55 ,$154.55 ,$152.79 ,$149.28 ,$149.28 ,$149.28 ,$134.17 ,$158.06
Carle Richland Memorial Hospital,8980636,phytonadione (vitamin K1) 10 mg/mL injection solution,409915850,J3430,636,$91.18 ,$91.18 ,$69.66 ,$82.06 ,$77.50 ,$77.50 ,$77.50 ,$80.24 ,$77.50 ,$80.24 ,$80.24 ,$79.33 ,$77.50 ,$77.50 ,$77.50 ,$69.66 ,$82.06
Carle Richland Memorial Hospital,8980636,piperacillin-tazobactam 2.25 gram intravenous solution,70860012020,J2543,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,piperacillin-tazobactam 3.375 gram intravenous solution,63323098321,J2543,636,$131.82 ,$131.82 ,$100.71 ,$118.64 ,$112.05 ,$112.05 ,$112.05 ,$116.00 ,$112.05 ,$116.00 ,$116.00 ,$114.68 ,$112.05 ,$112.05 ,$112.05 ,$100.71 ,$118.64
Carle Richland Memorial Hospital,8980636,piperacillin-tazobactam 3.375 gram intravenous solution,63323098323,J2543,636,$131.82 ,$131.82 ,$100.71 ,$118.64 ,$112.05 ,$112.05 ,$112.05 ,$116.00 ,$112.05 ,$116.00 ,$116.00 ,$114.68 ,$112.05 ,$112.05 ,$112.05 ,$100.71 ,$118.64
Carle Richland Memorial Hospital,8980636,piperacillin-tazobactam 3.375 gram intravenous solution,781311395,J2543,636,$142.41 ,$142.41 ,$108.80 ,$128.17 ,$121.05 ,$121.05 ,$121.05 ,$125.32 ,$121.05 ,$125.32 ,$125.32 ,$123.90 ,$121.05 ,$121.05 ,$121.05 ,$108.80 ,$128.17
Carle Richland Memorial Hospital,8980636,piperacillin-tazobactam 4.5 gram intravenous solution,70860012250,J2543,636,$111.52 ,$111.52 ,$85.20 ,$100.37 ,$94.79 ,$94.79 ,$94.79 ,$98.14 ,$94.79 ,$98.14 ,$98.14 ,$97.02 ,$94.79 ,$94.79 ,$94.79 ,$85.20 ,$100.37
Carle Richland Memorial Hospital,8980636,pneumococcal 23 polyvalent vaccine 25 mcg/0.5 mL injection solution,6494300,90732,636,$260.48 ,$260.48 ,$199.01 ,$234.43 ,$221.41 ,$221.41 ,$221.41 ,$229.22 ,$221.41 ,$229.22 ,$229.22 ,$226.62 ,$221.41 ,$221.41 ,$221.41 ,$199.01 ,$234.43
Carle Richland Memorial Hospital,8980636,pneumococcal 23 polyvalent vaccine 25 mcg/0.5 mL injection syringe,6483703,90732,636,$260.48 ,$260.48 ,$199.01 ,$234.43 ,$221.41 ,$221.41 ,$221.41 ,$229.22 ,$221.41 ,$229.22 ,$229.22 ,$226.62 ,$221.41 ,$221.41 ,$221.41 ,$199.01 ,$234.43
Carle Richland Memorial Hospital,8980636,potassium chloride 10 mEq/50 mL in sterile water intravenous piggyback,338070541,J3480,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,potassium chloride 2 mEq/mL intravenous solution,63323096502,J3480,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,potassium chloride 2 mEq/mL intravenous solution,63323096510,J3480,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,potassium chloride 20 mEq/L in 0.45 % sodium chloride intravenous soln,990925739,J3480,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,potassium chloride 20 mEq/L in 0.9 % sodium chloride intravenous,264786500,J3480,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,"prednisoLONE 15 mg/5 mL oral solution,prednisoLONE sodium phosphate 15 mg/5 mL (3 mg/mL) oral solution",121075908,J7510,636,$431.83 ,$431.83 ,$329.92 ,$388.65 ,$367.06 ,$367.06 ,$367.06 ,$380.01 ,$367.06 ,$380.01 ,$380.01 ,$375.69 ,$367.06 ,$367.06 ,$367.06 ,$329.92 ,$388.65
Carle Richland Memorial Hospital,8980636,"prednisoLONE sodium phosphate 15 mg/5 mL Oral Soln,prednisoLONE 15 mg/5 mL oral solution",9999040078,,636,$21.02 ,$21.02 ,$16.06 ,$18.92 ,$17.87 ,$17.87 ,$17.87 ,$18.50 ,$17.87 ,$18.50 ,$18.50 ,$18.29 ,$17.87 ,$17.87 ,$17.87 ,$16.06 ,$18.92
Carle Richland Memorial Hospital,8980636,predniSONE 1 mg tablet,54873925,,636,$3.63 ,$3.63 ,$2.77 ,$3.27 ,$3.09 ,$3.09 ,$3.09 ,$3.19 ,$3.09 ,$3.19 ,$3.19 ,$3.16 ,$3.09 ,$3.09 ,$3.09 ,$2.77 ,$3.27
Carle Richland Memorial Hospital,8980636,predniSONE 10 mg tablet,60687013411,,636,$3.32 ,$3.32 ,$2.54 ,$2.99 ,$2.82 ,$2.82 ,$2.82 ,$2.92 ,$2.82 ,$2.92 ,$2.92 ,$2.89 ,$2.82 ,$2.82 ,$2.82 ,$2.54 ,$2.99
Carle Richland Memorial Hospital,8980636,predniSONE 20 mg tablet,60687014501,,636,$3.43 ,$3.43 ,$2.62 ,$3.09 ,$2.92 ,$2.92 ,$2.92 ,$3.02 ,$2.92 ,$3.02 ,$3.02 ,$2.98 ,$2.92 ,$2.92 ,$2.92 ,$2.62 ,$3.09
Carle Richland Memorial Hospital,8980636,predniSONE 20 mg tablet,60687014511,,636,$3.43 ,$3.43 ,$2.62 ,$3.09 ,$2.92 ,$2.92 ,$2.92 ,$3.02 ,$2.92 ,$3.02 ,$3.02 ,$2.98 ,$2.92 ,$2.92 ,$2.92 ,$2.62 ,$3.09
Carle Richland Memorial Hospital,8980636,predniSONE 20 mg tablet,54001820,,636,$3.66 ,$3.66 ,$2.80 ,$3.29 ,$3.11 ,$3.11 ,$3.11 ,$3.22 ,$3.11 ,$3.22 ,$3.22 ,$3.18 ,$3.11 ,$3.11 ,$3.11 ,$2.80 ,$3.29
Carle Richland Memorial Hospital,8980636,predniSONE 5 mg tablet,60687012201,,636,$3.27 ,$3.27 ,$2.50 ,$2.94 ,$2.78 ,$2.78 ,$2.78 ,$2.88 ,$2.78 ,$2.88 ,$2.88 ,$2.84 ,$2.78 ,$2.78 ,$2.78 ,$2.50 ,$2.94
Carle Richland Memorial Hospital,8980636,predniSONE 5 mg tablet,60687012211,,636,$3.27 ,$3.27 ,$2.50 ,$2.94 ,$2.78 ,$2.78 ,$2.78 ,$2.88 ,$2.78 ,$2.88 ,$2.88 ,$2.84 ,$2.78 ,$2.78 ,$2.78 ,$2.50 ,$2.94
Carle Richland Memorial Hospital,8980636,prochlorperazine Edisylate 10 mg/2 mL (5 mg/mL) injection solution,70860077841,J0780,636,$47.75 ,$47.75 ,$36.48 ,$42.98 ,$40.59 ,$40.59 ,$40.59 ,$42.02 ,$40.59 ,$42.02 ,$42.02 ,$41.54 ,$40.59 ,$40.59 ,$40.59 ,$36.48 ,$42.98
Carle Richland Memorial Hospital,8980636,prochlorperazine maleate 10 mg tablet,59746011506,Q0164,636,$6.49 ,$6.49 ,$4.96 ,$5.84 ,$5.52 ,$5.52 ,$5.52 ,$5.71 ,$5.52 ,$5.71 ,$5.71 ,$5.65 ,$5.52 ,$5.52 ,$5.52 ,$4.96 ,$5.84
Carle Richland Memorial Hospital,8980636,prochlorperazine maleate 10 mg tablet,51079054201,Q0164,636,$6.86 ,$6.86 ,$5.24 ,$6.17 ,$5.83 ,$5.83 ,$5.83 ,$6.04 ,$5.83 ,$6.04 ,$6.04 ,$5.97 ,$5.83 ,$5.83 ,$5.83 ,$5.24 ,$6.17
Carle Richland Memorial Hospital,8980636,promethazine 25 mg/mL injection solution,641620801,J2550,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,promethazine 6.25 mg/5 mL oral syrup,50383080116,Q0169,636,$9.32 ,$9.32 ,$7.12 ,$8.39 ,$7.92 ,$7.92 ,$7.92 ,$8.20 ,$7.92 ,$8.20 ,$8.20 ,$8.11 ,$7.92 ,$7.92 ,$7.92 ,$7.12 ,$8.39
Carle Richland Memorial Hospital,8980636,propofoL 10 mg/mL intravenous emulsion,63323026994,,636,$20.26 ,$20.26 ,$15.48 ,$18.23 ,$17.22 ,$17.22 ,$17.22 ,$17.83 ,$17.22 ,$17.83 ,$17.83 ,$17.63 ,$17.22 ,$17.22 ,$17.22 ,$15.48 ,$18.23
Carle Richland Memorial Hospital,8980636,propofoL 10 mg/mL intravenous emulsion,409469933,,636,$78.29 ,$78.29 ,$59.81 ,$70.46 ,$66.55 ,$66.55 ,$66.55 ,$68.90 ,$66.55 ,$68.90 ,$68.90 ,$68.11 ,$66.55 ,$66.55 ,$66.55 ,$59.81 ,$70.46
Carle Richland Memorial Hospital,8980636,propofoL 10 mg/mL intravenous emulsion,409469924,,636,$153.07 ,$153.07 ,$116.95 ,$137.76 ,$130.11 ,$130.11 ,$130.11 ,$134.70 ,$130.11 ,$134.70 ,$134.70 ,$133.17 ,$130.11 ,$130.11 ,$130.11 ,$116.95 ,$137.76
Carle Richland Memorial Hospital,8980636,Propofol 10 mg/mL IV,63323026929,,636,$45.30 ,$45.30 ,$34.61 ,$40.77 ,$38.51 ,$38.51 ,$38.51 ,$39.86 ,$38.51 ,$39.86 ,$39.86 ,$39.41 ,$38.51 ,$38.51 ,$38.51 ,$34.61 ,$40.77
Carle Richland Memorial Hospital,8980636,propranoloL 1 mg/mL intravenous solution,143987210,J1800,636,$59.27 ,$59.27 ,$45.28 ,$53.34 ,$50.38 ,$50.38 ,$50.38 ,$52.16 ,$50.38 ,$52.16 ,$52.16 ,$51.56 ,$50.38 ,$50.38 ,$50.38 ,$45.28 ,$53.34
Carle Richland Memorial Hospital,8980636,protamine 10 mg/mL intravenous solution,63323022941,J2720,636,$71.79 ,$71.79 ,$54.85 ,$64.61 ,$61.02 ,$61.02 ,$61.02 ,$63.18 ,$61.02 ,$63.18 ,$63.18 ,$62.46 ,$61.02 ,$61.02 ,$61.02 ,$54.85 ,$64.61
Carle Richland Memorial Hospital,8980636,protamine 10 mg/mL intravenous solution,63323022994,J2720,636,$71.79 ,$71.79 ,$54.85 ,$64.61 ,$61.02 ,$61.02 ,$61.02 ,$63.18 ,$61.02 ,$63.18 ,$63.18 ,$62.46 ,$61.02 ,$61.02 ,$61.02 ,$54.85 ,$64.61
Carle Richland Memorial Hospital,8980636,rabies immune globulin (PF) 300 unit/mL intramuscular solution,13533031801,90375,636,"$1,491.60 ","$1,491.60 ","$1,139.58 ","$1,342.44 ","$1,267.86 ","$1,267.86 ","$1,267.86 ","$1,312.61 ","$1,267.86 ","$1,312.61 ","$1,312.61 ","$1,297.69 ","$1,267.86 ","$1,267.86 ","$1,267.86 ","$1,139.58 ","$1,342.44 "
Carle Richland Memorial Hospital,8980636,rabies immune globulin (PF) 300 unit/mL intramuscular solution,13533031805,90375,636,"$7,457.96 ","$7,457.96 ","$5,697.88 ","$6,712.16 ","$6,339.27 ","$6,339.27 ","$6,339.27 ","$6,563.00 ","$6,339.27 ","$6,563.00 ","$6,563.00 ","$6,488.43 ","$6,339.27 ","$6,339.27 ","$6,339.27 ","$5,697.88 ","$6,712.16 "
Carle Richland Memorial Hospital,8980636,"rabies vaccine, purified chicken embryo cell (PF) 2.5 unit IM susp",58160096412,90675,636,$803.13 ,$803.13 ,$613.59 ,$722.82 ,$682.66 ,$682.66 ,$682.66 ,$706.75 ,$682.66 ,$706.75 ,$706.75 ,$698.72 ,$682.66 ,$682.66 ,$682.66 ,$613.59 ,$722.82
Carle Richland Memorial Hospital,8980636,regadenoson 0.4 mg/5 mL intravenous syringe,469650189,J2785,636,"$1,436.73 ","$1,436.73 ","$1,097.66 ","$1,293.06 ","$1,221.22 ","$1,221.22 ","$1,221.22 ","$1,264.32 ","$1,221.22 ","$1,264.32 ","$1,264.32 ","$1,249.96 ","$1,221.22 ","$1,221.22 ","$1,221.22 ","$1,097.66 ","$1,293.06 "
Carle Richland Memorial Hospital,8980636,"rho(D) immune globulin 1,500 unit (300 mcg) intramuscular syringe",562780500,J2790,636,$563.63 ,$563.63 ,$430.61 ,$507.27 ,$479.09 ,$479.09 ,$479.09 ,$495.99 ,$479.09 ,$495.99 ,$495.99 ,$490.36 ,$479.09 ,$479.09 ,$479.09 ,$430.61 ,$507.27
Carle Richland Memorial Hospital,8980636,ropivacaine (PF) 2 mg/mL (0.2 %) injection solution,409930020,J2795,636,$0.70 ,$0.70 ,$0.53 ,$0.63 ,$0.60 ,$0.60 ,$0.60 ,$0.62 ,$0.60 ,$0.62 ,$0.62 ,$0.61 ,$0.60 ,$0.60 ,$0.60 ,$0.53 ,$0.63
Carle Richland Memorial Hospital,8980636,ropivacaine (PF) 2 mg/mL (0.2 %) injection solution,409930021,J2795,636,$0.70 ,$0.70 ,$0.53 ,$0.63 ,$0.60 ,$0.60 ,$0.60 ,$0.62 ,$0.60 ,$0.62 ,$0.62 ,$0.61 ,$0.60 ,$0.60 ,$0.60 ,$0.53 ,$0.63
Carle Richland Memorial Hospital,8980636,ropivacaine (PF) 2 mg/mL (0.2 %) injection solution,409930020,J2795,636,$27.94 ,$27.94 ,$21.35 ,$25.15 ,$23.75 ,$23.75 ,$23.75 ,$24.59 ,$23.75 ,$24.59 ,$24.59 ,$24.31 ,$23.75 ,$23.75 ,$23.75 ,$21.35 ,$25.15
Carle Richland Memorial Hospital,8980636,ropivacaine (PF) 2 mg/mL (0.2 %) injection solution,409930021,J2795,636,$27.94 ,$27.94 ,$21.35 ,$25.15 ,$23.75 ,$23.75 ,$23.75 ,$24.59 ,$23.75 ,$24.59 ,$24.59 ,$24.31 ,$23.75 ,$23.75 ,$23.75 ,$21.35 ,$25.15
Carle Richland Memorial Hospital,8980636,ropivacaine (PF) 2 mg/mL (0.2 %) injection solution,25021067182,J2795,636,$273.45 ,$273.45 ,$208.92 ,$246.11 ,$232.43 ,$232.43 ,$232.43 ,$240.64 ,$232.43 ,$240.64 ,$240.64 ,$237.90 ,$232.43 ,$232.43 ,$232.43 ,$208.92 ,$246.11
Carle Richland Memorial Hospital,8980636,ropivacaine (PF) 5 mg/mL (0.5 %) injection solution,409930131,J2795,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,sildenafiL (pulmonary hypertension) 20 mg tablet,60687041611,J3490,636,$78.94 ,$78.94 ,$60.31 ,$71.05 ,$67.10 ,$67.10 ,$67.10 ,$69.47 ,$67.10 ,$69.47 ,$69.47 ,$68.68 ,$67.10 ,$67.10 ,$67.10 ,$60.31 ,$71.05
Carle Richland Memorial Hospital,8980636,sildenafiL (pulmonary hypertension) 20 mg tablet,60687041621,J3490,636,$78.94 ,$78.94 ,$60.31 ,$71.05 ,$67.10 ,$67.10 ,$67.10 ,$69.47 ,$67.10 ,$69.47 ,$69.47 ,$68.68 ,$67.10 ,$67.10 ,$67.10 ,$60.31 ,$71.05
Carle Richland Memorial Hospital,8980636,sincalide 5 mcg solution for injection,270055615,J2805,636,$629.81 ,$629.81 ,$481.17 ,$566.83 ,$535.34 ,$535.34 ,$535.34 ,$554.23 ,$535.34 ,$554.23 ,$554.23 ,$547.93 ,$535.34 ,$535.34 ,$535.34 ,$481.17 ,$566.83
Carle Richland Memorial Hospital,8980636,sodium chloride 0.45 % intravenous solution,264780210,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.45 % intravenous solution,338004304,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.45 % intravenous solution,990798509,J7040,636,$453.97 ,$453.97 ,$346.83 ,$408.57 ,$385.87 ,$385.87 ,$385.87 ,$399.49 ,$385.87 ,$399.49 ,$399.49 ,$394.95 ,$385.87 ,$385.87 ,$385.87 ,$346.83 ,$408.57
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % injection solution,63323018601,J7040,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,264180032,J7030,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,264780000,J7030,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,990798423,J7030,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,264180031,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,264780010,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,990798303,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,264780020,J7050,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % intravenous solution,990798302,J7050,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,264180032,J7030,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,264780000,J7030,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,409798437,J7030,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,990798423,J7030,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,264180031,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,264780010,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,409798303,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,264780020,J7050,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 0.9 % IV,990798302,J7050,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium chloride 3 % intravenous injection solution,338005403,J7040,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,sodium hyaluronate 10 mg/mL intra-articular syringe,50016095721,,636,"$1,520.74 ","$1,520.74 ","$1,161.85 ","$1,368.67 ","$1,292.63 ","$1,292.63 ","$1,292.63 ","$1,338.25 ","$1,292.63 ","$1,338.25 ","$1,338.25 ","$1,323.04 ","$1,292.63 ","$1,292.63 ","$1,292.63 ","$1,161.85 ","$1,368.67 "
Carle Richland Memorial Hospital,8980636,succinylcholine chloride 20 mg/mL injection solution,69918070001,J0330,636,$76.03 ,$76.03 ,$58.09 ,$68.43 ,$64.63 ,$64.63 ,$64.63 ,$66.91 ,$64.63 ,$66.91 ,$66.91 ,$66.15 ,$64.63 ,$64.63 ,$64.63 ,$58.09 ,$68.43
Carle Richland Memorial Hospital,8980636,SUMAtriptan 6 mg/0.5 mL subcutaneous solution,55150017301,J3030,636,$419.64 ,$419.64 ,$320.60 ,$377.68 ,$356.69 ,$356.69 ,$356.69 ,$369.28 ,$356.69 ,$369.28 ,$369.28 ,$365.09 ,$356.69 ,$356.69 ,$356.69 ,$320.60 ,$377.68
Carle Richland Memorial Hospital,8980636,"tacrolimus 0.5 mg capsule, immediate-release",68084044901,J7507,636,$12.72 ,$12.72 ,$9.72 ,$11.45 ,$10.81 ,$10.81 ,$10.81 ,$11.19 ,$10.81 ,$11.19 ,$11.19 ,$11.07 ,$10.81 ,$10.81 ,$10.81 ,$9.72 ,$11.45
Carle Richland Memorial Hospital,8980636,"tacrolimus 0.5 mg capsule, immediate-release",68084044911,J7507,636,$12.72 ,$12.72 ,$9.72 ,$11.45 ,$10.81 ,$10.81 ,$10.81 ,$11.19 ,$10.81 ,$11.19 ,$11.19 ,$11.07 ,$10.81 ,$10.81 ,$10.81 ,$9.72 ,$11.45
Carle Richland Memorial Hospital,8980636,tamoxifen 10 mg tablet,591247260,J8999,636,$13.49 ,$13.49 ,$10.31 ,$12.14 ,$11.47 ,$11.47 ,$11.47 ,$11.87 ,$11.47 ,$11.87 ,$11.87 ,$11.74 ,$11.47 ,$11.47 ,$11.47 ,$10.31 ,$12.14
Carle Richland Memorial Hospital,8980636,tenecteplase 50 mg intravenous solution,50242012047,J3101,636,"$13,703.45 ","$13,703.45 ","$10,469.44 ","$12,333.11 ","$11,647.93 ","$11,647.93 ","$11,647.93 ","$12,059.04 ","$11,647.93 ","$12,059.04 ","$12,059.04 ","$11,922.00 ","$11,647.93 ","$11,647.93 ","$11,647.93 ","$10,469.44 ","$12,333.11 "
Carle Richland Memorial Hospital,8980636,terbutaline 1 mg/mL subcutaneous solution,63323066501,J3105,636,$129.04 ,$129.04 ,$98.59 ,$116.14 ,$109.68 ,$109.68 ,$109.68 ,$113.56 ,$109.68 ,$113.56 ,$113.56 ,$112.26 ,$109.68 ,$109.68 ,$109.68 ,$98.59 ,$116.14
Carle Richland Memorial Hospital,8980636,testosterone cypionate 200 mg/mL intramuscular oil,409656222,J1071,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,tetanus immune globulin (PF) 250 unit intramuscular syringe,13533063402,,636,"$1,299.77 ","$1,299.77 ",$993.02 ,"$1,169.79 ","$1,104.80 ","$1,104.80 ","$1,104.80 ","$1,143.80 ","$1,104.80 ","$1,143.80 ","$1,143.80 ","$1,130.80 ","$1,104.80 ","$1,104.80 ","$1,104.80 ",$993.02 ,"$1,169.79 "
Carle Richland Memorial Hospital,8980636,thiamine HCl (vitamin B1) 100 mg/mL injection solution,63323001326,J3411,636,$21.68 ,$21.68 ,$16.56 ,$19.51 ,$18.43 ,$18.43 ,$18.43 ,$19.08 ,$18.43 ,$19.08 ,$19.08 ,$18.86 ,$18.43 ,$18.43 ,$18.43 ,$16.56 ,$19.51
Carle Richland Memorial Hospital,8980636,thyrotropin alfa 0.9 mg intramuscular solution,58468003002,J3240,636,"$7,577.26 ","$7,577.26 ","$5,789.03 ","$6,819.53 ","$6,440.67 ","$6,440.67 ","$6,440.67 ","$6,667.99 ","$6,440.67 ","$6,667.99 ","$6,667.99 ","$6,592.22 ","$6,440.67 ","$6,440.67 ","$6,440.67 ","$5,789.03 ","$6,819.53 "
Carle Richland Memorial Hospital,8980636,tigecycline 50 mg intravenous solution,8499019,J3243,636,$943.61 ,$943.61 ,$720.92 ,$849.25 ,$802.07 ,$802.07 ,$802.07 ,$830.38 ,$802.07 ,$830.38 ,$830.38 ,$820.94 ,$802.07 ,$802.07 ,$802.07 ,$720.92 ,$849.25
Carle Richland Memorial Hospital,8980636,tobramycin 300 mg/5 mL in 0.225 % sodium chloride for nebulization,781717184,J7682,636,$143.36 ,$143.36 ,$109.53 ,$129.02 ,$121.86 ,$121.86 ,$121.86 ,$126.16 ,$121.86 ,$126.16 ,$126.16 ,$124.72 ,$121.86 ,$121.86 ,$121.86 ,$109.53 ,$129.02
Carle Richland Memorial Hospital,8980636,tobramycin 40 mg/mL injection solution,63323030626,J3260,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,tocilizumab 200 mg/10 mL (20 mg/mL) intravenous solution,50242013601,J3262,636,"$6,511.09 ","$6,511.09 ","$4,974.47 ","$5,859.98 ","$5,534.43 ","$5,534.43 ","$5,534.43 ","$5,729.76 ","$5,534.43 ","$5,729.76 ","$5,729.76 ","$5,664.65 ","$5,534.43 ","$5,534.43 ","$5,534.43 ","$4,974.47 ","$5,859.98 "
Carle Richland Memorial Hospital,8980636,tocilizumab 400 mg/20 mL (20 mg/mL) intravenous solution,50242013701,J3262,636,"$12,958.10 ","$12,958.10 ","$9,899.99 ","$11,662.29 ","$11,014.39 ","$11,014.39 ","$11,014.39 ","$11,403.13 ","$11,014.39 ","$11,403.13 ","$11,403.13 ","$11,273.55 ","$11,014.39 ","$11,014.39 ","$11,014.39 ","$9,899.99 ","$11,662.29 "
Carle Richland Memorial Hospital,8980636,tocilizumab 80 mg/4 mL (20 mg/mL) intravenous solution,50242013501,J3262,636,"$2,642.88 ","$2,642.88 ","$2,019.16 ","$2,378.59 ","$2,246.45 ","$2,246.45 ","$2,246.45 ","$2,325.73 ","$2,246.45 ","$2,325.73 ","$2,325.73 ","$2,299.31 ","$2,246.45 ","$2,246.45 ","$2,246.45 ","$2,019.16 ","$2,378.59 "
Carle Richland Memorial Hospital,8980636,triamcinolone acetonide (PF) 40 mg/mL intraocular suspension,65054301,J3300,636,$16.96 ,$16.96 ,$12.96 ,$15.26 ,$14.42 ,$14.42 ,$14.42 ,$14.92 ,$14.42 ,$14.92 ,$14.92 ,$14.76 ,$14.42 ,$14.42 ,$14.42 ,$12.96 ,$15.26
Carle Richland Memorial Hospital,8980636,triamcinolone acetonide 40 mg/mL suspension for injection,3029320,J3301,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,triamcinolone acetonide 40 mg/mL suspension for injection,70121104905,J3301,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,triamcinolone acetonide 40 mg/mL suspension for injection,70121116901,J3301,636,$44.27 ,$44.27 ,$33.82 ,$39.84 ,$37.63 ,$37.63 ,$37.63 ,$38.96 ,$37.63 ,$38.96 ,$38.96 ,$38.51 ,$37.63 ,$37.63 ,$37.63 ,$33.82 ,$39.84
Carle Richland Memorial Hospital,8980636,tuberculin PPD 5 tub. unit/0.1 mL intradermal injection solution,49281075221,86580,636,$19.96 ,$19.96 ,$15.25 ,$17.96 ,$16.97 ,$16.97 ,$16.97 ,$17.56 ,$16.97 ,$17.56 ,$17.56 ,$17.37 ,$16.97 ,$16.97 ,$16.97 ,$15.25 ,$17.96
Carle Richland Memorial Hospital,8980636,"vancomycin 1,000 mg intravenous injection",63323028441,J3370,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,vancomycin 5 gram intravenous solution,63323029566,J3370,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,vancomycin 500 mg intravenous solution,72611076110,J3370,636,$87.36 ,$87.36 ,$66.74 ,$78.62 ,$74.26 ,$74.26 ,$74.26 ,$76.88 ,$74.26 ,$76.88 ,$76.88 ,$76.00 ,$74.26 ,$74.26 ,$74.26 ,$66.74 ,$78.62
Carle Richland Memorial Hospital,8980636,vancomycin 750 mg intravenous solution,63323020326,J3370,636,$87.89 ,$87.89 ,$67.15 ,$79.10 ,$74.71 ,$74.71 ,$74.71 ,$77.34 ,$74.71 ,$77.34 ,$77.34 ,$76.46 ,$74.71 ,$74.71 ,$74.71 ,$67.15 ,$79.10
Carle Richland Memorial Hospital,8980636,vancomycin 750 mg intravenous solution,63323020320,J3370,636,$101.30 ,$101.30 ,$77.39 ,$91.17 ,$86.11 ,$86.11 ,$86.11 ,$89.14 ,$86.11 ,$89.14 ,$89.14 ,$88.13 ,$86.11 ,$86.11 ,$86.11 ,$77.39 ,$91.17
Carle Richland Memorial Hospital,8980636,"varicella virus vaccine live (PF) 1,350 unit/0.5 mL subcutaneous susp",6482701,90716,636,$335.61 ,$335.61 ,$256.41 ,$302.05 ,$285.27 ,$285.27 ,$285.27 ,$295.34 ,$285.27 ,$295.34 ,$295.34 ,$291.98 ,$285.27 ,$285.27 ,$285.27 ,$256.41 ,$302.05
Carle Richland Memorial Hospital,8980636,vedolizumab 300 mg intravenous solution,64764030020,,636,"$25,497.36 ","$25,497.36 ","$19,479.98 ","$22,947.62 ","$21,672.76 ","$21,672.76 ","$21,672.76 ","$22,437.68 ","$21,672.76 ","$22,437.68 ","$22,437.68 ","$22,182.70 ","$21,672.76 ","$21,672.76 ","$21,672.76 ","$19,479.98 ","$22,947.62 "
Carle Richland Memorial Hospital,8980636,zidovudine 10 mg/mL intravenous solution,49702021301,J3485,636,$238.77 ,$238.77 ,$182.42 ,$214.89 ,$202.95 ,$202.95 ,$202.95 ,$210.12 ,$202.95 ,$210.12 ,$210.12 ,$207.73 ,$202.95 ,$202.95 ,$202.95 ,$182.42 ,$214.89
Carle Richland Memorial Hospital,8980636,ziprasidone 20 mg/mL (final concentration) intramuscular solution,49120301,J3486,636,$343.04 ,$343.04 ,$262.08 ,$308.74 ,$291.58 ,$291.58 ,$291.58 ,$301.88 ,$291.58 ,$301.88 ,$301.88 ,$298.44 ,$291.58 ,$291.58 ,$291.58 ,$262.08 ,$308.74
Carle Richland Memorial Hospital,8980636,ziprasidone 20 mg/mL (final concentration) intramuscular solution,49120310,J3486,636,$343.04 ,$343.04 ,$262.08 ,$308.74 ,$291.58 ,$291.58 ,$291.58 ,$301.88 ,$291.58 ,$301.88 ,$301.88 ,$298.44 ,$291.58 ,$291.58 ,$291.58 ,$262.08 ,$308.74
Carle Richland Memorial Hospital,8980636,zoledronic acid 4 mg/100 mL-mannitol-0.9 % NaCl intravenous piggyback,25021082682,J3489,636,"$1,260.52 ","$1,260.52 ",$963.04 ,"$1,134.47 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,109.26 ","$1,071.44 ","$1,109.26 ","$1,109.26 ","$1,096.65 ","$1,071.44 ","$1,071.44 ","$1,071.44 ",$963.04 ,"$1,134.47 "
Carle Richland Memorial Hospital,8980636,zoledronic acid 5 mg/100 mL in mannitoL 5 %-water intravenous piggybck,55111068852,J3489,636,"$2,098.60 ","$2,098.60 ","$1,603.33 ","$1,888.74 ","$1,783.81 ","$1,783.81 ","$1,783.81 ","$1,846.77 ","$1,783.81 ","$1,846.77 ","$1,846.77 ","$1,825.78 ","$1,783.81 ","$1,783.81 ","$1,783.81 ","$1,603.33 ","$1,888.74 "
Carle Richland Memorial Hospital,8980637,amoxicillin 250 mg-potassium clavulanate 62.5 mg/5 mL oral suspension,60432006575,,637,$32.10 ,$32.10 ,$24.52 ,$28.89 ,$27.29 ,$27.29 ,$27.29 ,$28.25 ,$27.29 ,$28.25 ,$28.25 ,$27.93 ,$27.29 ,$27.29 ,$27.29 ,$24.52 ,$28.89
Carle Richland Memorial Hospital,8980637,apixaban 2.5 mg tablet,3089331,,637,$43.09 ,$43.09 ,$32.92 ,$38.78 ,$36.63 ,$36.63 ,$36.63 ,$37.92 ,$36.63 ,$37.92 ,$37.92 ,$37.49 ,$36.63 ,$36.63 ,$36.63 ,$32.92 ,$38.78
Carle Richland Memorial Hospital,8980637,apixaban 5 mg tablet,3089431,,637,$43.09 ,$43.09 ,$32.92 ,$38.78 ,$36.63 ,$36.63 ,$36.63 ,$37.92 ,$36.63 ,$37.92 ,$37.92 ,$37.49 ,$36.63 ,$36.63 ,$36.63 ,$32.92 ,$38.78
Carle Richland Memorial Hospital,8980637,atorvastatin 20 mg tablet,68084009811,,637,$6.32 ,$6.32 ,$4.83 ,$5.69 ,$5.37 ,$5.37 ,$5.37 ,$5.56 ,$5.37 ,$5.56 ,$5.56 ,$5.50 ,$5.37 ,$5.37 ,$5.37 ,$4.83 ,$5.69
Carle Richland Memorial Hospital,8980637,balsalazide 750 mg capsule,378675082,,637,$9.77 ,$9.77 ,$7.46 ,$8.79 ,$8.30 ,$8.30 ,$8.30 ,$8.60 ,$8.30 ,$8.60 ,$8.60 ,$8.50 ,$8.30 ,$8.30 ,$8.30 ,$7.46 ,$8.79
Carle Richland Memorial Hospital,8980637,bromfenac 0.09 % eye drops,62332050817,,637,"$1,016.72 ","$1,016.72 ",$776.77 ,$915.05 ,$864.21 ,$864.21 ,$864.21 ,$894.71 ,$864.21 ,$894.71 ,$894.71 ,$884.55 ,$864.21 ,$864.21 ,$864.21 ,$776.77 ,$915.05
Carle Richland Memorial Hospital,8980637,cefpodoxime 100 mg tablet,65862009520,,637,$31.73 ,$31.73 ,$24.24 ,$28.56 ,$26.97 ,$26.97 ,$26.97 ,$27.92 ,$26.97 ,$27.92 ,$27.92 ,$27.61 ,$26.97 ,$26.97 ,$26.97 ,$24.24 ,$28.56
Carle Richland Memorial Hospital,8980637,dronedarone 400 mg tablet,24414210,,637,$54.24 ,$54.24 ,$41.44 ,$48.82 ,$46.10 ,$46.10 ,$46.10 ,$47.73 ,$46.10 ,$47.73 ,$47.73 ,$47.19 ,$46.10 ,$46.10 ,$46.10 ,$41.44 ,$48.82
Carle Richland Memorial Hospital,8980637,gatifloxacin 0.5 % eye drops,50383018902,,637,$17.47 ,$17.47 ,$13.35 ,$15.72 ,$14.85 ,$14.85 ,$14.85 ,$15.37 ,$14.85 ,$15.37 ,$15.37 ,$15.20 ,$14.85 ,$14.85 ,$14.85 ,$13.35 ,$15.72
Carle Richland Memorial Hospital,8980637,haloperidoL 2 mg tablet,378021401,,637,$5.28 ,$5.28 ,$4.03 ,$4.75 ,$4.49 ,$4.49 ,$4.49 ,$4.65 ,$4.49 ,$4.65 ,$4.65 ,$4.59 ,$4.49 ,$4.49 ,$4.49 ,$4.03 ,$4.75
Carle Richland Memorial Hospital,8980637,hydroCHLOROthiazide 12.5 mg capsule,29300013001,,637,$4.31 ,$4.31 ,$3.29 ,$3.88 ,$3.66 ,$3.66 ,$3.66 ,$3.79 ,$3.66 ,$3.79 ,$3.79 ,$3.75 ,$3.66 ,$3.66 ,$3.66 ,$3.29 ,$3.88
Carle Richland Memorial Hospital,8980637,hydroCHLOROthiazide 12.5 mg capsule,51079077620,,637,$4.31 ,$4.31 ,$3.29 ,$3.88 ,$3.66 ,$3.66 ,$3.66 ,$3.79 ,$3.66 ,$3.79 ,$3.79 ,$3.75 ,$3.66 ,$3.66 ,$3.66 ,$3.29 ,$3.88
Carle Richland Memorial Hospital,8980637,HYDROcodone 10 mg-chlorpheniramine 8 mg/5 mL oral susp extend.rel 12hr,9999054867,,637,$23.43 ,$23.43 ,$17.90 ,$21.09 ,$19.92 ,$19.92 ,$19.92 ,$20.62 ,$19.92 ,$20.62 ,$20.62 ,$20.38 ,$19.92 ,$19.92 ,$19.92 ,$17.90 ,$21.09
Carle Richland Memorial Hospital,8980637,leflunomide 20 mg tablet,62332006230,,637,$67.91 ,$67.91 ,$51.88 ,$61.12 ,$57.72 ,$57.72 ,$57.72 ,$59.76 ,$57.72 ,$59.76 ,$59.76 ,$59.08 ,$57.72 ,$57.72 ,$57.72 ,$51.88 ,$61.12
Carle Richland Memorial Hospital,8980637,levETIRAcetam 250 mg tablet,68084085901,,637,$5.12 ,$5.12 ,$3.91 ,$4.61 ,$4.35 ,$4.35 ,$4.35 ,$4.51 ,$4.35 ,$4.51 ,$4.51 ,$4.45 ,$4.35 ,$4.35 ,$4.35 ,$3.91 ,$4.61
Carle Richland Memorial Hospital,8980637,mineral oil topical,54162018516,,637,$25.48 ,$25.48 ,$19.47 ,$22.93 ,$21.66 ,$21.66 ,$21.66 ,$22.42 ,$21.66 ,$22.42 ,$22.42 ,$22.17 ,$21.66 ,$21.66 ,$21.66 ,$19.47 ,$22.93
Carle Richland Memorial Hospital,8980637,QUEtiapine 100 mg tablet,60687034901,,637,$30.82 ,$30.82 ,$23.55 ,$27.74 ,$26.20 ,$26.20 ,$26.20 ,$27.12 ,$26.20 ,$27.12 ,$27.12 ,$26.81 ,$26.20 ,$26.20 ,$26.20 ,$23.55 ,$27.74
Carle Richland Memorial Hospital,8980637,QUEtiapine 100 mg tablet,60687034911,,637,$30.82 ,$30.82 ,$23.55 ,$27.74 ,$26.20 ,$26.20 ,$26.20 ,$27.12 ,$26.20 ,$27.12 ,$27.12 ,$26.81 ,$26.20 ,$26.20 ,$26.20 ,$23.55 ,$27.74
Carle Richland Memorial Hospital,8980637,QUEtiapine 100 mg tablet,310027110,,637,$36.15 ,$36.15 ,$27.62 ,$32.54 ,$30.73 ,$30.73 ,$30.73 ,$31.81 ,$30.73 ,$31.81 ,$31.81 ,$31.45 ,$30.73 ,$30.73 ,$30.73 ,$27.62 ,$32.54
Carle Richland Memorial Hospital,8190052,ODSC BASE RECOVERY - PHASE 2,,,710,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,8190152,ODSC PER 15 MIN RECOVERY - PHASE 2,,,710,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8120050,PACU BASE RECOVERY - PHASE 1,,,710,$950.00 ,$950.00 ,$725.80 ,$855.00 ,$807.50 ,$807.50 ,$807.50 ,$836.00 ,$807.50 ,$836.00 ,$836.00 ,$826.50 ,$807.50 ,$807.50 ,$807.50 ,$725.80 ,$855.00
Carle Richland Memorial Hospital,8120150,PACU PER 15 MIN RECOVERY - PHASE 1,,,710,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,8010710,POST CESAREAN RECOVERY,,,710,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,8029412,ANTEPARTUM MANIPULATION EXT. VERSION,,59412,720,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,8027039,HOME WHIRLPOOL SPA TREATMENT W/ATTENDANT,,97039,720,$68.00 ,$68.00 ,$51.95 ,$61.20 ,$57.80 ,$57.80 ,$57.80 ,$59.84 ,$57.80 ,$59.84 ,$59.84 ,$59.16 ,$57.80 ,$57.80 ,$57.80 ,$51.95 ,$61.20
Carle Richland Memorial Hospital,8027056,LABOR ROOM 31-60 MINUTES,,G0463,721,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8027057,LABOR ROOM 1-2 HOURS,,G0463,721,"$1,030.00 ","$1,030.00 ",$786.92 ,$927.00 ,$875.50 ,$875.50 ,$875.50 ,$906.40 ,$875.50 ,$906.40 ,$906.40 ,$896.10 ,$875.50 ,$875.50 ,$875.50 ,$786.92 ,$927.00
Carle Richland Memorial Hospital,8027058,LABOR ROOM 2-4 HOURS,,G0463,721,"$1,080.00 ","$1,080.00 ",$825.12 ,$972.00 ,$918.00 ,$918.00 ,$918.00 ,$950.40 ,$918.00 ,$950.40 ,$950.40 ,$939.60 ,$918.00 ,$918.00 ,$918.00 ,$825.12 ,$972.00
Carle Richland Memorial Hospital,8027059,LABOR ROOM 4-6 HOURS,,G0463,721,"$1,150.00 ","$1,150.00 ",$878.60 ,"$1,035.00 ",$977.50 ,$977.50 ,$977.50 ,"$1,012.00 ",$977.50 ,"$1,012.00 ","$1,012.00 ","$1,000.50 ",$977.50 ,$977.50 ,$977.50 ,$878.60 ,"$1,035.00 "
Carle Richland Memorial Hospital,8027061,LABOR ROOM 6-8 HOURS,,G0463,721,"$1,210.00 ","$1,210.00 ",$924.44 ,"$1,089.00 ","$1,028.50 ","$1,028.50 ","$1,028.50 ","$1,064.80 ","$1,028.50 ","$1,064.80 ","$1,064.80 ","$1,052.70 ","$1,028.50 ","$1,028.50 ","$1,028.50 ",$924.44 ,"$1,089.00 "
Carle Richland Memorial Hospital,8027062,LABOR ROOM 8-10 HOURS,,G0463,721,"$1,290.00 ","$1,290.00 ",$985.56 ,"$1,161.00 ","$1,096.50 ","$1,096.50 ","$1,096.50 ","$1,135.20 ","$1,096.50 ","$1,135.20 ","$1,135.20 ","$1,122.30 ","$1,096.50 ","$1,096.50 ","$1,096.50 ",$985.56 ,"$1,161.00 "
Carle Richland Memorial Hospital,8027063,LABOR ROOM 10-14 HOURS,,G0463,721,"$1,370.00 ","$1,370.00 ","$1,046.68 ","$1,233.00 ","$1,164.50 ","$1,164.50 ","$1,164.50 ","$1,205.60 ","$1,164.50 ","$1,205.60 ","$1,205.60 ","$1,191.90 ","$1,164.50 ","$1,164.50 ","$1,164.50 ","$1,046.68 ","$1,233.00 "
Carle Richland Memorial Hospital,8027064,LABOR ROOM 14 + HOURS,,G0463,721,"$1,620.00 ","$1,620.00 ","$1,237.68 ","$1,458.00 ","$1,377.00 ","$1,377.00 ","$1,377.00 ","$1,425.60 ","$1,377.00 ","$1,425.60 ","$1,425.60 ","$1,409.40 ","$1,377.00 ","$1,377.00 ","$1,377.00 ","$1,237.68 ","$1,458.00 "
Carle Richland Memorial Hospital,8027050,HIGH RISK,,,721,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,8027051,INTERMEDIATE RISK,,,721,$410.00 ,$410.00 ,$313.24 ,$369.00 ,$348.50 ,$348.50 ,$348.50 ,$360.80 ,$348.50 ,$360.80 ,$360.80 ,$356.70 ,$348.50 ,$348.50 ,$348.50 ,$313.24 ,$369.00
Carle Richland Memorial Hospital,8027052,LABOR ROOM,,G0463,721,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,8027060,CIRCUMCISION,,,723,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,8027070,DELIVERY ROOM & ROUTINE SUPPL,,,724,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,8493005,ELECTROCARDIOGRAM TRACING ONLY,,93005,730,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,8493041,RHYTHM ECG TRACING ONLY,,93041,730,$215.00 ,$215.00 ,$164.26 ,$193.50 ,$182.75 ,$182.75 ,$182.75 ,$189.20 ,$182.75 ,$189.20 ,$189.20 ,$187.05 ,$182.75 ,$182.75 ,$182.75 ,$164.26 ,$193.50
Carle Richland Memorial Hospital,8293270,XTRNL PT ACTIV ECG TRANSMIS RECORDING 30 DAYS,,93270,731,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,8293271,"EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT",,93271,731,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,8493226,"EXT ECG RECORD CONTIN 48 HR, SCAN ANALYSIS W REPORT",,93226,731,$920.00 ,$920.00 ,$702.88 ,$828.00 ,$782.00 ,$782.00 ,$782.00 ,$809.60 ,$782.00 ,$809.60 ,$809.60 ,$800.40 ,$782.00 ,$782.00 ,$782.00 ,$702.88 ,$828.00
Carle Richland Memorial Hospital,8493271,ECG/MONITORING AND ANALYSIS,,93271,731,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,8493225,CARDIAC HOLTER 24 HR MNTR RCRDNG,,93225,731,"$2,680.00 ","$2,680.00 ","$2,047.52 ","$2,412.00 ","$2,278.00 ","$2,278.00 ","$2,278.00 ","$2,358.40 ","$2,278.00 ","$2,358.40 ","$2,358.40 ","$2,331.60 ","$2,278.00 ","$2,278.00 ","$2,278.00 ","$2,047.52 ","$2,412.00 "
Carle Richland Memorial Hospital,8493270,CARDIO DIARY MEM TRC STRPS RCRDNG,,93270,731,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,8495700,EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS,,95700,740,$930.00 ,$930.00 ,$710.52 ,$837.00 ,$790.50 ,$790.50 ,$790.50 ,$818.40 ,$790.50 ,$818.40 ,$818.40 ,$809.10 ,$790.50 ,$790.50 ,$790.50 ,$710.52 ,$837.00
Carle Richland Memorial Hospital,8495819,ELECTROENCEPHALOGRAM,,95819,740,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,8495955,EEG DURING NON-INTRACRANIAL SURG,,95955,740,"$1,360.00 ","$1,360.00 ","$1,039.04 ","$1,224.00 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,196.80 ","$1,156.00 ","$1,196.80 ","$1,196.80 ","$1,183.20 ","$1,156.00 ","$1,156.00 ","$1,156.00 ","$1,039.04 ","$1,224.00 "
Carle Richland Memorial Hospital,8935810,ALL NIGHT POLYSOMNOGRAPHY,,95810,740,"$5,170.00 ","$5,170.00 ","$3,949.88 ","$4,653.00 ","$4,394.50 ","$4,394.50 ","$4,394.50 ","$4,549.60 ","$4,394.50 ","$4,549.60 ","$4,549.60 ","$4,497.90 ","$4,394.50 ","$4,394.50 ","$4,394.50 ","$3,949.88 ","$4,653.00 "
Carle Richland Memorial Hospital,8935811,ALL NIGHT POLYSOMNOGRAM W/CPAP,,95811,740,"$4,460.00 ","$4,460.00 ","$3,407.44 ","$4,014.00 ","$3,791.00 ","$3,791.00 ","$3,791.00 ","$3,924.80 ","$3,791.00 ","$3,924.80 ","$3,924.80 ","$3,880.20 ","$3,791.00 ","$3,791.00 ","$3,791.00 ","$3,407.44 ","$4,014.00 "
Carle Richland Memorial Hospital,8650027,INTUBATION,,31500,761,$930.00 ,$930.00 ,$710.52 ,$837.00 ,$790.50 ,$790.50 ,$790.50 ,$818.40 ,$790.50 ,$818.40 ,$818.40 ,$809.10 ,$790.50 ,$790.50 ,$790.50 ,$710.52 ,$837.00
Carle Richland Memorial Hospital,8940016,MIDLINE INSERTION,,36410,761,"$1,880.00 ","$1,880.00 ","$1,436.32 ","$1,692.00 ","$1,598.00 ","$1,598.00 ","$1,598.00 ","$1,654.40 ","$1,598.00 ","$1,654.40 ","$1,654.40 ","$1,635.60 ","$1,598.00 ","$1,598.00 ","$1,598.00 ","$1,436.32 ","$1,692.00 "
Carle Richland Memorial Hospital,8449082,ABD PARACENTESIS W/O IMAGING GUIDANCE,,49082,761,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,8449083,ABD PARACENTESIS W/ IMAGING GUIDANCE,,49083,761,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,8420606,ASP/INJ INTERMEDIATE JOINT/BURSA W/US GUIDANCE,,20606,761,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,8420611,ASP/INJ MAJOR JOINT/BURSA W/US GUIDANCE,,20611,761,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,8432400,"BIOPSY, PLEURA PERC NEEDLE",,32400,761,"$1,640.00 ","$1,640.00 ","$1,252.96 ","$1,476.00 ","$1,394.00 ","$1,394.00 ","$1,394.00 ","$1,443.20 ","$1,394.00 ","$1,443.20 ","$1,443.20 ","$1,426.80 ","$1,394.00 ","$1,394.00 ","$1,394.00 ","$1,252.96 ","$1,476.00 "
Carle Richland Memorial Hospital,8420206,"BIOPSY, MUSCLE",,20206,761,"$1,440.00 ","$1,440.00 ","$1,100.16 ","$1,296.00 ","$1,224.00 ","$1,224.00 ","$1,224.00 ","$1,267.20 ","$1,224.00 ","$1,267.20 ","$1,267.20 ","$1,252.80 ","$1,224.00 ","$1,224.00 ","$1,224.00 ","$1,100.16 ","$1,296.00 "
Carle Richland Memorial Hospital,8432405,"BIOPSY,LUNG/MEDIASTINUM,PERC",,32405,761,"$1,960.00 ","$1,960.00 ","$1,497.44 ","$1,764.00 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,724.80 ","$1,666.00 ","$1,724.80 ","$1,724.80 ","$1,705.20 ","$1,666.00 ","$1,666.00 ","$1,666.00 ","$1,497.44 ","$1,764.00 "
Carle Richland Memorial Hospital,8438221,BONE MARROW BX ONLY,,38221,761,$440.00 ,$440.00 ,$336.16 ,$396.00 ,$374.00 ,$374.00 ,$374.00 ,$387.20 ,$374.00 ,$387.20 ,$387.20 ,$382.80 ,$374.00 ,$374.00 ,$374.00 ,$336.16 ,$396.00
Carle Richland Memorial Hospital,8438505,"NEEDLE BIOPSY, LYMPH NODES",,38505,761,"$1,490.00 ","$1,490.00 ","$1,138.36 ","$1,341.00 ","$1,266.50 ","$1,266.50 ","$1,266.50 ","$1,311.20 ","$1,266.50 ","$1,311.20 ","$1,311.20 ","$1,296.30 ","$1,266.50 ","$1,266.50 ","$1,266.50 ","$1,138.36 ","$1,341.00 "
Carle Richland Memorial Hospital,8447000,"BIOSPY OF LIVER, PERCUTANEOUS",,47000,761,"$1,160.00 ","$1,160.00 ",$886.24 ,"$1,044.00 ",$986.00 ,$986.00 ,$986.00 ,"$1,020.80 ",$986.00 ,"$1,020.80 ","$1,020.80 ","$1,009.20 ",$986.00 ,$986.00 ,$986.00 ,$886.24 ,"$1,044.00 "
Carle Richland Memorial Hospital,8449180,"BIOSPY,ABDOMINAL, PERC NEEDLE",,49180,761,"$1,260.00 ","$1,260.00 ",$962.64 ,"$1,134.00 ","$1,071.00 ","$1,071.00 ","$1,071.00 ","$1,108.80 ","$1,071.00 ","$1,108.80 ","$1,108.80 ","$1,096.20 ","$1,071.00 ","$1,071.00 ","$1,071.00 ",$962.64 ,"$1,134.00 "
Carle Richland Memorial Hospital,8462270,LUMBAR PUNCTURE,,62270,761,"$1,010.00 ","$1,010.00 ",$771.64 ,$909.00 ,$858.50 ,$858.50 ,$858.50 ,$888.80 ,$858.50 ,$888.80 ,$888.80 ,$878.70 ,$858.50 ,$858.50 ,$858.50 ,$771.64 ,$909.00
Carle Richland Memorial Hospital,8462284,"INJ FOR MYELOGRAPHY,SPINAL",,62284,761,"$2,270.00 ","$2,270.00 ","$1,734.28 ","$2,043.00 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,997.60 ","$1,929.50 ","$1,997.60 ","$1,997.60 ","$1,974.90 ","$1,929.50 ","$1,929.50 ","$1,929.50 ","$1,734.28 ","$2,043.00 "
Carle Richland Memorial Hospital,8464483,"INJ,FORAMEN,L/S,1 LEVEL",,64483,761,"$1,170.00 ","$1,170.00 ",$893.88 ,"$1,053.00 ",$994.50 ,$994.50 ,$994.50 ,"$1,029.60 ",$994.50 ,"$1,029.60 ","$1,029.60 ","$1,017.90 ",$994.50 ,$994.50 ,$994.50 ,$893.88 ,"$1,053.00 "
Carle Richland Memorial Hospital,8425246,INJ PROC WRIST ARTHROGRAPHY,,25246,761,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8427093,INJ PROC HIP ARTHROGRAPHY W/O ANES,,27093,761,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8419000,PUNCTURE ASPRTN CYST OF BREAST,,19000,761,"$1,620.00 ","$1,620.00 ","$1,237.68 ","$1,458.00 ","$1,377.00 ","$1,377.00 ","$1,377.00 ","$1,425.60 ","$1,377.00 ","$1,425.60 ","$1,425.60 ","$1,409.40 ","$1,377.00 ","$1,377.00 ","$1,377.00 ","$1,237.68 ","$1,458.00 "
Carle Richland Memorial Hospital,8419001,"PUNCTURE ASPRTN CYST OF BREAST, EA ADDTNL",,19001,761,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,8460100,BX THYROID PERCUT CORE NEEDLE,,60100,761,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,8424220,INJ PROC ELBOW ARTHROGRAPHY,,24220,761,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8458340,CATH/INJECT HYSTEROSALPINGOGRAM,,58340,761,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8432554,THORACENTESIS W/O IMAGING,,32554,761,"$1,040.00 ","$1,040.00 ",$794.56 ,$936.00 ,$884.00 ,$884.00 ,$884.00 ,$915.20 ,$884.00 ,$915.20 ,$915.20 ,$904.80 ,$884.00 ,$884.00 ,$884.00 ,$794.56 ,$936.00
Carle Richland Memorial Hospital,8432555,THORACENTESIS W/IMAGING,,32555,761,"$1,150.00 ","$1,150.00 ",$878.60 ,"$1,035.00 ",$977.50 ,$977.50 ,$977.50 ,"$1,012.00 ",$977.50 ,"$1,012.00 ","$1,012.00 ","$1,000.50 ",$977.50 ,$977.50 ,$977.50 ,$878.60 ,"$1,035.00 "
Carle Richland Memorial Hospital,8438792,INJ PRC ID SENTINAL NODE,,38792,761,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,8420610,ASP/INJ MAJOR JOINT/BURSA W/O US GUIDANCE,,20610,761,$930.00 ,$930.00 ,$710.52 ,$837.00 ,$790.50 ,$790.50 ,$790.50 ,$818.40 ,$790.50 ,$818.40 ,$818.40 ,$809.10 ,$790.50 ,$790.50 ,$790.50 ,$710.52 ,$837.00
Carle Richland Memorial Hospital,8420600,ASP/INJ SMALL JOINT/BURSA W/O US GUIDANCE,,20600,761,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,8449465,EVALUATN GI-OSTOMY TUBE,,49465,761,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8451600,INJ PRC CYSTGRPHY/URETHCYSTGRPHY,,51600,761,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,8459000,AMNIOCENTESIS DIAGNOSTIC,,59000,761,"$1,010.00 ","$1,010.00 ",$771.64 ,$909.00 ,$858.50 ,$858.50 ,$858.50 ,$888.80 ,$858.50 ,$888.80 ,$888.80 ,$878.70 ,$858.50 ,$858.50 ,$858.50 ,$771.64 ,$909.00
Carle Richland Memorial Hospital,8420501,INJECT SINUS TRACT FOR DX,,20501,761,$425.00 ,$425.00 ,$324.70 ,$382.50 ,$361.25 ,$361.25 ,$361.25 ,$374.00 ,$361.25 ,$374.00 ,$374.00 ,$369.75 ,$361.25 ,$361.25 ,$361.25 ,$324.70 ,$382.50
Carle Richland Memorial Hospital,8451610,INJ FOR RETROGRD URETHOCYSTGRPHY,,51610,761,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,8026591,COLLCTN BLD SPCMN FROM VAD,,36591,761,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,8455700,"BX PROSTATE NEEDLE OR PUNCH, SINGL OR MULT",,55700,761,"$4,470.00 ","$4,470.00 ","$3,415.08 ","$4,023.00 ","$3,799.50 ","$3,799.50 ","$3,799.50 ","$3,933.60 ","$3,799.50 ","$3,933.60 ","$3,933.60 ","$3,888.90 ","$3,799.50 ","$3,799.50 ","$3,799.50 ","$3,415.08 ","$4,023.00 "
Carle Richland Memorial Hospital,8464450,"INJECT NERV BLCK,OTHR PERIPH NERV",,64450,761,$890.00 ,$890.00 ,$679.96 ,$801.00 ,$756.50 ,$756.50 ,$756.50 ,$783.20 ,$756.50 ,$783.20 ,$783.20 ,$774.30 ,$756.50 ,$756.50 ,$756.50 ,$679.96 ,$801.00
Carle Richland Memorial Hospital,8419281,PLC BRST LCLZTN DVC PERQ; 1RST LSN INCL MAMMO,,19281,761,"$1,920.00 ","$1,920.00 ","$1,466.88 ","$1,728.00 ","$1,632.00 ","$1,632.00 ","$1,632.00 ","$1,689.60 ","$1,632.00 ","$1,689.60 ","$1,689.60 ","$1,670.40 ","$1,632.00 ","$1,632.00 ","$1,632.00 ","$1,466.88 ","$1,728.00 "
Carle Richland Memorial Hospital,8419282,PLC BRST LCLZTN DVC PERQ; EA ADD LSN INCL MAMMO,,19282,761,$640.00 ,$640.00 ,$488.96 ,$576.00 ,$544.00 ,$544.00 ,$544.00 ,$563.20 ,$544.00 ,$563.20 ,$563.20 ,$556.80 ,$544.00 ,$544.00 ,$544.00 ,$488.96 ,$576.00
Carle Richland Memorial Hospital,8449406,"IMG GUIDE CATH FLD CLCTN PERI/RETRO, PERQ",,49406,761,"$3,420.00 ","$3,420.00 ","$2,612.88 ","$3,078.00 ","$2,907.00 ","$2,907.00 ","$2,907.00 ","$3,009.60 ","$2,907.00 ","$3,009.60 ","$3,009.60 ","$2,975.40 ","$2,907.00 ","$2,907.00 ","$2,907.00 ","$2,612.88 ","$3,078.00 "
Carle Richland Memorial Hospital,8419081,"BRST BX W/PLC LCL DVC STEREOTACTIC GUIDE, 1RST LSN",,19081,761,"$6,690.00 ","$6,690.00 ","$5,111.16 ","$6,021.00 ","$5,686.50 ","$5,686.50 ","$5,686.50 ","$5,887.20 ","$5,686.50 ","$5,887.20 ","$5,887.20 ","$5,820.30 ","$5,686.50 ","$5,686.50 ","$5,686.50 ","$5,111.16 ","$6,021.00 "
Carle Richland Memorial Hospital,8419083,"BRST BX W/PLC LCL DVC US GUIDE, 1RST LSN",,19083,761,"$3,130.00 ","$3,130.00 ","$2,391.32 ","$2,817.00 ","$2,660.50 ","$2,660.50 ","$2,660.50 ","$2,754.40 ","$2,660.50 ","$2,754.40 ","$2,754.40 ","$2,723.10 ","$2,660.50 ","$2,660.50 ","$2,660.50 ","$2,391.32 ","$2,817.00 "
Carle Richland Memorial Hospital,8419084,"BRST BX W/PLC LCL DC US GUIDE, EA ADD LSN",,19084,761,"$1,910.00 ","$1,910.00 ","$1,459.24 ","$1,719.00 ","$1,623.50 ","$1,623.50 ","$1,623.50 ","$1,680.80 ","$1,623.50 ","$1,680.80 ","$1,680.80 ","$1,661.70 ","$1,623.50 ","$1,623.50 ","$1,623.50 ","$1,459.24 ","$1,719.00 "
Carle Richland Memorial Hospital,8449405,"IMG GUIDE CATH FLD CLCTN VISCERAL, PERQ",,49405,761,"$2,540.00 ","$2,540.00 ","$1,940.56 ","$2,286.00 ","$2,159.00 ","$2,159.00 ","$2,159.00 ","$2,235.20 ","$2,159.00 ","$2,235.20 ","$2,235.20 ","$2,209.80 ","$2,159.00 ","$2,159.00 ","$2,159.00 ","$1,940.56 ","$2,286.00 "
Carle Richland Memorial Hospital,8427648,INJ PROC FOR ANKLE ARTHROGRAPHY,,27648,761,$455.00 ,$455.00 ,$347.62 ,$409.50 ,$386.75 ,$386.75 ,$386.75 ,$400.40 ,$386.75 ,$400.40 ,$400.40 ,$395.85 ,$386.75 ,$386.75 ,$386.75 ,$347.62 ,$409.50
Carle Richland Memorial Hospital,8420550,INJECT TENDON SHEATH/LIGAMENT,,20550,761,"$1,540.00 ","$1,540.00 ","$1,176.56 ","$1,386.00 ","$1,309.00 ","$1,309.00 ","$1,309.00 ","$1,355.20 ","$1,309.00 ","$1,355.20 ","$1,355.20 ","$1,339.80 ","$1,309.00 ","$1,309.00 ","$1,309.00 ","$1,176.56 ","$1,386.00 "
Carle Richland Memorial Hospital,8410005,FINE NEEDLE ASPIRATION BX W/US GDN 1ST LSN,,10005,761,"$1,000.00 ","$1,000.00 ",$764.00 ,$900.00 ,$850.00 ,$850.00 ,$850.00 ,$880.00 ,$850.00 ,$880.00 ,$880.00 ,$870.00 ,$850.00 ,$850.00 ,$850.00 ,$764.00 ,$900.00
Carle Richland Memorial Hospital,8021701,STRAIGHT CATH FOR PVR/DRAINAGE (NOT UA),,51701,761,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,8401001,Cdsm evicore,,G1001,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401002,Cdsm medcurrent,,G1002,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401003,Cdsm medicalis,,G1003,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401004,Cdsm ndsc,,G1004,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401007,Cdsm aim,,G1007,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401008,Cdsm cranberry pk,,G1008,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401009,Cdsm sage health,,G1009,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401010,Cdsm stanson,,G1010,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401011,Cdsm qualified nos,,G1011,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8029921,VISIT LEVEL 1,,G0463,761,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,8029212,VISIT LEVEL 2,,G0463,761,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,8029213,VISIT LEVEL 3,,G0463,761,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8029214,VISIT LEVEL 4,,G0463,761,$290.00 ,$290.00 ,$221.56 ,$261.00 ,$246.50 ,$246.50 ,$246.50 ,$255.20 ,$246.50 ,$255.20 ,$255.20 ,$252.30 ,$246.50 ,$246.50 ,$246.50 ,$221.56 ,$261.00
Carle Richland Memorial Hospital,8029215,VISIT LEVEL 5,,G0463,761,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,8029760,WOUND VAC DRESSING CHANGE,,97605,761,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8401012,CDSM AGILEMD,,G1012,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401013,CDSM EVIDENCECARE IMAGING ADVISOR,,G1013,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401014,CDSM INVENIQA SEMANTIC ANSWERS IN MEDICINE,,G1014,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401015,CDSM RELIANT MEDICAL GROUP,,G1015,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401016,CDSM SPEED OF CARE,,G1016,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401017,CDSM HEALTHHELP,,G1017,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401018,CDSM INFINX,,G1018,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8401019,CDSM LOGICNETS,,G1019,761,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8009803,HOSPITAL OUTPT CLINIC VISIT SPECIMEN COLLECTION,,C9803,761,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,8432408,CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,,32408,761,"$3,040.00 ","$3,040.00 ","$2,322.56 ","$2,736.00 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,675.20 ","$2,584.00 ","$2,675.20 ","$2,675.20 ","$2,644.80 ","$2,584.00 ","$2,584.00 ","$2,584.00 ","$2,322.56 ","$2,736.00 "
Carle Richland Memorial Hospital,8455880,TRANSRECTAL ABLTJ MAL PRST8 TISSUE HIFU W/US,,55880,761,"$4,880.00 ","$4,880.00 ","$3,728.32 ","$4,392.00 ","$4,148.00 ","$4,148.00 ","$4,148.00 ","$4,294.40 ","$4,148.00 ","$4,294.40 ","$4,294.40 ","$4,245.60 ","$4,148.00 ","$4,148.00 ","$4,148.00 ","$3,728.32 ","$4,392.00 "
Carle Richland Memorial Hospital,8423350,INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI,,23350,761,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8026360,HYDRATION IV INFUSN UP TO 1HR,,96360,761,$540.00 ,$540.00 ,$412.56 ,$486.00 ,$459.00 ,$459.00 ,$459.00 ,$475.20 ,$459.00 ,$475.20 ,$475.20 ,$469.80 ,$459.00 ,$459.00 ,$459.00 ,$412.56 ,$486.00
Carle Richland Memorial Hospital,8026361,HYDRATION IV INFUSION EA ADD H,,96361,761,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,8026365,IV INFUSION UP TO 1HR,,96365,761,$590.00 ,$590.00 ,$450.76 ,$531.00 ,$501.50 ,$501.50 ,$501.50 ,$519.20 ,$501.50 ,$519.20 ,$519.20 ,$513.30 ,$501.50 ,$501.50 ,$501.50 ,$450.76 ,$531.00
Carle Richland Memorial Hospital,8026366,IV INFUSION EA ADD HR,,96366,761,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,8026367,IV INFUSION SEQ -UP TO 1 HR,,96367,761,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8026368,IV INFUSION CONCURRENT,,96368,761,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8410160,"PUNCTURE ASPRTN ABCSS, HMTMA, BULLA, CYST",,10160,761,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,8026374,IV PUSH THER/DIAG MED,,96374,761,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8026375,IV PUSH EA ADD NEW DRUG,,96375,761,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,8026376,IV PUSH EA ADD SAME DRUG,,96376,761,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,8026523,IRRIGATN IMPLNTD VEN ACC DVC,,96523,761,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,8027610,URINARY CATHETER INSERTION,,51702,761,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,8027611,WOUND TREATMENT (VAC),,,761,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,8290471,ADMIN VACCINE,,90471,771,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,8020239,BAMLANIVIMAB-XXXX INFUSION,,M0239,771,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,8802390,BAMLANIVIMAB-XXXX INFUSION,,M0239,771,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,8020243,"INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB",,M0243,771,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,8802430,"INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB",,M0243,771,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,8020245,BAMLANIVIMAB AND ETESEVIMAB INFUSION,,M0245,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8802450,BAMLANIVIMAB AND ETESEVIMAB INFUSION,,M0245,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8200243,"INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB",,M0243,771,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,8020244,IV INF CASIRIVI AND IMDEVI,,M0244,771,"$1,350.00 ","$1,350.00 ","$1,031.40 ","$1,215.00 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,188.00 ","$1,147.50 ","$1,188.00 ","$1,188.00 ","$1,174.50 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,031.40 ","$1,215.00 "
Carle Richland Memorial Hospital,8820244,IV INF CASIRIVI AND IMDEVI,,M0244,771,"$1,350.00 ","$1,350.00 ","$1,031.40 ","$1,215.00 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,188.00 ","$1,147.50 ","$1,188.00 ","$1,188.00 ","$1,174.50 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,031.40 ","$1,215.00 "
Carle Richland Memorial Hospital,8200244,IV INF CASIRIVI AND IMDEVI,,M0244,771,"$1,350.00 ","$1,350.00 ","$1,031.40 ","$1,215.00 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,188.00 ","$1,147.50 ","$1,188.00 ","$1,188.00 ","$1,174.50 ","$1,147.50 ","$1,147.50 ","$1,147.50 ","$1,031.40 ","$1,215.00 "
Carle Richland Memorial Hospital,8200245,BAMLANIVIMAB AND ETESEVIMAB INFUSION,,M0245,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8020247,IV INF SOTORVIMAB,,M0247,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8820247,IV INF SOTORVIMAB,,M0247,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8200247,IV INF SOTORVIMAB,,M0247,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8020249,IV INF TOCILIZUMAB FIRST DOSE,,M0249,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8020250,IV INF TOCILIZUMAB SECOND DOSE,,M0250,771,$810.00 ,$810.00 ,$618.84 ,$729.00 ,$688.50 ,$688.50 ,$688.50 ,$712.80 ,$688.50 ,$712.80 ,$712.80 ,$704.70 ,$688.50 ,$688.50 ,$688.50 ,$618.84 ,$729.00
Carle Richland Memorial Hospital,8020009,ADMIN PNEUMONIA VACCINE,,G0009,771,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,8020008,ADMIN FLU VACCINE,,G0008,771,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,8020471,ADMIN VACCINE,,90471,771,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,8020472,ADMIN ADDTNL VACCINE,,90472,771,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8810471,ADMINISTER 1 VACCINE/TOXOID,,90471,771,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8890472,ADMINISTER ADNL VACCINE/TOXOID,,90472,771,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,8810472,ADMINISTER ADNL VACCINE/TOXOID,,90472,771,$95.00 ,$95.00 ,$72.58 ,$85.50 ,$80.75 ,$80.75 ,$80.75 ,$83.60 ,$80.75 ,$83.60 ,$83.60 ,$82.65 ,$80.75 ,$80.75 ,$80.75 ,$72.58 ,$85.50
Carle Richland Memorial Hospital,96127,BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT,,96127,900,$30.00 ,$30.00 ,$22.92 ,$27.00 ,$25.50 ,$25.50 ,$25.50 ,$26.40 ,$25.50 ,$26.40 ,$26.40 ,$26.10 ,$25.50 ,$25.50 ,$25.50 ,$22.92 ,$27.00
Carle Richland Memorial Hospital,90785,MEDICAL SERVICE,,90785,900,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,90791,MEDICAL SERVICE,,90791,900,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,90792,MEDICAL SERVICE,,90792,900,$520.00 ,$520.00 ,$397.28 ,$468.00 ,$442.00 ,$442.00 ,$442.00 ,$457.60 ,$442.00 ,$457.60 ,$457.60 ,$452.40 ,$442.00 ,$442.00 ,$442.00 ,$397.28 ,$468.00
Carle Richland Memorial Hospital,90832,MEDICAL SERVICE,,90832,900,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,90834,MEDICAL SERVICE,,90834,900,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,90837,MEDICAL SERVICE,,90837,900,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,90839,MEDICAL SERVICE,,90839,900,$400.00 ,$400.00 ,$305.60 ,$360.00 ,$340.00 ,$340.00 ,$340.00 ,$352.00 ,$340.00 ,$352.00 ,$352.00 ,$348.00 ,$340.00 ,$340.00 ,$340.00 ,$305.60 ,$360.00
Carle Richland Memorial Hospital,90840,MEDICAL SERVICE,,90840,900,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,90853,MEDICAL SERVICE,,90853,915,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,90846,MEDICAL SERVICE,,90846,916,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,90847,MEDICAL SERVICE,,90847,916,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,96112,DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR,,96112,918,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,96113,DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN,,96113,918,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,96121,NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR,,96121,918,$390.00 ,$390.00 ,$297.96 ,$351.00 ,$331.50 ,$331.50 ,$331.50 ,$343.20 ,$331.50 ,$343.20 ,$343.20 ,$339.30 ,$331.50 ,$331.50 ,$331.50 ,$297.96 ,$351.00
Carle Richland Memorial Hospital,96130,PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR,,96130,918,"$1,460.00 ","$1,460.00 ","$1,115.44 ","$1,314.00 ","$1,241.00 ","$1,241.00 ","$1,241.00 ","$1,284.80 ","$1,241.00 ","$1,284.80 ","$1,284.80 ","$1,270.20 ","$1,241.00 ","$1,241.00 ","$1,241.00 ","$1,115.44 ","$1,314.00 "
Carle Richland Memorial Hospital,96131,PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR,,96131,918,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,96132,NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR,,96132,918,"$1,460.00 ","$1,460.00 ","$1,115.44 ","$1,314.00 ","$1,241.00 ","$1,241.00 ","$1,241.00 ","$1,284.80 ","$1,241.00 ","$1,284.80 ","$1,284.80 ","$1,270.20 ","$1,241.00 ","$1,241.00 ","$1,241.00 ","$1,115.44 ","$1,314.00 "
Carle Richland Memorial Hospital,96133,NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR,,96133,918,$660.00 ,$660.00 ,$504.24 ,$594.00 ,$561.00 ,$561.00 ,$561.00 ,$580.80 ,$561.00 ,$580.80 ,$580.80 ,$574.20 ,$561.00 ,$561.00 ,$561.00 ,$504.24 ,$594.00
Carle Richland Memorial Hospital,96136,PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN,,96136,918,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,96137,PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN,,96137,918,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,96138,PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN,,96138,918,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,96139,PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN,,96139,918,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,96146,PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT,,96146,918,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,96110,DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM,,96110,918,$32.00 ,$32.00 ,$24.45 ,$28.80 ,$27.20 ,$27.20 ,$27.20 ,$28.16 ,$27.20 ,$28.16 ,$28.16 ,$27.84 ,$27.20 ,$27.20 ,$27.20 ,$24.45 ,$28.80
Carle Richland Memorial Hospital,96116,MEDICAL SERVICE,,96116,918,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,96160,PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM,,96160,918,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,96161,CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM,,96161,918,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,8029025,FETAL NON-STRESS TEST,,59025,920,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,95250,CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT,,95250,920,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,99173,"VISUAL SCREENING TEST, BILAT",,99173,920,$48.00 ,$48.00 ,$36.67 ,$43.20 ,$40.80 ,$40.80 ,$40.80 ,$42.24 ,$40.80 ,$42.24 ,$42.24 ,$41.76 ,$40.80 ,$40.80 ,$40.80 ,$36.67 ,$43.20
Carle Richland Memorial Hospital,95251,CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R,,95251,920,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8493979,DPLX SCN ARTA/IVC/ILAC LMTD,,93979,921,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,8493980,DUPLX SCN PENILE VESSELS; COMPLETE,,93980,921,"$1,550.00 ","$1,550.00 ","$1,184.20 ","$1,395.00 ","$1,317.50 ","$1,317.50 ","$1,317.50 ","$1,364.00 ","$1,317.50 ","$1,364.00 ","$1,364.00 ","$1,348.50 ","$1,317.50 ","$1,317.50 ","$1,317.50 ","$1,184.20 ","$1,395.00 "
Carle Richland Memorial Hospital,8493880,DUPLEX SCN EXTRCRN ART BILAT CMPLT,,93880,921,"$1,550.00 ","$1,550.00 ","$1,184.20 ","$1,395.00 ","$1,317.50 ","$1,317.50 ","$1,317.50 ","$1,364.00 ","$1,317.50 ","$1,364.00 ","$1,364.00 ","$1,348.50 ","$1,317.50 ","$1,317.50 ","$1,317.50 ","$1,184.20 ","$1,395.00 "
Carle Richland Memorial Hospital,8493882,DUPLEX SCN EXTRCRN ART UNILAT/LMTD,,93882,921,"$1,160.00 ","$1,160.00 ",$886.24 ,"$1,044.00 ",$986.00 ,$986.00 ,$986.00 ,"$1,020.80 ",$986.00 ,"$1,020.80 ","$1,020.80 ","$1,009.20 ",$986.00 ,$986.00 ,$986.00 ,$886.24 ,"$1,044.00 "
Carle Richland Memorial Hospital,8493922,ARTL EXTMTY DPPLR SNGL LVL BILAT,,93922,921,$720.00 ,$720.00 ,$550.08 ,$648.00 ,$612.00 ,$612.00 ,$612.00 ,$633.60 ,$612.00 ,$633.60 ,$633.60 ,$626.40 ,$612.00 ,$612.00 ,$612.00 ,$550.08 ,$648.00
Carle Richland Memorial Hospital,8493923,ARTL EXTMTY DPPLR MULT LVLS BILAT,,93923,921,$550.00 ,$550.00 ,$420.20 ,$495.00 ,$467.50 ,$467.50 ,$467.50 ,$484.00 ,$467.50 ,$484.00 ,$484.00 ,$478.50 ,$467.50 ,$467.50 ,$467.50 ,$420.20 ,$495.00
Carle Richland Memorial Hospital,8493925,DPLX SCN LWR EXT ART BILAT CMPLT,,93925,921,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,8493926,DPLX SCN LWR EXT ART UNILT/LMTD,,93926,921,"$1,090.00 ","$1,090.00 ",$832.76 ,$981.00 ,$926.50 ,$926.50 ,$926.50 ,$959.20 ,$926.50 ,$959.20 ,$959.20 ,$948.30 ,$926.50 ,$926.50 ,$926.50 ,$832.76 ,$981.00
Carle Richland Memorial Hospital,8493930,DPLX SCN UPPR EXT ART BILAT CMPLT,,93930,921,"$1,840.00 ","$1,840.00 ","$1,405.76 ","$1,656.00 ","$1,564.00 ","$1,564.00 ","$1,564.00 ","$1,619.20 ","$1,564.00 ","$1,619.20 ","$1,619.20 ","$1,600.80 ","$1,564.00 ","$1,564.00 ","$1,564.00 ","$1,405.76 ","$1,656.00 "
Carle Richland Memorial Hospital,8493931,DPLX SCN UPPR EXT ART UNILT/LMTD,,93931,921,"$1,390.00 ","$1,390.00 ","$1,061.96 ","$1,251.00 ","$1,181.50 ","$1,181.50 ","$1,181.50 ","$1,223.20 ","$1,181.50 ","$1,223.20 ","$1,223.20 ","$1,209.30 ","$1,181.50 ","$1,181.50 ","$1,181.50 ","$1,061.96 ","$1,251.00 "
Carle Richland Memorial Hospital,8493970,BILATERAL VENOUS DUPLEX,,93970,921,"$1,400.00 ","$1,400.00 ","$1,069.60 ","$1,260.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,232.00 ","$1,190.00 ","$1,232.00 ","$1,232.00 ","$1,218.00 ","$1,190.00 ","$1,190.00 ","$1,190.00 ","$1,069.60 ","$1,260.00 "
Carle Richland Memorial Hospital,8493971,FOLLOW-UP LMTD VEN DUPLEX,,93971,921,"$1,120.00 ","$1,120.00 ",$855.68 ,"$1,008.00 ",$952.00 ,$952.00 ,$952.00 ,$985.60 ,$952.00 ,$985.60 ,$985.60 ,$974.40 ,$952.00 ,$952.00 ,$952.00 ,$855.68 ,"$1,008.00 "
Carle Richland Memorial Hospital,8493975,DPLX SCN ABD/PLVC/RTROPTNL CMPLT,,93975,921,"$1,190.00 ","$1,190.00 ",$909.16 ,"$1,071.00 ","$1,011.50 ","$1,011.50 ","$1,011.50 ","$1,047.20 ","$1,011.50 ","$1,047.20 ","$1,047.20 ","$1,035.30 ","$1,011.50 ","$1,011.50 ","$1,011.50 ",$909.16 ,"$1,071.00 "
Carle Richland Memorial Hospital,8493976,DPLX SCN ABD/PLVC/RTROPTNL LMTD,,93976,921,"$1,080.00 ","$1,080.00 ",$825.12 ,$972.00 ,$918.00 ,$918.00 ,$918.00 ,$950.40 ,$918.00 ,$950.40 ,$950.40 ,$939.60 ,$918.00 ,$918.00 ,$918.00 ,$825.12 ,$972.00
Carle Richland Memorial Hospital,8493978,DPLX SCN ARTA/IVC/ILAC CMPLT,,93978,921,"$1,170.00 ","$1,170.00 ",$893.88 ,"$1,053.00 ",$994.50 ,$994.50 ,$994.50 ,"$1,029.60 ",$994.50 ,"$1,029.60 ","$1,029.60 ","$1,017.90 ",$994.50 ,$994.50 ,$994.50 ,$893.88 ,"$1,053.00 "
Carle Richland Memorial Hospital,95004,PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,95004,924,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,95024,INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,95024,924,$29.00 ,$29.00 ,$22.16 ,$26.10 ,$24.65 ,$24.65 ,$24.65 ,$25.52 ,$24.65 ,$25.52 ,$25.52 ,$25.23 ,$24.65 ,$24.65 ,$24.65 ,$22.16 ,$26.10
Carle Richland Memorial Hospital,8940010,PICC INSERTION,,,940,"$2,280.00 ","$2,280.00 ","$1,741.92 ","$2,052.00 ","$1,938.00 ","$1,938.00 ","$1,938.00 ","$2,006.40 ","$1,938.00 ","$2,006.40 ","$2,006.40 ","$1,983.60 ","$1,938.00 ","$1,938.00 ","$1,938.00 ","$1,741.92 ","$2,052.00 "
Carle Richland Memorial Hospital,8029195,"PHLEBOTOMY, THERAPEUTIC",,99195,940,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,8382381,THERAPUTIC PHLEBOTOMY,,99195,940,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8026372,INJ THER/DIAG MED SUBQ/IM,,96372,940,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,99195,PHLEBOTOMY,,99195,940,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,8658960,"SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN",,98960,942,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,8658961,"SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN",,98961,942,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,G0108,Diab manage trn per indiv,,G0108,942,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,G0109,Diab manage trn ind/group,,G0109,942,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,G0270,MNT subs tx for change dx,,G0270,942,$76.00 ,$76.00 ,$58.06 ,$68.40 ,$64.60 ,$64.60 ,$64.60 ,$66.88 ,$64.60 ,$66.88 ,$66.88 ,$66.12 ,$64.60 ,$64.60 ,$64.60 ,$58.06 ,$68.40
Carle Richland Memorial Hospital,G0271,Group MNT 2 or more 30 mins,,G0271,942,$63.00 ,$63.00 ,$48.13 ,$56.70 ,$53.55 ,$53.55 ,$53.55 ,$55.44 ,$53.55 ,$55.44 ,$55.44 ,$54.81 ,$53.55 ,$53.55 ,$53.55 ,$48.13 ,$56.70
Carle Richland Memorial Hospital,8663798,CARDIAC REHAB-PHASE II,,93798,943,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,8653797,OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR,,93797,943,$87.00 ,$87.00 ,$66.47 ,$78.30 ,$73.95 ,$73.95 ,$73.95 ,$76.56 ,$73.95 ,$76.56 ,$76.56 ,$75.69 ,$73.95 ,$73.95 ,$73.95 ,$66.47 ,$78.30
Carle Richland Memorial Hospital,8653798,OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING,,93798,943,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,8650075,PUL REHAB AEROBIC EXERCISE/HR,,G0424,948,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,94010,BREATHING CAPACITY TEST,,94010,960,$245.00 ,$245.00 ,$187.18 ,$220.50 ,$208.25 ,$208.25 ,$208.25 ,$215.60 ,$208.25 ,$215.60 ,$215.60 ,$213.15 ,$208.25 ,$208.25 ,$208.25 ,$187.18 ,$220.50
Carle Richland Memorial Hospital,94060,EVAL OF BRONCHOSPASM,,94060,960,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,1123F,"ADV CARE PLAN DISCUSSED, PLAN OR SURROGATE DOCUMENTED",,1123F,969,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,1124F,"ADV CARE PLAN DISCUSSED, UNABLE/UNWILL DOC PLAN OR SURROGATE",,1124F,969,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,8310320,"PATH MD PROF ALCOHOL, SERUM",,80307,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8310301,"PATH MD DRUG SCREEN, SNGL CLASS, PER DOS",,80307,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8310302,"PROF SVC DRUG SCREEN, PRESUMPTIVE, EACH PROCEDURE",,80307,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8310048,PROF SVC BASIC METABOLIC PANEL,,80048,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8310050,PROF SVC GENERAL HEALTH PANEL,,80050,971,$89.00 ,$89.00 ,$68.00 ,$80.10 ,$75.65 ,$75.65 ,$75.65 ,$78.32 ,$75.65 ,$78.32 ,$78.32 ,$77.43 ,$75.65 ,$75.65 ,$75.65 ,$68.00 ,$80.10
Carle Richland Memorial Hospital,8310051,PROF SVC ELECTROLYTE PANEL,,80051,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8310055,PROF SVC OBSTETRIC PANEL,,80055,971,$83.00 ,$83.00 ,$63.41 ,$74.70 ,$70.55 ,$70.55 ,$70.55 ,$73.04 ,$70.55 ,$73.04 ,$73.04 ,$72.21 ,$70.55 ,$70.55 ,$70.55 ,$63.41 ,$74.70
Carle Richland Memorial Hospital,8310061,PROF SVC LIPID PROFILE,,80061,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8310069,PROF SVC RENAL FUNCTION PANEL,,80069,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8310074,PROF SVC HEPATITIS ACUTE PANEL,,80074,971,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,8310076,PROF SVC HEPATIC FUNCTION PANEL,,80076,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8310156,PROF SVC DRUG ASSAY -CARBAMAZEPINE TOTL,,80156,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8312626,PATH MD PROF DHEA SULFATE,,82626,971,$31.00 ,$31.00 ,$23.68 ,$27.90 ,$26.35 ,$26.35 ,$26.35 ,$27.28 ,$26.35 ,$27.28 ,$27.28 ,$26.97 ,$26.35 ,$26.35 ,$26.35 ,$23.68 ,$27.90
Carle Richland Memorial Hospital,8312785,PATH MD PROF IMMUNOGLOBULIN E (IGE),,82785,971,$16.00 ,$16.00 ,$12.22 ,$14.40 ,$13.60 ,$13.60 ,$13.60 ,$14.08 ,$13.60 ,$14.08 ,$14.08 ,$13.92 ,$13.60 ,$13.60 ,$13.60 ,$12.22 ,$14.40
Carle Richland Memorial Hospital,8314681,PATH MD PROF C-PEPTIDE,,84681,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8316301,PATH MD PROF CARBOHYDARATE ANTIGEN 19-9,,86301,971,$31.00 ,$31.00 ,$23.68 ,$27.90 ,$26.35 ,$26.35 ,$26.35 ,$27.28 ,$26.35 ,$27.28 ,$27.28 ,$26.97 ,$26.35 ,$26.35 ,$26.35 ,$23.68 ,$27.90
Carle Richland Memorial Hospital,8316704,PATH MD PROF HEPATITIS B CORE TOTAL AB,,86704,971,$21.00 ,$21.00 ,$16.04 ,$18.90 ,$17.85 ,$17.85 ,$17.85 ,$18.48 ,$17.85 ,$18.48 ,$18.48 ,$18.27 ,$17.85 ,$17.85 ,$17.85 ,$16.04 ,$18.90
Carle Richland Memorial Hospital,8316708,PATH MD PROF HEPATITIS A TOTAL AB,,86708,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8316800,PATH MD PROF THYROGLOBULIN AB,,86800,971,$21.00 ,$21.00 ,$16.04 ,$18.90 ,$17.85 ,$17.85 ,$17.85 ,$18.48 ,$17.85 ,$18.48 ,$18.48 ,$18.27 ,$17.85 ,$17.85 ,$17.85 ,$16.04 ,$18.90
Carle Richland Memorial Hospital,8313525,PATH MD PROF INSULIN,,83525,971,$29.00 ,$29.00 ,$22.16 ,$26.10 ,$24.65 ,$24.65 ,$24.65 ,$25.52 ,$24.65 ,$25.52 ,$25.52 ,$25.23 ,$24.65 ,$24.65 ,$24.65 ,$22.16 ,$26.10
Carle Richland Memorial Hospital,8310158,PROF SVC CYCLOSPORINE ASSAY,,80158,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8310162,PROF SVC DRUG ASSAY -DIGOXIN,,80162,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8310164,PROF SVC DRUG ASSAY -VALPROIC ACID,,80164,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8310170,PROF SVC DRUG ASSAY -GENTAMYCIN,,80170,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8310176,PROF SVC DRUG ASSAY -LIDOCAINE,,80176,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315611,PATH MD PROF PROTHROMBIN TIME-SUBSTITUTION,,85611,971,$16.00 ,$16.00 ,$12.22 ,$14.40 ,$13.60 ,$13.60 ,$13.60 ,$14.08 ,$13.60 ,$14.08 ,$14.08 ,$13.92 ,$13.60 ,$13.60 ,$13.60 ,$12.22 ,$14.40
Carle Richland Memorial Hospital,8310178,PROF SVC DRUG ASSAY -LITHIUM,,80178,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8310184,PROF SVC DRUG ASSAY -PHENOBARBITAL,,80184,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8313993,"PATH MD PROF CALPROTECTIN, FECAL",,83993,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317902,PATH MD PROF HCVGE 87902 BILLING,,87902,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8310185,PROF SVC DRUG ASSAY -PHENYTOIN,,80185,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8311899,PATH MD PROF INFECT AGENT ANTIGEN DETECT IMMUNOASSAY,,87899,971,$19.00 ,$19.00 ,$14.52 ,$17.10 ,$16.15 ,$16.15 ,$16.15 ,$16.72 ,$16.15 ,$16.72 ,$16.72 ,$16.53 ,$16.15 ,$16.15 ,$16.15 ,$14.52 ,$17.10
Carle Richland Memorial Hospital,8310188,PROF SVC DRUG ASSAY -PRIMIDONE,,80188,971,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,8310192,PROF SVC DRUG ASSAY -PROCAINAMIDE,,80192,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8317808,PATH MD PROF RAPID ANTIGEN TEST,,87808,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317905,PATH MD PROF BACTERIAL VAGINOSIS SCREEN,,87905,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8310150,PROF SVC AMIKACIN,,80150,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8315576,PROF SVC PLATELET AGGREGATION,,85576,971,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,8317486,PATH MD PROF INF AGNT DTCTN,,87486,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8317581,PATH MD PROF INF AGNT DTCTN,,87581,971,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,8316480,PATH MD PROF TUBERCULOSIS TEST,,86480,971,$24.00 ,$24.00 ,$18.34 ,$21.60 ,$20.40 ,$20.40 ,$20.40 ,$21.12 ,$20.40 ,$21.12 ,$21.12 ,$20.88 ,$20.40 ,$20.40 ,$20.40 ,$18.34 ,$21.60
Carle Richland Memorial Hospital,8310198,PROF SVC DRUG ASSAY -THEOPHYLLINE,,80198,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315347,PATH MD PROF TEC COAG TIME; ACTIVATED,,85347,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315390,PATH MD PROF TEG FIBRINOLYSIS OR COAG SCRN INTERP & RPT,,85390,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8310303,PROF SVC LACTIC ACID,,83605,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8310200,PROF SVC DRUG ASSAY -TOBRAMYCIN,,80200,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8314481,"T3 (TRIIODOTHYRONINE), FREE",,84481,971,$26.00 ,$26.00 ,$19.86 ,$23.40 ,$22.10 ,$22.10 ,$22.10 ,$22.88 ,$22.10 ,$22.88 ,$22.88 ,$22.62 ,$22.10 ,$22.10 ,$22.10 ,$19.86 ,$23.40
Carle Richland Memorial Hospital,8317181,"CPT-ETEST SUSCEPTIBILTY STUDIES, PER AGENT",,87181,971,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,8317899,LABORATORY SERVICES,,87899,971,$19.00 ,$19.00 ,$14.52 ,$17.10 ,$16.15 ,$16.15 ,$16.15 ,$16.72 ,$16.15 ,$16.72 ,$16.72 ,$16.53 ,$16.15 ,$16.15 ,$16.15 ,$14.52 ,$17.10
Carle Richland Memorial Hospital,8317653,"PATH MD PROF STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE",,87653,971,$39.00 ,$39.00 ,$29.80 ,$35.10 ,$33.15 ,$33.15 ,$33.15 ,$34.32 ,$33.15 ,$34.32 ,$34.32 ,$33.93 ,$33.15 ,$33.15 ,$33.15 ,$29.80 ,$35.10
Carle Richland Memorial Hospital,8311374,"PATH MD PROF HLA CLASS I TYPING, LOW RESOLUTION",,81374,971,$25.00 ,$25.00 ,$19.10 ,$22.50 ,$21.25 ,$21.25 ,$21.25 ,$22.00 ,$21.25 ,$22.00 ,$22.00 ,$21.75 ,$21.25 ,$21.25 ,$21.25 ,$19.10 ,$22.50
Carle Richland Memorial Hospital,8310202,PROF SVC DRUG ASSAY -VANCOMYCIN,,80202,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8310400,PROF SVC ACTH STIM PNL-CORTISOL X 2,,80400,971,$39.00 ,$39.00 ,$29.80 ,$35.10 ,$33.15 ,$33.15 ,$33.15 ,$34.32 ,$33.15 ,$34.32 ,$34.32 ,$33.93 ,$33.15 ,$33.15 ,$33.15 ,$29.80 ,$35.10
Carle Richland Memorial Hospital,8316481,"PATH MD PROF TB TEST, CELL MEDIATED ANTIGEN RESPONSE, ENUM GAMMA INTERFRON T-CELLS",,86481,971,$54.00 ,$54.00 ,$41.26 ,$48.60 ,$45.90 ,$45.90 ,$45.90 ,$47.52 ,$45.90 ,$47.52 ,$47.52 ,$46.98 ,$45.90 ,$45.90 ,$45.90 ,$41.26 ,$48.60
Carle Richland Memorial Hospital,8311946,"PATH MD PROF RETICULOCYTE COUNT, AUTOMATED",,85046,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8311001,PROF SVC URINALYSIS,,81001,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8311002,PROF SVC URINALYSIS,,81002,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8311003,PROF SVC URINALYSIS,,81003,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8311015,PROF SVC URINALYSIS,,81015,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8311210,PATH MD PROF BRAF GENE ANALYSIS,,81210,971,$135.00 ,$135.00 ,$103.14 ,$121.50 ,$114.75 ,$114.75 ,$114.75 ,$118.80 ,$114.75 ,$118.80 ,$118.80 ,$117.45 ,$114.75 ,$114.75 ,$114.75 ,$103.14 ,$121.50
Carle Richland Memorial Hospital,8311301,PATH MD PROF MSI ANALYSIS,,81301,971,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,8311025,PROF SVC URINE PREGNANCY TEST,,81025,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8311050,PROF SVC VOL MEASURE -TIMED COLLCTN EA,,81050,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312010,PROF SVC B-HYDROXYBUTYRATE,,82010,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8312040,"PROF SVC ALBUMIN, SERUM",,82040,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312042,PROF SVC ALBUMIN OTHER,,82042,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312043,PROF SVC MICROALBUMIN URINE,,82043,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8312103,"PROF SVC ALPHA-1-ANTITRYPSIN, TOTAL",,82103,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8312105,"PROF SVC ALPHA-FETOPROTEIN, SERUM",,82105,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8312140,PROF SVC AMMONIA,,82140,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8317635,PATH MD PROF COVID,,87635,971,$26.00 ,$26.00 ,$19.86 ,$23.40 ,$22.10 ,$22.10 ,$22.10 ,$22.88 ,$22.10 ,$22.88 ,$22.88 ,$22.62 ,$22.10 ,$22.10 ,$22.10 ,$19.86 ,$23.40
Carle Richland Memorial Hospital,8310004,HC PATH MD PROF SARS-COV-2 BY NUCLEIC ACID,,U0003,971,$26.00 ,$26.00 ,$19.86 ,$23.40 ,$22.10 ,$22.10 ,$22.10 ,$22.88 ,$22.10 ,$22.88 ,$22.88 ,$22.62 ,$22.10 ,$22.10 ,$22.10 ,$19.86 ,$23.40
Carle Richland Memorial Hospital,8316769,PATH MD PROF SARS-COV-2 IGG,,86769,971,$26.00 ,$26.00 ,$19.86 ,$23.40 ,$22.10 ,$22.10 ,$22.10 ,$22.88 ,$22.10 ,$22.88 ,$22.88 ,$22.62 ,$22.10 ,$22.10 ,$22.10 ,$19.86 ,$23.40
Carle Richland Memorial Hospital,8312150,PROF SVC AMYLASE,,82150,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8312247,"PROF SVC BILIRUBIN, TOTAL",,82247,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312248,"PROF SVC BILIRUBIN, DIRECT",,82248,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312270,PROF SVC OCCULT BLOOD,,82270,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8312272,PROF SVC OCCULT BLOOD -SINGLE SPECIMEN,,82272,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8312274,PROF SVC FECAL OCCULT BLOOD,,82274,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8312306,PROF SVC 25 OH VITAMIN D TOTAL,,82306,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8312310,"PROF SVC CALCIUM, TOTAL",,82310,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312330,"PROF SVC CALCIUM, IONIZED",,82330,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8312340,"PROF SVC CALCIUM, URINE",,82340,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312374,PROF SVC CARBON DIOXIDE (BICARBONATE),,82374,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312378,PROF SVC CEA,,82378,971,$39.00 ,$39.00 ,$29.80 ,$35.10 ,$33.15 ,$33.15 ,$33.15 ,$34.32 ,$33.15 ,$34.32 ,$34.32 ,$33.93 ,$33.15 ,$33.15 ,$33.15 ,$29.80 ,$35.10
Carle Richland Memorial Hospital,8312384,"PROF SVC CATECHOLAMINE, URINE",,82384,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8312390,PROF SVC CERULOPLASMIN,,82390,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8312435,"PROF SVC CHLORIDE, BLOOD",,82435,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8312436,"PROF SVC CHLORIDE, URINE",,82436,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312438,"PROF SVC CHLORIDE, STOOL",,82438,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312465,"PROF SVC CHOLESTEROL, SERUM, TOTAL",,82465,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312533,"PROF SVC CORTISOL, TOTAL",,82533,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8312550,PROF SVC CREATINE KINASE CK/CPK/TOTAL,,82550,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312553,PROF SVC CK MB FRACTION,,82553,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8312565,"PROF SVC CREATININE, BLOOD",,82565,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312570,"PROF SVC CREATININE, OTHER SOURCE",,82570,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312575,PROF SVC CREATININE CLEARANCE,,82575,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8312607,PROF SVC VITAMIN B12,,82607,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8312670,PROF SVC ASSAY -ESTRADIOL,,82670,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8312677,"PROF SVC ESTRIOL, UNCONJUGATED",,82677,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8312728,PROF SVC FERRITIN,,82728,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8312731,PROF SVC FETAL FIBRONECTIN,,82731,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8312746,"PROF SVC FOLIC ACID (FOLATE), SERUM",,82746,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8312784,PROF SVC GAMMAGLOBULIN IGA/IGD/IGG/IGM,,82784,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8312945,PROF SVC GLUCOSE BODY FLUID (CSF),,82945,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8312947,"PROF SVC GLUCOSE, QUANTITATIVE",,82947,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312950,"PROF SVC GLUCOSE, POST GLUCOSE DOSE",,82950,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8312951,"PROF SVC GTT, THREE SPECIMENS",,82951,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8312952,"PROF SVC GTT, EA ADDL BEYOND THREE",,82952,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312960,PROF SVC G6PD SCREEN,,82960,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312977,"PROF SVC GLUTAMYLTRANSFERASE, GAMMA",,82977,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8313001,PROF SVC FOLLICLE STIMULATING HORMONE,,83001,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8313002,PROF SVC LUTEINIZING HORMONE (LH),,83002,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317507,PATH MD PROF GPP GI PATHOGEN PROBE 12-25 TARGETS,,87507,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8313010,"PROF SVC HAPTOGLOBIN, QUANTITATIVE",,83010,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8313033,PROF SVC APT TEST FOR FETAL HGB,,83033,971,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,8313036,"PROF SVC HEMOGLOBIN, GLYCATED (A1C)",,83036,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8317624,PATH MD PROF HPV HIGH RISK TYPES,,87624,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8313070,PROF SVC HEMOSIDERIN URINE QUALITATIVE,,83070,971,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,8313090,PROF SVC HOMOCYSTEINE ASSAY,,83090,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8313516,PROF SVC TISSUE TRANSGLUT. IGA,,83516,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317633,PATH MD PROF RPP RESPIRATORY VIRUS PROBE 12-25 TARGETS,,87633,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8313540,PROF SVC IRON,,83540,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8313550,PROF SVC IRON BINDING CAPACITY,,83550,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8313605,PROF SVC LACTIC ACID,,83605,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8313615,PROF SVC LACTATE DEHYDROGENASE (LD/LDH),,83615,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8313630,"PROF SVC LACTOFERRIN, FECAL, QUAL.",,83630,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8313661,PROF SVC L/S RATIO,,83661,971,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,8313690,PROF SVC LIPASE,,83690,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8313718,PROF SVC HDL CHOLESTEROL,,83718,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8313721,"PROF SVC LDL CHOLESTEROL, DIRECT",,83721,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8313735,PROF SVC MAGNESIUM,,83735,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8313835,PROF SVC METANEPHRINE URINE TOTAL,,83835,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8313872,"PROF SVC MUCIN, SYNOVIAL FLUID(ROPES TE",,83872,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8313874,PROF SVC MYOGLOBIN,,83874,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8313880,PROF SVC B-NATRIURETIC PEPTIDE,,83880,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8313883,"PROF SVC NEPHELOMETRY, EACH ANALYTE",,83883,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8313930,"PROF SVC OSMOLALITY, BLOOD",,83930,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8313935,"PROF SVC OSMOLALITY, URINE",,83935,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8313970,PROF SVC PARATHORMONE (PTH),,83970,971,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,8313986,"PROF SVC PH, BODY FLUID, EXCEPT BLOOD",,83986,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314075,PROF SVC ALKALINE PHOSPHATASE,,84075,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314081,PROF SVC PHOPHATIDYLGLYCEROL (IA MTHD),,84081,971,$39.00 ,$39.00 ,$29.80 ,$35.10 ,$33.15 ,$33.15 ,$33.15 ,$34.32 ,$33.15 ,$34.32 ,$34.32 ,$33.93 ,$33.15 ,$33.15 ,$33.15 ,$29.80 ,$35.10
Carle Richland Memorial Hospital,8314100,PROF SVC PHOSPHORUS INORGAN (PHOSPHATE),,84100,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314105,"PROF SVC PHOSPHORUS, URINE",,84105,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314119,"PROF SVC PORPHYRINS, URINE QUAL.",,84119,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8314132,"PROF SVC POTASSIUM, SERUM",,84132,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314133,"PROF SVC POTASSIUM, URINE",,84133,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314134,PROF SVC PREALBUMIN,,84134,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8314144,PROF SVC PROGESTRONE,,84144,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8314146,PROF SVC PROLACTIN,,84146,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8314153,PROF SVC PSA,,G0103,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8314155,"PROF SVC PROTEIN, TOTAL, SERUM",,84155,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314156,"PROF SVC PROTEIN, TOTAL, URINE",,84156,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8314157,"PROF SVC PROTEIN, TOTAL, OTHER SOURCE",,84157,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8314295,PROF SVC SODIUM SERUM PLASM/WHOLE BLOOD,,84295,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314300,"PROF SVC SODIUM, URINE",,84300,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314302,"PROF SVC SODIUM, BODY FLUID",,84302,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8314311,PROF SVC SPECTROPHOTOMETRY,,84311,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8314315,"PROF SVC SPECIFIC GRAVITY, BODY FLUID",,84315,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8314403,PROF SVC TESTOSTERONE,,84403,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8314436,PROF SVC T-4,,84436,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314439,"PROF SVC THYROXINE, FREE (T4)",,84439,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8314443,PROF SVC TSH,,84443,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8314450,"PROF SVC TRANSFERASE, ASPARTATE AMINO",,84450,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314460,"PROF SVC TRANSFERASE, ALANINE AMINO",,84460,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314466,PROF SVC TRANSFERRIN,,84466,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8314478,PROF SVC TRIGLYCERIDES,,84478,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314479,PROF SVC T UPTAKE,,84479,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314480,"PROF SVC TRIIODOTHYRONINE T3, TOTAL",,84480,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8314484,"PROF SVC TROPONIN, QUANTITATIVE",,84484,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8314520,"PROF SVC UREA NITROGEN, QUANTITATIVE",,84520,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8314540,"PROF SVC UREA NITROGEN, QUANTITATIVE",,84540,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314550,"PROF SVC URIC ACID, BLOOD",,84550,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314560,"PROF SVC URIC ACID, OTHER SOURCE",,84560,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8314585,"PROF SVC VMA, URINE (ADULT)",,84585,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8314702,"PROF SVC GONADOTROPIN, CHORIONIC (HCG)",,84702,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8314999,PROF SVC LAB - CHEMISTRY,,84999,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315002,PROF SVC BLEEDING TIME,,85002,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8315004,PROF SVC AUTOMATED DIFFERENTIAL WBC,,85004,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315007,PROF SVC MANUAL DIFFERENTIAL WBC COUNT,,85007,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8315009,PROF SVC MAN DIFF WBC COUNT BUFFY COAT,,85009,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8315013,PROF SVC MICROHEMATOCRIT -SPUN,,85013,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315025,PROF SVC CBC W/AUTOMATED DIFFERENTIAL,,85025,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315027,PROF SVC CBC W/O DIFFERENTIAL,,85027,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315041,PROF SVC RED BLOOD CELL COUNT ONLY,,85041,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315045,"PROF SVC RETICULOCYTE COUNT, AUTOMATED",,85045,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315048,PROF SVC WHITE CELL COUNT,,85048,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315049,PROF SVC PLATELET PROFILE,,85049,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315210,PROF SVC CLOTTING FACTOR II,,85210,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8315220,PROF SVC CLOTTING FACTOR V,,85220,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8315230,PROF SVC CLOTTING FACTOR VII,,85230,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8315240,PROF SVC CLOTTING FACTOR VIII,,85240,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8318250,PROF SVC CLOTTING FACTOR IX,,85250,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8315260,PROF SVC CLOTTING FACTOR X,,85260,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8315300,PROF SVC ANTITHROMBINE III ACTIVITY,,85300,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8315303,"PROF SVC PROTEIN C, ACTIVITY",,85303,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8315306,PROF SVC PROTEIN S ANTIGEN FREE,,85306,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8315307,PROF SVC ACTIVATED PROTEIN C RESISTANCE,,85307,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8315362,PROF SVC FIBRIN DEGREDATION PRODUCTS,,85362,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8315378,PROF SVC D-DIMER,,85378,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8315379,"PROF SVC D-DIMER, ULTRASENSITIVE",,85379,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8315384,PROF SVC FIBRINOGEN,,85384,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315460,PROF SVC KLEIHAUER-BETKE TEST,,85460,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315461,"PROF SVC FMH SCREEN, ROSETTE",,85461,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315540,PROF SVC LEUKOCYTE ALKALINE PHOSPHATASE,,85540,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315610,PROF SVC PROTHROMBIN TIME,,85610,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315613,PROF SVC LUPUS ANTICOAGULANT,,85613,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315635,PROF SVC REPTILASE TEST (VENOM TIME),,85635,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8315652,PROF SVC ESR,,85652,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315660,PROF SVC SICKLE CELL SCREEN,,85660,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315670,PROF SVC THROMBIN TIME,,85670,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315730,"PROF SVC THROMBOPLASTIN TIME, PTL (PTT)",,85730,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8315732,PROF SVC CORRECTION STUDIES,,85732,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8315999,PROF SVC LAB -HEMATOL/COAG,,85999,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8316022,PROF SVC HEPARIN DEPENDENT PLATELET ABS,,86022,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8316038,PROF SVC ANTINUCLEAR ANTIBODY SCREEN,,86038,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8316039,PROF SVC ANTINUCLEAR ANTIBODY PROFILE,,86039,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8316060,PROF SVC ANTISTREPTOLYSIN O (ASO) TITER,,86060,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8316140,PROF SVC C-REACTIVE PROTEIN,,86140,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8316141,"PROF SVC CRP, HIGH SENSITIVITY",,86141,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8316160,"PROF SVC COMPLEMENT ANTIGEN, EACH COMP.",,86160,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8316304,"PROF SVC TUMOR ANTIGEN, CA 125",,86304,971,$33.00 ,$33.00 ,$25.21 ,$29.70 ,$28.05 ,$28.05 ,$28.05 ,$29.04 ,$28.05 ,$29.04 ,$29.04 ,$28.71 ,$28.05 ,$28.05 ,$28.05 ,$25.21 ,$29.70
Carle Richland Memorial Hospital,8316308,PROF SVC MONO TEST,,86308,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8316355,PROF SVC B CELLS TOTAL COUNT,,86355,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316357,PROF SVC NK CELLS -TOTAL COUNT,,86357,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316359,"PROF SVC T CELLS, TOTAL COUNT",,86359,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316360,PROF SVC T CELLS; ABS CD4&CD8 COUNT W/R,,86360,971,$80.00 ,$80.00 ,$61.12 ,$72.00 ,$68.00 ,$68.00 ,$68.00 ,$70.40 ,$68.00 ,$70.40 ,$70.40 ,$69.60 ,$68.00 ,$68.00 ,$68.00 ,$61.12 ,$72.00
Carle Richland Memorial Hospital,8316376,PROF SVC LUPUS PANEL-THYROID MICROSOMAL,,86376,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8316431,PROF SVC RHEUMATOID FACTOR QUANTITATIVE,,86431,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8316592,PROF SVC LABORATORY TEST,,86592,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8316593,PROF SVC LABORATORY TEST,,86593,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8316631,PROF SVC CHLAMYDIA DETECTION,,86631,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8316644,PROF SVC CMV IGG ANTIBODY,,86644,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8316645,PROF SVC CMV IGM ANTIBODY,,86645,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8316677,PROF SVC HELICOBACTER PYLORI ANTIBODY,,86677,971,$60.00 ,$60.00 ,$45.84 ,$54.00 ,$51.00 ,$51.00 ,$51.00 ,$52.80 ,$51.00 ,$52.80 ,$52.80 ,$52.20 ,$51.00 ,$51.00 ,$51.00 ,$45.84 ,$54.00
Carle Richland Memorial Hospital,8316701,PROF SVC LABORATORY TEST FOR ANTIBODY,,86701,971,$49.00 ,$49.00 ,$37.44 ,$44.10 ,$41.65 ,$41.65 ,$41.65 ,$43.12 ,$41.65 ,$43.12 ,$43.12 ,$42.63 ,$41.65 ,$41.65 ,$41.65 ,$37.44 ,$44.10
Carle Richland Memorial Hospital,8316703,PROF SVC LABORATORY TEST FOR ANTIBODY,,G0432,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316705,PROF SVC HEPATITIS B CORE IGM ANTIBODY,,86705,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316706,PROF SVC HEPATITIS B SURFACE ANTIBODY,,86706,971,$42.00 ,$42.00 ,$32.09 ,$37.80 ,$35.70 ,$35.70 ,$35.70 ,$36.96 ,$35.70 ,$36.96 ,$36.96 ,$36.54 ,$35.70 ,$35.70 ,$35.70 ,$32.09 ,$37.80
Carle Richland Memorial Hospital,8316709,PROF SVC HEPATITIS A IGM ANTIBODY,,86709,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316735,PROF SVC MUMPS ANTIBODY IGG,,86735,971,$56.00 ,$56.00 ,$42.78 ,$50.40 ,$47.60 ,$47.60 ,$47.60 ,$49.28 ,$47.60 ,$49.28 ,$49.28 ,$48.72 ,$47.60 ,$47.60 ,$47.60 ,$42.78 ,$50.40
Carle Richland Memorial Hospital,8316738,PROF SVC MYCOPLASMA IGM AB BY EIA,,86738,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8316762,PROF SVC RUBELLA IGG SCREEN,,86762,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8316765,PROF SVC MEASELS IGG AB,,86765,971,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,8316787,PROF SVC VARICELLA AB IGG ANTIBODY,,86787,971,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,8316803,PROF SVC HEPATITIS C VIRUS ANTIBODY,,86803,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316812,PROF SVC HLA-B27 ANTIGEN,,86812,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8316849,PROF SVC LABORATORY TEST -IMMUNOLOGY,,86849,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8317015,"PROF SVC CONCENTRATION, INFECT AGENTS",,87015,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317040,PROF SVC BLOOD CULTURE,,87040,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317045,PROF SVC ENTERIC PATHOGENS CULTURE,,87045,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317046,PROF SVC ENT PATH CULT / ADNL PATHOGENS,,87046,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317070,PROF SVC BACT CULT ISOL/PRESMPTV ID OTH,,87070,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317071,PROF SVC BACT CULT QUANT AEROBIC W/ISO,,87071,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317073,PROF SVC BACT CULT QUANT ANA W/ISO,,87073,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317075,PROF SVC BACT CULT ANY SRC ANAEROBIC,,87075,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317076,PROF SVC BACT CULT DEF ID ANAEROBIC,,87076,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8317077,PROF SVC BACT CULT DEF ID AEROBIC,,87077,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317081,PROF SVC BACT CULTURE SCREENING ONLY,,87081,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317086,PROF SVC URINE CULTURE,,87086,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317088,PROF SVC URINE CULTURE PRESUMPTIVE ID,,87088,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8318101,"PROF SVC FUNGUS CULT, DERMAL",,87101,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317102,"PROF SVC FUNGAL CULT, OTHER SRC, ISOLAT",,87102,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317103,"PROF SVC FUNGAL CULTURE, BLOOD",,87103,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317106,PROF SVC FUNGAL CULTURE,,87106,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317107,"PROF SVC FUNGAL IDENTIFICATION, MOLD",,87107,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317116,"PROF SVC CULT, TUBRCL/ACID-FAST BACILLI",,87116,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317118,PROF SVC AFB ISOLATE IDENTIFICATION,,87118,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317149,"PROF SVC AFB ID, DNA, PROBE TECH",,87149,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317150,PROF SVC AMP PROB TECH EA ORGANISM,,87150,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317168,PROF SVC MACROSCOPIC EXAM -ARTHROPOD,,87168,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317169,"PROF SVC MACROSCOPIC EXAM, PARASITE",,87169,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317172,PROF SVC PIMWORM EXAM,,87172,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8317176,PROF SVC HOMOGENIZATN TISSUE FR CULTURE,,87176,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8317177,PROF SVC OVA AND PARASITE EXAM,,87177,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317184,"PROF SVC SUSCEPTIBILITY, DISK DIFFUSION",,87184,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317185,PROF SVC BETA LACTAMASE DETECTION,,87185,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317186,PROF SVC SENSITIVITY STUDIES,,87186,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317187,PROF SVC MIN BACTERIACIDAL LEVEL,,87187,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8317197,PROF SVC SERUM BACTERICIDAL TITER,,87197,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8317205,"PROF SVC SMEAR, PRIMARY SRCE RTN STAIN",,87205,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317206,"PROF SVC SMEAR, PRIMARY SRC FLRSNT/AF",,87206,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317209,PROF SVC SMEAR -COMPLEX STAIN,,87209,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317210,"PROF SVC WET MOUNT, PRIMARY SOURCE",,87210,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317220,"PROF SVC TISSUE EXAM, KOH MOUNT",,87220,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317281,PROF SVC PNEUMOCYSTIS CARINII IMMFL TCH,,87281,971,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,8317300,PROF SVC DRA/LEGIONELLA PNEUMOPHILA,,87300,971,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,8317324,PROF SVC CLOSTRIDIUM DIFFICILE TOXIN A,,87324,971,$22.00 ,$22.00 ,$16.81 ,$19.80 ,$18.70 ,$18.70 ,$18.70 ,$19.36 ,$18.70 ,$19.36 ,$19.36 ,$19.14 ,$18.70 ,$18.70 ,$18.70 ,$16.81 ,$19.80
Carle Richland Memorial Hospital,8317328,PROF SVC CRYPTOSPORIDIUM ANTIGEN,,87328,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317329,PROF SVC GIARDIA ANTIGEN,,87329,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317338,"PROF SVC H.PYLORI ANTIGEN, STOOL",,87338,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317340,PROF SVC HEPATITIS B SURFACE ANTIGEN,,87340,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317425,PROF SVC ROTOVIRUS ANTIGEN,,87425,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317427,PROF SVC INFECTIOUS AGENT DETECTION,,87427,971,$34.00 ,$34.00 ,$25.98 ,$30.60 ,$28.90 ,$28.90 ,$28.90 ,$29.92 ,$28.90 ,$29.92 ,$29.92 ,$29.58 ,$28.90 ,$28.90 ,$28.90 ,$25.98 ,$30.60
Carle Richland Memorial Hospital,8317449,PROF SVC INFECTIOUS AGENT ANTIGEN,,87449,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317451,PROF SVC GIARDIA/CRYPTOSPORIDIUM SCREEN,,87451,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317491,PROF SVC LABORATORY TEST,,87491,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317493,PROF SVC C DIFF TOXIN BY PCR,,87493,971,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,8317497,PROF SVC CYTOMEG DNA - QUANT,,87497,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317498,PROF SVC ENTEROVIRUS BY PCR,,87498,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317502,PROF SVC HUMAN INFLUENZA A,,87502,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317503,PROF SVC FLU A SUBTYPES,,87503,971,$28.00 ,$28.00 ,$21.39 ,$25.20 ,$23.80 ,$23.80 ,$23.80 ,$24.64 ,$23.80 ,$24.64 ,$24.64 ,$24.36 ,$23.80 ,$23.80 ,$23.80 ,$21.39 ,$25.20
Carle Richland Memorial Hospital,8317522,PROF SVC RNA QUANT BY PCR,,87522,971,$100.00 ,$100.00 ,$76.40 ,$90.00 ,$85.00 ,$85.00 ,$85.00 ,$88.00 ,$85.00 ,$88.00 ,$88.00 ,$87.00 ,$85.00 ,$85.00 ,$85.00 ,$76.40 ,$90.00
Carle Richland Memorial Hospital,8317529,PROF SVC INFECTIOUS AGENT DETECTION,,87529,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8317536,PROF SVC HIV-1 RNA,,87536,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317591,PROF SVC LABORATORY TEST,,87591,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317640,PROF SVC STAPH AUREUS AMP PROBE,,87640,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317641,PROF SVC INF AGENT AMPI PROBE,,87641,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317798,PROF SVC AMPL PROBE EA ORG,,87798,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8317804,PROF SVC INFECTIOUS AGNT,,87804,971,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,8317807,PROF SVC RESPIRATORY SYNCYTIAL VIRUS,,87807,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317880,"PROF SVC STREPTOCOCCUS, GROUP A",,87880,971,$23.00 ,$23.00 ,$17.57 ,$20.70 ,$19.55 ,$19.55 ,$19.55 ,$20.24 ,$19.55 ,$20.24 ,$20.24 ,$20.01 ,$19.55 ,$19.55 ,$19.55 ,$17.57 ,$20.70
Carle Richland Memorial Hospital,8317999,PROF SVC LAB -MICROBIOLOGY,,87999,971,$17.00 ,$17.00 ,$12.99 ,$15.30 ,$14.45 ,$14.45 ,$14.45 ,$14.96 ,$14.45 ,$14.96 ,$14.96 ,$14.79 ,$14.45 ,$14.45 ,$14.45 ,$12.99 ,$15.30
Carle Richland Memorial Hospital,8311220,PATH MD PROF PT-CFIBS-CFTR GENE ANALYSIS,,81220,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,8312803,PROF SVC ABG,,82803,971,$51.00 ,$51.00 ,$38.96 ,$45.90 ,$43.35 ,$43.35 ,$43.35 ,$44.88 ,$43.35 ,$44.88 ,$44.88 ,$44.37 ,$43.35 ,$43.35 ,$43.35 ,$38.96 ,$45.90
Carle Richland Memorial Hospital,8314112,PROF SVC AMNUSURE ROM,,84112,971,$18.00 ,$18.00 ,$13.75 ,$16.20 ,$15.30 ,$15.30 ,$15.30 ,$15.84 ,$15.30 ,$15.84 ,$15.84 ,$15.66 ,$15.30 ,$15.30 ,$15.30 ,$13.75 ,$16.20
Carle Richland Memorial Hospital,85060,BLOOD SMEAR INTERPRETATION,,85060,971,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,88307,"SURG PATH,LEVEL V",,88307,971,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,74740,X-RAY HYSTEROSALPINGOGRAM,,74740,972,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,76815,"US,PREGNANT UTERUS,LIMITED, 1/> FETUSES",,76815,972,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,76857,SONO PELVIS LIMITED,,76857,972,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,76946,SONO GUIDE AMNIOCENTESIS,,76946,972,$770.00 ,$770.00 ,$588.28 ,$693.00 ,$654.50 ,$654.50 ,$654.50 ,$677.60 ,$654.50 ,$677.60 ,$677.60 ,$669.90 ,$654.50 ,$654.50 ,$654.50 ,$588.28 ,$693.00
Carle Richland Memorial Hospital,76831,"SONO EXAM, HYSTEROSONOGRAPHY",,76831,972,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,99281,EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB,,99281,981,$245.00 ,$245.00 ,$187.18 ,$220.50 ,$208.25 ,$208.25 ,$208.25 ,$215.60 ,$208.25 ,$215.60 ,$215.60 ,$213.15 ,$208.25 ,$208.25 ,$208.25 ,$187.18 ,$220.50
Carle Richland Memorial Hospital,99282,EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,,99282,981,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,99283,EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,,99283,981,$560.00 ,$560.00 ,$427.84 ,$504.00 ,$476.00 ,$476.00 ,$476.00 ,$492.80 ,$476.00 ,$492.80 ,$492.80 ,$487.20 ,$476.00 ,$476.00 ,$476.00 ,$427.84 ,$504.00
Carle Richland Memorial Hospital,99284,EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,,99284,981,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,99285,EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,,99285,981,"$1,270.00 ","$1,270.00 ",$970.28 ,"$1,143.00 ","$1,079.50 ","$1,079.50 ","$1,079.50 ","$1,117.60 ","$1,079.50 ","$1,117.60 ","$1,117.60 ","$1,104.90 ","$1,079.50 ","$1,079.50 ","$1,079.50 ",$970.28 ,"$1,143.00 "
Carle Richland Memorial Hospital,99217,OBSERVATION CARE DISCHARGE MANAGEMENT,,99217,987,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,99218,INITIAL OBSERVATION CARE/DAY LEVEL 1,,99218,987,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,99219,INITIAL OBSERVATION CARE/DAY LEVEL 2,,99219,987,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,99220,INITIAL OBSERVATION CARE/DAY LEVEL 3,,99220,987,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,99221,INITIAL HOSPITAL CARE/DAY LEVEL 1,,99221,987,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,99222,INITIAL HOSPITAL CARE/DAY LEVEL 2,,99222,987,$495.00 ,$495.00 ,$378.18 ,$445.50 ,$420.75 ,$420.75 ,$420.75 ,$435.60 ,$420.75 ,$435.60 ,$435.60 ,$430.65 ,$420.75 ,$420.75 ,$420.75 ,$378.18 ,$445.50
Carle Richland Memorial Hospital,99223,INITIAL HOSPITAL CARE/DAY LEVEL 3,,99223,987,$650.00 ,$650.00 ,$496.60 ,$585.00 ,$552.50 ,$552.50 ,$552.50 ,$572.00 ,$552.50 ,$572.00 ,$572.00 ,$565.50 ,$552.50 ,$552.50 ,$552.50 ,$496.60 ,$585.00
Carle Richland Memorial Hospital,99231,SBSQ HOSPITAL CARE/DAY LEVEL 1,,99231,987,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,99232,SBSQ HOSPITAL CARE/DAY LEVEL 2,,99232,987,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,99233,SBSQ HOSPITAL CARE/DAY LEVEL 3,,99233,987,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,99238,"HOSPITAL DISCHARGE DAY,<30 MIN",,99238,987,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,99239,"HOSPITAL DISCHARGE DAY,>30 MIN",,99239,987,$355.00 ,$355.00 ,$271.22 ,$319.50 ,$301.75 ,$301.75 ,$301.75 ,$312.40 ,$301.75 ,$312.40 ,$312.40 ,$308.85 ,$301.75 ,$301.75 ,$301.75 ,$271.22 ,$319.50
Carle Richland Memorial Hospital,99251,PR INITL INPATIENT CONSULT NEW/ESTAB PT LEVEL 1,,99251,987,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,99252,PR INITL INPATIENT CONSULT NEW/ESTAB PT LEVEL 2,,99252,987,$350.00 ,$350.00 ,$267.40 ,$315.00 ,$297.50 ,$297.50 ,$297.50 ,$308.00 ,$297.50 ,$308.00 ,$308.00 ,$304.50 ,$297.50 ,$297.50 ,$297.50 ,$267.40 ,$315.00
Carle Richland Memorial Hospital,99253,PR INITL INPATIENT CONSULT NEW/ESTAB PT LEVEL 3,,99253,987,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,99254,PR INITL INPATIENT CONSULT NEW/ESTAB PT LEVEL 4,,99254,987,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,99255,PR INITIAL INPATIENT CONSULT NEW/ESTAB PT LEVEL 5,,99255,987,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,99356,PROLONGED SVC I/P OR OBS SETTING 1ST HOUR,,99356,987,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,99357,PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN,,99357,987,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,99234,OBSERVATION/INPATIENT HOSPITAL CARE LEVEL 1,,99234,987,$480.00 ,$480.00 ,$366.72 ,$432.00 ,$408.00 ,$408.00 ,$408.00 ,$422.40 ,$408.00 ,$422.40 ,$422.40 ,$417.60 ,$408.00 ,$408.00 ,$408.00 ,$366.72 ,$432.00
Carle Richland Memorial Hospital,99235,OBSERVATION/INPATIENT HOSPITAL CARE LEVEL 2,,99235,987,$740.00 ,$740.00 ,$565.36 ,$666.00 ,$629.00 ,$629.00 ,$629.00 ,$651.20 ,$629.00 ,$651.20 ,$651.20 ,$643.80 ,$629.00 ,$629.00 ,$629.00 ,$565.36 ,$666.00
Carle Richland Memorial Hospital,99236,OBSERVATION/INPATIENT HOSPITAL CARE LEVEL 3,,99236,987,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,99460,"INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH CENTER",,99460,987,$365.00 ,$365.00 ,$278.86 ,$328.50 ,$310.25 ,$310.25 ,$310.25 ,$321.20 ,$310.25 ,$321.20 ,$321.20 ,$317.55 ,$310.25 ,$310.25 ,$310.25 ,$278.86 ,$328.50
Carle Richland Memorial Hospital,99462,"SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN",,99462,987,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,99463,"INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE",,99463,987,$415.00 ,$415.00 ,$317.06 ,$373.50 ,$352.75 ,$352.75 ,$352.75 ,$365.20 ,$352.75 ,$365.20 ,$365.20 ,$361.05 ,$352.75 ,$352.75 ,$352.75 ,$317.06 ,$373.50
Carle Richland Memorial Hospital,99464,ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN,,99464,987,$485.00 ,$485.00 ,$370.54 ,$436.50 ,$412.25 ,$412.25 ,$412.25 ,$426.80 ,$412.25 ,$426.80 ,$426.80 ,$421.95 ,$412.25 ,$412.25 ,$412.25 ,$370.54 ,$436.50
Carle Richland Memorial Hospital,99465,DELIVERY/BIRTHING ROOM RESUSCITATION,,99465,987,$940.00 ,$940.00 ,$718.16 ,$846.00 ,$799.00 ,$799.00 ,$799.00 ,$827.20 ,$799.00 ,$827.20 ,$827.20 ,$817.80 ,$799.00 ,$799.00 ,$799.00 ,$718.16 ,$846.00
Carle Richland Memorial Hospital,99468,"INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL",,99468,987,"$4,350.00 ","$4,350.00 ","$3,323.40 ","$3,915.00 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,828.00 ","$3,697.50 ","$3,828.00 ","$3,828.00 ","$3,784.50 ","$3,697.50 ","$3,697.50 ","$3,697.50 ","$3,323.40 ","$3,915.00 "
Carle Richland Memorial Hospital,99224,SBSQ OBSERVATION CARE/DAY LEVEL 1,,99224,987,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,99225,SBSQ OBSERVATION CARE/DAY LEVEL 2,,99225,987,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,99226,SBSQ OBSERVATION CARE/DAY LEVEL 3,,99226,987,$330.00 ,$330.00 ,$252.12 ,$297.00 ,$280.50 ,$280.50 ,$280.50 ,$290.40 ,$280.50 ,$290.40 ,$290.40 ,$287.10 ,$280.50 ,$280.50 ,$280.50 ,$252.12 ,$297.00
Carle Richland Memorial Hospital,7579639,Pr Vitascrub,,0,990,$70.00 ,$70.00 ,$53.48 ,$63.00 ,$59.50 ,$59.50 ,$59.50 ,$61.60 ,$59.50 ,$61.60 ,$61.60 ,$60.90 ,$59.50 ,$59.50 ,$59.50 ,$53.48 ,$63.00
Carle Richland Memorial Hospital,7579638,Pr Oilacleanse,,0,990,$43.00 ,$43.00 ,$32.85 ,$38.70 ,$36.55 ,$36.55 ,$36.55 ,$37.84 ,$36.55 ,$37.84 ,$37.84 ,$37.41 ,$36.55 ,$36.55 ,$36.55 ,$32.85 ,$38.70
Carle Richland Memorial Hospital,8380002,CRYO POOR PLASMA PANEL,,,,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,G2025,SERVICES FURNISHED VIA TELEHEALTH,,,,$190.00 ,$190.00 ,$145.16 ,$171.00 ,$161.50 ,$161.50 ,$161.50 ,$167.20 ,$161.50 ,$167.20 ,$167.20 ,$165.30 ,$161.50 ,$161.50 ,$161.50 ,$145.16 ,$171.00
Carle Richland Memorial Hospital,97763,ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN,,97763,,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,99483,ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,,99483,,$670.00 ,$670.00 ,$511.88 ,$603.00 ,$569.50 ,$569.50 ,$569.50 ,$589.60 ,$569.50 ,$589.60 ,$589.60 ,$582.90 ,$569.50 ,$569.50 ,$569.50 ,$511.88 ,$603.00
Carle Richland Memorial Hospital,7000503,Pr Weight Management Class,,,,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,10030,IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE,,10030,,"$2,750.00 ","$2,750.00 ","$2,101.00 ","$2,475.00 ","$2,337.50 ","$2,337.50 ","$2,337.50 ","$2,420.00 ","$2,337.50 ","$2,420.00 ","$2,420.00 ","$2,392.50 ","$2,337.50 ","$2,337.50 ","$2,337.50 ","$2,101.00 ","$2,475.00 "
Carle Richland Memorial Hospital,19081,BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE,,19081,,"$3,300.00 ","$3,300.00 ","$2,521.20 ","$2,970.00 ","$2,805.00 ","$2,805.00 ","$2,805.00 ","$2,904.00 ","$2,805.00 ","$2,904.00 ","$2,904.00 ","$2,871.00 ","$2,805.00 ","$2,805.00 ","$2,805.00 ","$2,521.20 ","$2,970.00 "
Carle Richland Memorial Hospital,19082,BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE,,19082,,"$2,630.00 ","$2,630.00 ","$2,009.32 ","$2,367.00 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,314.40 ","$2,235.50 ","$2,314.40 ","$2,314.40 ","$2,288.10 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,009.32 ","$2,367.00 "
Carle Richland Memorial Hospital,19083,BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE,,19083,,"$3,270.00 ","$3,270.00 ","$2,498.28 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,877.60 ","$2,779.50 ","$2,877.60 ","$2,877.60 ","$2,844.90 ","$2,779.50 ","$2,779.50 ","$2,779.50 ","$2,498.28 ","$2,943.00 "
Carle Richland Memorial Hospital,19084,BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE,,19084,,"$2,590.00 ","$2,590.00 ","$1,978.76 ","$2,331.00 ","$2,201.50 ","$2,201.50 ","$2,201.50 ","$2,279.20 ","$2,201.50 ","$2,279.20 ","$2,279.20 ","$2,253.30 ","$2,201.50 ","$2,201.50 ","$2,201.50 ","$1,978.76 ","$2,331.00 "
Carle Richland Memorial Hospital,19085,BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE,,19085,,"$4,920.00 ","$4,920.00 ","$3,758.88 ","$4,428.00 ","$4,182.00 ","$4,182.00 ","$4,182.00 ","$4,329.60 ","$4,182.00 ","$4,329.60 ","$4,329.60 ","$4,280.40 ","$4,182.00 ","$4,182.00 ","$4,182.00 ","$3,758.88 ","$4,428.00 "
Carle Richland Memorial Hospital,19086,BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE,,19086,,"$3,870.00 ","$3,870.00 ","$2,956.68 ","$3,483.00 ","$3,289.50 ","$3,289.50 ","$3,289.50 ","$3,405.60 ","$3,289.50 ","$3,405.60 ","$3,405.60 ","$3,366.90 ","$3,289.50 ","$3,289.50 ","$3,289.50 ","$2,956.68 ","$3,483.00 "
Carle Richland Memorial Hospital,19281,PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE,,19281,,"$1,290.00 ","$1,290.00 ",$985.56 ,"$1,161.00 ","$1,096.50 ","$1,096.50 ","$1,096.50 ","$1,135.20 ","$1,096.50 ","$1,135.20 ","$1,135.20 ","$1,122.30 ","$1,096.50 ","$1,096.50 ","$1,096.50 ",$985.56 ,"$1,161.00 "
Carle Richland Memorial Hospital,19282,PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE,,19282,,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,19283,PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID,,19283,,"$1,450.00 ","$1,450.00 ","$1,107.80 ","$1,305.00 ","$1,232.50 ","$1,232.50 ","$1,232.50 ","$1,276.00 ","$1,232.50 ","$1,276.00 ","$1,276.00 ","$1,261.50 ","$1,232.50 ","$1,232.50 ","$1,232.50 ","$1,107.80 ","$1,305.00 "
Carle Richland Memorial Hospital,19284,PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC,,19284,,"$1,020.00 ","$1,020.00 ",$779.28 ,$918.00 ,$867.00 ,$867.00 ,$867.00 ,$897.60 ,$867.00 ,$897.60 ,$897.60 ,$887.40 ,$867.00 ,$867.00 ,$867.00 ,$779.28 ,$918.00
Carle Richland Memorial Hospital,19285,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,,19285,,"$2,330.00 ","$2,330.00 ","$1,780.12 ","$2,097.00 ","$1,980.50 ","$1,980.50 ","$1,980.50 ","$2,050.40 ","$1,980.50 ","$2,050.40 ","$2,050.40 ","$2,027.10 ","$1,980.50 ","$1,980.50 ","$1,980.50 ","$1,780.12 ","$2,097.00 "
Carle Richland Memorial Hospital,19286,PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE,,19286,,"$1,950.00 ","$1,950.00 ","$1,489.80 ","$1,755.00 ","$1,657.50 ","$1,657.50 ","$1,657.50 ","$1,716.00 ","$1,657.50 ","$1,716.00 ","$1,716.00 ","$1,696.50 ","$1,657.50 ","$1,657.50 ","$1,657.50 ","$1,489.80 ","$1,755.00 "
Carle Richland Memorial Hospital,19287,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID,,19287,,"$4,330.00 ","$4,330.00 ","$3,308.12 ","$3,897.00 ","$3,680.50 ","$3,680.50 ","$3,680.50 ","$3,810.40 ","$3,680.50 ","$3,810.40 ","$3,810.40 ","$3,767.10 ","$3,680.50 ","$3,680.50 ","$3,680.50 ","$3,308.12 ","$3,897.00 "
Carle Richland Memorial Hospital,19288,PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID,,19288,,"$3,410.00 ","$3,410.00 ","$2,605.24 ","$3,069.00 ","$2,898.50 ","$2,898.50 ","$2,898.50 ","$3,000.80 ","$2,898.50 ","$3,000.80 ","$3,000.80 ","$2,966.70 ","$2,898.50 ","$2,898.50 ","$2,898.50 ","$2,605.24 ","$3,069.00 "
Carle Richland Memorial Hospital,99446,INTERPROF PHONE/INTERNET ASSESS/MANAGE 5-10,,99446,,$71.00 ,$71.00 ,$54.24 ,$63.90 ,$60.35 ,$60.35 ,$60.35 ,$62.48 ,$60.35 ,$62.48 ,$62.48 ,$61.77 ,$60.35 ,$60.35 ,$60.35 ,$54.24 ,$63.90
Carle Richland Memorial Hospital,99447,INTERPROF PHONE/INTERNET ASSESS/MANAGE 11-20,,99447,,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,99448,INTERPROF PHONE/INTERNET ASSESS/MANAGE 21-30,,99448,,$220.00 ,$220.00 ,$168.08 ,$198.00 ,$187.00 ,$187.00 ,$187.00 ,$193.60 ,$187.00 ,$193.60 ,$193.60 ,$191.40 ,$187.00 ,$187.00 ,$187.00 ,$168.08 ,$198.00
Carle Richland Memorial Hospital,99449,INTERPROF PHONE/INTERNET ASSESS/MANAGE31/>,,99449,,$465.00 ,$465.00 ,$355.26 ,$418.50 ,$395.25 ,$395.25 ,$395.25 ,$409.20 ,$395.25 ,$409.20 ,$409.20 ,$404.55 ,$395.25 ,$395.25 ,$395.25 ,$355.26 ,$418.50
Carle Richland Memorial Hospital,20604,ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT,,20604,,$500.00 ,$500.00 ,$382.00 ,$450.00 ,$425.00 ,$425.00 ,$425.00 ,$440.00 ,$425.00 ,$440.00 ,$440.00 ,$435.00 ,$425.00 ,$425.00 ,$425.00 ,$382.00 ,$450.00
Carle Richland Memorial Hospital,20606,ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US,,20606,,$570.00 ,$570.00 ,$435.48 ,$513.00 ,$484.50 ,$484.50 ,$484.50 ,$501.60 ,$484.50 ,$501.60 ,$501.60 ,$495.90 ,$484.50 ,$484.50 ,$484.50 ,$435.48 ,$513.00
Carle Richland Memorial Hospital,33948,ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,,33948,,"$2,520.00 ","$2,520.00 ","$1,925.28 ","$2,268.00 ","$2,142.00 ","$2,142.00 ","$2,142.00 ","$2,217.60 ","$2,142.00 ","$2,217.60 ","$2,217.60 ","$2,192.40 ","$2,142.00 ","$2,142.00 ","$2,142.00 ","$1,925.28 ","$2,268.00 "
Carle Richland Memorial Hospital,46601,ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT,,46601,,$860.00 ,$860.00 ,$657.04 ,$774.00 ,$731.00 ,$731.00 ,$731.00 ,$756.80 ,$731.00 ,$756.80 ,$756.80 ,$748.20 ,$731.00 ,$731.00 ,$731.00 ,$657.04 ,$774.00
Carle Richland Memorial Hospital,46607,ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX,,46607,,"$1,750.00 ","$1,750.00 ","$1,337.00 ","$1,575.00 ","$1,487.50 ","$1,487.50 ","$1,487.50 ","$1,540.00 ","$1,487.50 ","$1,540.00 ","$1,540.00 ","$1,522.50 ","$1,487.50 ","$1,487.50 ","$1,487.50 ","$1,337.00 ","$1,575.00 "
Carle Richland Memorial Hospital,52441,CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE,,52441,,"$9,460.00 ","$9,460.00 ","$7,227.44 ","$8,514.00 ","$8,041.00 ","$8,041.00 ","$8,041.00 ","$8,324.80 ","$8,041.00 ","$8,324.80 ","$8,324.80 ","$8,230.20 ","$8,041.00 ","$8,041.00 ","$8,041.00 ","$7,227.44 ","$8,514.00 "
Carle Richland Memorial Hospital,52442,CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL,,52442,,"$7,310.00 ","$7,310.00 ","$5,584.84 ","$6,579.00 ","$6,213.50 ","$6,213.50 ","$6,213.50 ","$6,432.80 ","$6,213.50 ","$6,432.80 ","$6,432.80 ","$6,359.70 ","$6,213.50 ","$6,213.50 ","$6,213.50 ","$5,584.84 ","$6,579.00 "
Carle Richland Memorial Hospital,99188,APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP,,99188,,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,99498,ADVANCE CARE PLANNING EA ADDL 30 MINS,,99498,,$270.00 ,$270.00 ,$206.28 ,$243.00 ,$229.50 ,$229.50 ,$229.50 ,$237.60 ,$229.50 ,$237.60 ,$237.60 ,$234.90 ,$229.50 ,$229.50 ,$229.50 ,$206.28 ,$243.00
Carle Richland Memorial Hospital,96156,HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT,,96156,,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,96158,HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN,,96158,,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,96159,HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN,,96159,,$82.00 ,$82.00 ,$62.65 ,$73.80 ,$69.70 ,$69.70 ,$69.70 ,$72.16 ,$69.70 ,$72.16 ,$72.16 ,$71.34 ,$69.70 ,$69.70 ,$69.70 ,$62.65 ,$73.80
Carle Richland Memorial Hospital,96164,HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN,,96164,,$53.00 ,$53.00 ,$40.49 ,$47.70 ,$45.05 ,$45.05 ,$45.05 ,$46.64 ,$45.05 ,$46.64 ,$46.64 ,$46.11 ,$45.05 ,$45.05 ,$45.05 ,$40.49 ,$47.70
Carle Richland Memorial Hospital,96165,HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN,,96165,,$27.00 ,$27.00 ,$20.63 ,$24.30 ,$22.95 ,$22.95 ,$22.95 ,$23.76 ,$22.95 ,$23.76 ,$23.76 ,$23.49 ,$22.95 ,$22.95 ,$22.95 ,$20.63 ,$24.30
Carle Richland Memorial Hospital,96167,HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN,,96167,,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,96168,HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN,,96168,,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,96170,HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN,,96170,,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,96171,HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15,,96171,,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,99473,SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION,,99473,,$45.00 ,$45.00 ,$34.38 ,$40.50 ,$38.25 ,$38.25 ,$38.25 ,$39.60 ,$38.25 ,$39.60 ,$39.60 ,$39.15 ,$38.25 ,$38.25 ,$38.25 ,$34.38 ,$40.50
Carle Richland Memorial Hospital,G2086,Off base opioid tx 70min,,G2086,,"$1,200.00 ","$1,200.00 ",$916.80 ,"$1,080.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ","$1,056.00 ","$1,020.00 ","$1,056.00 ","$1,056.00 ","$1,044.00 ","$1,020.00 ","$1,020.00 ","$1,020.00 ",$916.80 ,"$1,080.00 "
Carle Richland Memorial Hospital,G2087,"Off base opioid tx, 60 m",,G2087,,"$1,080.00 ","$1,080.00 ",$825.12 ,$972.00 ,$918.00 ,$918.00 ,$918.00 ,$950.40 ,$918.00 ,$950.40 ,$950.40 ,$939.60 ,$918.00 ,$918.00 ,$918.00 ,$825.12 ,$972.00
Carle Richland Memorial Hospital,G2088,"Off base opioid tx, add30",,G2088,,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,7020094,VOLLURE COSMETIC,,,,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,7020095,KYBELLA PER VIAL COSMETIC,,,,$125.00 ,$125.00 ,$95.50 ,$112.50 ,$106.25 ,$106.25 ,$106.25 ,$110.00 ,$106.25 ,$110.00 ,$110.00 ,$108.75 ,$106.25 ,$106.25 ,$106.25 ,$95.50 ,$112.50
Carle Richland Memorial Hospital,7099401,RMH SCHOOL/SPORTS PHYSICIAL,,0,,$25.00 ,$25.00 ,$19.10 ,$22.50 ,$21.25 ,$21.25 ,$21.25 ,$22.00 ,$21.25 ,$22.00 ,$22.00 ,$21.75 ,$21.25 ,$21.25 ,$21.25 ,$19.10 ,$22.50
Carle Richland Memorial Hospital,82803,"BLOOD GASES: PH, PO2 & PCO2",,82803,,$175.00 ,$175.00 ,$133.70 ,$157.50 ,$148.75 ,$148.75 ,$148.75 ,$154.00 ,$148.75 ,$154.00 ,$154.00 ,$152.25 ,$148.75 ,$148.75 ,$148.75 ,$133.70 ,$157.50
Carle Richland Memorial Hospital,83036,GLYCOSYLATED HEMOGLOBIN TEST,,83036,,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,83605,ASSAY OF LACTIC ACID,,83605,,$140.00 ,$140.00 ,$106.96 ,$126.00 ,$119.00 ,$119.00 ,$119.00 ,$123.20 ,$119.00 ,$123.20 ,$123.20 ,$121.80 ,$119.00 ,$119.00 ,$119.00 ,$106.96 ,$126.00
Carle Richland Memorial Hospital,83986,PH BODY FLUID NOS,,83986,,$40.00 ,$40.00 ,$30.56 ,$36.00 ,$34.00 ,$34.00 ,$34.00 ,$35.20 ,$34.00 ,$35.20 ,$35.20 ,$34.80 ,$34.00 ,$34.00 ,$34.00 ,$30.56 ,$36.00
Carle Richland Memorial Hospital,85025,COMPLETE CBC & AUTO DIFF WBC,,85025,,$80.00 ,$80.00 ,$61.12 ,$72.00 ,$68.00 ,$68.00 ,$68.00 ,$70.40 ,$68.00 ,$70.40 ,$70.40 ,$69.60 ,$68.00 ,$68.00 ,$68.00 ,$61.12 ,$72.00
Carle Richland Memorial Hospital,85379,"FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT",,85379,,$160.00 ,$160.00 ,$122.24 ,$144.00 ,$136.00 ,$136.00 ,$136.00 ,$140.80 ,$136.00 ,$140.80 ,$140.80 ,$139.20 ,$136.00 ,$136.00 ,$136.00 ,$122.24 ,$144.00
Carle Richland Memorial Hospital,87101,CULTURE FUNGI-SKIN HAIR NAILS,,87101,,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,89310,"SEMEN ANALYSIS,MOTIL & COUNT W/O HUHNER",,89310,,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,90849,MULTIP FAMILY-GROUP PSYCHOTHERAPY,,90849,,$255.00 ,$255.00 ,$194.82 ,$229.50 ,$216.75 ,$216.75 ,$216.75 ,$224.40 ,$216.75 ,$224.40 ,$224.40 ,$221.85 ,$216.75 ,$216.75 ,$216.75 ,$194.82 ,$229.50
Carle Richland Memorial Hospital,90870,MEDICAL SERVICE,,90870,,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,90880,MEDICAL SERVICE,,90880,,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,90882,MEDICAL SERVICE,,90882,,$235.00 ,$235.00 ,$179.54 ,$211.50 ,$199.75 ,$199.75 ,$199.75 ,$206.80 ,$199.75 ,$206.80 ,$206.80 ,$204.45 ,$199.75 ,$199.75 ,$199.75 ,$179.54 ,$211.50
Carle Richland Memorial Hospital,90887,MEDICAL SERVICE,,90887,,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,90889,MEDICAL SERVICE,,90889,,$230.00 ,$230.00 ,$175.72 ,$207.00 ,$195.50 ,$195.50 ,$195.50 ,$202.40 ,$195.50 ,$202.40 ,$202.40 ,$200.10 ,$195.50 ,$195.50 ,$195.50 ,$175.72 ,$207.00
Carle Richland Memorial Hospital,90935,HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION,,90935,,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,90937,"HEMODIALYSIS, REPEATED EVAL.",,90937,,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,91065,BREATH HYDROGEN/METHANE TEST,,91065,,$485.00 ,$485.00 ,$370.54 ,$436.50 ,$412.25 ,$412.25 ,$412.25 ,$426.80 ,$412.25 ,$426.80 ,$426.80 ,$421.95 ,$412.25 ,$412.25 ,$412.25 ,$370.54 ,$436.50
Carle Richland Memorial Hospital,92002,"EYE EXAM, NEW PATIENT,INTERMED",,92002,,$205.00 ,$205.00 ,$156.62 ,$184.50 ,$174.25 ,$174.25 ,$174.25 ,$180.40 ,$174.25 ,$180.40 ,$180.40 ,$178.35 ,$174.25 ,$174.25 ,$174.25 ,$156.62 ,$184.50
Carle Richland Memorial Hospital,92004,"EYE EXAM, NEW PATIENT,COMPREHESV",,92004,,$300.00 ,$300.00 ,$229.20 ,$270.00 ,$255.00 ,$255.00 ,$255.00 ,$264.00 ,$255.00 ,$264.00 ,$264.00 ,$261.00 ,$255.00 ,$255.00 ,$255.00 ,$229.20 ,$270.00
Carle Richland Memorial Hospital,92511,NASOPHARYNGOSCOPY,,92511,,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,92557,COMPREHENSIVE HEARING TEST,,92557,,$225.00 ,$225.00 ,$171.90 ,$202.50 ,$191.25 ,$191.25 ,$191.25 ,$198.00 ,$191.25 ,$198.00 ,$198.00 ,$195.75 ,$191.25 ,$191.25 ,$191.25 ,$171.90 ,$202.50
Carle Richland Memorial Hospital,92960,"CARDIOVERSION, ELECTIVE;EXTERN",,92960,,$960.00 ,$960.00 ,$733.44 ,$864.00 ,$816.00 ,$816.00 ,$816.00 ,$844.80 ,$816.00 ,$844.80 ,$844.80 ,$835.20 ,$816.00 ,$816.00 ,$816.00 ,$733.44 ,$864.00
Carle Richland Memorial Hospital,93503,INSERT/PLACE FLOW DIRECT CATH,,93503,,"$1,450.00 ","$1,450.00 ","$1,107.80 ","$1,305.00 ","$1,232.50 ","$1,232.50 ","$1,232.50 ","$1,276.00 ","$1,232.50 ","$1,276.00 ","$1,276.00 ","$1,261.50 ","$1,232.50 ","$1,232.50 ","$1,232.50 ","$1,107.80 ","$1,305.00 "
Carle Richland Memorial Hospital,94070,"EVAL OF BRONCHOSPASM,PROLONGED",,94070,,$610.00 ,$610.00 ,$466.04 ,$549.00 ,$518.50 ,$518.50 ,$518.50 ,$536.80 ,$518.50 ,$536.80 ,$536.80 ,$530.70 ,$518.50 ,$518.50 ,$518.50 ,$466.04 ,$549.00
Carle Richland Memorial Hospital,94762,"NONINVASV OXYGEN SATUT,CONTINUOUS",,94762,,$165.00 ,$165.00 ,$126.06 ,$148.50 ,$140.25 ,$140.25 ,$140.25 ,$145.20 ,$140.25 ,$145.20 ,$145.20 ,$143.55 ,$140.25 ,$140.25 ,$140.25 ,$126.06 ,$148.50
Carle Richland Memorial Hospital,95044,ALLERGY PATCH TESTS,,95044,,$40.00 ,$40.00 ,$30.56 ,$36.00 ,$34.00 ,$34.00 ,$34.00 ,$35.20 ,$34.00 ,$35.20 ,$35.20 ,$34.80 ,$34.00 ,$34.00 ,$34.00 ,$30.56 ,$36.00
Carle Richland Memorial Hospital,95145,"PROFES SVC,IMMUNOTHERAPY,1 INSECT VENOM",,95145,,$77.00 ,$77.00 ,$58.83 ,$69.30 ,$65.45 ,$65.45 ,$65.45 ,$67.76 ,$65.45 ,$67.76 ,$67.76 ,$66.99 ,$65.45 ,$65.45 ,$65.45 ,$58.83 ,$69.30
Carle Richland Memorial Hospital,95147,"ANTIGEN RX SERV,INSECT,3 VENOMS",,95147,,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,95148,"ANTIGEN RX SERV,INSECT,4 VENOMS",,95148,,$145.00 ,$145.00 ,$110.78 ,$130.50 ,$123.25 ,$123.25 ,$123.25 ,$127.60 ,$123.25 ,$127.60 ,$127.60 ,$126.15 ,$123.25 ,$123.25 ,$123.25 ,$110.78 ,$130.50
Carle Richland Memorial Hospital,95149,"ANTIGEN RX SERV,INSECT,5 VENOMS",,95149,,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,95165,"PROFES SVC,IMMUNOTHER,SINGLE/MULT AGS",,95165,,$39.00 ,$39.00 ,$29.80 ,$35.10 ,$33.15 ,$33.15 ,$33.15 ,$34.32 ,$33.15 ,$34.32 ,$34.32 ,$33.93 ,$33.15 ,$33.15 ,$33.15 ,$29.80 ,$35.10
Carle Richland Memorial Hospital,95180,"RAPID DESENSITIZATION PROC,EACH HOUR",,95180,,$430.00 ,$430.00 ,$328.52 ,$387.00 ,$365.50 ,$365.50 ,$365.50 ,$378.40 ,$365.50 ,$378.40 ,$378.40 ,$374.10 ,$365.50 ,$365.50 ,$365.50 ,$328.52 ,$387.00
Carle Richland Memorial Hospital,96105,ASSESSMENT OF APHASIA,,96105,,$460.00 ,$460.00 ,$351.44 ,$414.00 ,$391.00 ,$391.00 ,$391.00 ,$404.80 ,$391.00 ,$404.80 ,$404.80 ,$400.20 ,$391.00 ,$391.00 ,$391.00 ,$351.44 ,$414.00
Carle Richland Memorial Hospital,96450,"CHEMOTHER,CNS,W/LUMBAR PUNCTURE",,96450,,"$1,110.00 ","$1,110.00 ",$848.04 ,$999.00 ,$943.50 ,$943.50 ,$943.50 ,$976.80 ,$943.50 ,$976.80 ,$976.80 ,$965.70 ,$943.50 ,$943.50 ,$943.50 ,$848.04 ,$999.00
Carle Richland Memorial Hospital,96542,"CHEMOTHER INJECT,SUBARACH/INTRAVENT",,96542,,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,99360,PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES,,99360,,$375.00 ,$375.00 ,$286.50 ,$337.50 ,$318.75 ,$318.75 ,$318.75 ,$330.00 ,$318.75 ,$330.00 ,$330.00 ,$326.25 ,$318.75 ,$318.75 ,$318.75 ,$286.50 ,$337.50
Carle Richland Memorial Hospital,99401,"PREVENT COUNSEL,INDIV,15 MIN",,99401,,$99.00 ,$99.00 ,$75.64 ,$89.10 ,$84.15 ,$84.15 ,$84.15 ,$87.12 ,$84.15 ,$87.12 ,$87.12 ,$86.13 ,$84.15 ,$84.15 ,$84.15 ,$75.64 ,$89.10
Carle Richland Memorial Hospital,99404,"PREVENT COUNSEL,INDIV,60 MIN",,99404,,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,99412,"PREVENT COUNSEL,GROUP,60 MIN",,99412,,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,99456,DISABILITY EXAM/OTHER DR,,99456,,$375.00 ,$375.00 ,$286.50 ,$337.50 ,$318.75 ,$318.75 ,$318.75 ,$330.00 ,$318.75 ,$330.00 ,$330.00 ,$326.25 ,$318.75 ,$318.75 ,$318.75 ,$286.50 ,$337.50
Carle Richland Memorial Hospital,D0140,Limit oral eval problm focus,,D0140,,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,90956,ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT,,90956,,"$1,480.00 ","$1,480.00 ","$1,130.72 ","$1,332.00 ","$1,258.00 ","$1,258.00 ","$1,258.00 ","$1,302.40 ","$1,258.00 ","$1,302.40 ","$1,302.40 ","$1,287.60 ","$1,258.00 ","$1,258.00 ","$1,258.00 ","$1,130.72 ","$1,332.00 "
Carle Richland Memorial Hospital,84484,"ASSAY OF TROPONIN, QUANT",,84484,,$100.00 ,$100.00 ,$76.40 ,$90.00 ,$85.00 ,$85.00 ,$85.00 ,$88.00 ,$85.00 ,$88.00 ,$88.00 ,$87.00 ,$85.00 ,$85.00 ,$85.00 ,$76.40 ,$90.00
Carle Richland Memorial Hospital,90875,MEDICAL SERVICE,,90875,,$210.00 ,$210.00 ,$160.44 ,$189.00 ,$178.50 ,$178.50 ,$178.50 ,$184.80 ,$178.50 ,$184.80 ,$184.80 ,$182.70 ,$178.50 ,$178.50 ,$178.50 ,$160.44 ,$189.00
Carle Richland Memorial Hospital,90876,MEDICAL SERVICE,,90876,,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,89259,"CRYOPRESERVATION, SPERM",,89259,,$385.00 ,$385.00 ,$294.14 ,$346.50 ,$327.25 ,$327.25 ,$327.25 ,$338.80 ,$327.25 ,$338.80 ,$338.80 ,$334.95 ,$327.25 ,$327.25 ,$327.25 ,$294.14 ,$346.50
Carle Richland Memorial Hospital,89261,"SPERM ISOLATION, COMPLEX",,89261,,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,90865,NARCOSYNTHESIS,,90865,,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,90885,MEDICAL SERVICE,,90885,,$285.00 ,$285.00 ,$217.74 ,$256.50 ,$242.25 ,$242.25 ,$242.25 ,$250.80 ,$242.25 ,$250.80 ,$250.80 ,$247.95 ,$242.25 ,$242.25 ,$242.25 ,$217.74 ,$256.50
Carle Richland Memorial Hospital,G0104,CA screen;flexi sigmoidscope,,G0104,,"$1,090.00 ","$1,090.00 ",$832.76 ,$981.00 ,$926.50 ,$926.50 ,$926.50 ,$959.20 ,$926.50 ,$959.20 ,$959.20 ,$948.30 ,$926.50 ,$926.50 ,$926.50 ,$832.76 ,$981.00
Carle Richland Memorial Hospital,96150,MEDICAL SERVICE,,96150,,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,96151,MEDICAL SERVICE,,96151,,$82.00 ,$82.00 ,$62.65 ,$73.80 ,$69.70 ,$69.70 ,$69.70 ,$72.16 ,$69.70 ,$72.16 ,$72.16 ,$71.34 ,$69.70 ,$69.70 ,$69.70 ,$62.65 ,$73.80
Carle Richland Memorial Hospital,96152,MEDICAL SERVICE,,96152,,$78.00 ,$78.00 ,$59.59 ,$70.20 ,$66.30 ,$66.30 ,$66.30 ,$68.64 ,$66.30 ,$68.64 ,$68.64 ,$67.86 ,$66.30 ,$66.30 ,$66.30 ,$59.59 ,$70.20
Carle Richland Memorial Hospital,96153,MEDICAL SERVICE,,96153,,$25.00 ,$25.00 ,$19.10 ,$22.50 ,$21.25 ,$21.25 ,$21.25 ,$22.00 ,$21.25 ,$22.00 ,$22.00 ,$21.75 ,$21.25 ,$21.25 ,$21.25 ,$19.10 ,$22.50
Carle Richland Memorial Hospital,96154,MEDICAL SERVICE,,96154,,$91.00 ,$91.00 ,$69.52 ,$81.90 ,$77.35 ,$77.35 ,$77.35 ,$80.08 ,$77.35 ,$80.08 ,$80.08 ,$79.17 ,$77.35 ,$77.35 ,$77.35 ,$69.52 ,$81.90
Carle Richland Memorial Hospital,97804,"MED NUTR THER, GROUP, EA 30 MIN",,97804,,$62.00 ,$62.00 ,$47.37 ,$55.80 ,$52.70 ,$52.70 ,$52.70 ,$54.56 ,$52.70 ,$54.56 ,$54.56 ,$53.94 ,$52.70 ,$52.70 ,$52.70 ,$47.37 ,$55.80
Carle Richland Memorial Hospital,77427,"RADIATION,MANGEMENT,5 TX'S",,77427,,"$1,600.00 ","$1,600.00 ","$1,222.40 ","$1,440.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,408.00 ","$1,360.00 ","$1,408.00 ","$1,408.00 ","$1,392.00 ","$1,360.00 ","$1,360.00 ","$1,360.00 ","$1,222.40 ","$1,440.00 "
Carle Richland Memorial Hospital,83880,NATRIURETIC PEPTIDE,,83880,,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,87172,PINWORM EXAM,,87172,,$66.00 ,$66.00 ,$50.42 ,$59.40 ,$56.10 ,$56.10 ,$56.10 ,$58.08 ,$56.10 ,$58.08 ,$58.08 ,$57.42 ,$56.10 ,$56.10 ,$56.10 ,$50.42 ,$59.40
Carle Richland Memorial Hospital,94002,"VENT MANAGEMENT, INPATIENT, INITIAL DAY",,94002,,$820.00 ,$820.00 ,$626.48 ,$738.00 ,$697.00 ,$697.00 ,$697.00 ,$721.60 ,$697.00 ,$721.60 ,$721.60 ,$713.40 ,$697.00 ,$697.00 ,$697.00 ,$626.48 ,$738.00
Carle Richland Memorial Hospital,94003,"VENT MANAGEMENT, INPATIENT, SUBSEQ DAY",,94003,,$485.00 ,$485.00 ,$370.54 ,$436.50 ,$412.25 ,$412.25 ,$412.25 ,$426.80 ,$412.25 ,$426.80 ,$426.80 ,$421.95 ,$412.25 ,$412.25 ,$412.25 ,$370.54 ,$436.50
Carle Richland Memorial Hospital,94004,"VENT MANAGEMENT, NURSING HOME,PER DAY",,94004,,$340.00 ,$340.00 ,$259.76 ,$306.00 ,$289.00 ,$289.00 ,$289.00 ,$299.20 ,$289.00 ,$299.20 ,$299.20 ,$295.80 ,$289.00 ,$289.00 ,$289.00 ,$259.76 ,$306.00
Carle Richland Memorial Hospital,94005,"VENT MANAGEMENT, HOME, > 30 MIN",,94005,,$600.00 ,$600.00 ,$458.40 ,$540.00 ,$510.00 ,$510.00 ,$510.00 ,$528.00 ,$510.00 ,$528.00 ,$528.00 ,$522.00 ,$510.00 ,$510.00 ,$510.00 ,$458.40 ,$540.00
Carle Richland Memorial Hospital,96040,"GENETIC COUNSELING, EACH 30 MIN",,96040,,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,96409,"CHEMOTHER, IV PUSH, SNGL DRUG",,96409,,$510.00 ,$510.00 ,$389.64 ,$459.00 ,$433.50 ,$433.50 ,$433.50 ,$448.80 ,$433.50 ,$448.80 ,$448.80 ,$443.70 ,$433.50 ,$433.50 ,$433.50 ,$389.64 ,$459.00
Carle Richland Memorial Hospital,96411,"CHEMOTHER, IV PUSH,EA ADD DRUG",,96411,,$295.00 ,$295.00 ,$225.38 ,$265.50 ,$250.75 ,$250.75 ,$250.75 ,$259.60 ,$250.75 ,$259.60 ,$259.60 ,$256.65 ,$250.75 ,$250.75 ,$250.75 ,$225.38 ,$265.50
Carle Richland Memorial Hospital,96413,"CHEMOTHER, IV INFUSION, 1 HR",,96413,,$630.00 ,$630.00 ,$481.32 ,$567.00 ,$535.50 ,$535.50 ,$535.50 ,$554.40 ,$535.50 ,$554.40 ,$554.40 ,$548.10 ,$535.50 ,$535.50 ,$535.50 ,$481.32 ,$567.00
Carle Richland Memorial Hospital,96415,"CHEMOTHER, IV INFUSION, EA ADD HR",,96415,,$170.00 ,$170.00 ,$129.88 ,$153.00 ,$144.50 ,$144.50 ,$144.50 ,$149.60 ,$144.50 ,$149.60 ,$149.60 ,$147.90 ,$144.50 ,$144.50 ,$144.50 ,$129.88 ,$153.00
Carle Richland Memorial Hospital,96416,CHEMOTHER PROLONG INFUSE W/PUMP,,96416,,$750.00 ,$750.00 ,$573.00 ,$675.00 ,$637.50 ,$637.50 ,$637.50 ,$660.00 ,$637.50 ,$660.00 ,$660.00 ,$652.50 ,$637.50 ,$637.50 ,$637.50 ,$573.00 ,$675.00
Carle Richland Memorial Hospital,96417,"CHEMOTHER, IV INFUSE, EACH SEQU INFUS",,96417,,$370.00 ,$370.00 ,$282.68 ,$333.00 ,$314.50 ,$314.50 ,$314.50 ,$325.60 ,$314.50 ,$325.60 ,$325.60 ,$321.90 ,$314.50 ,$314.50 ,$314.50 ,$282.68 ,$333.00
Carle Richland Memorial Hospital,96521,"REFILL/MAINT, PORTABLE PUMP",,96521,,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,96522,REFILL/MAINT SYSTEMIC PUMP/RESVR,,96522,,$395.00 ,$395.00 ,$301.78 ,$355.50 ,$335.75 ,$335.75 ,$335.75 ,$347.60 ,$335.75 ,$347.60 ,$347.60 ,$343.65 ,$335.75 ,$335.75 ,$335.75 ,$301.78 ,$355.50
Carle Richland Memorial Hospital,97605,NEGATIVE PRESSURE WOUND THERAPY DME = 50 SQ CM,,97605,,$265.00 ,$265.00 ,$202.46 ,$238.50 ,$225.25 ,$225.25 ,$225.25 ,$233.20 ,$225.25 ,$233.20 ,$233.20 ,$230.55 ,$225.25 ,$225.25 ,$225.25 ,$202.46 ,$238.50
Carle Richland Memorial Hospital,97606,NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,,97606,,$335.00 ,$335.00 ,$255.94 ,$301.50 ,$284.75 ,$284.75 ,$284.75 ,$294.80 ,$284.75 ,$294.80 ,$294.80 ,$291.45 ,$284.75 ,$284.75 ,$284.75 ,$255.94 ,$301.50
Carle Richland Memorial Hospital,97760,ORTHOTICS MGMT & TRAINJ INITIAL ENCTR EA 15 MINS,,97760,,$155.00 ,$155.00 ,$118.42 ,$139.50 ,$131.75 ,$131.75 ,$131.75 ,$136.40 ,$131.75 ,$136.40 ,$136.40 ,$134.85 ,$131.75 ,$131.75 ,$131.75 ,$118.42 ,$139.50
Carle Richland Memorial Hospital,99339,"DOMICIL/REST-HOME CARE SUPERVISION, <30 MIN",,99339,,$245.00 ,$245.00 ,$187.18 ,$220.50 ,$208.25 ,$208.25 ,$208.25 ,$215.60 ,$208.25 ,$215.60 ,$215.60 ,$213.15 ,$208.25 ,$208.25 ,$208.25 ,$187.18 ,$220.50
Carle Richland Memorial Hospital,99340,"DOMICIL/REST-HOME CARE SUPERVISION, =>30 MIN",,99340,,$380.00 ,$380.00 ,$290.32 ,$342.00 ,$323.00 ,$323.00 ,$323.00 ,$334.40 ,$323.00 ,$334.40 ,$334.40 ,$330.60 ,$323.00 ,$323.00 ,$323.00 ,$290.32 ,$342.00
Carle Richland Memorial Hospital,89322,"SEMEN ANALYSIS, STRICT MORPHOLOGIC CRITERIA",,89322,,$360.00 ,$360.00 ,$275.04 ,$324.00 ,$306.00 ,$306.00 ,$306.00 ,$316.80 ,$306.00 ,$316.80 ,$316.80 ,$313.20 ,$306.00 ,$306.00 ,$306.00 ,$275.04 ,$324.00
Carle Richland Memorial Hospital,90951,ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS,,90951,,"$4,140.00 ","$4,140.00 ","$3,162.96 ","$3,726.00 ","$3,519.00 ","$3,519.00 ","$3,519.00 ","$3,643.20 ","$3,519.00 ","$3,643.20 ","$3,643.20 ","$3,601.80 ","$3,519.00 ","$3,519.00 ","$3,519.00 ","$3,162.96 ","$3,726.00 "
Carle Richland Memorial Hospital,90954,ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS,,90954,,"$4,240.00 ","$4,240.00 ","$3,239.36 ","$3,816.00 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,731.20 ","$3,604.00 ","$3,731.20 ","$3,731.20 ","$3,688.80 ","$3,604.00 ","$3,604.00 ","$3,604.00 ","$3,239.36 ","$3,816.00 "
Carle Richland Memorial Hospital,90955,ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS,,90955,,"$2,020.00 ","$2,020.00 ","$1,543.28 ","$1,818.00 ","$1,717.00 ","$1,717.00 ","$1,717.00 ","$1,777.60 ","$1,717.00 ","$1,777.60 ","$1,777.60 ","$1,757.40 ","$1,717.00 ","$1,717.00 ","$1,717.00 ","$1,543.28 ","$1,818.00 "
Carle Richland Memorial Hospital,90957,ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS,,90957,,"$3,350.00 ","$3,350.00 ","$2,559.40 ","$3,015.00 ","$2,847.50 ","$2,847.50 ","$2,847.50 ","$2,948.00 ","$2,847.50 ","$2,948.00 ","$2,948.00 ","$2,914.50 ","$2,847.50 ","$2,847.50 ","$2,847.50 ","$2,559.40 ","$3,015.00 "
Carle Richland Memorial Hospital,90958,ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS,,90958,,"$2,250.00 ","$2,250.00 ","$1,719.00 ","$2,025.00 ","$1,912.50 ","$1,912.50 ","$1,912.50 ","$1,980.00 ","$1,912.50 ","$1,980.00 ","$1,980.00 ","$1,957.50 ","$1,912.50 ","$1,912.50 ","$1,912.50 ","$1,719.00 ","$2,025.00 "
Carle Richland Memorial Hospital,90959,ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT,,90959,,"$1,420.00 ","$1,420.00 ","$1,084.88 ","$1,278.00 ","$1,207.00 ","$1,207.00 ","$1,207.00 ","$1,249.60 ","$1,207.00 ","$1,249.60 ","$1,249.60 ","$1,235.40 ","$1,207.00 ","$1,207.00 ","$1,207.00 ","$1,084.88 ","$1,278.00 "
Carle Richland Memorial Hospital,90960,ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS,,90960,,"$1,370.00 ","$1,370.00 ","$1,046.68 ","$1,233.00 ","$1,164.50 ","$1,164.50 ","$1,164.50 ","$1,205.60 ","$1,164.50 ","$1,205.60 ","$1,205.60 ","$1,191.90 ","$1,164.50 ","$1,164.50 ","$1,164.50 ","$1,046.68 ","$1,233.00 "
Carle Richland Memorial Hospital,90961,ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS,,90961,,"$1,110.00 ","$1,110.00 ",$848.04 ,$999.00 ,$943.50 ,$943.50 ,$943.50 ,$976.80 ,$943.50 ,$976.80 ,$976.80 ,$965.70 ,$943.50 ,$943.50 ,$943.50 ,$848.04 ,$999.00
Carle Richland Memorial Hospital,90962,ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT,,90962,,$900.00 ,$900.00 ,$687.60 ,$810.00 ,$765.00 ,$765.00 ,$765.00 ,$792.00 ,$765.00 ,$792.00 ,$792.00 ,$783.00 ,$765.00 ,$765.00 ,$765.00 ,$687.60 ,$810.00
Carle Richland Memorial Hospital,90963,"ESRD SERVICES, HOME DIALYSIS, PER MONTH, < 2 YR OLD",,90963,,"$2,870.00 ","$2,870.00 ","$2,192.68 ","$2,583.00 ","$2,439.50 ","$2,439.50 ","$2,439.50 ","$2,525.60 ","$2,439.50 ","$2,525.60 ","$2,525.60 ","$2,496.90 ","$2,439.50 ","$2,439.50 ","$2,439.50 ","$2,192.68 ","$2,583.00 "
Carle Richland Memorial Hospital,90964,"ESRD SERVICES, HOME DIALYSIS, PER MONTH, 2-11 YR OLD",,90964,,"$2,390.00 ","$2,390.00 ","$1,825.96 ","$2,151.00 ","$2,031.50 ","$2,031.50 ","$2,031.50 ","$2,103.20 ","$2,031.50 ","$2,103.20 ","$2,103.20 ","$2,079.30 ","$2,031.50 ","$2,031.50 ","$2,031.50 ","$1,825.96 ","$2,151.00 "
Carle Richland Memorial Hospital,90965,"ESRD SERVICES, HOME DIALYSIS, PER MONTH, 12-19 YR OLD",,90965,,"$2,160.00 ","$2,160.00 ","$1,650.24 ","$1,944.00 ","$1,836.00 ","$1,836.00 ","$1,836.00 ","$1,900.80 ","$1,836.00 ","$1,900.80 ","$1,900.80 ","$1,879.20 ","$1,836.00 ","$1,836.00 ","$1,836.00 ","$1,650.24 ","$1,944.00 "
Carle Richland Memorial Hospital,90966,"ESRD SERVICES, HOME DIALYSIS, PER MONTH, 20+ YR OLD",,90966,,"$1,020.00 ","$1,020.00 ",$779.28 ,$918.00 ,$867.00 ,$867.00 ,$867.00 ,$897.60 ,$867.00 ,$897.60 ,$897.60 ,$887.40 ,$867.00 ,$867.00 ,$867.00 ,$779.28 ,$918.00
Carle Richland Memorial Hospital,90967,"ESRD SERVICES, PER DAY, < 2 YR OLD",,90967,,$115.00 ,$115.00 ,$87.86 ,$103.50 ,$97.75 ,$97.75 ,$97.75 ,$101.20 ,$97.75 ,$101.20 ,$101.20 ,$100.05 ,$97.75 ,$97.75 ,$97.75 ,$87.86 ,$103.50
Carle Richland Memorial Hospital,90968,"ESRD SERVICES, PER DAY, 2-11 YR OLD",,90968,,$88.00 ,$88.00 ,$67.23 ,$79.20 ,$74.80 ,$74.80 ,$74.80 ,$77.44 ,$74.80 ,$77.44 ,$77.44 ,$76.56 ,$74.80 ,$74.80 ,$74.80 ,$67.23 ,$79.20
Carle Richland Memorial Hospital,90969,"ESRD SERVICES, PER DAY, 12-19 YR OLD",,90969,,$79.00 ,$79.00 ,$60.36 ,$71.10 ,$67.15 ,$67.15 ,$67.15 ,$69.52 ,$67.15 ,$69.52 ,$69.52 ,$68.73 ,$67.15 ,$67.15 ,$67.15 ,$60.36 ,$71.10
Carle Richland Memorial Hospital,90970,"ESRD SERVICES, PER DAY,20+ YR OLD",,90970,,$44.00 ,$44.00 ,$33.62 ,$39.60 ,$37.40 ,$37.40 ,$37.40 ,$38.72 ,$37.40 ,$38.72 ,$38.72 ,$38.28 ,$37.40 ,$37.40 ,$37.40 ,$33.62 ,$39.60
Carle Richland Memorial Hospital,96125,MEDICAL SERVICE,,96125,,$730.00 ,$730.00 ,$557.72 ,$657.00 ,$620.50 ,$620.50 ,$620.50 ,$642.40 ,$620.50 ,$642.40 ,$642.40 ,$635.10 ,$620.50 ,$620.50 ,$620.50 ,$557.72 ,$657.00
Carle Richland Memorial Hospital,96367,IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,,96367,,$180.00 ,$180.00 ,$137.52 ,$162.00 ,$153.00 ,$153.00 ,$153.00 ,$158.40 ,$153.00 ,$158.40 ,$158.40 ,$156.60 ,$153.00 ,$153.00 ,$153.00 ,$137.52 ,$162.00
Carle Richland Memorial Hospital,96368,"IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION",,96368,,$130.00 ,$130.00 ,$99.32 ,$117.00 ,$110.50 ,$110.50 ,$110.50 ,$114.40 ,$110.50 ,$114.40 ,$114.40 ,$113.10 ,$110.50 ,$110.50 ,$110.50 ,$99.32 ,$117.00
Carle Richland Memorial Hospital,96369,"SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR",,96369,,$780.00 ,$780.00 ,$595.92 ,$702.00 ,$663.00 ,$663.00 ,$663.00 ,$686.40 ,$663.00 ,$686.40 ,$686.40 ,$678.60 ,$663.00 ,$663.00 ,$663.00 ,$595.92 ,$702.00
Carle Richland Memorial Hospital,96370,"SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR",,96370,,$105.00 ,$105.00 ,$80.22 ,$94.50 ,$89.25 ,$89.25 ,$89.25 ,$92.40 ,$89.25 ,$92.40 ,$92.40 ,$91.35 ,$89.25 ,$89.25 ,$89.25 ,$80.22 ,$94.50
Carle Richland Memorial Hospital,96371,"SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,ADD PUMP SET",,96371,,$390.00 ,$390.00 ,$297.96 ,$351.00 ,$331.50 ,$331.50 ,$331.50 ,$343.20 ,$331.50 ,$343.20 ,$343.20 ,$339.30 ,$331.50 ,$331.50 ,$331.50 ,$297.96 ,$351.00
Carle Richland Memorial Hospital,99366,TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN,,99366,,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,99367,TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN,,99367,,$250.00 ,$250.00 ,$191.00 ,$225.00 ,$212.50 ,$212.50 ,$212.50 ,$220.00 ,$212.50 ,$220.00 ,$220.00 ,$217.50 ,$212.50 ,$212.50 ,$212.50 ,$191.00 ,$225.00
Carle Richland Memorial Hospital,99368,TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,,99368,,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,99409,ALCOHOL/SUBSTANCE SCREEN & INTERVEN >30 MIN,,99409,,$260.00 ,$260.00 ,$198.64 ,$234.00 ,$221.00 ,$221.00 ,$221.00 ,$228.80 ,$221.00 ,$228.80 ,$228.80 ,$226.20 ,$221.00 ,$221.00 ,$221.00 ,$198.64 ,$234.00
Carle Richland Memorial Hospital,99469,"SUBSEQUENT HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL",,99469,,"$2,660.00 ","$2,660.00 ","$2,032.24 ","$2,394.00 ","$2,261.00 ","$2,261.00 ","$2,261.00 ","$2,340.80 ","$2,261.00 ","$2,340.80 ","$2,340.80 ","$2,314.20 ","$2,261.00 ","$2,261.00 ","$2,261.00 ","$2,032.24 ","$2,394.00 "
Carle Richland Memorial Hospital,99471,INITIAL PED CRITICAL CARE 29 DAY THRU 24 MO,,99471,,"$3,760.00 ","$3,760.00 ","$2,872.64 ","$3,384.00 ","$3,196.00 ","$3,196.00 ","$3,196.00 ","$3,308.80 ","$3,196.00 ","$3,308.80 ","$3,308.80 ","$3,271.20 ","$3,196.00 ","$3,196.00 ","$3,196.00 ","$2,872.64 ","$3,384.00 "
Carle Richland Memorial Hospital,99472,SUBSEQUENT PED CRITICAL CARE 29 DAY THRU 24 MO,,99472,,"$2,630.00 ","$2,630.00 ","$2,009.32 ","$2,367.00 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,314.40 ","$2,235.50 ","$2,314.40 ","$2,314.40 ","$2,288.10 ","$2,235.50 ","$2,235.50 ","$2,235.50 ","$2,009.32 ","$2,367.00 "
Carle Richland Memorial Hospital,99475,INITIAL PED CRITICAL CARE 2 YR THRU 5 YR,,99475,,"$3,110.00 ","$3,110.00 ","$2,376.04 ","$2,799.00 ","$2,643.50 ","$2,643.50 ","$2,643.50 ","$2,736.80 ","$2,643.50 ","$2,736.80 ","$2,736.80 ","$2,705.70 ","$2,643.50 ","$2,643.50 ","$2,643.50 ","$2,376.04 ","$2,799.00 "
Carle Richland Memorial Hospital,99476,SUBSEQUENT PED CRITICAL CARE 2 YR THRU 5 YR,,99476,,"$2,110.00 ","$2,110.00 ","$1,612.04 ","$1,899.00 ","$1,793.50 ","$1,793.50 ","$1,793.50 ","$1,856.80 ","$1,793.50 ","$1,856.80 ","$1,856.80 ","$1,835.70 ","$1,793.50 ","$1,793.50 ","$1,793.50 ","$1,612.04 ","$1,899.00 "
Carle Richland Memorial Hospital,99477,"INITIAL HOSP NEONATE 28 DAY OR LESS, NOT CRITICALLY ILL",,99477,,"$2,410.00 ","$2,410.00 ","$1,841.24 ","$2,169.00 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$2,120.80 ","$2,048.50 ","$2,120.80 ","$2,120.80 ","$2,096.70 ","$2,048.50 ","$2,048.50 ","$2,048.50 ","$1,841.24 ","$2,169.00 "
Carle Richland Memorial Hospital,99478,SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS,,99478,,"$1,100.00 ","$1,100.00 ",$840.40 ,$990.00 ,$935.00 ,$935.00 ,$935.00 ,$968.00 ,$935.00 ,$968.00 ,$968.00 ,$957.00 ,$935.00 ,$935.00 ,$935.00 ,$840.40 ,$990.00
Carle Richland Memorial Hospital,99479,SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS,,99479,,"$1,030.00 ","$1,030.00 ",$786.92 ,$927.00 ,$875.50 ,$875.50 ,$875.50 ,$906.40 ,$875.50 ,$906.40 ,$906.40 ,$896.10 ,$875.50 ,$875.50 ,$875.50 ,$786.92 ,$927.00
Carle Richland Memorial Hospital,99480,SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS,,99480,,$970.00 ,$970.00 ,$741.08 ,$873.00 ,$824.50 ,$824.50 ,$824.50 ,$853.60 ,$824.50 ,$853.60 ,$853.60 ,$843.90 ,$824.50 ,$824.50 ,$824.50 ,$741.08 ,$873.00
Carle Richland Memorial Hospital,1157F,ADVANCE CARE PLAN OR EQUIV PRESENT IN MEDICAL RECORD,,1157F,,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01
Carle Richland Memorial Hospital,G0396,Alcohol/subs interv 15-30mn,,G0396,,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,G0397,Alcohol/subs interv >30 min,,G0397,,$240.00 ,$240.00 ,$183.36 ,$216.00 ,$204.00 ,$204.00 ,$204.00 ,$211.20 ,$204.00 ,$211.20 ,$211.20 ,$208.80 ,$204.00 ,$204.00 ,$204.00 ,$183.36 ,$216.00
Carle Richland Memorial Hospital,G0406,Inpt/tele Follow Up 15,,G0406,,$185.00 ,$185.00 ,$141.34 ,$166.50 ,$157.25 ,$157.25 ,$157.25 ,$162.80 ,$157.25 ,$162.80 ,$162.80 ,$160.95 ,$157.25 ,$157.25 ,$157.25 ,$141.34 ,$166.50
Carle Richland Memorial Hospital,G0407,Inpt/tele Follow Up 25,,G0407,,$305.00 ,$305.00 ,$233.02 ,$274.50 ,$259.25 ,$259.25 ,$259.25 ,$268.40 ,$259.25 ,$268.40 ,$268.40 ,$265.35 ,$259.25 ,$259.25 ,$259.25 ,$233.02 ,$274.50
Carle Richland Memorial Hospital,G0408,Inpt/tele Follow Up 35,,G0408,,$430.00 ,$430.00 ,$328.52 ,$387.00 ,$365.50 ,$365.50 ,$365.50 ,$378.40 ,$365.50 ,$378.40 ,$378.40 ,$374.10 ,$365.50 ,$365.50 ,$365.50 ,$328.52 ,$387.00
Carle Richland Memorial Hospital,G0420,Ed svc CKD ind per session,,G0420,,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,G0421,Ed svc CKD grp per session,,G0421,,$68.00 ,$68.00 ,$51.95 ,$61.20 ,$57.80 ,$57.80 ,$57.80 ,$59.84 ,$57.80 ,$59.84 ,$59.84 ,$59.16 ,$57.80 ,$57.80 ,$57.80 ,$51.95 ,$61.20
Carle Richland Memorial Hospital,G0425,Inpt/ed Teleconsult30,,G0425,,$445.00 ,$445.00 ,$339.98 ,$400.50 ,$378.25 ,$378.25 ,$378.25 ,$391.60 ,$378.25 ,$391.60 ,$391.60 ,$387.15 ,$378.25 ,$378.25 ,$378.25 ,$339.98 ,$400.50
Carle Richland Memorial Hospital,G0426,Inpt/ed Teleconsult50,,G0426,,$580.00 ,$580.00 ,$443.12 ,$522.00 ,$493.00 ,$493.00 ,$493.00 ,$510.40 ,$493.00 ,$510.40 ,$510.40 ,$504.60 ,$493.00 ,$493.00 ,$493.00 ,$443.12 ,$522.00
Carle Richland Memorial Hospital,G0427,Inpt/ed Teleconsult70,,G0427,,$870.00 ,$870.00 ,$664.68 ,$783.00 ,$739.50 ,$739.50 ,$739.50 ,$765.60 ,$739.50 ,$765.60 ,$765.60 ,$756.90 ,$739.50 ,$739.50 ,$739.50 ,$664.68 ,$783.00
Carle Richland Memorial Hospital,7090616,Cosmetic Consultation,,0,,$75.00 ,$75.00 ,$57.30 ,$67.50 ,$63.75 ,$63.75 ,$63.75 ,$66.00 ,$63.75 ,$66.00 ,$66.00 ,$65.25 ,$63.75 ,$63.75 ,$63.75 ,$57.30 ,$67.50
Carle Richland Memorial Hospital,7551117,Fiducial Markers 1 Pack,,A4648,,$356.00 ,$356.00 ,$271.98 ,$320.40 ,$302.60 ,$302.60 ,$302.60 ,$313.28 ,$302.60 ,$313.28 ,$313.28 ,$309.72 ,$302.60 ,$302.60 ,$302.60 ,$271.98 ,$320.40
Carle Richland Memorial Hospital,7551118,Fiducial Marker 3 Pack,,A4648,,$675.00 ,$675.00 ,$515.70 ,$607.50 ,$573.75 ,$573.75 ,$573.75 ,$594.00 ,$573.75 ,$594.00 ,$594.00 ,$587.25 ,$573.75 ,$573.75 ,$573.75 ,$515.70 ,$607.50
Carle Richland Memorial Hospital,7999916,Pr Ime Eval And Report,,99456,,$840.00 ,$840.00 ,$641.76 ,$756.00 ,$714.00 ,$714.00 ,$714.00 ,$739.20 ,$714.00 ,$739.20 ,$739.20 ,$730.80 ,$714.00 ,$714.00 ,$714.00 ,$641.76 ,$756.00
Carle Richland Memorial Hospital,7999917,Pr Psych Ime Rcrd Rvw Per Hr,,90885,,$200.00 ,$200.00 ,$152.80 ,$180.00 ,$170.00 ,$170.00 ,$170.00 ,$176.00 ,$170.00 ,$176.00 ,$176.00 ,$174.00 ,$170.00 ,$170.00 ,$170.00 ,$152.80 ,$180.00
Carle Richland Memorial Hospital,84112,EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN,,84112,,$150.00 ,$150.00 ,$114.60 ,$135.00 ,$127.50 ,$127.50 ,$127.50 ,$132.00 ,$127.50 ,$132.00 ,$132.00 ,$130.50 ,$127.50 ,$127.50 ,$127.50 ,$114.60 ,$135.00
Carle Richland Memorial Hospital,90867,REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&MNG,,90867,,"$1,050.00 ","$1,050.00 ",$802.20 ,$945.00 ,$892.50 ,$892.50 ,$892.50 ,$924.00 ,$892.50 ,$924.00 ,$924.00 ,$913.50 ,$892.50 ,$892.50 ,$892.50 ,$802.20 ,$945.00
Carle Richland Memorial Hospital,90868,THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNGT,,90868,,$880.00 ,$880.00 ,$672.32 ,$792.00 ,$748.00 ,$748.00 ,$748.00 ,$774.40 ,$748.00 ,$774.40 ,$774.40 ,$765.60 ,$748.00 ,$748.00 ,$748.00 ,$672.32 ,$792.00
Carle Richland Memorial Hospital,96446,"CHEMOTHERAPY, PERITONEAL CAVITY VIA INDWELLING PORT/CATHETER",,96446,,$910.00 ,$910.00 ,$695.24 ,$819.00 ,$773.50 ,$773.50 ,$773.50 ,$800.80 ,$773.50 ,$800.80 ,$800.80 ,$791.70 ,$773.50 ,$773.50 ,$773.50 ,$695.24 ,$819.00
Carle Richland Memorial Hospital,0212T,"COMPREHENSIVE AUDIOMETRY THRESHOLD AND SPEECH RECOGNITION, AUTOMATED",,0212T,,$275.00 ,$275.00 ,$210.10 ,$247.50 ,$233.75 ,$233.75 ,$233.75 ,$242.00 ,$233.75 ,$242.00 ,$242.00 ,$239.25 ,$233.75 ,$233.75 ,$233.75 ,$210.10 ,$247.50
Carle Richland Memorial Hospital,G0445,High inten beh couns STD 30m,,G0445,,$74.00 ,$74.00 ,$56.54 ,$66.60 ,$62.90 ,$62.90 ,$62.90 ,$65.12 ,$62.90 ,$65.12 ,$65.12 ,$64.38 ,$62.90 ,$62.90 ,$62.90 ,$56.54 ,$66.60
Carle Richland Memorial Hospital,32554,THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,,32554,,"$5,940.00 ","$5,940.00 ","$4,538.16 ","$5,346.00 ","$5,049.00 ","$5,049.00 ","$5,049.00 ","$5,227.20 ","$5,049.00 ","$5,227.20 ","$5,227.20 ","$5,167.80 ","$5,049.00 ","$5,049.00 ","$5,049.00 ","$4,538.16 ","$5,346.00 "
Carle Richland Memorial Hospital,32555,THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,,32555,,"$3,820.00 ","$3,820.00 ","$2,918.48 ","$3,438.00 ","$3,247.00 ","$3,247.00 ","$3,247.00 ","$3,361.60 ","$3,247.00 ","$3,361.60 ","$3,361.60 ","$3,323.40 ","$3,247.00 ","$3,247.00 ","$3,247.00 ","$2,918.48 ","$3,438.00 "
Carle Richland Memorial Hospital,32556,PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING,,32556,,"$4,180.00 ","$4,180.00 ","$3,193.52 ","$3,762.00 ","$3,553.00 ","$3,553.00 ","$3,553.00 ","$3,678.40 ","$3,553.00 ","$3,678.40 ","$3,678.40 ","$3,636.60 ","$3,553.00 ","$3,553.00 ","$3,553.00 ","$3,193.52 ","$3,762.00 "
Carle Richland Memorial Hospital,32557,PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING,,32557,,"$7,390.00 ","$7,390.00 ","$5,645.96 ","$6,651.00 ","$6,281.50 ","$6,281.50 ","$6,281.50 ","$6,503.20 ","$6,281.50 ","$6,503.20 ","$6,503.20 ","$6,429.30 ","$6,281.50 ","$6,281.50 ","$6,281.50 ","$5,645.96 ","$6,651.00 "
Carle Richland Memorial Hospital,95907,MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB,,95907,,$700.00 ,$700.00 ,$534.80 ,$630.00 ,$595.00 ,$595.00 ,$595.00 ,$616.00 ,$595.00 ,$616.00 ,$616.00 ,$609.00 ,$595.00 ,$595.00 ,$595.00 ,$534.80 ,$630.00
Carle Richland Memorial Hospital,95908,MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB,,95908,,$850.00 ,$850.00 ,$649.40 ,$765.00 ,$722.50 ,$722.50 ,$722.50 ,$748.00 ,$722.50 ,$748.00 ,$748.00 ,$739.50 ,$722.50 ,$722.50 ,$722.50 ,$649.40 ,$765.00
Carle Richland Memorial Hospital,95909,MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB,,95909,,"$1,010.00 ","$1,010.00 ",$771.64 ,$909.00 ,$858.50 ,$858.50 ,$858.50 ,$888.80 ,$858.50 ,$888.80 ,$888.80 ,$878.70 ,$858.50 ,$858.50 ,$858.50 ,$771.64 ,$909.00
Carle Richland Memorial Hospital,95910,MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB,,95910,,"$1,410.00 ","$1,410.00 ","$1,077.24 ","$1,269.00 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,240.80 ","$1,198.50 ","$1,240.80 ","$1,240.80 ","$1,226.70 ","$1,198.50 ","$1,198.50 ","$1,198.50 ","$1,077.24 ","$1,269.00 "
Carle Richland Memorial Hospital,95911,MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB,,95911,,"$1,630.00 ","$1,630.00 ","$1,245.32 ","$1,467.00 ","$1,385.50 ","$1,385.50 ","$1,385.50 ","$1,434.40 ","$1,385.50 ","$1,434.40 ","$1,434.40 ","$1,418.10 ","$1,385.50 ","$1,385.50 ","$1,385.50 ","$1,245.32 ","$1,467.00 "
Carle Richland Memorial Hospital,95912,MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB,,95912,,"$2,090.00 ","$2,090.00 ","$1,596.76 ","$1,881.00 ","$1,776.50 ","$1,776.50 ","$1,776.50 ","$1,839.20 ","$1,776.50 ","$1,839.20 ","$1,839.20 ","$1,818.30 ","$1,776.50 ","$1,776.50 ","$1,776.50 ","$1,596.76 ","$1,881.00 "
Carle Richland Memorial Hospital,95913,MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB,,95913,,"$2,240.00 ","$2,240.00 ","$1,711.36 ","$2,016.00 ","$1,904.00 ","$1,904.00 ","$1,904.00 ","$1,971.20 ","$1,904.00 ","$1,971.20 ","$1,971.20 ","$1,948.80 ","$1,904.00 ","$1,904.00 ","$1,904.00 ","$1,711.36 ","$2,016.00 "
Carle Richland Memorial Hospital,10035,PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE,,10035,,"$2,050.00 ","$2,050.00 ","$1,566.20 ","$1,845.00 ","$1,742.50 ","$1,742.50 ","$1,742.50 ","$1,804.00 ","$1,742.50 ","$1,804.00 ","$1,804.00 ","$1,783.50 ","$1,742.50 ","$1,742.50 ","$1,742.50 ","$1,566.20 ","$1,845.00 "
Carle Richland Memorial Hospital,10036,PERQ SFT TISS LOC DEVICE PLMT ADD LES W/GDNCE,,10036,,"$1,790.00 ","$1,790.00 ","$1,367.56 ","$1,611.00 ","$1,521.50 ","$1,521.50 ","$1,521.50 ","$1,575.20 ","$1,521.50 ","$1,575.20 ","$1,575.20 ","$1,557.30 ","$1,521.50 ","$1,521.50 ","$1,521.50 ","$1,367.56 ","$1,611.00 "
Carle Richland Memorial Hospital,99177,INSTRUMENT BASED OCULAR SCR BI W/ONSITE ANALYSIS,,99177,,$80.00 ,$80.00 ,$61.12 ,$72.00 ,$68.00 ,$68.00 ,$68.00 ,$70.40 ,$68.00 ,$70.40 ,$70.40 ,$69.60 ,$68.00 ,$68.00 ,$68.00 ,$61.12 ,$72.00
Carle Richland Memorial Hospital,99415,PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR,,99415,,$110.00 ,$110.00 ,$84.04 ,$99.00 ,$93.50 ,$93.50 ,$93.50 ,$96.80 ,$93.50 ,$96.80 ,$96.80 ,$95.70 ,$93.50 ,$93.50 ,$93.50 ,$84.04 ,$99.00
Carle Richland Memorial Hospital,99416,PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL,,99416,,$70.00 ,$70.00 ,$53.48 ,$63.00 ,$59.50 ,$59.50 ,$59.50 ,$61.60 ,$59.50 ,$61.60 ,$61.60 ,$60.90 ,$59.50 ,$59.50 ,$59.50 ,$53.48 ,$63.00
Carle Richland Memorial Hospital,27197,CLSD TX PELVIC RING FX W/O MANIPULATION,,27197,,$800.00 ,$800.00 ,$611.20 ,$720.00 ,$680.00 ,$680.00 ,$680.00 ,$704.00 ,$680.00 ,$704.00 ,$704.00 ,$696.00 ,$680.00 ,$680.00 ,$680.00 ,$611.20 ,$720.00
Carle Richland Memorial Hospital,96377,APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,,96377,,$90.00 ,$90.00 ,$68.76 ,$81.00 ,$76.50 ,$76.50 ,$76.50 ,$79.20 ,$76.50 ,$79.20 ,$79.20 ,$78.30 ,$76.50 ,$76.50 ,$76.50 ,$68.76 ,$81.00
Carle Richland Memorial Hospital,99152,MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS,,99152,,$280.00 ,$280.00 ,$213.92 ,$252.00 ,$238.00 ,$238.00 ,$238.00 ,$246.40 ,$238.00 ,$246.40 ,$246.40 ,$243.60 ,$238.00 ,$238.00 ,$238.00 ,$213.92 ,$252.00
Carle Richland Memorial Hospital,99153,MOD SED SAME PHYS/QHP EACH ADDL 15 MINS,,99153,,$120.00 ,$120.00 ,$91.68 ,$108.00 ,$102.00 ,$102.00 ,$102.00 ,$105.60 ,$102.00 ,$105.60 ,$105.60 ,$104.40 ,$102.00 ,$102.00 ,$102.00 ,$91.68 ,$108.00
Carle Richland Memorial Hospital,G0500,Mod sedat endo service >5yrs,,G0500,,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Carle Richland Memorial Hospital,7099199,Pr Repeat Form Completion,,99199,,$11.00 ,$11.00 ,$8.40 ,$9.90 ,$9.35 ,$9.35 ,$9.35 ,$9.68 ,$9.35 ,$9.68 ,$9.68 ,$9.57 ,$9.35 ,$9.35 ,$9.35 ,$8.40 ,$9.90
Carle Richland Memorial Hospital,G0513,"Prolong prev svcs, first 30m",,G0513,,$530.00 ,$530.00 ,$404.92 ,$477.00 ,$450.50 ,$450.50 ,$450.50 ,$466.40 ,$450.50 ,$466.40 ,$466.40 ,$461.10 ,$450.50 ,$450.50 ,$450.50 ,$404.92 ,$477.00
Carle Richland Memorial Hospital,G0514,"Prolong prev svcs, addl 30m",,G0514,,$315.00 ,$315.00 ,$240.66 ,$283.50 ,$267.75 ,$267.75 ,$267.75 ,$277.20 ,$267.75 ,$277.20 ,$277.20 ,$274.05 ,$267.75 ,$267.75 ,$267.75 ,$240.66 ,$283.50
Table 2: Payer Negotiated Rates,,,,,,,,,,,,,,,,,,,,,,
ContractName,CodeType,Code,Description,Service Description,Base Rate Methodology,Negotiated Charge / Base Rate,ServiceCode,Deidentified Minimum,Deidentified Maximum,,,,,,,,,,,,,
Aetna,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$260,218.80 ",IP,"260,218.80","304,800.80",,,,,,,,,,,,,
Aetna,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Medical/Surgical,Relative Weights,"$134,730.90 ",IP,"134,730.90","167,641.91",,,,,,,,,,,,,
Aetna,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$171,949.50 ",IP,"171,949.50","199,844.40",,,,,,,,,,,,,
Aetna,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$107,302.50 ",IP,"107,302.50","124,823.83",,,,,,,,,,,,,
Aetna,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Medical/Surgical,Relative Weights,"$92,115.00 ",IP,"92,115.00","107,579.79",,,,,,,,,,,,,
Aetna,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Medical/Surgical,Relative Weights,"$42,267.60 ",IP,"42,267.60","49,370.76",,,,,,,,,,,,,
Aetna,DRG,MS-007,LUNG TRANSPLANT,Medical/Surgical,Relative Weights,"$104,220.00 ",IP,"104,220.00","121,796.36",,,,,,,,,,,,,
Aetna,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Medical/Surgical,Relative Weights,"$48,899.70 ",IP,"48,899.70","57,106.22",,,,,,,,,,,,,
Aetna,DRG,MS-010,PANCREAS TRANSPLANT,Medical/Surgical,Relative Weights,"$32,580.00 ",IP,"32,580.00","38,069.06",,,,,,,,,,,,,
Aetna,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Medical/Surgical,Relative Weights,"$45,192.60 ",IP,"45,192.60","52,787.58",,,,,,,,,,,,,
Aetna,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Medical/Surgical,Relative Weights,"$34,495.20 ",IP,"34,495.20","40,323.08",,,,,,,,,,,,,
Aetna,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$24,514.20 ",IP,"24,514.20","28,627.82",,,,,,,,,,,,,
Aetna,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Medical/Surgical,Relative Weights,"$96,093.00 ",IP,"96,093.00","134,471.31",,,,,,,,,,,,,
Aetna,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Medical/Surgical,Relative Weights,"$60,626.70 ",IP,"60,626.70","70,779.80",,,,,,,,,,,,,
Aetna,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$43,701.30 ",IP,"43,701.30","50,828.19",,,,,,,,,,,,,
Aetna,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,Medical/Surgical,Relative Weights,"$337,050.90 ",IP,"337,050.90","392,813.07",,,,,,,,,,,,,
Aetna,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Medical/Surgical,Relative Weights,"$60,117.30 ",IP,"60,117.30","70,103.17",,,,,,,,,,,,,
Aetna,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Medical/Surgical,Relative Weights,"$93,033.00 ",IP,"93,033.00","108,598.41",,,,,,,,,,,,,
Aetna,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Medical/Surgical,Relative Weights,"$67,891.50 ",IP,"67,891.50","79,255.03",,,,,,,,,,,,,
Aetna,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$43,585.20 ",IP,"43,585.20","51,137.57",,,,,,,,,,,,,
Aetna,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Medical/Surgical,Relative Weights,"$51,047.10 ",IP,"51,047.10","59,584.38",,,,,,,,,,,,,
Aetna,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$35,451.00 ",IP,"35,451.00","41,381.70",,,,,,,,,,,,,
Aetna,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$40,476.60 ",IP,"40,476.60","47,266.16",,,,,,,,,,,,,
Aetna,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$27,558.00 ",IP,"27,558.00","32,179.33",,,,,,,,,,,,,
Aetna,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$22,628.70 ",IP,"22,628.70","26,431.67",,,,,,,,,,,,,
Aetna,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$52,407.90 ",IP,"52,407.90","61,243.86",,,,,,,,,,,,,
Aetna,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Medical/Surgical,Relative Weights,"$29,671.20 ",IP,"29,671.20","34,673.29",,,,,,,,,,,,,
Aetna,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$21,211.20 ",IP,"21,211.20","24,803.76",,,,,,,,,,,,,
Aetna,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$39,345.30 ",IP,"39,345.30","45,944.47",,,,,,,,,,,,,
Aetna,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$19,948.50 ",IP,"19,948.50","23,278.98",,,,,,,,,,,,,
Aetna,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,499.80 ",IP,"15,499.80","18,106.93",,,,,,,,,,,,,
Aetna,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$35,802.90 ",IP,"35,802.90","41,824.72",,,,,,,,,,,,,
Aetna,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$21,057.30 ",IP,"21,057.30","24,593.30",,,,,,,,,,,,,
Aetna,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,670.70 ",IP,"16,670.70","19,480.18",,,,,,,,,,,,,
Aetna,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$29,498.40 ",IP,"29,498.40","34,459.67",,,,,,,,,,,,,
Aetna,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$14,929.20 ",IP,"14,929.20","17,439.77",,,,,,,,,,,,,
Aetna,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,251.90 ",IP,"10,251.90","11,985.70",,,,,,,,,,,,,
Aetna,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$34,783.20 ",IP,"34,783.20","41,647.93",,,,,,,,,,,,,
Aetna,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Medical/Surgical,Relative Weights,"$21,147.30 ",IP,"21,147.30","24,737.47",,,,,,,,,,,,,
Aetna,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,110.80 ",IP,"17,110.80","19,834.80",,,,,,,,,,,,,
Aetna,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical/Surgical,Relative Weights,"$16,681.50 ",IP,"16,681.50","19,415.99",,,,,,,,,,,,,
Aetna,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,227.60 ",IP,"10,227.60","11,955.18",,,,,,,,,,,,,
Aetna,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical/Surgical,Relative Weights,"$12,314.70 ",IP,"12,314.70","14,372.31",,,,,,,,,,,,,
Aetna,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,401.40 ",IP,"9,401.40","10,979.70",,,,,,,,,,,,,
Aetna,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$19,757.70 ",IP,"19,757.70","23,016.96",,,,,,,,,,,,,
Aetna,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$11,407.50 ",IP,"11,407.50","13,303.18",,,,,,,,,,,,,
Aetna,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical/Surgical,Relative Weights,"$15,640.20 ",IP,"15,640.20","18,275.29",,,,,,,,,,,,,
Aetna,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical/Surgical,Relative Weights,"$10,145.70 ",IP,"10,145.70","11,854.16",,,,,,,,,,,,,
Aetna,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,259.30 ",IP,"8,259.30","9,634.86",,,,,,,,,,,,,
Aetna,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical/Surgical,Relative Weights,"$26,020.80 ",IP,"26,020.80","30,392.53",,,,,,,,,,,,,
Aetna,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical/Surgical,Relative Weights,"$17,894.70 ",IP,"17,894.70","20,911.31",,,,,,,,,,,,,
Aetna,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,387.30 ",IP,"15,387.30","17,993.28",,,,,,,,,,,,,
Aetna,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical/Surgical,Relative Weights,"$17,270.10 ",IP,"17,270.10","20,130.50",,,,,,,,,,,,,
Aetna,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical/Surgical,Relative Weights,"$9,180.00 ",IP,"9,180.00","10,714.52",,,,,,,,,,,,,
Aetna,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,404.40 ",IP,"6,404.40","7,480.80",,,,,,,,,,,,,
Aetna,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical/Surgical,Relative Weights,"$12,832.20 ",IP,"12,832.20","14,991.07",,,,,,,,,,,,,
Aetna,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,000.10 ",IP,"8,000.10","9,350.74",,,,,,,,,,,,,
Aetna,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical/Surgical,Relative Weights,"$7,083.90 ",IP,"7,083.90","8,272.13",,,,,,,,,,,,,
Aetna,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$15,116.40 ",IP,"15,116.40","17,640.76",,,,,,,,,,,,,
Aetna,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$9,106.20 ",IP,"9,106.20","10,636.65",,,,,,,,,,,,,
Aetna,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,945.30 ",IP,"6,945.30","8,115.34",,,,,,,,,,,,,
Aetna,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$13,076.10 ",IP,"13,076.10","15,252.04",,,,,,,,,,,,,
Aetna,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,171.00 ",IP,"9,171.00","10,716.62",,,,,,,,,,,,,
Aetna,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical/Surgical,Relative Weights,"$14,643.00 ",IP,"14,643.00","17,110.40",,,,,,,,,,,,,
Aetna,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,864.10 ",IP,"8,864.10","10,322.01",,,,,,,,,,,,,
Aetna,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical/Surgical,Relative Weights,"$13,796.10 ",IP,"13,796.10","16,120.18",,,,,,,,,,,,,
Aetna,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical/Surgical,Relative Weights,"$8,549.10 ",IP,"8,549.10","9,986.33",,,,,,,,,,,,,
Aetna,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,559.20 ",IP,"6,559.20","7,648.12",,,,,,,,,,,,,
Aetna,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical/Surgical,Relative Weights,"$18,858.60 ",IP,"18,858.60","22,014.12",,,,,,,,,,,,,
Aetna,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,958.80 ",IP,"6,958.80","8,123.76",,,,,,,,,,,,,
Aetna,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical/Surgical,Relative Weights,"$20,375.10 ",IP,"20,375.10","23,761.99",,,,,,,,,,,,,
Aetna,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical/Surgical,Relative Weights,"$12,096.00 ",IP,"12,096.00","14,118.71",,,,,,,,,,,,,
Aetna,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,150.40 ",IP,"8,150.40","9,514.90",,,,,,,,,,,,,
Aetna,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical/Surgical,Relative Weights,"$20,805.30 ",IP,"20,805.30","24,270.25",,,,,,,,,,,,,
Aetna,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical/Surgical,Relative Weights,"$11,470.50 ",IP,"11,470.50","13,394.73",,,,,,,,,,,,,
Aetna,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,772.40 ",IP,"7,772.40","9,077.14",,,,,,,,,,,,,
Aetna,DRG,MS-088,CONCUSSION WITH MCC,Medical/Surgical,Relative Weights,"$13,096.80 ",IP,"13,096.80","15,356.21",,,,,,,,,,,,,
Aetna,DRG,MS-089,CONCUSSION WITH CC,Medical/Surgical,Relative Weights,"$9,571.50 ",IP,"9,571.50","11,167.01",,,,,,,,,,,,,
Aetna,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,691.40 ",IP,"7,691.40","8,995.06",,,,,,,,,,,,,
Aetna,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$14,857.20 ",IP,"14,857.20","17,351.37",,,,,,,,,,,,,
Aetna,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$8,900.10 ",IP,"8,900.10","10,376.73",,,,,,,,,,,,,
Aetna,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,039.80 ",IP,"7,039.80","8,221.62",,,,,,,,,,,,,
Aetna,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$32,741.10 ",IP,"32,741.10","38,231.11",,,,,,,,,,,,,
Aetna,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$22,565.70 ",IP,"22,565.70","26,391.68",,,,,,,,,,,,,
Aetna,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$20,994.30 ",IP,"20,994.30","24,534.37",,,,,,,,,,,,,
Aetna,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical/Surgical,Relative Weights,"$33,843.60 ",IP,"33,843.60","39,488.61",,,,,,,,,,,,,
Aetna,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical/Surgical,Relative Weights,"$19,012.50 ",IP,"19,012.50","22,213.00",,,,,,,,,,,,,
Aetna,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,617.10 ",IP,"12,617.10","14,703.79",,,,,,,,,,,,,
Aetna,DRG,MS-100,SEIZURES WITH MCC,Medical/Surgical,Relative Weights,"$16,887.60 ",IP,"16,887.60","19,715.89",,,,,,,,,,,,,
Aetna,DRG,MS-101,SEIZURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,995.60 ",IP,"7,995.60","9,333.90",,,,,,,,,,,,,
Aetna,DRG,MS-102,HEADACHES WITH MCC,Medical/Surgical,Relative Weights,"$10,377.90 ",IP,"10,377.90","12,119.34",,,,,,,,,,,,,
Aetna,DRG,MS-103,HEADACHES WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,465.50 ",IP,"7,465.50","8,715.15",,,,,,,,,,,,,
Aetna,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$19,749.60 ",IP,"19,749.60","23,064.31",,,,,,,,,,,,,
Aetna,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,028.40 ",IP,"13,028.40","15,211.00",,,,,,,,,,,,,
Aetna,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Medical/Surgical,Relative Weights,"$13,109.40 ",IP,"13,109.40","15,293.08",,,,,,,,,,,,,
Aetna,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$16,944.30 ",IP,"16,944.30","19,753.78",,,,,,,,,,,,,
Aetna,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,370.80 ",IP,"9,370.80","10,932.34",,,,,,,,,,,,,
Aetna,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical/Surgical,Relative Weights,"$10,715.40 ",IP,"10,715.40","12,508.69",,,,,,,,,,,,,
Aetna,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,809.50 ",IP,"5,809.50","6,774.71",,,,,,,,,,,,,
Aetna,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical/Surgical,Relative Weights,"$6,901.20 ",IP,"6,901.20","8,053.25",,,,,,,,,,,,,
Aetna,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical/Surgical,Relative Weights,"$12,618.00 ",IP,"12,618.00","14,719.57",,,,,,,,,,,,,
Aetna,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,533.00 ",IP,"7,533.00","8,790.91",,,,,,,,,,,,,
Aetna,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$19,291.50 ",IP,"19,291.50","22,525.53",,,,,,,,,,,,,
Aetna,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,299.50 ",IP,"11,299.50","13,211.63",,,,,,,,,,,,,
Aetna,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$13,587.30 ",IP,"13,587.30","15,454.08",,,,,,,,,,,,,
Aetna,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,708.50 ",IP,"7,708.50","8,871.94",,,,,,,,,,,,,
Aetna,DRG,MS-139,SALIVARY GLAND PROCEDURES,Medical/Surgical,Relative Weights,"$11,106.90 ",IP,"11,106.90","12,909.62",,,,,,,,,,,,,
Aetna,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$35,801.10 ",IP,"35,801.10","41,887.85",,,,,,,,,,,,,
Aetna,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$19,854.90 ",IP,"19,854.90","23,229.52",,,,,,,,,,,,,
Aetna,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,445.90 ",IP,"14,445.90","16,929.40",,,,,,,,,,,,,
Aetna,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$26,818.20 ",IP,"26,818.20","31,188.07",,,,,,,,,,,,,
Aetna,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$15,853.50 ",IP,"15,853.50","18,420.51",,,,,,,,,,,,,
Aetna,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,021.40 ",IP,"11,021.40","12,769.66",,,,,,,,,,,,,
Aetna,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$18,369.90 ",IP,"18,369.90","21,394.31",,,,,,,,,,,,,
Aetna,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$11,709.90 ",IP,"11,709.90","13,691.48",,,,,,,,,,,,,
Aetna,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,083.00 ",IP,"7,083.00","8,274.23",,,,,,,,,,,,,
Aetna,DRG,MS-149,DYSEQUILIBRIUM,Medical/Surgical,Relative Weights,"$6,633.00 ",IP,"6,633.00","7,739.67",,,,,,,,,,,,,
Aetna,DRG,MS-150,EPISTAXIS WITH MCC,Medical/Surgical,Relative Weights,"$11,947.50 ",IP,"11,947.50","13,939.82",,,,,,,,,,,,,
Aetna,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,645.60 ",IP,"6,645.60","7,755.45",,,,,,,,,,,,,
Aetna,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical/Surgical,Relative Weights,"$9,724.50 ",IP,"9,724.50","11,332.22",,,,,,,,,,,,,
Aetna,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,418.80 ",IP,"6,418.80","7,477.64",,,,,,,,,,,,,
Aetna,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$13,921.20 ",IP,"13,921.20","16,231.73",,,,,,,,,,,,,
Aetna,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$8,185.50 ",IP,"8,185.50","9,542.26",,,,,,,,,,,,,
Aetna,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,925.60 ",IP,"5,925.60","6,919.92",,,,,,,,,,,,,
Aetna,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical/Surgical,Relative Weights,"$14,185.80 ",IP,"14,185.80","16,546.37",,,,,,,,,,,,,
Aetna,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical/Surgical,Relative Weights,"$8,101.80 ",IP,"8,101.80","9,356.00",,,,,,,,,,,,,
Aetna,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,967.90 ",IP,"5,967.90","6,900.98",,,,,,,,,,,,,
Aetna,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$45,061.20 ",IP,"45,061.20","52,189.87",,,,,,,,,,,,,
Aetna,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$23,900.40 ",IP,"23,900.40","27,736.52",,,,,,,,,,,,,
Aetna,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,249.40 ",IP,"17,249.40","20,084.20",,,,,,,,,,,,,
Aetna,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$33,511.50 ",IP,"33,511.50","39,879.01",,,,,,,,,,,,,
Aetna,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$16,368.30 ",IP,"16,368.30","19,583.30",,,,,,,,,,,,,
Aetna,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,189.60 ",IP,"12,189.60","14,410.20",,,,,,,,,,,,,
Aetna,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical/Surgical,Relative Weights,"$13,914.00 ",IP,"13,914.00","16,249.62",,,,,,,,,,,,,
Aetna,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,990.20 ",IP,"7,990.20","9,330.74",,,,,,,,,,,,,
Aetna,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical/Surgical,Relative Weights,"$16,641.90 ",IP,"16,641.90","19,418.09",,,,,,,,,,,,,
Aetna,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical/Surgical,Relative Weights,"$10,870.20 ",IP,"10,870.20","12,689.69",,,,,,,,,,,,,
Aetna,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,854.30 ",IP,"7,854.30","9,166.59",,,,,,,,,,,,,
Aetna,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical/Surgical,Relative Weights,"$15,659.10 ",IP,"15,659.10","18,286.87",,,,,,,,,,,,,
Aetna,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical/Surgical,Relative Weights,"$10,080.90 ",IP,"10,080.90","11,795.23",,,,,,,,,,,,,
Aetna,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,128.00 ",IP,"7,128.00","8,286.86",,,,,,,,,,,,,
Aetna,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical/Surgical,Relative Weights,"$14,030.10 ",IP,"14,030.10","16,369.58",,,,,,,,,,,,,
Aetna,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical/Surgical,Relative Weights,"$9,368.10 ",IP,"9,368.10","10,937.61",,,,,,,,,,,,,
Aetna,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,974.10 ",IP,"6,974.10","8,140.59",,,,,,,,,,,,,
Aetna,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical/Surgical,Relative Weights,"$13,894.20 ",IP,"13,894.20","16,239.09",,,,,,,,,,,,,
Aetna,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical/Surgical,Relative Weights,"$9,296.10 ",IP,"9,296.10","10,861.84",,,,,,,,,,,,,
Aetna,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,565.50 ",IP,"6,565.50","7,661.80",,,,,,,,,,,,,
Aetna,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical/Surgical,Relative Weights,"$11,034.90 ",IP,"11,034.90","12,888.57",,,,,,,,,,,,,
Aetna,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical/Surgical,Relative Weights,"$10,125.90 ",IP,"10,125.90","11,826.80",,,,,,,,,,,,,
Aetna,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical/Surgical,Relative Weights,"$7,958.70 ",IP,"7,958.70","9,292.86",,,,,,,,,,,,,
Aetna,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,260.40 ",IP,"6,260.40","7,312.43",,,,,,,,,,,,,
Aetna,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical/Surgical,Relative Weights,"$11,808.00 ",IP,"11,808.00","13,792.50",,,,,,,,,,,,,
Aetna,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical/Surgical,Relative Weights,"$7,775.10 ",IP,"7,775.10","9,081.35",,,,,,,,,,,,,
Aetna,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,992.20 ",IP,"5,992.20","6,997.80",,,,,,,,,,,,,
Aetna,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical/Surgical,Relative Weights,"$15,647.40 ",IP,"15,647.40","18,268.98",,,,,,,,,,,,,
Aetna,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical/Surgical,Relative Weights,"$9,063.00 ",IP,"9,063.00","10,581.93",,,,,,,,,,,,,
Aetna,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,690.60 ",IP,"6,690.60","7,811.22",,,,,,,,,,,,,
Aetna,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical/Surgical,Relative Weights,"$16,110.00 ",IP,"16,110.00","18,810.91",,,,,,,,,,,,,
Aetna,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical/Surgical,Relative Weights,"$9,688.50 ",IP,"9,688.50","11,312.23",,,,,,,,,,,,,
Aetna,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,386.40 ",IP,"6,386.40","7,466.07",,,,,,,,,,,,,
Aetna,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical/Surgical,Relative Weights,"$8,703.00 ",IP,"8,703.00","10,161.01",,,,,,,,,,,,,
Aetna,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,363.00 ",IP,"6,363.00","7,423.98",,,,,,,,,,,,,
Aetna,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical/Surgical,Relative Weights,"$7,142.40 ",IP,"7,142.40","8,339.48",,,,,,,,,,,,,
Aetna,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$15,163.20 ",IP,"15,163.20","17,702.84",,,,,,,,,,,,,
Aetna,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,974.00 ",IP,"7,974.00","9,304.44",,,,,,,,,,,,,
Aetna,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical/Surgical,Relative Weights,"$51,624.90 ",IP,"51,624.90","60,258.91",,,,,,,,,,,,,
Aetna,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical/Surgical,Relative Weights,"$22,903.20 ",IP,"22,903.20","26,752.62",,,,,,,,,,,,,
Aetna,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Medical/Surgical,Relative Weights,"$95,025.60 ",IP,"95,025.60","117,414.58",,,,,,,,,,,,,
Aetna,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$90,353.70 ",IP,"90,353.70","109,755.94",,,,,,,,,,,,,
Aetna,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Medical/Surgical,Relative Weights,"$58,351.50 ",IP,"58,351.50","68,323.73",,,,,,,,,,,,,
Aetna,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$54,983.70 ",IP,"54,121.89","59,467.93",,,,,,,,,,,,,
Aetna,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$72,518.40 ",IP,"72,518.40","84,763.82",,,,,,,,,,,,,
Aetna,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Medical/Surgical,Relative Weights,"$48,647.70 ",IP,"48,647.70","56,823.15",,,,,,,,,,,,,
Aetna,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$41,219.10 ",IP,"41,219.10","47,903.85",,,,,,,,,,,,,
Aetna,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Medical/Surgical,Relative Weights,"$71,559.00 ",IP,"71,559.00","88,615.24",,,,,,,,,,,,,
Aetna,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Medical/Surgical,Relative Weights,"$52,187.40 ",IP,"52,187.40","65,369.93",,,,,,,,,,,,,
Aetna,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Medical/Surgical,Relative Weights,"$67,671.90 ",IP,"67,671.90","77,472.43",,,,,,,,,,,,,
Aetna,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Medical/Surgical,Relative Weights,"$50,560.20 ",IP,"50,560.20","59,210.82",,,,,,,,,,,,,
Aetna,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$59,085.00 ",IP,"59,085.00","69,575.97",,,,,,,,,,,,,
Aetna,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$46,908.90 ",IP,"46,908.90","55,265.74",,,,,,,,,,,,,
Aetna,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$47,972.70 ",IP,"47,972.70","65,403.60",,,,,,,,,,,,,
Aetna,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$30,970.80 ",IP,"30,970.80","41,965.72",,,,,,,,,,,,,
Aetna,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Medical/Surgical,Relative Weights,"$78,443.10 ",IP,"78,443.10","89,342.37",,,,,,,,,,,,,
Aetna,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Medical/Surgical,Relative Weights,"$53,584.20 ",IP,"53,584.20","62,067.81",,,,,,,,,,,,,
Aetna,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Medical/Surgical,Relative Weights,"$71,300.70 ",IP,"71,300.70","82,002.58",,,,,,,,,,,,,
Aetna,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$48,024.00 ",IP,"48,024.00","55,955.00",,,,,,,,,,,,,
Aetna,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$54,936.90 ",IP,"54,936.90","63,455.79",,,,,,,,,,,,,
Aetna,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$36,873.00 ",IP,"36,873.00","42,942.26",,,,,,,,,,,,,
Aetna,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Medical/Surgical,Relative Weights,"$43,344.00 ",IP,"43,344.00","50,601.95",,,,,,,,,,,,,
Aetna,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Medical/Surgical,Relative Weights,"$25,099.20 ",IP,"25,099.20","29,359.17",,,,,,,,,,,,,
Aetna,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,331.60 ",IP,"14,331.60","16,746.30",,,,,,,,,,,,,
Aetna,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Medical/Surgical,Relative Weights,"$33,548.40 ",IP,"33,548.40","39,171.87",,,,,,,,,,,,,
Aetna,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Medical/Surgical,Relative Weights,"$22,666.50 ",IP,"22,666.50","26,650.55",,,,,,,,,,,,,
Aetna,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$18,569.70 ",IP,"18,569.70","21,737.36",,,,,,,,,,,,,
Aetna,DRG,MS-245,AICD GENERATOR PROCEDURES,Medical/Surgical,Relative Weights,"$48,760.20 ",IP,"48,760.20","56,971.52",,,,,,,,,,,,,
Aetna,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Medical/Surgical,Relative Weights,"$28,118.70 ",IP,"28,118.70","32,891.74",,,,,,,,,,,,,
Aetna,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$17,758.80 ",IP,"17,758.80","20,921.83",,,,,,,,,,,,,
Aetna,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Medical/Surgical,Relative Weights,"$28,459.80 ",IP,"28,459.80","33,398.95",,,,,,,,,,,,,
Aetna,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$16,863.30 ",IP,"16,863.30","19,775.87",,,,,,,,,,,,,
Aetna,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Medical/Surgical,Relative Weights,"$22,696.20 ",IP,"22,696.20","26,547.42",,,,,,,,,,,,,
Aetna,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$14,925.60 ",IP,"14,925.60","17,466.08",,,,,,,,,,,,,
Aetna,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$29,931.30 ",IP,"29,931.30","34,943.73",,,,,,,,,,,,,
Aetna,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$23,882.40 ",IP,"23,882.40","27,924.89",,,,,,,,,,,,,
Aetna,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,343.10 ",IP,"16,343.10","19,041.37",,,,,,,,,,,,,
Aetna,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$22,817.70 ",IP,"22,817.70","26,759.99",,,,,,,,,,,,,
Aetna,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$14,797.80 ",IP,"14,797.80","17,290.34",,,,,,,,,,,,,
Aetna,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,486.80 ",IP,"10,486.80","12,217.20",,,,,,,,,,,,,
Aetna,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Medical/Surgical,Relative Weights,"$28,512.90 ",IP,"28,512.90","33,687.28",,,,,,,,,,,,,
Aetna,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$18,802.80 ",IP,"18,802.80","22,310.86",,,,,,,,,,,,,
Aetna,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Medical/Surgical,Relative Weights,"$32,105.70 ",IP,"32,105.70","37,716.54",,,,,,,,,,,,,
Aetna,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Medical/Surgical,Relative Weights,"$17,945.10 ",IP,"17,945.10","20,954.45",,,,,,,,,,,,,
Aetna,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,355.80 ",IP,"15,355.80","17,974.34",,,,,,,,,,,,,
Aetna,DRG,MS-263,VEIN LIGATION AND STRIPPING,Medical/Surgical,Relative Weights,"$20,818.80 ",IP,"20,818.80","24,258.67",,,,,,,,,,,,,
Aetna,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$29,282.40 ",IP,"29,282.40","34,176.60",,,,,,,,,,,,,
Aetna,DRG,MS-265,AICD LEAD PROCEDURES,Medical/Surgical,Relative Weights,"$30,289.50 ",IP,"30,289.50","35,385.69",,,,,,,,,,,,,
Aetna,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$63,431.10 ",IP,"63,431.10","74,683.84",,,,,,,,,,,,,
Aetna,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$50,382.00 ",IP,"50,382.00","58,938.27",,,,,,,,,,,,,
Aetna,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Medical/Surgical,Relative Weights,"$62,669.70 ",IP,"62,669.70","73,183.26",,,,,,,,,,,,,
Aetna,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Medical/Surgical,Relative Weights,"$38,835.90 ",IP,"38,835.90","45,402.54",,,,,,,,,,,,,
Aetna,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$46,683.00 ",IP,"46,683.00","54,525.98",,,,,,,,,,,,,
Aetna,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$32,088.60 ",IP,"32,088.60","37,510.29",,,,,,,,,,,,,
Aetna,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$24,194.70 ",IP,"24,194.70","28,294.24",,,,,,,,,,,,,
Aetna,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$34,440.30 ",IP,"34,440.30","40,378.86",,,,,,,,,,,,,
Aetna,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$29,579.40 ",IP,"29,579.40","34,572.26",,,,,,,,,,,,,
Aetna,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical/Surgical,Relative Weights,"$14,462.10 ",IP,"14,462.10","17,112.50",,,,,,,,,,,,,
Aetna,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical/Surgical,Relative Weights,"$8,375.40 ",IP,"8,375.40","9,808.49",,,,,,,,,,,,,
Aetna,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,534.90 ",IP,"6,534.90","7,634.44",,,,,,,,,,,,,
Aetna,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical/Surgical,Relative Weights,"$16,782.30 ",IP,"16,782.30","19,621.19",,,,,,,,,,,,,
Aetna,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical/Surgical,Relative Weights,"$6,510.60 ",IP,"6,510.60","7,725.99",,,,,,,,,,,,,
Aetna,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$4,452.30 ",IP,"4,452.30","5,223.62",,,,,,,,,,,,,
Aetna,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$19,226.70 ",IP,"19,226.70","23,298.97",,,,,,,,,,,,,
Aetna,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$10,035.90 ",IP,"10,035.90","12,101.45",,,,,,,,,,,,,
Aetna,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical/Surgical,Relative Weights,"$24,168.60 ",IP,"24,168.60","28,212.16",,,,,,,,,,,,,
Aetna,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical/Surgical,Relative Weights,"$14,792.40 ",IP,"14,792.40","17,285.08",,,,,,,,,,,,,
Aetna,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,242.10 ",IP,"9,242.10","10,771.34",,,,,,,,,,,,,
Aetna,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical/Surgical,Relative Weights,"$11,414.70 ",IP,"11,414.70","14,110.29",,,,,,,,,,,,,
Aetna,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical/Surgical,Relative Weights,"$7,771.50 ",IP,"7,771.50","9,419.14",,,,,,,,,,,,,
Aetna,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,309.10 ",IP,"5,309.10","6,867.31",,,,,,,,,,,,,
Aetna,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical/Surgical,Relative Weights,"$11,545.20 ",IP,"11,545.20","13,491.54",,,,,,,,,,,,,
Aetna,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,856.90 ",IP,"8,856.90","10,326.22",,,,,,,,,,,,,
Aetna,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical/Surgical,Relative Weights,"$14,356.80 ",IP,"14,356.80","16,782.08",,,,,,,,,,,,,
Aetna,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical/Surgical,Relative Weights,"$6,363.00 ",IP,"6,363.00","7,414.51",,,,,,,,,,,,,
Aetna,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$4,399.20 ",IP,"4,399.20","5,137.33",,,,,,,,,,,,,
Aetna,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$13,793.40 ",IP,"13,793.40","16,114.92",,,,,,,,,,,,,
Aetna,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$9,394.20 ",IP,"9,394.20","10,967.07",,,,,,,,,,,,,
Aetna,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,687.90 ",IP,"6,687.90","7,813.33",,,,,,,,,,,,,
Aetna,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical/Surgical,Relative Weights,"$9,853.20 ",IP,"9,853.20","11,506.90",,,,,,,,,,,,,
Aetna,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,098.40 ",IP,"6,098.40","7,117.76",,,,,,,,,,,,,
Aetna,DRG,MS-304,HYPERTENSION WITH MCC,Medical/Surgical,Relative Weights,"$9,873.00 ",IP,"9,873.00","11,529.00",,,,,,,,,,,,,
Aetna,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,659.10 ",IP,"6,659.10","7,771.24",,,,,,,,,,,,,
Aetna,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$13,566.60 ",IP,"13,566.60","15,823.44",,,,,,,,,,,,,
Aetna,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,833.60 ",IP,"7,833.60","9,138.17",,,,,,,,,,,,,
Aetna,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$10,808.10 ",IP,"10,808.10","12,620.23",,,,,,,,,,,,,
Aetna,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$6,754.50 ",IP,"6,754.50","7,885.94",,,,,,,,,,,,,
Aetna,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,032.80 ",IP,"5,032.80","5,876.04",,,,,,,,,,,,,
Aetna,DRG,MS-311,ANGINA PECTORIS,Medical/Surgical,Relative Weights,"$6,286.50 ",IP,"6,286.50","7,334.53",,,,,,,,,,,,,
Aetna,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical/Surgical,Relative Weights,"$7,548.30 ",IP,"7,548.30","8,809.86",,,,,,,,,,,,,
Aetna,DRG,MS-313,CHEST PAIN,Medical/Surgical,Relative Weights,"$6,492.60 ",IP,"6,492.60","7,584.98",,,,,,,,,,,,,
Aetna,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$18,762.30 ",IP,"18,762.30","21,923.62",,,,,,,,,,,,,
Aetna,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$8,760.60 ",IP,"8,760.60","10,262.03",,,,,,,,,,,,,
Aetna,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,510.60 ",IP,"6,510.60","7,886.99",,,,,,,,,,,,,
Aetna,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$38,861.10 ",IP,"38,861.10","45,415.16",,,,,,,,,,,,,
Aetna,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$21,650.40 ",IP,"21,650.40","25,715.06",,,,,,,,,,,,,
Aetna,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$47,846.70 ",IP,"47,846.70","56,589.54",,,,,,,,,,,,,
Aetna,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$23,082.30 ",IP,"23,082.30","27,460.82",,,,,,,,,,,,,
Aetna,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,002.10 ",IP,"15,002.10","17,526.06",,,,,,,,,,,,,
Aetna,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$43,975.80 ",IP,"43,975.80","51,039.71",,,,,,,,,,,,,
Aetna,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$22,943.70 ",IP,"22,943.70","26,717.90",,,,,,,,,,,,,
Aetna,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,394.50 ",IP,"15,394.50","17,995.38",,,,,,,,,,,,,
Aetna,DRG,MS-332,RECTAL RESECTION WITH MCC,Medical/Surgical,Relative Weights,"$37,453.50 ",IP,"37,453.50","43,772.52",,,,,,,,,,,,,
Aetna,DRG,MS-333,RECTAL RESECTION WITH CC,Medical/Surgical,Relative Weights,"$19,271.70 ",IP,"19,271.70","22,529.74",,,,,,,,,,,,,
Aetna,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,477.40 ",IP,"14,477.40","16,933.61",,,,,,,,,,,,,
Aetna,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Medical/Surgical,Relative Weights,"$35,221.50 ",IP,"35,221.50","40,938.68",,,,,,,,,,,,,
Aetna,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Medical/Surgical,Relative Weights,"$20,621.70 ",IP,"20,621.70","24,022.96",,,,,,,,,,,,,
Aetna,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,735.70 ",IP,"14,735.70","17,179.85",,,,,,,,,,,,,
Aetna,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$25,175.70 ",IP,"25,175.70","29,451.77",,,,,,,,,,,,,
Aetna,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$15,276.60 ",IP,"15,276.60","17,836.49",,,,,,,,,,,,,
Aetna,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,054.70 ",IP,"11,054.70","12,926.45",,,,,,,,,,,,,
Aetna,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$20,901.60 ",IP,"20,901.60","24,373.37",,,,,,,,,,,,,
Aetna,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$12,896.10 ",IP,"12,896.10","15,080.51",,,,,,,,,,,,,
Aetna,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,977.40 ",IP,"9,977.40","11,674.22",,,,,,,,,,,,,
Aetna,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$25,365.60 ",IP,"25,365.60","29,473.87",,,,,,,,,,,,,
Aetna,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$14,209.20 ",IP,"14,209.20","16,602.14",,,,,,,,,,,,,
Aetna,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,478.60 ",IP,"11,478.60","13,416.83",,,,,,,,,,,,,
Aetna,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$22,182.30 ",IP,"22,182.30","25,903.42",,,,,,,,,,,,,
Aetna,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$12,132.90 ",IP,"12,132.90","14,126.08",,,,,,,,,,,,,
Aetna,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,813.70 ",IP,"8,813.70","10,305.17",,,,,,,,,,,,,
Aetna,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$22,093.20 ",IP,"22,093.20","25,806.61",,,,,,,,,,,,,
Aetna,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$13,434.30 ",IP,"13,434.30","15,683.48",,,,,,,,,,,,,
Aetna,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,939.60 ",IP,"9,939.60","11,606.87",,,,,,,,,,,,,
Aetna,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Medical/Surgical,Relative Weights,"$27,224.10 ",IP,"27,224.10","31,656.34",,,,,,,,,,,,,
Aetna,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Medical/Surgical,Relative Weights,"$16,063.20 ",IP,"16,063.20","18,762.51",,,,,,,,,,,,,
Aetna,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,241.80 ",IP,"12,241.80","14,302.86",,,,,,,,,,,,,
Aetna,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$38,770.20 ",IP,"38,770.20","45,158.40",,,,,,,,,,,,,
Aetna,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$20,416.50 ",IP,"20,416.50","23,715.69",,,,,,,,,,,,,
Aetna,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,141.90 ",IP,"12,141.90","14,090.30",,,,,,,,,,,,,
Aetna,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$17,541.90 ",IP,"17,541.90","20,438.82",,,,,,,,,,,,,
Aetna,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$9,694.80 ",IP,"9,694.80","11,331.17",,,,,,,,,,,,,
Aetna,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,732.90 ",IP,"6,732.90","7,866.99",,,,,,,,,,,,,
Aetna,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical/Surgical,Relative Weights,"$15,580.80 ",IP,"15,580.80","18,186.90",,,,,,,,,,,,,
Aetna,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical/Surgical,Relative Weights,"$9,263.70 ",IP,"9,263.70","10,813.43",,,,,,,,,,,,,
Aetna,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,701.40 ",IP,"6,701.40","7,823.85",,,,,,,,,,,,,
Aetna,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$18,663.30 ",IP,"18,663.30","21,760.51",,,,,,,,,,,,,
Aetna,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$10,868.40 ",IP,"10,868.40","12,679.16",,,,,,,,,,,,,
Aetna,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,090.10 ",IP,"8,090.10","9,420.19",,,,,,,,,,,,,
Aetna,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical/Surgical,Relative Weights,"$16,210.80 ",IP,"16,210.80","18,929.82",,,,,,,,,,,,,
Aetna,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical/Surgical,Relative Weights,"$8,941.50 ",IP,"8,941.50","10,451.44",,,,,,,,,,,,,
Aetna,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,734.80 ",IP,"5,734.80","6,704.20",,,,,,,,,,,,,
Aetna,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical/Surgical,Relative Weights,"$16,979.40 ",IP,"16,979.40","19,815.86",,,,,,,,,,,,,
Aetna,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical/Surgical,Relative Weights,"$9,533.70 ",IP,"9,533.70","11,151.22",,,,,,,,,,,,,
Aetna,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,917.40 ",IP,"6,917.40","8,084.82",,,,,,,,,,,,,
Aetna,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical/Surgical,Relative Weights,"$11,813.40 ",IP,"11,813.40","13,794.60",,,,,,,,,,,,,
Aetna,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,035.20 ",IP,"8,035.20","9,390.73",,,,,,,,,,,,,
Aetna,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical/Surgical,Relative Weights,"$14,600.70 ",IP,"14,600.70","17,037.79",,,,,,,,,,,,,
Aetna,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical/Surgical,Relative Weights,"$8,955.90 ",IP,"8,955.90","10,454.60",,,,,,,,,,,,,
Aetna,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,432.30 ",IP,"6,432.30","7,508.16",,,,,,,,,,,,,
Aetna,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical/Surgical,Relative Weights,"$13,631.40 ",IP,"13,631.40","15,908.67",,,,,,,,,,,,,
Aetna,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical/Surgical,Relative Weights,"$7,408.80 ",IP,"7,408.80","8,647.80",,,,,,,,,,,,,
Aetna,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,247.90 ",IP,"5,247.90","6,130.70",,,,,,,,,,,,,
Aetna,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$11,242.80 ",IP,"11,242.80","13,094.82",,,,,,,,,,,,,
Aetna,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,892.20 ",IP,"6,892.20","8,043.78",,,,,,,,,,,,,
Aetna,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$14,950.80 ",IP,"14,950.80","17,400.83",,,,,,,,,,,,,
Aetna,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$8,468.10 ",IP,"8,468.10","9,876.89",,,,,,,,,,,,,
Aetna,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,863.50 ",IP,"5,863.50","6,836.79",,,,,,,,,,,,,
Aetna,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$51,638.40 ",IP,"51,638.40","60,302.05",,,,,,,,,,,,,
Aetna,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$25,928.10 ",IP,"25,928.10","30,274.67",,,,,,,,,,,,,
Aetna,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$19,062.00 ",IP,"19,062.00","22,266.67",,,,,,,,,,,,,
Aetna,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$33,776.10 ",IP,"33,776.10","39,455.99",,,,,,,,,,,,,
Aetna,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$19,047.60 ",IP,"19,047.60","22,248.78",,,,,,,,,,,,,
Aetna,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,114.70 ",IP,"14,114.70","16,475.86",,,,,,,,,,,,,
Aetna,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$33,781.50 ",IP,"33,781.50","39,486.51",,,,,,,,,,,,,
Aetna,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$20,497.50 ",IP,"20,497.50","23,947.19",,,,,,,,,,,,,
Aetna,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,578.10 ",IP,"15,578.10","18,219.52",,,,,,,,,,,,,
Aetna,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$32,654.70 ",IP,"32,654.70","38,151.14",,,,,,,,,,,,,
Aetna,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$18,285.30 ",IP,"18,285.30","21,381.68",,,,,,,,,,,,,
Aetna,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,800.70 ",IP,"12,800.70","14,965.81",,,,,,,,,,,,,
Aetna,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$21,818.70 ",IP,"21,818.70","25,502.49",,,,,,,,,,,,,
Aetna,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$15,201.00 ",IP,"15,201.00","17,763.88",,,,,,,,,,,,,
Aetna,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,837.70 ",IP,"11,837.70","13,839.85",,,,,,,,,,,,,
Aetna,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$31,648.50 ",IP,"31,648.50","36,978.87",,,,,,,,,,,,,
Aetna,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$17,167.50 ",IP,"17,167.50","20,087.35",,,,,,,,,,,,,
Aetna,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,082.40 ",IP,"13,082.40","15,273.08",,,,,,,,,,,,,
Aetna,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$37,673.10 ",IP,"37,673.10","43,975.62",,,,,,,,,,,,,
Aetna,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$20,556.90 ",IP,"20,556.90","24,009.28",,,,,,,,,,,,,
Aetna,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,884.30 ",IP,"13,884.30","16,240.15",,,,,,,,,,,,,
Aetna,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical/Surgical,Relative Weights,"$16,927.20 ",IP,"16,927.20","19,805.34",,,,,,,,,,,,,
Aetna,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical/Surgical,Relative Weights,"$9,269.10 ",IP,"9,269.10","10,822.91",,,,,,,,,,,,,
Aetna,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,586.30 ",IP,"5,586.30","6,520.05",,,,,,,,,,,,,
Aetna,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical/Surgical,Relative Weights,"$15,780.60 ",IP,"15,780.60","18,444.71",,,,,,,,,,,,,
Aetna,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical/Surgical,Relative Weights,"$10,093.50 ",IP,"10,093.50","11,787.86",,,,,,,,,,,,,
Aetna,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,063.10 ",IP,"8,063.10","9,412.82",,,,,,,,,,,,,
Aetna,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$14,380.20 ",IP,"14,380.20","16,797.86",,,,,,,,,,,,,
Aetna,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$7,606.80 ",IP,"7,606.80","8,885.62",,,,,,,,,,,,,
Aetna,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,456.70 ",IP,"5,456.70","6,375.89",,,,,,,,,,,,,
Aetna,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical/Surgical,Relative Weights,"$16,915.50 ",IP,"16,915.50","19,822.18",,,,,,,,,,,,,
Aetna,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical/Surgical,Relative Weights,"$8,370.00 ",IP,"8,370.00","9,803.23",,,,,,,,,,,,,
Aetna,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,968.80 ",IP,"5,968.80","6,974.64",,,,,,,,,,,,,
Aetna,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical/Surgical,Relative Weights,"$15,044.40 ",IP,"15,044.40","17,560.78",,,,,,,,,,,,,
Aetna,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical/Surgical,Relative Weights,"$9,697.50 ",IP,"9,697.50","11,331.17",,,,,,,,,,,,,
Aetna,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,349.40 ",IP,"7,349.40","8,588.87",,,,,,,,,,,,,
Aetna,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Medical/Surgical,Relative Weights,"$82,692.00 ",IP,"82,692.00","96,744.25",,,,,,,,,,,,,
Aetna,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Medical/Surgical,Relative Weights,"$54,837.90 ",IP,"54,837.90","64,170.31",,,,,,,,,,,,,
Aetna,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$43,031.70 ",IP,"43,031.70","50,415.69",,,,,,,,,,,,,
Aetna,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Medical/Surgical,Relative Weights,"$77,400.00 ",IP,"77,400.00","90,477.81",,,,,,,,,,,,,
Aetna,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Medical/Surgical,Relative Weights,"$58,463.10 ",IP,"58,463.10","68,420.55",,,,,,,,,,,,,
Aetna,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$45,068.40 ",IP,"45,068.40","52,798.10",,,,,,,,,,,,,
Aetna,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Medical/Surgical,Relative Weights,"$60,601.50 ",IP,"60,601.50","70,838.73",,,,,,,,,,,,,
Aetna,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Medical/Surgical,Relative Weights,"$35,376.30 ",IP,"35,376.30","41,383.80",,,,,,,,,,,,,
Aetna,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Medical/Surgical,Relative Weights,"$54,735.30 ",IP,"54,735.30","63,939.85",,,,,,,,,,,,,
Aetna,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Medical/Surgical,Relative Weights,"$28,272.60 ",IP,"28,272.60","33,086.42",,,,,,,,,,,,,
Aetna,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$48,332.70 ",IP,"48,332.70","56,460.10",,,,,,,,,,,,,
Aetna,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$26,783.10 ",IP,"26,783.10","31,300.66",,,,,,,,,,,,,
Aetna,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,596.90 ",IP,"16,596.90","19,400.20",,,,,,,,,,,,,
Aetna,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Medical/Surgical,Relative Weights,"$48,111.30 ",IP,"48,111.30","56,245.44",,,,,,,,,,,,,
Aetna,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Medical/Surgical,Relative Weights,"$32,197.50 ",IP,"32,197.50","37,632.35",,,,,,,,,,,,,
Aetna,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$25,221.60 ",IP,"25,221.60","29,506.49",,,,,,,,,,,,,
Aetna,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Medical/Surgical,Relative Weights,"$27,773.10 ",IP,"27,773.10","32,457.14",,,,,,,,,,,,,
Aetna,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Medical/Surgical,Relative Weights,"$17,102.70 ",IP,"17,102.70","19,992.65",,,,,,,,,,,,,
Aetna,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Medical/Surgical,Relative Weights,"$45,177.30 ",IP,"45,177.30","52,791.79",,,,,,,,,,,,,
Aetna,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Medical/Surgical,Relative Weights,"$27,483.30 ",IP,"27,483.30","32,128.82",,,,,,,,,,,,,
Aetna,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$22,851.00 ",IP,"22,851.00","26,730.52",,,,,,,,,,,,,
Aetna,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$36,684.90 ",IP,"36,684.90","42,858.07",,,,,,,,,,,,,
Aetna,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$19,766.70 ",IP,"19,766.70","23,083.25",,,,,,,,,,,,,
Aetna,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,442.70 ",IP,"10,442.70","12,204.58",,,,,,,,,,,,,
Aetna,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Relative Weights,"$30,230.10 ",IP,"30,230.10","35,324.66",,,,,,,,,,,,,
Aetna,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical/Surgical,Relative Weights,"$21,225.60 ",IP,"21,225.60","24,801.66",,,,,,,,,,,,,
Aetna,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,285.50 ",IP,"16,285.50","19,039.26",,,,,,,,,,,,,
Aetna,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Medical/Surgical,Relative Weights,"$27,232.20 ",IP,"27,232.20","31,826.81",,,,,,,,,,,,,
Aetna,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Medical/Surgical,Relative Weights,"$18,864.90 ",IP,"18,864.90","22,050.95",,,,,,,,,,,,,
Aetna,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,812.20 ",IP,"14,812.20","17,329.28",,,,,,,,,,,,,
Aetna,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Medical/Surgical,Relative Weights,"$21,471.30 ",IP,"21,471.30","25,111.03",,,,,,,,,,,,,
Aetna,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Medical/Surgical,Relative Weights,"$30,686.40 ",IP,"30,686.40","35,858.17",,,,,,,,,,,,,
Aetna,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Medical/Surgical,Relative Weights,"$19,344.60 ",IP,"19,344.60","22,607.61",,,,,,,,,,,,,
Aetna,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,761.80 ",IP,"14,761.80","17,260.88",,,,,,,,,,,,,
Aetna,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Medical/Surgical,Relative Weights,"$17,781.30 ",IP,"17,781.30","20,778.72",,,,,,,,,,,,,
Aetna,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,683.80 ",IP,"11,683.80","13,660.96",,,,,,,,,,,,,
Aetna,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Medical/Surgical,Relative Weights,"$31,230.00 ",IP,"31,230.00","36,495.87",,,,,,,,,,,,,
Aetna,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Medical/Surgical,Relative Weights,"$20,932.20 ",IP,"20,932.20","24,468.08",,,,,,,,,,,,,
Aetna,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,665.30 ",IP,"16,665.30","19,487.54",,,,,,,,,,,,,
Aetna,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Medical/Surgical,Relative Weights,"$32,777.10 ",IP,"32,777.10","38,242.69",,,,,,,,,,,,,
Aetna,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Medical/Surgical,Relative Weights,"$17,877.60 ",IP,"17,877.60","20,894.47",,,,,,,,,,,,,
Aetna,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,063.50 ",IP,"13,063.50","15,349.90",,,,,,,,,,,,,
Aetna,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Medical/Surgical,Relative Weights,"$23,253.30 ",IP,"23,253.30","27,194.59",,,,,,,,,,,,,
Aetna,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,791.00 ",IP,"10,791.00","12,613.92",,,,,,,,,,,,,
Aetna,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$28,705.50 ",IP,"28,705.50","33,188.49",,,,,,,,,,,,,
Aetna,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$15,786.90 ",IP,"15,786.90","18,362.64",,,,,,,,,,,,,
Aetna,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,995.20 ",IP,"11,995.20","14,004.01",,,,,,,,,,,,,
Aetna,DRG,MS-503,FOOT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$23,765.40 ",IP,"23,765.40","27,661.81",,,,,,,,,,,,,
Aetna,DRG,MS-504,FOOT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$15,975.00 ",IP,"15,975.00","18,666.75",,,,,,,,,,,,,
Aetna,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,975.00 ",IP,"15,975.00","18,666.75",,,,,,,,,,,,,
Aetna,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Medical/Surgical,Relative Weights,"$13,352.40 ",IP,"13,352.40","15,528.79",,,,,,,,,,,,,
Aetna,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$18,548.10 ",IP,"18,548.10","21,280.66",,,,,,,,,,,,,
Aetna,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,687.30 ",IP,"12,687.30","14,879.52",,,,,,,,,,,,,
Aetna,DRG,MS-509,ARTHROSCOPY,Medical/Surgical,Relative Weights,"$15,178.50 ",IP,"15,178.50","17,613.40",,,,,,,,,,,,,
Aetna,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$24,693.30 ",IP,"24,693.30","28,735.16",,,,,,,,,,,,,
Aetna,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$17,706.60 ",IP,"17,706.60","20,714.53",,,,,,,,,,,,,
Aetna,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,990.50 ",IP,"13,990.50","16,375.89",,,,,,,,,,,,,
Aetna,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$14,148.00 ",IP,"14,148.00","16,405.36",,,,,,,,,,,,,
Aetna,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,991.90 ",IP,"8,991.90","10,461.97",,,,,,,,,,,,,
Aetna,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$28,265.40 ",IP,"28,265.40","33,010.65",,,,,,,,,,,,,
Aetna,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$17,665.20 ",IP,"17,665.20","20,636.66",,,,,,,,,,,,,
Aetna,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,583.80 ",IP,"12,583.80","14,697.47",,,,,,,,,,,,,
Aetna,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Medical/Surgical,Relative Weights,"$32,282.10 ",IP,"32,282.10","37,717.59",,,,,,,,,,,,,
Aetna,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Medical/Surgical,Relative Weights,"$17,640.00 ",IP,"17,640.00","20,600.88",,,,,,,,,,,,,
Aetna,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,764.70 ",IP,"12,764.70","14,915.30",,,,,,,,,,,,,
Aetna,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Medical/Surgical,Relative Weights,"$27,595.80 ",IP,"27,595.80","32,236.16",,,,,,,,,,,,,
Aetna,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Medical/Surgical,Relative Weights,"$19,704.60 ",IP,"19,704.60","23,035.90",,,,,,,,,,,,,
Aetna,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical/Surgical,Relative Weights,"$12,745.80 ",IP,"12,745.80","14,864.79",,,,,,,,,,,,,
Aetna,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,111.80 ",IP,"7,111.80","8,298.44",,,,,,,,,,,,,
Aetna,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical/Surgical,Relative Weights,"$11,095.20 ",IP,"11,095.20","12,983.28",,,,,,,,,,,,,
Aetna,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,945.30 ",IP,"6,945.30","8,119.55",,,,,,,,,,,,,
Aetna,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical/Surgical,Relative Weights,"$8,418.60 ",IP,"8,418.60","9,820.06",,,,,,,,,,,,,
Aetna,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,508.80 ",IP,"6,508.80","7,591.29",,,,,,,,,,,,,
Aetna,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical/Surgical,Relative Weights,"$17,529.30 ",IP,"17,529.30","20,427.25",,,,,,,,,,,,,
Aetna,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical/Surgical,Relative Weights,"$11,714.40 ",IP,"11,714.40","13,630.44",,,,,,,,,,,,,
Aetna,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,588.80 ",IP,"7,588.80","8,845.63",,,,,,,,,,,,,
Aetna,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$16,282.80 ",IP,"16,282.80","18,997.17",,,,,,,,,,,,,
Aetna,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$9,406.80 ",IP,"9,406.80","10,978.65",,,,,,,,,,,,,
Aetna,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,999.30 ",IP,"6,999.30","8,167.95",,,,,,,,,,,,,
Aetna,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$22,527.90 ",IP,"22,527.90","26,302.24",,,,,,,,,,,,,
Aetna,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$10,872.00 ",IP,"10,872.00","12,697.05",,,,,,,,,,,,,
Aetna,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,502.40 ",IP,"7,502.40","8,765.66",,,,,,,,,,,,,
Aetna,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical/Surgical,Relative Weights,"$18,457.20 ",IP,"18,457.20","21,357.48",,,,,,,,,,,,,
Aetna,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical/Surgical,Relative Weights,"$11,249.10 ",IP,"11,249.10","13,121.13",,,,,,,,,,,,,
Aetna,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,910.10 ",IP,"7,910.10","9,288.65",,,,,,,,,,,,,
Aetna,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical/Surgical,Relative Weights,"$14,646.60 ",IP,"14,646.60","17,079.88",,,,,,,,,,,,,
Aetna,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,490.60 ",IP,"8,490.60","9,912.67",,,,,,,,,,,,,
Aetna,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical/Surgical,Relative Weights,"$11,443.50 ",IP,"11,443.50","13,346.32",,,,,,,,,,,,,
Aetna,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,132.50 ",IP,"7,132.50","8,317.38",,,,,,,,,,,,,
Aetna,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Relative Weights,"$12,316.50 ",IP,"12,316.50","14,340.74",,,,,,,,,,,,,
Aetna,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,278.30 ",IP,"7,278.30","8,484.69",,,,,,,,,,,,,
Aetna,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical/Surgical,Relative Weights,"$12,591.90 ",IP,"12,591.90","14,668.01",,,,,,,,,,,,,
Aetna,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,752.60 ",IP,"7,752.60","9,031.89",,,,,,,,,,,,,
Aetna,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Relative Weights,"$16,787.70 ",IP,"16,787.70","19,655.91",,,,,,,,,,,,,
Aetna,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical/Surgical,Relative Weights,"$9,684.00 ",IP,"9,684.00","11,326.96",,,,,,,,,,,,,
Aetna,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,131.60 ",IP,"7,131.60","8,324.75",,,,,,,,,,,,,
Aetna,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical/Surgical,Relative Weights,"$12,706.20 ",IP,"12,706.20","14,816.38",,,,,,,,,,,,,
Aetna,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,849.80 ",IP,"7,849.80","9,163.43",,,,,,,,,,,,,
Aetna,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$13,712.40 ",IP,"13,712.40","15,929.72",,,,,,,,,,,,,
Aetna,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$9,083.70 ",IP,"9,083.70","10,589.29",,,,,,,,,,,,,
Aetna,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,767.10 ",IP,"6,767.10","7,908.03",,,,,,,,,,,,,
Aetna,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Medical/Surgical,Relative Weights,"$25,575.30 ",IP,"25,575.30","29,846.38",,,,,,,,,,,,,
Aetna,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Medical/Surgical,Relative Weights,"$14,718.60 ",IP,"14,718.60","17,181.95",,,,,,,,,,,,,
Aetna,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,939.60 ",IP,"9,939.60","11,602.66",,,,,,,,,,,,,
Aetna,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Medical/Surgical,Relative Weights,"$49,851.90 ",IP,"49,851.90","58,269.01",,,,,,,,,,,,,
Aetna,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Medical/Surgical,Relative Weights,"$29,218.50 ",IP,"29,218.50","34,181.86",,,,,,,,,,,,,
Aetna,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,868.80 ",IP,"15,868.80","18,536.26",,,,,,,,,,,,,
Aetna,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Medical/Surgical,Relative Weights,"$45,573.30 ",IP,"45,573.30","53,150.62",,,,,,,,,,,,,
Aetna,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Medical/Surgical,Relative Weights,"$22,946.40 ",IP,"22,946.40","26,873.64",,,,,,,,,,,,,
Aetna,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,356.80 ",IP,"14,356.80","17,159.86",,,,,,,,,,,,,
Aetna,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$28,304.10 ",IP,"28,304.10","30,809.24",,,,,,,,,,,,,
Aetna,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$15,559.20 ",IP,"15,559.20","16,839.96",,,,,,,,,,,,,
Aetna,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,391.20 ",IP,"12,391.20","13,401.77",,,,,,,,,,,,,
Aetna,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$14,787.90 ",IP,"14,787.90","17,213.52",,,,,,,,,,,,,
Aetna,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,873.50 ",IP,"13,873.50","16,183.32",,,,,,,,,,,,,
Aetna,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$16,530.30 ",IP,"16,530.30","19,197.11",,,,,,,,,,,,,
Aetna,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,656.40 ",IP,"15,656.40","18,274.24",,,,,,,,,,,,,
Aetna,DRG,MS-592,SKIN ULCERS WITH MCC,Medical/Surgical,Relative Weights,"$15,248.70 ",IP,"15,248.70","17,749.14",,,,,,,,,,,,,
Aetna,DRG,MS-593,SKIN ULCERS WITH CC,Medical/Surgical,Relative Weights,"$10,265.40 ",IP,"10,265.40","11,962.55",,,,,,,,,,,,,
Aetna,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,344.00 ",IP,"7,344.00","8,615.18",,,,,,,,,,,,,
Aetna,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$18,148.50 ",IP,"18,148.50","21,173.33",,,,,,,,,,,,,
Aetna,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,952.30 ",IP,"8,952.30","10,409.35",,,,,,,,,,,,,
Aetna,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$14,796.00 ",IP,"14,796.00","17,222.99",,,,,,,,,,,,,
Aetna,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$10,016.10 ",IP,"10,016.10","11,693.16",,,,,,,,,,,,,
Aetna,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,042.60 ",IP,"6,042.60","7,063.04",,,,,,,,,,,,,
Aetna,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical/Surgical,Relative Weights,"$8,972.10 ",IP,"8,972.10","10,477.75",,,,,,,,,,,,,
Aetna,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,181.20 ",IP,"6,181.20","7,235.61",,,,,,,,,,,,,
Aetna,DRG,MS-602,CELLULITIS WITH MCC,Medical/Surgical,Relative Weights,"$13,050.00 ",IP,"13,050.00","15,117.34",,,,,,,,,,,,,
Aetna,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,682.40 ",IP,"7,682.40","8,889.83",,,,,,,,,,,,,
Aetna,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical/Surgical,Relative Weights,"$13,301.10 ",IP,"13,301.10","15,692.95",,,,,,,,,,,,,
Aetna,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,135.10 ",IP,"8,135.10","9,567.51",,,,,,,,,,,,,
Aetna,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$13,608.90 ",IP,"13,608.90","15,900.25",,,,,,,,,,,,,
Aetna,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,453.80 ",IP,"7,453.80","8,687.79",,,,,,,,,,,,,
Aetna,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$21,507.30 ",IP,"21,507.30","25,116.30",,,,,,,,,,,,,
Aetna,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,175.00 ",IP,"14,175.00","16,564.25",,,,,,,,,,,,,
Aetna,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$35,695.80 ",IP,"35,695.80","41,974.14",,,,,,,,,,,,,
Aetna,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$18,268.20 ",IP,"18,268.20","21,404.83",,,,,,,,,,,,,
Aetna,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,728.80 ",IP,"11,728.80","13,711.47",,,,,,,,,,,,,
Aetna,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Medical/Surgical,Relative Weights,"$27,555.30 ",IP,"27,555.30","32,211.96",,,,,,,,,,,,,
Aetna,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Medical/Surgical,Relative Weights,"$15,864.30 ",IP,"15,864.30","18,532.06",,,,,,,,,,,,,
Aetna,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,373.90 ",IP,"14,373.90","16,798.92",,,,,,,,,,,,,
Aetna,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$32,534.10 ",IP,"32,534.10","38,017.49",,,,,,,,,,,,,
Aetna,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$16,843.50 ",IP,"16,843.50","19,708.53",,,,,,,,,,,,,
Aetna,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,890.10 ",IP,"9,890.10","11,515.32",,,,,,,,,,,,,
Aetna,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$25,561.80 ",IP,"25,561.80","29,897.95",,,,,,,,,,,,,
Aetna,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$14,876.10 ",IP,"14,876.10","17,387.15",,,,,,,,,,,,,
Aetna,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,645.20 ",IP,"10,645.20","12,436.08",,,,,,,,,,,,,
Aetna,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$33,114.60 ",IP,"33,114.60","38,915.11",,,,,,,,,,,,,
Aetna,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$21,107.70 ",IP,"21,107.70","24,695.38",,,,,,,,,,,,,
Aetna,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,683.70 ",IP,"12,683.70","14,804.81",,,,,,,,,,,,,
Aetna,DRG,MS-637,DIABETES WITH MCC,Medical/Surgical,Relative Weights,"$12,389.40 ",IP,"12,389.40","14,465.97",,,,,,,,,,,,,
Aetna,DRG,MS-638,DIABETES WITH CC,Medical/Surgical,Relative Weights,"$7,914.60 ",IP,"7,914.60","9,253.93",,,,,,,,,,,,,
Aetna,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,486.40 ",IP,"5,486.40","6,411.66",,,,,,,,,,,,,
Aetna,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical/Surgical,Relative Weights,"$11,077.20 ",IP,"11,077.20","12,920.14",,,,,,,,,,,,,
Aetna,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,787.80 ",IP,"6,787.80","7,923.82",,,,,,,,,,,,,
Aetna,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical/Surgical,Relative Weights,"$11,608.20 ",IP,"11,608.20","13,548.36",,,,,,,,,,,,,
Aetna,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$15,009.30 ",IP,"15,009.30","17,502.91",,,,,,,,,,,,,
Aetna,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$9,178.20 ",IP,"9,178.20","10,715.57",,,,,,,,,,,,,
Aetna,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,917.40 ",IP,"6,917.40","8,079.56",,,,,,,,,,,,,
Aetna,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Medical/Surgical,Relative Weights,"$40,686.30 ",IP,"40,686.30","47,491.35",,,,,,,,,,,,,
Aetna,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$33,285.60 ",IP,"33,285.60","38,867.75",,,,,,,,,,,,,
Aetna,DRG,MS-652,KIDNEY TRANSPLANT,Medical/Surgical,Relative Weights,"$28,665.90 ",IP,"28,665.90","33,483.13",,,,,,,,,,,,,
Aetna,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$49,132.80 ",IP,"49,132.80","57,341.93",,,,,,,,,,,,,
Aetna,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$26,125.20 ",IP,"26,125.20","30,518.80",,,,,,,,,,,,,
Aetna,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$18,722.70 ",IP,"18,722.70","21,888.89",,,,,,,,,,,,,
Aetna,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Medical/Surgical,Relative Weights,"$29,565.00 ",IP,"29,565.00","34,533.33",,,,,,,,,,,,,
Aetna,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Medical/Surgical,Relative Weights,"$17,412.30 ",IP,"17,412.30","20,352.53",,,,,,,,,,,,,
Aetna,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,201.10 ",IP,"14,201.10","16,616.87",,,,,,,,,,,,,
Aetna,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Medical/Surgical,Relative Weights,"$23,997.60 ",IP,"23,997.60","28,041.69",,,,,,,,,,,,,
Aetna,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Medical/Surgical,Relative Weights,"$12,987.90 ",IP,"12,987.90","15,188.90",,,,,,,,,,,,,
Aetna,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,573.30 ",IP,"9,573.30","11,200.68",,,,,,,,,,,,,
Aetna,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$26,435.70 ",IP,"26,435.70","30,830.29",,,,,,,,,,,,,
Aetna,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$14,395.50 ",IP,"14,395.50","16,783.13",,,,,,,,,,,,,
Aetna,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,654.20 ",IP,"10,654.20","12,461.34",,,,,,,,,,,,,
Aetna,DRG,MS-665,PROSTATECTOMY WITH MCC,Medical/Surgical,Relative Weights,"$27,375.30 ",IP,"27,375.30","31,955.19",,,,,,,,,,,,,
Aetna,DRG,MS-666,PROSTATECTOMY WITH CC,Medical/Surgical,Relative Weights,"$15,657.30 ",IP,"15,657.30","18,250.04",,,,,,,,,,,,,
Aetna,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,977.50 ",IP,"8,977.50","10,469.33",,,,,,,,,,,,,
Aetna,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$25,256.70 ",IP,"25,256.70","28,991.92",,,,,,,,,,,,,
Aetna,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$14,071.50 ",IP,"14,071.50","16,120.18",,,,,,,,,,,,,
Aetna,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,806.50 ",IP,"8,806.50","10,275.71",,,,,,,,,,,,,
Aetna,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$16,031.70 ",IP,"16,031.70","18,696.21",,,,,,,,,,,,,
Aetna,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,353.60 ",IP,"10,353.60","12,110.92",,,,,,,,,,,,,
Aetna,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$31,214.70 ",IP,"31,214.70","36,442.20",,,,,,,,,,,,,
Aetna,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$21,448.80 ",IP,"21,448.80","25,048.95",,,,,,,,,,,,,
Aetna,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,792.30 ",IP,"15,792.30","18,436.30",,,,,,,,,,,,,
Aetna,DRG,MS-682,RENAL FAILURE WITH MCC,Medical/Surgical,Relative Weights,"$13,254.30 ",IP,"13,254.30","15,470.91",,,,,,,,,,,,,
Aetna,DRG,MS-683,RENAL FAILURE WITH CC,Medical/Surgical,Relative Weights,"$7,913.70 ",IP,"7,913.70","9,240.25",,,,,,,,,,,,,
Aetna,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,471.10 ",IP,"5,471.10","6,392.72",,,,,,,,,,,,,
Aetna,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical/Surgical,Relative Weights,"$16,877.70 ",IP,"16,877.70","19,711.68",,,,,,,,,,,,,
Aetna,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical/Surgical,Relative Weights,"$9,450.90 ",IP,"9,450.90","11,026.00",,,,,,,,,,,,,
Aetna,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,172.20 ",IP,"6,172.20","7,211.41",,,,,,,,,,,,,
Aetna,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical/Surgical,Relative Weights,"$10,027.80 ",IP,"10,027.80","11,694.21",,,,,,,,,,,,,
Aetna,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,146.00 ",IP,"7,146.00","8,336.32",,,,,,,,,,,,,
Aetna,DRG,MS-693,URINARY STONES WITH MCC,Medical/Surgical,Relative Weights,"$12,019.50 ",IP,"12,019.50","13,351.58",,,,,,,,,,,,,
Aetna,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,940.80 ",IP,"6,940.80","7,674.42",,,,,,,,,,,,,
Aetna,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical/Surgical,Relative Weights,"$10,239.30 ",IP,"10,239.30","11,957.28",,,,,,,,,,,,,
Aetna,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,227.10 ",IP,"6,227.10","7,257.71",,,,,,,,,,,,,
Aetna,DRG,MS-697,URETHRAL STRICTURE,Medical/Surgical,Relative Weights,"$8,993.70 ",IP,"8,993.70","10,491.43",,,,,,,,,,,,,
Aetna,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$14,495.40 ",IP,"14,495.40","16,907.30",,,,,,,,,,,,,
Aetna,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$9,243.00 ",IP,"9,243.00","10,788.18",,,,,,,,,,,,,
Aetna,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,718.50 ",IP,"6,718.50","7,837.53",,,,,,,,,,,,,
Aetna,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$17,299.80 ",IP,"17,299.80","20,210.47",,,,,,,,,,,,,
Aetna,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,420.80 ",IP,"13,420.80","15,694.00",,,,,,,,,,,,,
Aetna,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$20,843.10 ",IP,"20,843.10","24,328.12",,,,,,,,,,,,,
Aetna,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,414.40 ",IP,"14,414.40","16,835.75",,,,,,,,,,,,,
Aetna,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$19,184.40 ",IP,"19,184.40","22,417.15",,,,,,,,,,,,,
Aetna,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,540.00 ",IP,"9,540.00","11,128.07",,,,,,,,,,,,,
Aetna,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Medical/Surgical,Relative Weights,"$13,440.60 ",IP,"13,440.60","15,696.11",,,,,,,,,,,,,
Aetna,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,359.20 ",IP,"8,359.20","9,770.61",,,,,,,,,,,,,
Aetna,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$18,194.40 ",IP,"18,194.40","21,244.88",,,,,,,,,,,,,
Aetna,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,482.20 ",IP,"11,482.20","13,432.61",,,,,,,,,,,,,
Aetna,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$16,205.40 ",IP,"16,205.40","18,925.62",,,,,,,,,,,,,
Aetna,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,111.40 ",IP,"11,111.40","13,008.53",,,,,,,,,,,,,
Aetna,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$15,413.40 ",IP,"15,413.40","17,983.81",,,,,,,,,,,,,
Aetna,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$9,827.10 ",IP,"9,827.10","11,460.60",,,,,,,,,,,,,
Aetna,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,832.90 ",IP,"5,832.90","6,833.64",,,,,,,,,,,,,
Aetna,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical/Surgical,Relative Weights,"$11,569.50 ",IP,"11,569.50","13,489.43",,,,,,,,,,,,,
Aetna,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,702.30 ",IP,"6,702.30","7,821.75",,,,,,,,,,,,,
Aetna,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$12,789.00 ",IP,"12,789.00","14,922.67",,,,,,,,,,,,,
Aetna,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,251.30 ",IP,"7,251.30","8,455.23",,,,,,,,,,,,,
Aetna,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical/Surgical,Relative Weights,"$9,067.50 ",IP,"9,067.50","10,573.51",,,,,,,,,,,,,
Aetna,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,120.10 ",IP,"5,120.10","5,952.86",,,,,,,,,,,,,
Aetna,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Medical/Surgical,Relative Weights,"$20,018.70 ",IP,"20,018.70","23,390.52",,,,,,,,,,,,,
Aetna,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,722.40 ",IP,"12,722.40","14,874.26",,,,,,,,,,,,,
Aetna,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$38,346.30 ",IP,"38,346.30","44,809.04",,,,,,,,,,,,,
Aetna,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$18,522.90 ",IP,"18,522.90","21,658.44",,,,,,,,,,,,,
Aetna,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,283.10 ",IP,"13,283.10","15,538.26",,,,,,,,,,,,,
Aetna,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$34,416.00 ",IP,"34,416.00","40,215.75",,,,,,,,,,,,,
Aetna,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$16,214.40 ",IP,"16,214.40","18,941.40",,,,,,,,,,,,,
Aetna,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,519.10 ",IP,"11,519.10","13,464.18",,,,,,,,,,,,,
Aetna,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$15,462.90 ",IP,"11,830.00","16,723.99",,,,,,,,,,,,,
Aetna,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,195.20 ",IP,"10,195.20","11,830.00",,,,,,,,,,,,,
Aetna,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Medical/Surgical,Relative Weights,"$16,158.60 ",IP,"16,158.60","18,878.26",,,,,,,,,,,,,
Aetna,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,530.00 ",IP,"10,530.00","12,317.17",,,,,,,,,,,,,
Aetna,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$14,503.50 ",IP,"14,503.50","16,935.72",,,,,,,,,,,,,
Aetna,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,451.90 ",IP,"8,451.90","9,870.57",,,,,,,,,,,,,
Aetna,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Medical/Surgical,Relative Weights,"$12,128.40 ",IP,"12,128.40","14,188.16",,,,,,,,,,,,,
Aetna,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$24,424.20 ",IP,"24,424.20","28,489.97",,,,,,,,,,,,,
Aetna,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,174.20 ",IP,"13,174.20","15,425.67",,,,,,,,,,,,,
Aetna,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$16,435.80 ",IP,"16,435.80","19,162.38",,,,,,,,,,,,,
Aetna,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$10,163.70 ",IP,"10,163.70","11,865.73",,,,,,,,,,,,,
Aetna,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,265.60 ",IP,"8,265.60","9,640.12",,,,,,,,,,,,,
Aetna,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$13,722.30 ",IP,"13,722.30","16,017.06",,,,,,,,,,,,,
Aetna,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$8,727.30 ",IP,"8,727.30","10,175.74",,,,,,,,,,,,,
Aetna,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,150.60 ",IP,"6,150.60","7,189.31",,,,,,,,,,,,,
Aetna,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical/Surgical,Relative Weights,"$8,280.90 ",IP,"8,280.90","9,708.52",,,,,,,,,,,,,
Aetna,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,317.20 ",IP,"5,317.20","6,208.57",,,,,,,,,,,,,
Aetna,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Medical/Surgical,Relative Weights,"$10,526.40 ",IP,"3,245.00","12,320.33",,,,,,,,,,,,,
Aetna,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$14,558.40 ",IP,"14,558.40","17,051.47",,,,,,,,,,,,,
Aetna,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Medical/Surgical,Relative Weights,"$8,008.20 ",IP,"8,008.20","9,345.48",,,,,,,,,,,,,
Aetna,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$6,970.50 ",IP,"6,970.50","8,090.08",,,,,,,,,,,,,
Aetna,DRG,MS-779,ABORTION WITHOUT D&C,Medical/Surgical,Relative Weights,"$9,531.00 ",IP,"9,531.00","10,948.13",,,,,,,,,,,,,
Aetna,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,Medical/Surgical,Relative Weights,"$16,874.10 ",IP,"4,275.00","19,706.42",,,,,,,,,,,,,
Aetna,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,Medical/Surgical,Relative Weights,"$9,863.10 ",IP,"4,275.00","11,521.63",,,,,,,,,,,,,
Aetna,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,251.20 ",IP,"4,275.00","9,631.70",,,,,,,,,,,,,
Aetna,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,Medical/Surgical,Relative Weights,"$14,349.60 ",IP,"4,275.00","16,743.15",,,,,,,,,,,,,
Aetna,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,Medical/Surgical,Relative Weights,"$9,579.60 ",IP,"4,275.00","11,182.79",,,,,,,,,,,,,
Aetna,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,986.60 ",IP,"4,275.00","9,334.95",,,,,,,,,,,,,
Aetna,DRG,MS-789,NEONATES- DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY,Medical/Surgical,Relative Weights,"$15,480.00 ",IP,"15,480.00","18,083.78",,,,,,,,,,,,,
Aetna,DRG,MS-790,EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME- NEONATE,Medical/Surgical,Relative Weights,"$51,048.90 ",IP,"51,048.90","59,634.89",,,,,,,,,,,,,
Aetna,DRG,MS-791,PREMATURITY WITH MAJOR PROBLEMS,Medical/Surgical,Relative Weights,"$34,864.20 ",IP,"34,864.20","40,728.22",,,,,,,,,,,,,
Aetna,DRG,MS-792,PREMATURITY WITHOUT MAJOR PROBLEMS,Medical/Surgical,Relative Weights,"$21,036.60 ",IP,"21,036.60","24,574.36",,,,,,,,,,,,,
Aetna,DRG,MS-793,FULL TERM NEONATE WITH MAJOR PROBLEMS,Medical/Surgical,Relative Weights,"$35,812.80 ",IP,"35,812.80","41,836.29",,,,,,,,,,,,,
Aetna,DRG,MS-794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,Medical/Surgical,Relative Weights,"$12,675.60 ",IP,"12,675.60","14,807.97",,,,,,,,,,,,,
Aetna,DRG,MS-795,NORMAL NEWBORN,Medical/Surgical,Relative Weights,"$1,716.30 ",IP,"1,716.30","2,004.63",,,,,,,,,,,,,
Aetna,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Medical/Surgical,Relative Weights,"$9,637.20 ",IP,"3,245.00","11,237.51",,,,,,,,,,,,,
Aetna,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Medical/Surgical,Relative Weights,"$8,274.60 ",IP,"3,245.00","9,680.11",,,,,,,,,,,,,
Aetna,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,447.50 ",IP,"3,245.00","8,705.68",,,,,,,,,,,,,
Aetna,DRG,MS-799,SPLENECTOMY WITH MCC,Medical/Surgical,Relative Weights,"$46,326.60 ",IP,"46,326.60","54,129.26",,,,,,,,,,,,,
Aetna,DRG,MS-800,SPLENECTOMY WITH CC,Medical/Surgical,Relative Weights,"$26,585.10 ",IP,"26,585.10","31,057.58",,,,,,,,,,,,,
Aetna,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,156.00 ",IP,"15,156.00","17,715.47",,,,,,,,,,,,,
Aetna,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Medical/Surgical,Relative Weights,"$33,405.30 ",IP,"33,405.30","39,026.65",,,,,,,,,,,,,
Aetna,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Medical/Surgical,Relative Weights,"$16,978.50 ",IP,"16,978.50","19,833.75",,,,,,,,,,,,,
Aetna,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,293.10 ",IP,"12,293.10","14,355.48",,,,,,,,,,,,,
Aetna,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Medical/Surgical,Relative Weights,"$9,269.10 ",IP,"3,245.00","10,805.02",,,,,,,,,,,,,
Aetna,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Medical/Surgical,Relative Weights,"$6,611.40 ",IP,"3,245.00","7,722.83",,,,,,,,,,,,,
Aetna,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,780.70 ",IP,"3,245.00","6,746.30",,,,,,,,,,,,,
Aetna,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$19,672.20 ",IP,"19,672.20","22,918.04",,,,,,,,,,,,,
Aetna,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$11,010.60 ",IP,"11,010.60","12,855.95",,,,,,,,,,,,,
Aetna,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,655.30 ",IP,"8,655.30","10,109.45",,,,,,,,,,,,,
Aetna,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$12,413.70 ",IP,"12,413.70","14,496.48",,,,,,,,,,,,,
Aetna,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,922.70 ",IP,"7,922.70","9,257.08",,,,,,,,,,,,,
Aetna,DRG,MS-813,COAGULATION DISORDERS,Medical/Surgical,Relative Weights,"$13,905.90 ",IP,"13,905.90","16,254.88",,,,,,,,,,,,,
Aetna,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$17,025.30 ",IP,"17,025.30","19,896.89",,,,,,,,,,,,,
Aetna,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$8,940.60 ",IP,"8,940.60","10,444.08",,,,,,,,,,,,,
Aetna,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,949.90 ",IP,"5,949.90","6,954.65",,,,,,,,,,,,,
Aetna,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$20,761.20 ",IP,"20,761.20","24,221.84",,,,,,,,,,,,,
Aetna,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$12,238.20 ",IP,"12,238.20","13,853.53",,,,,,,,,,,,,
Aetna,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,884.80 ",IP,"8,884.80","10,500.90",,,,,,,,,,,,,
Aetna,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$51,225.30 ",IP,"51,225.30","59,847.46",,,,,,,,,,,,,
Aetna,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$19,396.80 ",IP,"19,396.80","22,678.12",,,,,,,,,,,,,
Aetna,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,263.50 ",IP,"11,263.50","13,170.59",,,,,,,,,,,,,
Aetna,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$40,516.20 ",IP,"40,516.20","47,322.98",,,,,,,,,,,,,
Aetna,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$21,279.60 ",IP,"21,279.60","24,862.69",,,,,,,,,,,,,
Aetna,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,613.50 ",IP,"12,613.50","14,739.57",,,,,,,,,,,,,
Aetna,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$45,400.50 ",IP,"45,400.50","53,002.25",,,,,,,,,,,,,
Aetna,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$22,505.40 ",IP,"22,505.40","26,282.24",,,,,,,,,,,,,
Aetna,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,066.00 ",IP,"15,066.00","17,654.44",,,,,,,,,,,,,
Aetna,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$28,875.60 ",IP,"28,875.60","33,733.58",,,,,,,,,,,,,
Aetna,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,338.00 ",IP,"13,338.00","15,537.21",,,,,,,,,,,,,
Aetna,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$10,096.20 ",IP,"10,096.20","11,797.34",,,,,,,,,,,,,
Aetna,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$7,004.70 ",IP,"7,004.70","8,205.84",,,,,,,,,,,,,
Aetna,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$4,833.00 ",IP,"4,833.00","5,640.33",,,,,,,,,,,,,
Aetna,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$54,469.80 ",IP,"54,469.80","63,665.20",,,,,,,,,,,,,
Aetna,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$19,023.30 ",IP,"19,023.30","22,242.47",,,,,,,,,,,,,
Aetna,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,561.50 ",IP,"10,561.50","12,307.70",,,,,,,,,,,,,
Aetna,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical/Surgical,Relative Weights,"$51,293.70 ",IP,"51,293.70","59,972.68",,,,,,,,,,,,,
Aetna,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical/Surgical,Relative Weights,"$20,341.80 ",IP,"20,341.80","23,769.35",,,,,,,,,,,,,
Aetna,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,384.80 ",IP,"13,384.80","15,640.33",,,,,,,,,,,,,
Aetna,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical/Surgical,Relative Weights,"$28,984.50 ",IP,"28,984.50","33,838.81",,,,,,,,,,,,,
Aetna,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical/Surgical,Relative Weights,"$14,594.40 ",IP,"14,594.40","17,055.68",,,,,,,,,,,,,
Aetna,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,873.00 ",IP,"9,873.00","11,525.84",,,,,,,,,,,,,
Aetna,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$17,168.40 ",IP,"17,168.40","20,024.22",,,,,,,,,,,,,
Aetna,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$10,657.80 ",IP,"10,657.80","12,422.40",,,,,,,,,,,,,
Aetna,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,640.10 ",IP,"7,640.10","8,917.19",,,,,,,,,,,,,
Aetna,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$24,056.10 ",IP,"24,056.10","28,095.36",,,,,,,,,,,,,
Aetna,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$12,024.90 ",IP,"12,024.90","14,050.31",,,,,,,,,,,,,
Aetna,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,290.70 ",IP,"9,290.70","10,828.17",,,,,,,,,,,,,
Aetna,DRG,MS-849,RADIOTHERAPY,Medical/Surgical,Relative Weights,"$22,442.40 ",IP,"22,442.40","26,175.96",,,,,,,,,,,,,
Aetna,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$44,710.20 ",IP,"44,710.20","52,032.03",,,,,,,,,,,,,
Aetna,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$19,099.80 ",IP,"19,099.80","22,039.37",,,,,,,,,,,,,
Aetna,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,678.20 ",IP,"13,678.20","15,731.89",,,,,,,,,,,,,
Aetna,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$41,975.10 ",IP,"41,975.10","47,834.40",,,,,,,,,,,,,
Aetna,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$18,921.60 ",IP,"18,921.60","21,411.15",,,,,,,,,,,,,
Aetna,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,236.40 ",IP,"12,236.40","14,189.21",,,,,,,,,,,,,
Aetna,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical/Surgical,Relative Weights,"$17,070.30 ",IP,"17,070.30","19,770.61",,,,,,,,,,,,,
Aetna,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,102.60 ",IP,"9,102.60","10,285.18",,,,,,,,,,,,,
Aetna,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical/Surgical,Relative Weights,"$7,888.50 ",IP,"7,888.50","9,207.63",,,,,,,,,,,,,
Aetna,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical/Surgical,Relative Weights,"$13,300.20 ",IP,"13,300.20","15,562.46",,,,,,,,,,,,,
Aetna,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,551.00 ",IP,"7,551.00","8,809.86",,,,,,,,,,,,,
Aetna,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$20,133.90 ",IP,"20,133.90","23,461.03",,,,,,,,,,,,,
Aetna,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$9,594.00 ",IP,"9,594.00","11,137.54",,,,,,,,,,,,,
Aetna,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,556.50 ",IP,"6,556.50","7,639.70",,,,,,,,,,,,,
Aetna,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical/Surgical,Relative Weights,"$57,951.00 ",IP,"57,951.00","67,608.17",,,,,,,,,,,,,
Aetna,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical/Surgical,Relative Weights,"$16,849.80 ",IP,"16,849.80","19,659.07",,,,,,,,,,,,,
Aetna,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,236.70 ",IP,"9,236.70","10,750.30",,,,,,,,,,,,,
Aetna,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Medical/Surgical,Relative Weights,"$29,412.00 ",IP,"29,412.00","34,318.66",,,,,,,,,,,,,
Aetna,DRG,MS-880,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,Medical/Surgical,Relative Weights,"$7,780.50 ",IP,"7,780.50","9,087.66",,,,,,,,,,,,,
Aetna,DRG,MS-881,DEPRESSIVE NEUROSES,Medical/Surgical,Relative Weights,"$7,218.00 ",IP,"7,218.00","8,433.13",,,,,,,,,,,,,
Aetna,DRG,MS-882,NEUROSES EXCEPT DEPRESSIVE,Medical/Surgical,Relative Weights,"$7,412.40 ",IP,"7,412.40","8,660.43",,,,,,,,,,,,,
Aetna,DRG,MS-883,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,Medical/Surgical,Relative Weights,"$14,236.20 ",IP,"14,236.20","16,608.45",,,,,,,,,,,,,
Aetna,DRG,MS-884,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,Medical/Surgical,Relative Weights,"$13,025.70 ",IP,"13,025.70","15,193.11",,,,,,,,,,,,,
Aetna,DRG,MS-885,PSYCHOSES,Medical/Surgical,Relative Weights,"$11,154.60 ",IP,"11,154.60","13,018.00",,,,,,,,,,,,,
Aetna,DRG,MS-886,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,Medical/Surgical,Relative Weights,"$11,013.30 ",IP,"11,013.30","12,853.84",,,,,,,,,,,,,
Aetna,DRG,MS-887,OTHER MENTAL DISORDER DIAGNOSES,Medical/Surgical,Relative Weights,"$9,718.20 ",IP,"9,718.20","11,351.16",,,,,,,,,,,,,
Aetna,DRG,MS-894,ALCOHOL- DRUG ABUSE OR DEPENDENCE- LEFT AMA,Medical/Surgical,Relative Weights,"$4,941.00 ",IP,"4,941.00","5,761.34",,,,,,,,,,,,,
Aetna,DRG,MS-895,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,Medical/Surgical,Relative Weights,"$14,392.80 ",IP,"14,392.80","16,752.62",,,,,,,,,,,,,
Aetna,DRG,MS-896,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC,Medical/Surgical,Relative Weights,"$16,022.70 ",IP,"16,022.70","18,699.37",,,,,,,,,,,,,
Aetna,DRG,MS-897,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,443.00 ",IP,"7,443.00","8,686.74",,,,,,,,,,,,,
Aetna,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Medical/Surgical,Relative Weights,"$38,418.30 ",IP,"38,418.30","44,851.13",,,,,,,,,,,,,
Aetna,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Medical/Surgical,Relative Weights,"$17,678.70 ",IP,"17,678.70","20,650.34",,,,,,,,,,,,,
Aetna,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,217.70 ",IP,"10,217.70","11,937.29",,,,,,,,,,,,,
Aetna,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Medical/Surgical,Relative Weights,"$33,543.00 ",IP,"33,543.00","39,160.29",,,,,,,,,,,,,
Aetna,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,850.00 ",IP,"14,850.00","17,277.71",,,,,,,,,,,,,
Aetna,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Medical/Surgical,Relative Weights,"$16,234.20 ",IP,"16,234.20","18,876.16",,,,,,,,,,,,,
Aetna,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Medical/Surgical,Relative Weights,"$35,533.80 ",IP,"35,533.80","41,640.56",,,,,,,,,,,,,
Aetna,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Medical/Surgical,Relative Weights,"$18,453.60 ",IP,"18,453.60","21,471.13",,,,,,,,,,,,,
Aetna,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,339.00 ",IP,"12,339.00","14,468.07",,,,,,,,,,,,,
Aetna,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical/Surgical,Relative Weights,"$14,747.40 ",IP,"14,747.40","17,219.84",,,,,,,,,,,,,
Aetna,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,982.10 ",IP,"7,982.10","9,350.74",,,,,,,,,,,,,
Aetna,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical/Surgical,Relative Weights,"$15,295.50 ",IP,"15,295.50","17,863.84",,,,,,,,,,,,,
Aetna,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical/Surgical,Relative Weights,"$5,925.60 ",IP,"5,925.60","6,916.77",,,,,,,,,,,,,
Aetna,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical/Surgical,Relative Weights,"$13,306.50 ",IP,"13,306.50","15,547.73",,,,,,,,,,,,,
Aetna,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,124.40 ",IP,"7,124.40","8,324.75",,,,,,,,,,,,,
Aetna,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical/Surgical,Relative Weights,"$16,596.90 ",IP,"16,596.90","19,303.39",,,,,,,,,,,,,
Aetna,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical/Surgical,Relative Weights,"$9,221.40 ",IP,"9,221.40","10,810.28",,,,,,,,,,,,,
Aetna,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,281.10 ",IP,"6,281.10","7,275.60",,,,,,,,,,,,,
Aetna,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$14,293.80 ",IP,"14,293.80","16,706.31",,,,,,,,,,,,,
Aetna,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,458.20 ",IP,"8,458.20","9,790.60",,,,,,,,,,,,,
Aetna,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Medical/Surgical,Relative Weights,"$189,821.70 ",IP,"189,821.70","221,308.16",,,,,,,,,,,,,
Aetna,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Medical/Surgical,Relative Weights,"$58,784.40 ",IP,"58,784.40","68,600.49",,,,,,,,,,,,,
Aetna,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$27,125.10 ",IP,"27,125.10","31,662.65",,,,,,,,,,,,,
Aetna,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical/Surgical,Relative Weights,"$20,366.10 ",IP,"20,366.10","23,756.72",,,,,,,,,,,,,
Aetna,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical/Surgical,Relative Weights,"$17,468.10 ",IP,"17,468.10","20,386.21",,,,,,,,,,,,,
Aetna,DRG,MS-935,NON-EXTENSIVE BURNS,Medical/Surgical,Relative Weights,"$17,396.10 ",IP,"17,396.10","20,344.12",,,,,,,,,,,,,
Aetna,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Medical/Surgical,Relative Weights,"$30,371.40 ",IP,"30,371.40","35,632.98",,,,,,,,,,,,,
Aetna,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Medical/Surgical,Relative Weights,"$19,988.10 ",IP,"19,988.10","23,335.80",,,,,,,,,,,,,
Aetna,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,307.90 ",IP,"17,307.90","20,253.62",,,,,,,,,,,,,
Aetna,DRG,MS-945,REHABILITATION WITH CC/MCC,Medical/Surgical,Relative Weights,"$13,337.10 ",IP,"13,337.10","15,623.50",,,,,,,,,,,,,
Aetna,DRG,MS-946,REHABILITATION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,135.80 ",IP,"10,135.80","11,861.53",,,,,,,,,,,,,
Aetna,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical/Surgical,Relative Weights,"$10,746.00 ",IP,"10,746.00","12,523.42",,,,,,,,,,,,,
Aetna,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,083.90 ",IP,"7,083.90","8,266.87",,,,,,,,,,,,,
Aetna,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical/Surgical,Relative Weights,"$9,989.10 ",IP,"9,989.10","11,650.01",,,,,,,,,,,,,
Aetna,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,661.80 ",IP,"6,661.80","7,775.44",,,,,,,,,,,,,
Aetna,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical/Surgical,Relative Weights,"$5,036.40 ",IP,"5,036.40","5,873.94",,,,,,,,,,,,,
Aetna,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Medical/Surgical,Relative Weights,"$56,603.70 ",IP,"56,603.70","66,168.62",,,,,,,,,,,,,
Aetna,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Medical/Surgical,Relative Weights,"$34,650.00 ",IP,"34,650.00","40,500.92",,,,,,,,,,,,,
Aetna,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical/Surgical,Relative Weights,"$66,788.10 ",IP,"66,788.10","78,089.08",,,,,,,,,,,,,
Aetna,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical/Surgical,Relative Weights,"$37,851.30 ",IP,"37,851.30","44,253.42",,,,,,,,,,,,,
Aetna,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$24,624.90 ",IP,"24,624.90","28,771.99",,,,,,,,,,,,,
Aetna,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical/Surgical,Relative Weights,"$24,569.10 ",IP,"24,569.10","28,666.76",,,,,,,,,,,,,
Aetna,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical/Surgical,Relative Weights,"$13,426.20 ",IP,"13,426.20","15,662.43",,,,,,,,,,,,,
Aetna,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,212.50 ",IP,"8,212.50","9,606.45",,,,,,,,,,,,,
Aetna,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$52,667.10 ",IP,"52,667.10","60,900.81",,,,,,,,,,,,,
Aetna,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$26,898.30 ",IP,"26,898.30","30,991.29",,,,,,,,,,,,,
Aetna,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical/Surgical,Relative Weights,"$24,214.50 ",IP,"24,214.50","28,261.62",,,,,,,,,,,,,
Aetna,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical/Surgical,Relative Weights,"$11,538.90 ",IP,"11,538.90","13,459.97",,,,,,,,,,,,,
Aetna,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,546.40 ",IP,"8,546.40","9,987.38",,,,,,,,,,,,,
Aetna,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical/Surgical,Relative Weights,"$11,918.70 ",IP,"11,918.70","13,898.78",,,,,,,,,,,,,
Aetna,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$41,530.50 ",IP,"41,530.50","48,487.88",,,,,,,,,,,,,
Aetna,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$22,829.40 ",IP,"22,829.40","26,743.15",,,,,,,,,,,,,
Aetna,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,870.70 ",IP,"14,870.70","17,413.46",,,,,,,,,,,,,
Aetna,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$29,483.10 ",IP,"29,483.10","34,327.08",,,,,,,,,,,,,
Aetna,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$15,357.60 ",IP,"15,357.60","17,686.01",,,,,,,,,,,,,
Aetna,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,112.40 ",IP,"10,112.40","11,742.62",,,,,,,,,,,,,
Aetna,ExceptRevenueCode,360,Operating Room Services,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Aetna,ExceptRevenueCode,361,Operating Room Services: Minor surgery,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Aetna,ExceptRevenueCode,369,Operating Room Services: Other operating room services,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Aetna,ExceptRevenueCode,481,Cardiology: Cardiac catheter lab,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Aetna,ExceptRevenueCode,490,Ambulatory Surgery,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Aetna,ExceptRevenueCode,750,Gastrointestinal,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Aetna,ExceptRevenueCode,790,Extra-Corp Shock Wage Therapy,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Aetna,,,,All Other,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
BCBS of IL,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"281,947.26",,,,,,,,,,,,,
BCBS of IL,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"155,072.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"284,088.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"224,999.56",,,,,,,,,,,,,
BCBS of IL,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Surgical,Per Diem,"$2,651.84 ",IP,930,"99,513.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"45,669.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-007,LUNG TRANSPLANT,Surgical,Per Diem,"$2,651.84 ",IP,930,"112,664.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Surgical,Per Diem,"$2,651.84 ",IP,930,"52,824.47",,,,,,,,,,,,,
BCBS of IL,DRG,MS-010,PANCREAS TRANSPLANT,Surgical,Per Diem,"$2,651.84 ",IP,930,"35,214.69",,,,,,,,,,,,,
BCBS of IL,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"48,829.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"74,654.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,317.87",,,,,,,,,,,,,
BCBS of IL,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Surgical,Per Diem,"$2,651.84 ",IP,930,"124,388.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"65,472.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"47,017.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,Medical,Per Diem,"$2,651.84 ",IP,880,"363,360.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Surgical,Per Diem,"$2,651.84 ",IP,930,"64,846.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"100,455.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"73,312.59",,,,,,,,,,,,,
BCBS of IL,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"47,303.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Surgical,Per Diem,"$2,651.84 ",IP,930,"73,951.33",,,,,,,,,,,,,
BCBS of IL,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"39,702.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"100,858.36",,,,,,,,,,,,,
BCBS of IL,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"47,469.26",,,,,,,,,,,,,
BCBS of IL,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,826.86",,,,,,,,,,,,,
BCBS of IL,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"56,651.88",,,,,,,,,,,,,
BCBS of IL,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Surgical,Per Diem,"$2,651.84 ",IP,930,"39,621.18",,,,,,,,,,,,,
BCBS of IL,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,340.89",,,,,,,,,,,,,
BCBS of IL,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"42,499.62",,,,,,,,,,,,,
BCBS of IL,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,825.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,749.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"38,688.76",,,,,,,,,,,,,
BCBS of IL,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,749.33",,,,,,,,,,,,,
BCBS of IL,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,019.58",,,,,,,,,,,,,
BCBS of IL,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"33,522.99",,,,,,,,,,,,,
BCBS of IL,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,772.44",,,,,,,,,,,,,
BCBS of IL,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,297.42",,,,,,,,,,,,,
BCBS of IL,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"74,748.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,882.69",,,,,,,,,,,,,
BCBS of IL,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,244.51",,,,,,,,,,,,,
BCBS of IL,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,960.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,058.80",,,,,,,,,,,,,
BCBS of IL,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"26,640.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,029.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"21,291.18",,,,,,,,,,,,,
BCBS of IL,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,305.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,905.04",,,,,,,,,,,,,
BCBS of IL,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,554.38",,,,,,,,,,,,,
BCBS of IL,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,686.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"28,113.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,343.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,644.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"29,588.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical,Per Diem,"$2,651.84 ",IP,880,"15,543.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,253.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,867.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,660.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,563.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,318.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,839.13",,,,,,,,,,,,,
BCBS of IL,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,341.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,444.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,913.11",,,,,,,,,,,,,
BCBS of IL,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,827.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,548.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,911.51",,,,,,,,,,,,,
BCBS of IL,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,237.57",,,,,,,,,,,,,
BCBS of IL,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,074.67",,,,,,,,,,,,,
BCBS of IL,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,363.53",,,,,,,,,,,,,
BCBS of IL,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,010.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"21,980.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,494.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,801.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"45,763.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,459.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,138.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-088,CONCUSSION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,204.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-089,CONCUSSION WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,793.62",,,,,,,,,,,,,
BCBS of IL,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,126.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,050.39",,,,,,,,,,,,,
BCBS of IL,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,405.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,377.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"50,515.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"33,641.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"22,694.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"36,527.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"38,577.09",,,,,,,,,,,,,
BCBS of IL,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,601.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-100,SEIZURES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"21,842.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-101,SEIZURES WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,634.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-102,HEADACHES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,210.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-103,HEADACHES WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,918.22",,,,,,,,,,,,,
BCBS of IL,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,334.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,070.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,146.42",,,,,,,,,,,,,
BCBS of IL,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,272.66",,,,,,,,,,,,,
BCBS of IL,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"10,112.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,570.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,709.38",,,,,,,,,,,,,
BCBS of IL,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical,Per Diem,"$2,651.84 ",IP,880,"8,500.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,615.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,131.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,836.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,221.04",,,,,,,,,,,,,
BCBS of IL,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,295.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,787.56",,,,,,,,,,,,,
BCBS of IL,DRG,MS-139,SALIVARY GLAND PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,941.67",,,,,,,,,,,,,
BCBS of IL,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"38,747.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,487.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,660.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"28,849.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,039.37",,,,,,,,,,,,,
BCBS of IL,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,812.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,790.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,664.91",,,,,,,,,,,,,
BCBS of IL,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,653.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-149,DYSEQUILIBRIUM,Medical,Per Diem,"$2,651.84 ",IP,880,"7,392.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-150,EPISTAXIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,894.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,173.96",,,,,,,,,,,,,
BCBS of IL,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,482.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,916.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,014.70",,,,,,,,,,,,,
BCBS of IL,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,892.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,456.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,305.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,313.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,737.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"101,978.91",,,,,,,,,,,,,
BCBS of IL,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"39,411.86",,,,,,,,,,,,,
BCBS of IL,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,578.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"46,767.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,246.95",,,,,,,,,,,,,
BCBS of IL,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,687.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical,Per Diem,"$2,651.84 ",IP,880,"18,304.55",,,,,,,,,,,,,
BCBS of IL,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,051.96",,,,,,,,,,,,,
BCBS of IL,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"28,695.97",,,,,,,,,,,,,
BCBS of IL,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"23,962.45",,,,,,,,,,,,,
BCBS of IL,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,328.33",,,,,,,,,,,,,
BCBS of IL,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"24,073.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,177.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,666.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,222.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,216.38",,,,,,,,,,,,,
BCBS of IL,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,201.76",,,,,,,,,,,,,
BCBS of IL,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"40,210.79",,,,,,,,,,,,,
BCBS of IL,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,210.89",,,,,,,,,,,,,
BCBS of IL,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,884.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical,Per Diem,"$2,651.84 ",IP,880,"16,929.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,531.37",,,,,,,,,,,,,
BCBS of IL,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,266.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,118.38",,,,,,,,,,,,,
BCBS of IL,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,397.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,652.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,432.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,102.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,659.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,378.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,033.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,173.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,175.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,399.15",,,,,,,,,,,,,
BCBS of IL,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,867.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical,Per Diem,"$2,651.84 ",IP,880,"8,328.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"34,334.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,606.80",,,,,,,,,,,,,
BCBS of IL,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical,Per Diem,"$2,651.84 ",IP,880,"76,148.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical,Per Diem,"$2,651.84 ",IP,880,"31,656.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Surgical,Per Diem,"$2,651.84 ",IP,930,"108,611.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"126,394.99",,,,,,,,,,,,,
BCBS of IL,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"74,069.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"50,063.91",,,,,,,,,,,,,
BCBS of IL,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"95,509.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"60,249.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"57,682.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"81,970.99",,,,,,,,,,,,,
BCBS of IL,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"60,468.58",,,,,,,,,,,,,
BCBS of IL,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"71,663.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"54,771.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"64,359.26",,,,,,,,,,,,,
BCBS of IL,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"51,121.99",,,,,,,,,,,,,
BCBS of IL,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"60,499.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"57,167.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"82,643.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"57,414.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"137,557.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"52,820.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"94,461.59",,,,,,,,,,,,,
BCBS of IL,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"49,122.62",,,,,,,,,,,,,
BCBS of IL,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"84,834.80",,,,,,,,,,,,,
BCBS of IL,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"54,863.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,430.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,106.15",,,,,,,,,,,,,
BCBS of IL,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"32,586.89",,,,,,,,,,,,,
BCBS of IL,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,107.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-245,AICD GENERATOR PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"52,699.88",,,,,,,,,,,,,
BCBS of IL,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,425.56",,,,,,,,,,,,,
BCBS of IL,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,353.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,894.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"32,084.95",,,,,,,,,,,,,
BCBS of IL,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,556.94",,,,,,,,,,,,,
BCBS of IL,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,457.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"61,448.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"37,067.89",,,,,,,,,,,,,
BCBS of IL,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,026.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,753.56",,,,,,,,,,,,,
BCBS of IL,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,755.71",,,,,,,,,,,,,
BCBS of IL,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,301.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,161.45",,,,,,,,,,,,,
BCBS of IL,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,638.03",,,,,,,,,,,,,
BCBS of IL,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,888.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,383.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,626.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-263,VEIN LIGATION AND STRIPPING,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,439.79",,,,,,,,,,,,,
BCBS of IL,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,614.09",,,,,,,,,,,,,
BCBS of IL,DRG,MS-265,AICD LEAD PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"32,732.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"69,084.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"54,519.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"67,696.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,998.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"50,437.69",,,,,,,,,,,,,
BCBS of IL,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,697.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"26,172.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"37,351.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,980.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"29,690.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"23,082.57",,,,,,,,,,,,,
BCBS of IL,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,276.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"38,792.07",,,,,,,,,,,,,
BCBS of IL,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"25,216.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"4,831.96",,,,,,,,,,,,,
BCBS of IL,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"31,281.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,170.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"47,943.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,989.07",,,,,,,,,,,,,
BCBS of IL,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,963.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"24,955.04",,,,,,,,,,,,,
BCBS of IL,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,086.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,312.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,745.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,551.97",,,,,,,,,,,,,
BCBS of IL,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,523.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,858.58",,,,,,,,,,,,,
BCBS of IL,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"4,752.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,496.95",,,,,,,,,,,,,
BCBS of IL,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,144.77",,,,,,,,,,,,,
BCBS of IL,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,251.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,024.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,191.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-304,HYPERTENSION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,664.57",,,,,,,,,,,,,
BCBS of IL,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,013.43",,,,,,,,,,,,,
BCBS of IL,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,637.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,453.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,068.11",,,,,,,,,,,,,
BCBS of IL,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,737.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,351.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-311,ANGINA PECTORIS,Medical,Per Diem,"$2,651.84 ",IP,880,"6,784.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical,Per Diem,"$2,651.84 ",IP,880,"8,308.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-313,CHEST PAIN,Medical,Per Diem,"$2,651.84 ",IP,880,"7,016.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"21,590.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,251.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,062.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"42,010.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,786.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"72,806.55",,,,,,,,,,,,,
BCBS of IL,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"36,840.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,222.70",,,,,,,,,,,,,
BCBS of IL,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"58,786.79",,,,,,,,,,,,,
BCBS of IL,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"32,076.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,739.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-332,RECTAL RESECTION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"40,490.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-333,RECTAL RESECTION WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,168.53",,,,,,,,,,,,,
BCBS of IL,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,161.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"40,376.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,773.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,745.42",,,,,,,,,,,,,
BCBS of IL,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"42,970.69",,,,,,,,,,,,,
BCBS of IL,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,459.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,383.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,545.89",,,,,,,,,,,,,
BCBS of IL,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,376.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,823.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,263.96",,,,,,,,,,,,,
BCBS of IL,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,196.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,121.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,961.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,526.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"9,532.51",,,,,,,,,,,,,
BCBS of IL,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,871.66",,,,,,,,,,,,,
BCBS of IL,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,886.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"10,736.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"42,132.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,629.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,128.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,772.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,937.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,746.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,906.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,533.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,008.96",,,,,,,,,,,,,
BCBS of IL,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,975.37",,,,,,,,,,,,,
BCBS of IL,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,263.75",,,,,,,,,,,,,
BCBS of IL,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,237.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,879.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,469.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,713.88",,,,,,,,,,,,,
BCBS of IL,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,510.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,201.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,353.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,330.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,393.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,875.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,760.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,686.62",,,,,,,,,,,,,
BCBS of IL,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,760.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,619.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,388.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,414.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,770.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,374.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,398.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,984.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,096.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,892.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,654.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"112,898.03",,,,,,,,,,,,,
BCBS of IL,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,825.91",,,,,,,,,,,,,
BCBS of IL,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,794.09",,,,,,,,,,,,,
BCBS of IL,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"39,095.75",,,,,,,,,,,,,
BCBS of IL,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,580.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,240.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"36,525.86",,,,,,,,,,,,,
BCBS of IL,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,151.66",,,,,,,,,,,,,
BCBS of IL,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,838.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"47,586.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"25,671.18",,,,,,,,,,,,,
BCBS of IL,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,836.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,590.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,926.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,420.41",,,,,,,,,,,,,
BCBS of IL,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,206.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,581.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,127.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"40,678.39",,,,,,,,,,,,,
BCBS of IL,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,209.09",,,,,,,,,,,,,
BCBS of IL,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,022.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,308.42",,,,,,,,,,,,,
BCBS of IL,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,980.70",,,,,,,,,,,,,
BCBS of IL,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,045.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,484.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,731.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,707.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"25,887.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,357.76",,,,,,,,,,,,,
BCBS of IL,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,273.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,401.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,680.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,700.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,244.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,433.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,848.68",,,,,,,,,,,,,
BCBS of IL,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"89,490.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"59,358.91",,,,,,,,,,,,,
BCBS of IL,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"46,635.59",,,,,,,,,,,,,
BCBS of IL,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"83,693.91",,,,,,,,,,,,,
BCBS of IL,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"63,290.47",,,,,,,,,,,,,
BCBS of IL,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"48,839.37",,,,,,,,,,,,,
BCBS of IL,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"65,527.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"38,280.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"59,145.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,605.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"103,000.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"33,683.44",,,,,,,,,,,,,
BCBS of IL,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,945.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"52,028.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,810.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,294.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,852.97",,,,,,,,,,,,,
BCBS of IL,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,493.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"48,833.53",,,,,,,,,,,,,
BCBS of IL,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,719.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,726.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"39,644.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"25,444.94",,,,,,,,,,,,,
BCBS of IL,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,391.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"32,676.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,472.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,611.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"33,955.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,785.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,467.71",,,,,,,,,,,,,
BCBS of IL,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,228.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"33,169.58",,,,,,,,,,,,,
BCBS of IL,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"37,924.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,429.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,220.76",,,,,,,,,,,,,
BCBS of IL,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"13,956.09",,,,,,,,,,,,,
BCBS of IL,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"33,759.46",,,,,,,,,,,,,
BCBS of IL,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,633.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,026.39",,,,,,,,,,,,,
BCBS of IL,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"35,375.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,327.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,198.99",,,,,,,,,,,,,
BCBS of IL,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"25,155.58",,,,,,,,,,,,,
BCBS of IL,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,668.15",,,,,,,,,,,,,
BCBS of IL,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,700.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,582.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,954.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-503,FOOT PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"25,587.77",,,,,,,,,,,,,
BCBS of IL,DRG,MS-504,FOOT PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,267.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,267.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,732.26",,,,,,,,,,,,,
BCBS of IL,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,685.07",,,,,,,,,,,,,
BCBS of IL,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"13,763.88",,,,,,,,,,,,,
BCBS of IL,DRG,MS-509,ARTHROSCOPY,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,292.77",,,,,,,,,,,,,
BCBS of IL,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"26,580.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,161.38",,,,,,,,,,,,,
BCBS of IL,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,148.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,495.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"9,677.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,535.56",,,,,,,,,,,,,
BCBS of IL,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,939.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,164.18",,,,,,,,,,,,,
BCBS of IL,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,889.58",,,,,,,,,,,,,
BCBS of IL,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,056.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"13,796.97",,,,,,,,,,,,,
BCBS of IL,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,819.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,308.70",,,,,,,,,,,,,
BCBS of IL,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,750.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,003.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,009.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,296.75",,,,,,,,,,,,,
BCBS of IL,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,083.77",,,,,,,,,,,,,
BCBS of IL,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,438.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,895.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,619.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,354.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"42,249.68",,,,,,,,,,,,,
BCBS of IL,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"21,655.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,656.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"28,263.70",,,,,,,,,,,,,
BCBS of IL,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,348.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,953.43",,,,,,,,,,,,,
BCBS of IL,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,756.13",,,,,,,,,,,,,
BCBS of IL,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,137.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,709.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,193.22",,,,,,,,,,,,,
BCBS of IL,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,169.43",,,,,,,,,,,,,
BCBS of IL,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,345.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,693.75",,,,,,,,,,,,,
BCBS of IL,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,265.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,848.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,568.22",,,,,,,,,,,,,
BCBS of IL,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,354.69",,,,,,,,,,,,,
BCBS of IL,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,182.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,188.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,700.57",,,,,,,,,,,,,
BCBS of IL,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,525.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,252.79",,,,,,,,,,,,,
BCBS of IL,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,735.33",,,,,,,,,,,,,
BCBS of IL,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,516.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,315.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,608.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,893.68",,,,,,,,,,,,,
BCBS of IL,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"10,732.71",,,,,,,,,,,,,
BCBS of IL,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"53,900.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,618.95",,,,,,,,,,,,,
BCBS of IL,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,146.44",,,,,,,,,,,,,
BCBS of IL,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"49,165.46",,,,,,,,,,,,,
BCBS of IL,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"40,864.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,873.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"28,499.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,577.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,187.94",,,,,,,,,,,,,
BCBS of IL,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,922.88",,,,,,,,,,,,,
BCBS of IL,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,969.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,757.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,904.06",,,,,,,,,,,,,
BCBS of IL,DRG,MS-592,SKIN ULCERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,418.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-593,SKIN ULCERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,065.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,969.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,585.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,628.87",,,,,,,,,,,,,
BCBS of IL,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,931.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,816.42",,,,,,,,,,,,,
BCBS of IL,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,533.46",,,,,,,,,,,,,
BCBS of IL,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,692.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,644.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-602,CELLULITIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,311.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,223.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,516.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,528.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,708.07",,,,,,,,,,,,,
BCBS of IL,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,036.39",,,,,,,,,,,,,
BCBS of IL,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,233.11",,,,,,,,,,,,,
BCBS of IL,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,961.86",,,,,,,,,,,,,
BCBS of IL,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"38,826.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,974.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,683.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"46,417.37",,,,,,,,,,,,,
BCBS of IL,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,276.15",,,,,,,,,,,,,
BCBS of IL,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,824.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"35,167.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,650.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"10,651.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,656.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,454.94",,,,,,,,,,,,,
BCBS of IL,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,627.38",,,,,,,,,,,,,
BCBS of IL,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"35,997.31",,,,,,,,,,,,,
BCBS of IL,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"42,844.13",,,,,,,,,,,,,
BCBS of IL,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"62,529.13",,,,,,,,,,,,,
BCBS of IL,DRG,MS-637,DIABETES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,384.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-638,DIABETES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,497.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,523.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,032.71",,,,,,,,,,,,,
BCBS of IL,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,705.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical,Per Diem,"$2,651.84 ",IP,880,"12,532.53",,,,,,,,,,,,,
BCBS of IL,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,190.56",,,,,,,,,,,,,
BCBS of IL,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,912.13",,,,,,,,,,,,,
BCBS of IL,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,473.77",,,,,,,,,,,,,
BCBS of IL,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"43,930.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"35,953.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-652,KIDNEY TRANSPLANT,Surgical,Per Diem,"$2,651.84 ",IP,930,"30,972.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"53,042.51",,,,,,,,,,,,,
BCBS of IL,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,877.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,247.69",,,,,,,,,,,,,
BCBS of IL,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,944.07",,,,,,,,,,,,,
BCBS of IL,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,776.42",,,,,,,,,,,,,
BCBS of IL,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,687.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"25,939.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,402.18",,,,,,,,,,,,,
BCBS of IL,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,610.09",,,,,,,,,,,,,
BCBS of IL,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"28,518.67",,,,,,,,,,,,,
BCBS of IL,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,524.76",,,,,,,,,,,,,
BCBS of IL,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,527.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-665,PROSTATECTOMY WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,559.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-666,PROSTATECTOMY WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,881.68",,,,,,,,,,,,,
BCBS of IL,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"9,684.36",,,,,,,,,,,,,
BCBS of IL,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,290.18",,,,,,,,,,,,,
BCBS of IL,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,911.51",,,,,,,,,,,,,
BCBS of IL,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"9,916.13",,,,,,,,,,,,,
BCBS of IL,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,294.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,202.86",,,,,,,,,,,,,
BCBS of IL,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"72,221.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,957.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,920.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-682,RENAL FAILURE WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"28,276.40",,,,,,,,,,,,,
BCBS of IL,DRG,MS-683,RENAL FAILURE WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,981.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,604.95",,,,,,,,,,,,,
BCBS of IL,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,233.73",,,,,,,,,,,,,
BCBS of IL,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,308.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,670.71",,,,,,,,,,,,,
BCBS of IL,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,266.88",,,,,,,,,,,,,
BCBS of IL,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,711.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-693,URINARY STONES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,038.03",,,,,,,,,,,,,
BCBS of IL,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,989.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,060.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,088.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-697,URETHRAL STRICTURE,Medical,Per Diem,"$2,651.84 ",IP,880,"9,704.80",,,,,,,,,,,,,
BCBS of IL,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,964.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,322.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,322.67",,,,,,,,,,,,,
BCBS of IL,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,671.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,904.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,504.03",,,,,,,,,,,,,
BCBS of IL,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,135.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,736.34",,,,,,,,,,,,,
BCBS of IL,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"10,293.71",,,,,,,,,,,,,
BCBS of IL,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,519.23",,,,,,,,,,,,,
BCBS of IL,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"9,038.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"19,651.97",,,,,,,,,,,,,
BCBS of IL,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,425.45",,,,,,,,,,,,,
BCBS of IL,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,506.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,033.17",,,,,,,,,,,,,
BCBS of IL,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,635.41",,,,,,,,,,,,,
BCBS of IL,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,601.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,900.09",,,,,,,,,,,,,
BCBS of IL,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,478.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,235.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,803.79",,,,,,,,,,,,,
BCBS of IL,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,821.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,780.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"5,506.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"21,636.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"13,759.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,449.32",,,,,,,,,,,,,
BCBS of IL,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"24,678.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,233.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"37,200.43",,,,,,,,,,,,,
BCBS of IL,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,521.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,454.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,713.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,021.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,462.80",,,,,,,,,,,,,
BCBS of IL,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,393.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,985.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"10,529.41",,,,,,,,,,,,,
BCBS of IL,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"13,124.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"26,353.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,269.07",,,,,,,,,,,,,
BCBS of IL,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,725.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,542.79",,,,,,,,,,,,,
BCBS of IL,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,899.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,816.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,412.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,933.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,819.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,742.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Vaginal Delivery,Per Case,"$547,309.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,800.08",,,,,,,,,,,,,
BCBS of IL,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Surgical,Per Diem,"$2,651.84 ",IP,930,"8,928.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical,Per Diem,"$2,651.84 ",IP,880,"7,483.50",,,,,,,,,,,,,
BCBS of IL,DRG,MS-779,ABORTION WITHOUT D&C,Medical,Per Diem,"$2,651.84 ",IP,880,"10,127.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,C-Section,Per Diem,"$8,038.59 ",IP,"2,975.00","17,026.59",,,,,,,,,,,,,
BCBS of IL,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,C-Section,Per Diem,"$8,038.59 ",IP,"2,975.00","9,954.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$8,038.59 ",IP,"2,975.00","8,321.91",,,,,,,,,,,,,
BCBS of IL,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,C-Section,Per Diem,"$8,038.59 ",IP,"2,975.00","14,466.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,C-Section,Per Diem,"$8,038.59 ",IP,"2,975.00","9,662.07",,,,,,,,,,,,,
BCBS of IL,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$8,038.59 ",IP,"2,975.00","8,065.51",,,,,,,,,,,,,
BCBS of IL,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Vaginal Delivery,Per Case,"$547,309.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Vaginal Delivery,Per Case,"$547,309.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Case,"$547,309.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-799,SPLENECTOMY WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"50,070.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-800,SPLENECTOMY WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"28,728.93",,,,,,,,,,,,,
BCBS of IL,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,774.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"36,100.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,346.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"13,279.12",,,,,,,,,,,,,
BCBS of IL,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Vaginal Delivery,Per Case,"$547,309.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Vaginal Delivery,Per Case,"$547,309.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Case,"$547,309.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"21,199.68",,,,,,,,,,,,,
BCBS of IL,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,075.41",,,,,,,,,,,,,
BCBS of IL,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,300.53",,,,,,,,,,,,,
BCBS of IL,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,949.69",,,,,,,,,,,,,
BCBS of IL,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,563.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-813,COAGULATION DISORDERS,Medical,Per Diem,"$2,651.84 ",IP,880,"15,036.11",,,,,,,,,,,,,
BCBS of IL,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,405.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"13,663.66",,,,,,,,,,,,,
BCBS of IL,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,433.20",,,,,,,,,,,,,
BCBS of IL,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,405.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,814.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"9,713.56",,,,,,,,,,,,,
BCBS of IL,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"122,617.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,576.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,517.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"43,774.77",,,,,,,,,,,,,
BCBS of IL,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"22,998.52",,,,,,,,,,,,,
BCBS of IL,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"13,634.41",,,,,,,,,,,,,
BCBS of IL,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"49,028.21",,,,,,,,,,,,,
BCBS of IL,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"33,856.22",,,,,,,,,,,,,
BCBS of IL,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"32,407.03",,,,,,,,,,,,,
BCBS of IL,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,204.28",,,,,,,,,,,,,
BCBS of IL,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,372.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,912.79",,,,,,,,,,,,,
BCBS of IL,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,590.57",,,,,,,,,,,,,
BCBS of IL,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"5,217.42",,,,,,,,,,,,,
BCBS of IL,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"151,525.57",,,,,,,,,,,,,
BCBS of IL,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"108,442.41",,,,,,,,,,,,,
BCBS of IL,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"19,754.19",,,,,,,,,,,,,
BCBS of IL,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"55,476.01",,,,,,,,,,,,,
BCBS of IL,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical,Per Diem,"$2,651.84 ",IP,880,"21,987.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"14,467.64",,,,,,,,,,,,,
BCBS of IL,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"38,835.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"23,414.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,675.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,522.83",,,,,,,,,,,,,
BCBS of IL,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"21,166.22",,,,,,,,,,,,,
BCBS of IL,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,814.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"25,988.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"12,996.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"10,016.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-849,RADIOTHERAPY,Medical,Per Diem,"$2,651.84 ",IP,880,"24,213.33",,,,,,,,,,,,,
BCBS of IL,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"91,309.54",,,,,,,,,,,,,
BCBS of IL,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"37,668.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"27,510.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"119,992.39",,,,,,,,,,,,,
BCBS of IL,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,964.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"20,693.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"64,183.43",,,,,,,,,,,,,
BCBS of IL,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,618.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical,Per Diem,"$2,651.84 ",IP,880,"8,517.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,920.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,149.30",,,,,,,,,,,,,
BCBS of IL,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"31,175.95",,,,,,,,,,,,,
BCBS of IL,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,802.66",,,,,,,,,,,,,
BCBS of IL,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,060.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical,Per Diem,"$2,651.84 ",IP,880,"62,539.00",,,,,,,,,,,,,
BCBS of IL,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"31,444.24",,,,,,,,,,,,,
BCBS of IL,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,068.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Surgical,Per Diem,"$2,651.84 ",IP,930,"31,745.49",,,,,,,,,,,,,
BCBS of IL,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,488.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,640.59",,,,,,,,,,,,,
BCBS of IL,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"11,230.37",,,,,,,,,,,,,
BCBS of IL,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"36,224.11",,,,,,,,,,,,,
BCBS of IL,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"15,982.25",,,,,,,,,,,,,
BCBS of IL,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Surgical,Per Diem,"$2,651.84 ",IP,930,"17,460.85",,,,,,,,,,,,,
BCBS of IL,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"52,333.81",,,,,,,,,,,,,
BCBS of IL,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"23,274.39",,,,,,,,,,,,,
BCBS of IL,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"14,200.04",,,,,,,,,,,,,
BCBS of IL,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,928.72",,,,,,,,,,,,,
BCBS of IL,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,649.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,524.44",,,,,,,,,,,,,
BCBS of IL,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"6,398.16",,,,,,,,,,,,,
BCBS of IL,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"18,792.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,700.57",,,,,,,,,,,,,
BCBS of IL,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"17,856.05",,,,,,,,,,,,,
BCBS of IL,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,715.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"8,817.98",,,,,,,,,,,,,
BCBS of IL,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"15,453.70",,,,,,,,,,,,,
BCBS of IL,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"9,056.51",,,,,,,,,,,,,
BCBS of IL,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Surgical,Per Diem,"$2,651.84 ",IP,930,"204,714.78",,,,,,,,,,,,,
BCBS of IL,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"63,456.92",,,,,,,,,,,,,
BCBS of IL,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"29,288.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical,Per Diem,"$2,651.84 ",IP,880,"21,975.48",,,,,,,,,,,,,
BCBS of IL,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical,Per Diem,"$2,651.84 ",IP,880,"18,857.68",,,,,,,,,,,,,
BCBS of IL,DRG,MS-935,NON-EXTENSIVE BURNS,Medical,Per Diem,"$2,651.84 ",IP,880,"18,818.74",,,,,,,,,,,,,
BCBS of IL,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"32,961.27",,,,,,,,,,,,,
BCBS of IL,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"35,826.95",,,,,,,,,,,,,
BCBS of IL,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,735.03",,,,,,,,,,,,,
BCBS of IL,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"11,584.43",,,,,,,,,,,,,
BCBS of IL,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,647.03",,,,,,,,,,,,,
BCBS of IL,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,233.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"7,192.45",,,,,,,,,,,,,
BCBS of IL,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical,Per Diem,"$2,651.84 ",IP,880,"12,539.35",,,,,,,,,,,,,
BCBS of IL,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Per Diem,"$2,651.84 ",IP,930,"99,563.62",,,,,,,,,,,,,
BCBS of IL,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Per Diem,"$2,651.84 ",IP,930,"48,319.58",,,,,,,,,,,,,
BCBS of IL,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"81,020.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"41,927.10",,,,,,,,,,,,,
BCBS of IL,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,550.88",,,,,,,,,,,,,
BCBS of IL,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"41,610.90",,,,,,,,,,,,,
BCBS of IL,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"28,388.26",,,,,,,,,,,,,
BCBS of IL,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"16,749.46",,,,,,,,,,,,,
BCBS of IL,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"56,334.55",,,,,,,,,,,,,
BCBS of IL,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"28,667.60",,,,,,,,,,,,,
BCBS of IL,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"95,225.61",,,,,,,,,,,,,
BCBS of IL,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical,Per Diem,"$2,651.84 ",IP,880,"34,297.84",,,,,,,,,,,,,
BCBS of IL,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical,Per Diem,"$2,651.84 ",IP,880,"20,273.82",,,,,,,,,,,,,
BCBS of IL,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical,Per Diem,"$2,651.84 ",IP,880,"32,684.59",,,,,,,,,,,,,
BCBS of IL,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"51,698.29",,,,,,,,,,,,,
BCBS of IL,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"34,570.65",,,,,,,,,,,,,
BCBS of IL,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"16,317.63",,,,,,,,,,,,,
BCBS of IL,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"55,966.14",,,,,,,,,,,,,
BCBS of IL,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,"$2,651.84 ",IP,930,"18,900.02",,,,,,,,,,,,,
BCBS of IL,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,"$2,651.84 ",IP,930,"12,784.87",,,,,,,,,,,,,
BCBS of IL,ExceptRevenue,124,Psychiatric,Psych/Sub Abuse,Per Diem,"$1,368.27 ",IP,900,"1,368.27",,,,,,,,,,,,,
BCBS of IL,ExceptRevenue,126,Detoxification,Psych/Sub Abuse,Per Diem,"$1,368.27 ",IP,"1,368.27","1,368.27",,,,,,,,,,,,,
BCBS of IL,ExceptRevenue,128,Rehab,Psych/Sub Abuse,Per Diem,"$1,368.27 ",IP,"1,082.00","1,368.27",,,,,,,,,,,,,
BCBS of IL,ExceptRevenueCode,360,Operating Room Services,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
BCBS of IL,ExceptRevenueCode,361,Operating Room Services: Minor surgery,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
BCBS of IL,ExceptRevenueCode,369,Operating Room Services: Other operating room services,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
BCBS of IL,ExceptRevenueCode,480,Cardiology,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
BCBS of IL,ExceptRevenueCode,490,Ambulatory Surgery,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
BCBS of IL,ExceptRevenueCode,761,Treatment/Observation Room: Treatment room,Observation,Straight Discount,70.00%,OP,900,900,,,,,,,,,,,,,
BCBS of IL,ExceptRevenueCode,762,Treatment/Observation Room: Observation room,Observation,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
BCBS of IL,,,,All Other,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Beacon Health Options,ExceptRevenue,124,Psychiatric,Psychiatric,Per Diem,$900.00 ,IP,900,"1,368.27",,,,,,,,,,,,,
Beacon Health Options,ExceptRevenueCode,761,Treatment/Observation Room: Treatment room,Observation,Per Case,$900.00 ,OP,900,900,,,,,,,,,,,,,
Beacon Health Options,,,,All Other,Straight Discount,50.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenue,118,Rehab,Rehabilitation,Per Diem,"$1,082.00 ",IP,"1,082.00","1,082.00",,,,,,,,,,,,,
Cigna,ExceptRevenue,128,Rehab,Rehabilitation,Per Diem,"$1,082.00 ",IP,"1,082.00","1,082.00",,,,,,,,,,,,,
Cigna,ExceptRevenue,138,Rehab,Rehabilitation,Per Diem,"$1,082.00 ",IP,"1,082.00","1,082.00",,,,,,,,,,,,,
Cigna,ExceptRevenue,148,Rehab,Rehabilitation,Per Diem,"$1,082.00 ",IP,"1,082.00","1,082.00",,,,,,,,,,,,,
Cigna,ExceptRevenue,158,Rehab,Rehabilitation,Per Diem,"$1,082.00 ",IP,"1,082.00","1,082.00",,,,,,,,,,,,,
Cigna,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$281,441.09 ",IP,"260,218.80","304,800.80",,,,,,,,,,,,,
Cigna,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Medical/Surgical,Relative Weights,"$145,718.95 ",IP,"134,730.90","167,641.91",,,,,,,,,,,,,
Cigna,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$185,972.94 ",IP,"171,949.50","199,844.40",,,,,,,,,,,,,
Cigna,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$116,053.62 ",IP,"107,302.50","124,823.83",,,,,,,,,,,,,
Cigna,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Medical/Surgical,Relative Weights,"$99,627.49 ",IP,"92,115.00","107,579.79",,,,,,,,,,,,,
Cigna,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Medical/Surgical,Relative Weights,"$45,714.76 ",IP,"42,267.60","49,370.76",,,,,,,,,,,,,
Cigna,DRG,MS-007,LUNG TRANSPLANT,Medical/Surgical,Relative Weights,"$112,719.72 ",IP,"104,220.00","121,796.36",,,,,,,,,,,,,
Cigna,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Medical/Surgical,Relative Weights,"$52,887.74 ",IP,"48,899.70","57,106.22",,,,,,,,,,,,,
Cigna,DRG,MS-010,PANCREAS TRANSPLANT,Medical/Surgical,Relative Weights,"$35,237.08 ",IP,"32,580.00","38,069.06",,,,,,,,,,,,,
Cigna,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Medical/Surgical,Relative Weights,"$48,878.31 ",IP,"45,192.60","52,787.58",,,,,,,,,,,,,
Cigna,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Medical/Surgical,Relative Weights,"$37,308.48 ",IP,"34,495.20","40,323.08",,,,,,,,,,,,,
Cigna,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$26,513.47 ",IP,"24,514.20","28,627.82",,,,,,,,,,,,,
Cigna,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Medical/Surgical,Relative Weights,"$103,929.92 ",IP,"96,093.00","134,471.31",,,,,,,,,,,,,
Cigna,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Medical/Surgical,Relative Weights,"$65,571.14 ",IP,"60,626.70","70,779.80",,,,,,,,,,,,,
Cigna,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$47,265.38 ",IP,"43,701.30","50,828.19",,,,,,,,,,,,,
Cigna,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,Medical/Surgical,Relative Weights,"$364,539.27 ",IP,"337,050.90","392,813.07",,,,,,,,,,,,,
Cigna,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Medical/Surgical,Relative Weights,"$65,020.20 ",IP,"60,117.30","70,103.17",,,,,,,,,,,,,
Cigna,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Medical/Surgical,Relative Weights,"$100,620.36 ",IP,"93,033.00","108,598.41",,,,,,,,,,,,,
Cigna,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Medical/Surgical,Relative Weights,"$73,428.43 ",IP,"67,891.50","79,255.03",,,,,,,,,,,,,
Cigna,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$47,139.82 ",IP,"43,585.20","51,137.57",,,,,,,,,,,,,
Cigna,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Medical/Surgical,Relative Weights,"$55,210.27 ",IP,"51,047.10","59,584.38",,,,,,,,,,,,,
Cigna,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$38,342.23 ",IP,"35,451.00","41,381.70",,,,,,,,,,,,,
Cigna,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$43,777.69 ",IP,"40,476.60","47,266.16",,,,,,,,,,,,,
Cigna,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$29,805.51 ",IP,"27,558.00","32,179.33",,,,,,,,,,,,,
Cigna,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$24,474.20 ",IP,"22,628.70","26,431.67",,,,,,,,,,,,,
Cigna,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$56,682.06 ",IP,"52,407.90","61,243.86",,,,,,,,,,,,,
Cigna,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Medical/Surgical,Relative Weights,"$32,091.05 ",IP,"29,671.20","34,673.29",,,,,,,,,,,,,
Cigna,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$22,941.09 ",IP,"21,211.20","24,803.76",,,,,,,,,,,,,
Cigna,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$42,554.13 ",IP,"39,345.30","45,944.47",,,,,,,,,,,,,
Cigna,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$21,575.41 ",IP,"19,948.50","23,278.98",,,,,,,,,,,,,
Cigna,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,763.89 ",IP,"15,499.80","18,106.93",,,,,,,,,,,,,
Cigna,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$38,722.83 ",IP,"35,802.90","41,824.72",,,,,,,,,,,,,
Cigna,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$22,774.64 ",IP,"21,057.30","24,593.30",,,,,,,,,,,,,
Cigna,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$18,030.29 ",IP,"16,670.70","19,480.18",,,,,,,,,,,,,
Cigna,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$31,904.16 ",IP,"29,498.40","34,459.67",,,,,,,,,,,,,
Cigna,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$16,146.76 ",IP,"14,929.20","17,439.77",,,,,,,,,,,,,
Cigna,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,088.00 ",IP,"10,251.90","11,985.70",,,,,,,,,,,,,
Cigna,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$37,619.96 ",IP,"34,783.20","41,647.93",,,,,,,,,,,,,
Cigna,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Medical/Surgical,Relative Weights,"$22,871.98 ",IP,"21,147.30","24,737.47",,,,,,,,,,,,,
Cigna,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$18,506.28 ",IP,"17,110.80","19,834.80",,,,,,,,,,,,,
Cigna,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical/Surgical,Relative Weights,"$18,041.97 ",IP,"16,681.50","19,415.99",,,,,,,,,,,,,
Cigna,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,061.72 ",IP,"10,227.60","11,955.18",,,,,,,,,,,,,
Cigna,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical/Surgical,Relative Weights,"$13,319.03 ",IP,"12,314.70","14,372.31",,,,,,,,,,,,,
Cigna,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$10,168.14 ",IP,"9,401.40","10,979.70",,,,,,,,,,,,,
Cigna,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$21,369.05 ",IP,"19,757.70","23,016.96",,,,,,,,,,,,,
Cigna,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$12,337.85 ",IP,"11,407.50","13,303.18",,,,,,,,,,,,,
Cigna,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical/Surgical,Relative Weights,"$16,915.75 ",IP,"15,640.20","18,275.29",,,,,,,,,,,,,
Cigna,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical/Surgical,Relative Weights,"$10,973.14 ",IP,"10,145.70","11,854.16",,,,,,,,,,,,,
Cigna,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,932.89 ",IP,"8,259.30","9,634.86",,,,,,,,,,,,,
Cigna,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical/Surgical,Relative Weights,"$28,142.94 ",IP,"26,020.80","30,392.53",,,,,,,,,,,,,
Cigna,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical/Surgical,Relative Weights,"$19,354.11 ",IP,"17,894.70","20,911.31",,,,,,,,,,,,,
Cigna,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,642.22 ",IP,"15,387.30","17,993.28",,,,,,,,,,,,,
Cigna,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical/Surgical,Relative Weights,"$18,678.57 ",IP,"17,270.10","20,130.50",,,,,,,,,,,,,
Cigna,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical/Surgical,Relative Weights,"$9,928.68 ",IP,"9,180.00","10,714.52",,,,,,,,,,,,,
Cigna,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,926.71 ",IP,"6,404.40","7,480.80",,,,,,,,,,,,,
Cigna,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical/Surgical,Relative Weights,"$13,878.74 ",IP,"12,832.20","14,991.07",,,,,,,,,,,,,
Cigna,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,652.55 ",IP,"8,000.10","9,350.74",,,,,,,,,,,,,
Cigna,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical/Surgical,Relative Weights,"$7,661.63 ",IP,"7,083.90","8,272.13",,,,,,,,,,,,,
Cigna,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$16,349.23 ",IP,"15,116.40","17,640.76",,,,,,,,,,,,,
Cigna,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$9,848.86 ",IP,"9,106.20","10,636.65",,,,,,,,,,,,,
Cigna,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,511.73 ",IP,"6,945.30","8,115.34",,,,,,,,,,,,,
Cigna,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$14,142.53 ",IP,"13,076.10","15,252.04",,,,,,,,,,,,,
Cigna,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,918.95 ",IP,"9,171.00","10,716.62",,,,,,,,,,,,,
Cigna,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical/Surgical,Relative Weights,"$15,837.22 ",IP,"14,643.00","17,110.40",,,,,,,,,,,,,
Cigna,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,587.02 ",IP,"8,864.10","10,322.01",,,,,,,,,,,,,
Cigna,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical/Surgical,Relative Weights,"$14,921.25 ",IP,"13,796.10","16,120.18",,,,,,,,,,,,,
Cigna,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical/Surgical,Relative Weights,"$9,246.33 ",IP,"8,549.10","9,986.33",,,,,,,,,,,,,
Cigna,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,094.14 ",IP,"6,559.20","7,648.12",,,,,,,,,,,,,
Cigna,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical/Surgical,Relative Weights,"$20,396.62 ",IP,"18,858.60","22,014.12",,,,,,,,,,,,,
Cigna,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,526.33 ",IP,"6,958.80","8,123.76",,,,,,,,,,,,,
Cigna,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical/Surgical,Relative Weights,"$22,036.80 ",IP,"20,375.10","23,761.99",,,,,,,,,,,,,
Cigna,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical/Surgical,Relative Weights,"$13,082.50 ",IP,"12,096.00","14,118.71",,,,,,,,,,,,,
Cigna,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,815.11 ",IP,"8,150.40","9,514.90",,,,,,,,,,,,,
Cigna,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical/Surgical,Relative Weights,"$22,502.09 ",IP,"20,805.30","24,270.25",,,,,,,,,,,,,
Cigna,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical/Surgical,Relative Weights,"$12,405.98 ",IP,"11,470.50","13,394.73",,,,,,,,,,,,,
Cigna,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,406.28 ",IP,"7,772.40","9,077.14",,,,,,,,,,,,,
Cigna,DRG,MS-088,CONCUSSION WITH MCC,Medical/Surgical,Relative Weights,"$14,164.92 ",IP,"13,096.80","15,356.21",,,,,,,,,,,,,
Cigna,DRG,MS-089,CONCUSSION WITH CC,Medical/Surgical,Relative Weights,"$10,352.11 ",IP,"9,571.50","11,167.01",,,,,,,,,,,,,
Cigna,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,318.68 ",IP,"7,691.40","8,995.06",,,,,,,,,,,,,
Cigna,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$16,068.89 ",IP,"14,857.20","17,351.37",,,,,,,,,,,,,
Cigna,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$9,625.95 ",IP,"8,900.10","10,376.73",,,,,,,,,,,,,
Cigna,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,613.93 ",IP,"7,039.80","8,221.62",,,,,,,,,,,,,
Cigna,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$35,411.32 ",IP,"32,741.10","38,231.11",,,,,,,,,,,,,
Cigna,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$24,406.06 ",IP,"22,565.70","26,391.68",,,,,,,,,,,,,
Cigna,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$22,706.50 ",IP,"20,994.30","24,534.37",,,,,,,,,,,,,
Cigna,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical/Surgical,Relative Weights,"$36,603.73 ",IP,"33,843.60","39,488.61",,,,,,,,,,,,,
Cigna,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical/Surgical,Relative Weights,"$20,563.08 ",IP,"19,012.50","22,213.00",,,,,,,,,,,,,
Cigna,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,646.09 ",IP,"12,617.10","14,703.79",,,,,,,,,,,,,
Cigna,DRG,MS-100,SEIZURES WITH MCC,Medical/Surgical,Relative Weights,"$18,264.88 ",IP,"16,887.60","19,715.89",,,,,,,,,,,,,
Cigna,DRG,MS-101,SEIZURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,647.69 ",IP,"7,995.60","9,333.90",,,,,,,,,,,,,
Cigna,DRG,MS-102,HEADACHES WITH MCC,Medical/Surgical,Relative Weights,"$11,224.28 ",IP,"10,377.90","12,119.34",,,,,,,,,,,,,
Cigna,DRG,MS-103,HEADACHES WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,074.35 ",IP,"7,465.50","8,715.15",,,,,,,,,,,,,
Cigna,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$21,360.29 ",IP,"19,749.60","23,064.31",,,,,,,,,,,,,
Cigna,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,090.94 ",IP,"13,028.40","15,211.00",,,,,,,,,,,,,
Cigna,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Medical/Surgical,Relative Weights,"$14,178.54 ",IP,"13,109.40","15,293.08",,,,,,,,,,,,,
Cigna,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$18,326.20 ",IP,"16,944.30","19,753.78",,,,,,,,,,,,,
Cigna,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,135.04 ",IP,"9,370.80","10,932.34",,,,,,,,,,,,,
Cigna,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical/Surgical,Relative Weights,"$11,589.30 ",IP,"10,715.40","12,508.69",,,,,,,,,,,,,
Cigna,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,283.30 ",IP,"5,809.50","6,774.71",,,,,,,,,,,,,
Cigna,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical/Surgical,Relative Weights,"$7,464.03 ",IP,"6,901.20","8,053.25",,,,,,,,,,,,,
Cigna,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical/Surgical,Relative Weights,"$13,647.07 ",IP,"12,618.00","14,719.57",,,,,,,,,,,,,
Cigna,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,147.36 ",IP,"7,533.00","8,790.91",,,,,,,,,,,,,
Cigna,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$20,864.83 ",IP,"19,291.50","22,525.53",,,,,,,,,,,,,
Cigna,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,221.04 ",IP,"11,299.50","13,211.63",,,,,,,,,,,,,
Cigna,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$14,695.42 ",IP,"13,587.30","15,454.08",,,,,,,,,,,,,
Cigna,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,337.17 ",IP,"7,708.50","8,871.94",,,,,,,,,,,,,
Cigna,DRG,MS-139,SALIVARY GLAND PROCEDURES,Medical/Surgical,Relative Weights,"$12,012.73 ",IP,"11,106.90","12,909.62",,,,,,,,,,,,,
Cigna,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$38,720.88 ",IP,"35,801.10","41,887.85",,,,,,,,,,,,,
Cigna,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$21,474.18 ",IP,"19,854.90","23,229.52",,,,,,,,,,,,,
Cigna,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,624.04 ",IP,"14,445.90","16,929.40",,,,,,,,,,,,,
Cigna,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$29,005.37 ",IP,"26,818.20","31,188.07",,,,,,,,,,,,,
Cigna,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$17,146.44 ",IP,"15,853.50","18,420.51",,,,,,,,,,,,,
Cigna,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,920.26 ",IP,"11,021.40","12,769.66",,,,,,,,,,,,,
Cigna,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$19,868.07 ",IP,"18,369.90","21,394.31",,,,,,,,,,,,,
Cigna,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$12,664.91 ",IP,"11,709.90","13,691.48",,,,,,,,,,,,,
Cigna,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,660.66 ",IP,"7,083.00","8,274.23",,,,,,,,,,,,,
Cigna,DRG,MS-149,DYSEQUILIBRIUM,Medical/Surgical,Relative Weights,"$7,173.96 ",IP,"6,633.00","7,739.67",,,,,,,,,,,,,
Cigna,DRG,MS-150,EPISTAXIS WITH MCC,Medical/Surgical,Relative Weights,"$12,921.89 ",IP,"11,947.50","13,939.82",,,,,,,,,,,,,
Cigna,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,187.59 ",IP,"6,645.60","7,755.45",,,,,,,,,,,,,
Cigna,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical/Surgical,Relative Weights,"$10,517.59 ",IP,"9,724.50","11,332.22",,,,,,,,,,,,,
Cigna,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,942.29 ",IP,"6,418.80","7,477.64",,,,,,,,,,,,,
Cigna,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$15,056.55 ",IP,"13,921.20","16,231.73",,,,,,,,,,,,,
Cigna,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$8,853.07 ",IP,"8,185.50","9,542.26",,,,,,,,,,,,,
Cigna,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,408.87 ",IP,"5,925.60","6,919.92",,,,,,,,,,,,,
Cigna,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical/Surgical,Relative Weights,"$15,342.73 ",IP,"14,185.80","16,546.37",,,,,,,,,,,,,
Cigna,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical/Surgical,Relative Weights,"$8,762.55 ",IP,"8,101.80","9,356.00",,,,,,,,,,,,,
Cigna,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,454.62 ",IP,"5,967.90","6,900.98",,,,,,,,,,,,,
Cigna,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$48,736.19 ",IP,"45,061.20","52,189.87",,,,,,,,,,,,,
Cigna,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$25,849.61 ",IP,"23,900.40","27,736.52",,,,,,,,,,,,,
Cigna,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$18,656.18 ",IP,"17,249.40","20,084.20",,,,,,,,,,,,,
Cigna,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$36,244.55 ",IP,"33,511.50","39,879.01",,,,,,,,,,,,,
Cigna,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$17,703.23 ",IP,"16,368.30","19,583.30",,,,,,,,,,,,,
Cigna,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,183.73 ",IP,"12,189.60","14,410.20",,,,,,,,,,,,,
Cigna,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical/Surgical,Relative Weights,"$15,048.76 ",IP,"13,914.00","16,249.62",,,,,,,,,,,,,
Cigna,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,641.85 ",IP,"7,990.20","9,330.74",,,,,,,,,,,,,
Cigna,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical/Surgical,Relative Weights,"$17,999.14 ",IP,"16,641.90","19,418.09",,,,,,,,,,,,,
Cigna,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical/Surgical,Relative Weights,"$11,756.73 ",IP,"10,870.20","12,689.69",,,,,,,,,,,,,
Cigna,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,494.86 ",IP,"7,854.30","9,166.59",,,,,,,,,,,,,
Cigna,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical/Surgical,Relative Weights,"$16,936.19 ",IP,"15,659.10","18,286.87",,,,,,,,,,,,,
Cigna,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical/Surgical,Relative Weights,"$10,903.05 ",IP,"10,080.90","11,795.23",,,,,,,,,,,,,
Cigna,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,709.33 ",IP,"7,128.00","8,286.86",,,,,,,,,,,,,
Cigna,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical/Surgical,Relative Weights,"$15,174.33 ",IP,"14,030.10","16,369.58",,,,,,,,,,,,,
Cigna,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical/Surgical,Relative Weights,"$10,132.12 ",IP,"9,368.10","10,937.61",,,,,,,,,,,,,
Cigna,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,542.88 ",IP,"6,974.10","8,140.59",,,,,,,,,,,,,
Cigna,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical/Surgical,Relative Weights,"$15,027.35 ",IP,"13,894.20","16,239.09",,,,,,,,,,,,,
Cigna,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical/Surgical,Relative Weights,"$10,054.25 ",IP,"9,296.10","10,861.84",,,,,,,,,,,,,
Cigna,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,100.95 ",IP,"6,565.50","7,661.80",,,,,,,,,,,,,
Cigna,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical/Surgical,Relative Weights,"$11,934.86 ",IP,"11,034.90","12,888.57",,,,,,,,,,,,,
Cigna,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical/Surgical,Relative Weights,"$10,951.72 ",IP,"10,125.90","11,826.80",,,,,,,,,,,,,
Cigna,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical/Surgical,Relative Weights,"$8,607.78 ",IP,"7,958.70","9,292.86",,,,,,,,,,,,,
Cigna,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,770.97 ",IP,"6,260.40","7,312.43",,,,,,,,,,,,,
Cigna,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical/Surgical,Relative Weights,"$12,771.01 ",IP,"11,808.00","13,792.50",,,,,,,,,,,,,
Cigna,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical/Surgical,Relative Weights,"$8,409.20 ",IP,"7,775.10","9,081.35",,,,,,,,,,,,,
Cigna,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,480.90 ",IP,"5,992.20","6,997.80",,,,,,,,,,,,,
Cigna,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical/Surgical,Relative Weights,"$16,923.53 ",IP,"15,647.40","18,268.98",,,,,,,,,,,,,
Cigna,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical/Surgical,Relative Weights,"$9,802.14 ",IP,"9,063.00","10,581.93",,,,,,,,,,,,,
Cigna,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,236.26 ",IP,"6,690.60","7,811.22",,,,,,,,,,,,,
Cigna,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical/Surgical,Relative Weights,"$17,423.86 ",IP,"16,110.00","18,810.91",,,,,,,,,,,,,
Cigna,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical/Surgical,Relative Weights,"$10,478.65 ",IP,"9,688.50","11,312.23",,,,,,,,,,,,,
Cigna,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,907.25 ",IP,"6,386.40","7,466.07",,,,,,,,,,,,,
Cigna,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical/Surgical,Relative Weights,"$9,412.78 ",IP,"8,703.00","10,161.01",,,,,,,,,,,,,
Cigna,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,881.94 ",IP,"6,363.00","7,423.98",,,,,,,,,,,,,
Cigna,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical/Surgical,Relative Weights,"$7,724.90 ",IP,"7,142.40","8,339.48",,,,,,,,,,,,,
Cigna,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$16,399.84 ",IP,"15,163.20","17,702.84",,,,,,,,,,,,,
Cigna,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,624.32 ",IP,"7,974.00","9,304.44",,,,,,,,,,,,,
Cigna,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical/Surgical,Relative Weights,"$55,835.20 ",IP,"51,624.90","60,258.91",,,,,,,,,,,,,
Cigna,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical/Surgical,Relative Weights,"$24,771.08 ",IP,"22,903.20","26,752.62",,,,,,,,,,,,,
Cigna,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Medical/Surgical,Relative Weights,"$102,775.47 ",IP,"95,025.60","117,414.58",,,,,,,,,,,,,
Cigna,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$97,722.55 ",IP,"90,353.70","109,755.94",,,,,,,,,,,,,
Cigna,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Medical/Surgical,Relative Weights,"$63,110.39 ",IP,"58,351.50","68,323.73",,,,,,,,,,,,,
Cigna,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$59,467.93 ",IP,"54,121.89","59,467.93",,,,,,,,,,,,,
Cigna,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$78,432.68 ",IP,"72,518.40","84,763.82",,,,,,,,,,,,,
Cigna,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Medical/Surgical,Relative Weights,"$52,615.19 ",IP,"48,647.70","56,823.15",,,,,,,,,,,,,
Cigna,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$44,580.75 ",IP,"41,219.10","47,903.85",,,,,,,,,,,,,
Cigna,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Medical/Surgical,Relative Weights,"$77,395.03 ",IP,"71,559.00","88,615.24",,,,,,,,,,,,,
Cigna,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Medical/Surgical,Relative Weights,"$56,443.57 ",IP,"52,187.40","65,369.93",,,,,,,,,,,,,
Cigna,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Medical/Surgical,Relative Weights,"$73,190.92 ",IP,"67,671.90","77,472.43",,,,,,,,,,,,,
Cigna,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Medical/Surgical,Relative Weights,"$54,683.67 ",IP,"50,560.20","59,210.82",,,,,,,,,,,,,
Cigna,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$63,903.71 ",IP,"59,085.00","69,575.97",,,,,,,,,,,,,
Cigna,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$50,734.58 ",IP,"46,908.90","55,265.74",,,,,,,,,,,,,
Cigna,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$51,885.14 ",IP,"47,972.70","65,403.60",,,,,,,,,,,,,
Cigna,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$33,496.64 ",IP,"30,970.80","41,965.72",,,,,,,,,,,,,
Cigna,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Medical/Surgical,Relative Weights,"$84,840.57 ",IP,"78,443.10","89,342.37",,,,,,,,,,,,,
Cigna,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Medical/Surgical,Relative Weights,"$57,954.29 ",IP,"53,584.20","62,067.81",,,,,,,,,,,,,
Cigna,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Medical/Surgical,Relative Weights,"$77,115.67 ",IP,"71,300.70","82,002.58",,,,,,,,,,,,,
Cigna,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$51,940.62 ",IP,"48,024.00","55,955.00",,,,,,,,,,,,,
Cigna,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$59,417.31 ",IP,"54,936.90","63,455.79",,,,,,,,,,,,,
Cigna,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$39,880.20 ",IP,"36,873.00","42,942.26",,,,,,,,,,,,,
Cigna,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Medical/Surgical,Relative Weights,"$46,878.94 ",IP,"43,344.00","50,601.95",,,,,,,,,,,,,
Cigna,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Medical/Surgical,Relative Weights,"$27,146.18 ",IP,"25,099.20","29,359.17",,,,,,,,,,,,,
Cigna,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,500.42 ",IP,"14,331.60","16,746.30",,,,,,,,,,,,,
Cigna,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Medical/Surgical,Relative Weights,"$36,284.46 ",IP,"33,548.40","39,171.87",,,,,,,,,,,,,
Cigna,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Medical/Surgical,Relative Weights,"$24,515.08 ",IP,"22,666.50","26,650.55",,,,,,,,,,,,,
Cigna,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$20,084.16 ",IP,"18,569.70","21,737.36",,,,,,,,,,,,,
Cigna,DRG,MS-245,AICD GENERATOR PROCEDURES,Medical/Surgical,Relative Weights,"$52,736.87 ",IP,"48,760.20","56,971.52",,,,,,,,,,,,,
Cigna,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Medical/Surgical,Relative Weights,"$30,411.94 ",IP,"28,118.70","32,891.74",,,,,,,,,,,,,
Cigna,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$19,207.13 ",IP,"17,758.80","20,921.83",,,,,,,,,,,,,
Cigna,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Medical/Surgical,Relative Weights,"$30,780.85 ",IP,"28,459.80","33,398.95",,,,,,,,,,,,,
Cigna,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$18,238.60 ",IP,"16,863.30","19,775.87",,,,,,,,,,,,,
Cigna,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Medical/Surgical,Relative Weights,"$24,547.20 ",IP,"22,696.20","26,547.42",,,,,,,,,,,,,
Cigna,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$16,142.87 ",IP,"14,925.60","17,466.08",,,,,,,,,,,,,
Cigna,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$32,372.36 ",IP,"29,931.30","34,943.73",,,,,,,,,,,,,
Cigna,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$25,830.14 ",IP,"23,882.40","27,924.89",,,,,,,,,,,,,
Cigna,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,675.97 ",IP,"16,343.10","19,041.37",,,,,,,,,,,,,
Cigna,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$24,678.61 ",IP,"22,817.70","26,759.99",,,,,,,,,,,,,
Cigna,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$16,004.64 ",IP,"14,797.80","17,290.34",,,,,,,,,,,,,
Cigna,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,342.06 ",IP,"10,486.80","12,217.20",,,,,,,,,,,,,
Cigna,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Medical/Surgical,Relative Weights,"$30,838.29 ",IP,"28,512.90","33,687.28",,,,,,,,,,,,,
Cigna,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Medical/Surgical,Relative Weights,"$20,336.27 ",IP,"18,802.80","22,310.86",,,,,,,,,,,,,
Cigna,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Medical/Surgical,Relative Weights,"$34,724.10 ",IP,"32,105.70","37,716.54",,,,,,,,,,,,,
Cigna,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Medical/Surgical,Relative Weights,"$19,408.62 ",IP,"17,945.10","20,954.45",,,,,,,,,,,,,
Cigna,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,608.15 ",IP,"15,355.80","17,974.34",,,,,,,,,,,,,
Cigna,DRG,MS-263,VEIN LIGATION AND STRIPPING,Medical/Surgical,Relative Weights,"$22,516.69 ",IP,"20,818.80","24,258.67",,,,,,,,,,,,,
Cigna,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$31,670.54 ",IP,"29,282.40","34,176.60",,,,,,,,,,,,,
Cigna,DRG,MS-265,AICD LEAD PROCEDURES,Medical/Surgical,Relative Weights,"$32,759.78 ",IP,"30,289.50","35,385.69",,,,,,,,,,,,,
Cigna,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$68,604.26 ",IP,"63,431.10","74,683.84",,,,,,,,,,,,,
Cigna,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$54,490.93 ",IP,"50,382.00","58,938.27",,,,,,,,,,,,,
Cigna,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Medical/Surgical,Relative Weights,"$67,780.76 ",IP,"62,669.70","73,183.26",,,,,,,,,,,,,
Cigna,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Medical/Surgical,Relative Weights,"$42,003.18 ",IP,"38,835.90","45,402.54",,,,,,,,,,,,,
Cigna,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$50,490.26 ",IP,"46,683.00","54,525.98",,,,,,,,,,,,,
Cigna,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$34,705.60 ",IP,"32,088.60","37,510.29",,,,,,,,,,,,,
Cigna,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$26,167.91 ",IP,"24,194.70","28,294.24",,,,,,,,,,,,,
Cigna,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$37,249.10 ",IP,"34,440.30","40,378.86",,,,,,,,,,,,,
Cigna,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$31,991.76 ",IP,"29,579.40","34,572.26",,,,,,,,,,,,,
Cigna,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical/Surgical,Relative Weights,"$15,641.56 ",IP,"14,462.10","17,112.50",,,,,,,,,,,,,
Cigna,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical/Surgical,Relative Weights,"$9,058.46 ",IP,"8,375.40","9,808.49",,,,,,,,,,,,,
Cigna,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,067.86 ",IP,"6,534.90","7,634.44",,,,,,,,,,,,,
Cigna,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical/Surgical,Relative Weights,"$18,150.99 ",IP,"16,782.30","19,621.19",,,,,,,,,,,,,
Cigna,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical/Surgical,Relative Weights,"$7,041.58 ",IP,"6,510.60","7,725.99",,,,,,,,,,,,,
Cigna,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$4,815.41 ",IP,"4,452.30","5,223.62",,,,,,,,,,,,,
Cigna,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Relative Weights,"$20,794.74 ",IP,"19,226.70","23,298.97",,,,,,,,,,,,,
Cigna,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Relative Weights,"$10,854.38 ",IP,"10,035.90","12,101.45",,,,,,,,,,,,,
Cigna,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical/Surgical,Relative Weights,"$26,139.68 ",IP,"24,168.60","28,212.16",,,,,,,,,,,,,
Cigna,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical/Surgical,Relative Weights,"$15,998.80 ",IP,"14,792.40","17,285.08",,,,,,,,,,,,,
Cigna,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,995.84 ",IP,"9,242.10","10,771.34",,,,,,,,,,,,,
Cigna,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical/Surgical,Relative Weights,"$12,345.63 ",IP,"11,414.70","14,110.29",,,,,,,,,,,,,
Cigna,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical/Surgical,Relative Weights,"$8,405.31 ",IP,"7,771.50","9,419.14",,,,,,,,,,,,,
Cigna,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,742.09 ",IP,"5,309.10","6,867.31",,,,,,,,,,,,,
Cigna,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical/Surgical,Relative Weights,"$12,486.78 ",IP,"11,545.20","13,491.54",,,,,,,,,,,,,
Cigna,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,579.23 ",IP,"8,856.90","10,326.22",,,,,,,,,,,,,
Cigna,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical/Surgical,Relative Weights,"$15,527.68 ",IP,"14,356.80","16,782.08",,,,,,,,,,,,,
Cigna,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical/Surgical,Relative Weights,"$6,881.94 ",IP,"6,363.00","7,414.51",,,,,,,,,,,,,
Cigna,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$4,757.98 ",IP,"4,399.20","5,137.33",,,,,,,,,,,,,
Cigna,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$14,918.33 ",IP,"13,793.40","16,114.92",,,,,,,,,,,,,
Cigna,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$10,160.35 ",IP,"9,394.20","10,967.07",,,,,,,,,,,,,
Cigna,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,233.34 ",IP,"6,687.90","7,813.33",,,,,,,,,,,,,
Cigna,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical/Surgical,Relative Weights,"$10,656.78 ",IP,"9,853.20","11,506.90",,,,,,,,,,,,,
Cigna,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,595.76 ",IP,"6,098.40","7,117.76",,,,,,,,,,,,,
Cigna,DRG,MS-304,HYPERTENSION WITH MCC,Medical/Surgical,Relative Weights,"$10,678.20 ",IP,"9,873.00","11,529.00",,,,,,,,,,,,,
Cigna,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,202.19 ",IP,"6,659.10","7,771.24",,,,,,,,,,,,,
Cigna,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$14,673.03 ",IP,"13,566.60","15,823.44",,,,,,,,,,,,,
Cigna,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,472.47 ",IP,"7,833.60","9,138.17",,,,,,,,,,,,,
Cigna,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$11,689.56 ",IP,"10,808.10","12,620.23",,,,,,,,,,,,,
Cigna,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$7,305.37 ",IP,"6,754.50","7,885.94",,,,,,,,,,,,,
Cigna,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,443.25 ",IP,"5,032.80","5,876.04",,,,,,,,,,,,,
Cigna,DRG,MS-311,ANGINA PECTORIS,Medical/Surgical,Relative Weights,"$6,799.20 ",IP,"6,286.50","7,334.53",,,,,,,,,,,,,
Cigna,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical/Surgical,Relative Weights,"$8,163.91 ",IP,"7,548.30","8,809.86",,,,,,,,,,,,,
Cigna,DRG,MS-313,CHEST PAIN,Medical/Surgical,Relative Weights,"$7,022.11 ",IP,"6,492.60","7,584.98",,,,,,,,,,,,,
Cigna,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$20,292.47 ",IP,"18,762.30","21,923.62",,,,,,,,,,,,,
Cigna,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$9,475.08 ",IP,"8,760.60","10,262.03",,,,,,,,,,,,,
Cigna,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,041.58 ",IP,"6,510.60","7,886.99",,,,,,,,,,,,,
Cigna,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$42,030.44 ",IP,"38,861.10","45,415.16",,,,,,,,,,,,,
Cigna,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$23,416.11 ",IP,"21,650.40","25,715.06",,,,,,,,,,,,,
Cigna,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$51,748.86 ",IP,"47,846.70","56,589.54",,,,,,,,,,,,,
Cigna,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$24,964.79 ",IP,"23,082.30","27,460.82",,,,,,,,,,,,,
Cigna,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,225.60 ",IP,"15,002.10","17,526.06",,,,,,,,,,,,,
Cigna,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$47,562.27 ",IP,"43,975.80","51,039.71",,,,,,,,,,,,,
Cigna,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$24,814.89 ",IP,"22,943.70","26,717.90",,,,,,,,,,,,,
Cigna,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,650.01 ",IP,"15,394.50","17,995.38",,,,,,,,,,,,,
Cigna,DRG,MS-332,RECTAL RESECTION WITH MCC,Medical/Surgical,Relative Weights,"$40,508.04 ",IP,"37,453.50","43,772.52",,,,,,,,,,,,,
Cigna,DRG,MS-333,RECTAL RESECTION WITH CC,Medical/Surgical,Relative Weights,"$20,843.41 ",IP,"19,271.70","22,529.74",,,,,,,,,,,,,
Cigna,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,658.11 ",IP,"14,477.40","16,933.61",,,,,,,,,,,,,
Cigna,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Medical/Surgical,Relative Weights,"$38,094.01 ",IP,"35,221.50","40,938.68",,,,,,,,,,,,,
Cigna,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Medical/Surgical,Relative Weights,"$22,303.51 ",IP,"20,621.70","24,022.96",,,,,,,,,,,,,
Cigna,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,937.48 ",IP,"14,735.70","17,179.85",,,,,,,,,,,,,
Cigna,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$27,228.92 ",IP,"25,175.70","29,451.77",,,,,,,,,,,,,
Cigna,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$16,522.49 ",IP,"15,276.60","17,836.49",,,,,,,,,,,,,
Cigna,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,956.27 ",IP,"11,054.70","12,926.45",,,,,,,,,,,,,
Cigna,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$22,606.24 ",IP,"20,901.60","24,373.37",,,,,,,,,,,,,
Cigna,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$13,947.85 ",IP,"12,896.10","15,080.51",,,,,,,,,,,,,
Cigna,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,791.11 ",IP,"9,977.40","11,674.22",,,,,,,,,,,,,
Cigna,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$27,434.31 ",IP,"25,365.60","29,473.87",,,,,,,,,,,,,
Cigna,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$15,368.04 ",IP,"14,209.20","16,602.14",,,,,,,,,,,,,
Cigna,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,414.74 ",IP,"11,478.60","13,416.83",,,,,,,,,,,,,
Cigna,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$23,991.39 ",IP,"22,182.30","25,903.42",,,,,,,,,,,,,
Cigna,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$13,122.41 ",IP,"12,132.90","14,126.08",,,,,,,,,,,,,
Cigna,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,532.51 ",IP,"8,813.70","10,305.17",,,,,,,,,,,,,
Cigna,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$23,895.02 ",IP,"22,093.20","25,806.61",,,,,,,,,,,,,
Cigna,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$14,529.94 ",IP,"13,434.30","15,683.48",,,,,,,,,,,,,
Cigna,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,750.23 ",IP,"9,939.60","11,606.87",,,,,,,,,,,,,
Cigna,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Medical/Surgical,Relative Weights,"$29,444.38 ",IP,"27,224.10","31,656.34",,,,,,,,,,,,,
Cigna,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Medical/Surgical,Relative Weights,"$17,373.24 ",IP,"16,063.20","18,762.51",,,,,,,,,,,,,
Cigna,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,240.19 ",IP,"12,241.80","14,302.86",,,,,,,,,,,,,
Cigna,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$41,932.13 ",IP,"38,770.20","45,158.40",,,,,,,,,,,,,
Cigna,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$22,081.58 ",IP,"20,416.50","23,715.69",,,,,,,,,,,,,
Cigna,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,132.14 ",IP,"12,141.90","14,090.30",,,,,,,,,,,,,
Cigna,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$18,972.54 ",IP,"17,541.90","20,438.82",,,,,,,,,,,,,
Cigna,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$10,485.46 ",IP,"9,694.80","11,331.17",,,,,,,,,,,,,
Cigna,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,282.01 ",IP,"6,732.90","7,866.99",,,,,,,,,,,,,
Cigna,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical/Surgical,Relative Weights,"$16,851.50 ",IP,"15,580.80","18,186.90",,,,,,,,,,,,,
Cigna,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical/Surgical,Relative Weights,"$10,019.21 ",IP,"9,263.70","10,813.43",,,,,,,,,,,,,
Cigna,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,247.94 ",IP,"6,701.40","7,823.85",,,,,,,,,,,,,
Cigna,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$20,185.40 ",IP,"18,663.30","21,760.51",,,,,,,,,,,,,
Cigna,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$11,754.78 ",IP,"10,868.40","12,679.16",,,,,,,,,,,,,
Cigna,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,749.89 ",IP,"8,090.10","9,420.19",,,,,,,,,,,,,
Cigna,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical/Surgical,Relative Weights,"$17,532.88 ",IP,"16,210.80","18,929.82",,,,,,,,,,,,,
Cigna,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical/Surgical,Relative Weights,"$9,670.73 ",IP,"8,941.50","10,451.44",,,,,,,,,,,,,
Cigna,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,202.50 ",IP,"5,734.80","6,704.20",,,,,,,,,,,,,
Cigna,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical/Surgical,Relative Weights,"$18,364.16 ",IP,"16,979.40","19,815.86",,,,,,,,,,,,,
Cigna,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical/Surgical,Relative Weights,"$10,311.23 ",IP,"9,533.70","11,151.22",,,,,,,,,,,,,
Cigna,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,481.55 ",IP,"6,917.40","8,084.82",,,,,,,,,,,,,
Cigna,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical/Surgical,Relative Weights,"$12,776.85 ",IP,"11,813.40","13,794.60",,,,,,,,,,,,,
Cigna,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,690.52 ",IP,"8,035.20","9,390.73",,,,,,,,,,,,,
Cigna,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical/Surgical,Relative Weights,"$15,791.47 ",IP,"14,600.70","17,037.79",,,,,,,,,,,,,
Cigna,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical/Surgical,Relative Weights,"$9,686.30 ",IP,"8,955.90","10,454.60",,,,,,,,,,,,,
Cigna,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,956.89 ",IP,"6,432.30","7,508.16",,,,,,,,,,,,,
Cigna,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical/Surgical,Relative Weights,"$14,743.12 ",IP,"13,631.40","15,908.67",,,,,,,,,,,,,
Cigna,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical/Surgical,Relative Weights,"$8,013.03 ",IP,"7,408.80","8,647.80",,,,,,,,,,,,,
Cigna,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,675.90 ",IP,"5,247.90","6,130.70",,,,,,,,,,,,,
Cigna,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$12,159.71 ",IP,"11,242.80","13,094.82",,,,,,,,,,,,,
Cigna,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,454.30 ",IP,"6,892.20","8,043.78",,,,,,,,,,,,,
Cigna,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$16,170.12 ",IP,"14,950.80","17,400.83",,,,,,,,,,,,,
Cigna,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$9,158.72 ",IP,"8,468.10","9,876.89",,,,,,,,,,,,,
Cigna,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,341.70 ",IP,"5,863.50","6,836.79",,,,,,,,,,,,,
Cigna,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$55,849.80 ",IP,"51,638.40","60,302.05",,,,,,,,,,,,,
Cigna,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$28,042.68 ",IP,"25,928.10","30,274.67",,,,,,,,,,,,,
Cigna,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$20,616.61 ",IP,"19,062.00","22,266.67",,,,,,,,,,,,,
Cigna,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$36,530.73 ",IP,"33,776.10","39,455.99",,,,,,,,,,,,,
Cigna,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$20,601.04 ",IP,"19,047.60","22,248.78",,,,,,,,,,,,,
Cigna,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,265.83 ",IP,"14,114.70","16,475.86",,,,,,,,,,,,,
Cigna,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$36,536.57 ",IP,"33,781.50","39,486.51",,,,,,,,,,,,,
Cigna,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$22,169.19 ",IP,"20,497.50","23,947.19",,,,,,,,,,,,,
Cigna,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,848.58 ",IP,"15,578.10","18,219.52",,,,,,,,,,,,,
Cigna,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$35,317.87 ",IP,"32,654.70","38,151.14",,,,,,,,,,,,,
Cigna,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$19,776.57 ",IP,"18,285.30","21,381.68",,,,,,,,,,,,,
Cigna,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,844.67 ",IP,"12,800.70","14,965.81",,,,,,,,,,,,,
Cigna,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Medical/Surgical,Relative Weights,"$23,598.14 ",IP,"21,818.70","25,502.49",,,,,,,,,,,,,
Cigna,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Medical/Surgical,Relative Weights,"$16,440.73 ",IP,"15,201.00","17,763.88",,,,,,,,,,,,,
Cigna,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,803.13 ",IP,"11,837.70","13,839.85",,,,,,,,,,,,,
Cigna,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$34,229.61 ",IP,"31,648.50","36,978.87",,,,,,,,,,,,,
Cigna,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$18,567.61 ",IP,"17,167.50","20,087.35",,,,,,,,,,,,,
Cigna,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,149.34 ",IP,"13,082.40","15,273.08",,,,,,,,,,,,,
Cigna,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$40,745.55 ",IP,"37,673.10","43,975.62",,,,,,,,,,,,,
Cigna,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$22,233.43 ",IP,"20,556.90","24,009.28",,,,,,,,,,,,,
Cigna,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,016.64 ",IP,"13,884.30","16,240.15",,,,,,,,,,,,,
Cigna,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical/Surgical,Relative Weights,"$18,307.71 ",IP,"16,927.20","19,805.34",,,,,,,,,,,,,
Cigna,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical/Surgical,Relative Weights,"$10,025.05 ",IP,"9,269.10","10,822.91",,,,,,,,,,,,,
Cigna,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,041.89 ",IP,"5,586.30","6,520.05",,,,,,,,,,,,,
Cigna,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical/Surgical,Relative Weights,"$17,067.60 ",IP,"15,780.60","18,444.71",,,,,,,,,,,,,
Cigna,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical/Surgical,Relative Weights,"$10,916.68 ",IP,"10,093.50","11,787.86",,,,,,,,,,,,,
Cigna,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,720.69 ",IP,"8,063.10","9,412.82",,,,,,,,,,,,,
Cigna,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$15,552.99 ",IP,"14,380.20","16,797.86",,,,,,,,,,,,,
Cigna,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$8,227.18 ",IP,"7,606.80","8,885.62",,,,,,,,,,,,,
Cigna,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,901.72 ",IP,"5,456.70","6,375.89",,,,,,,,,,,,,
Cigna,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical/Surgical,Relative Weights,"$18,295.05 ",IP,"16,915.50","19,822.18",,,,,,,,,,,,,
Cigna,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical/Surgical,Relative Weights,"$9,052.62 ",IP,"8,370.00","9,803.23",,,,,,,,,,,,,
Cigna,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,455.59 ",IP,"5,968.80","6,974.64",,,,,,,,,,,,,
Cigna,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical/Surgical,Relative Weights,"$16,271.35 ",IP,"15,044.40","17,560.78",,,,,,,,,,,,,
Cigna,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical/Surgical,Relative Weights,"$10,488.39 ",IP,"9,697.50","11,331.17",,,,,,,,,,,,,
Cigna,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,948.78 ",IP,"7,349.40","8,588.87",,,,,,,,,,,,,
Cigna,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Medical/Surgical,Relative Weights,"$89,435.99 ",IP,"82,692.00","96,744.25",,,,,,,,,,,,,
Cigna,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Medical/Surgical,Relative Weights,"$59,310.24 ",IP,"54,837.90","64,170.31",,,,,,,,,,,,,
Cigna,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$46,541.17 ",IP,"43,031.70","50,415.69",,,,,,,,,,,,,
Cigna,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Medical/Surgical,Relative Weights,"$83,712.40 ",IP,"77,400.00","90,477.81",,,,,,,,,,,,,
Cigna,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Medical/Surgical,Relative Weights,"$63,231.09 ",IP,"58,463.10","68,420.55",,,,,,,,,,,,,
Cigna,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$48,743.98 ",IP,"45,068.40","52,798.10",,,,,,,,,,,,,
Cigna,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Medical/Surgical,Relative Weights,"$65,543.89 ",IP,"60,601.50","70,838.73",,,,,,,,,,,,,
Cigna,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Medical/Surgical,Relative Weights,"$38,261.43 ",IP,"35,376.30","41,383.80",,,,,,,,,,,,,
Cigna,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Medical/Surgical,Relative Weights,"$59,199.27 ",IP,"54,735.30","63,939.85",,,,,,,,,,,,,
Cigna,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Medical/Surgical,Relative Weights,"$30,578.39 ",IP,"28,272.60","33,086.42",,,,,,,,,,,,,
Cigna,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$52,274.50 ",IP,"48,332.70","56,460.10",,,,,,,,,,,,,
Cigna,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$28,967.41 ",IP,"26,783.10","31,300.66",,,,,,,,,,,,,
Cigna,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,950.47 ",IP,"16,596.90","19,400.20",,,,,,,,,,,,,
Cigna,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Medical/Surgical,Relative Weights,"$52,035.04 ",IP,"48,111.30","56,245.44",,,,,,,,,,,,,
Cigna,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Medical/Surgical,Relative Weights,"$34,823.39 ",IP,"32,197.50","37,632.35",,,,,,,,,,,,,
Cigna,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$27,278.56 ",IP,"25,221.60","29,506.49",,,,,,,,,,,,,
Cigna,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Medical/Surgical,Relative Weights,"$30,038.15 ",IP,"27,773.10","32,457.14",,,,,,,,,,,,,
Cigna,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Medical/Surgical,Relative Weights,"$18,497.52 ",IP,"17,102.70","19,992.65",,,,,,,,,,,,,
Cigna,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Medical/Surgical,Relative Weights,"$48,861.76 ",IP,"45,177.30","52,791.79",,,,,,,,,,,,,
Cigna,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Medical/Surgical,Relative Weights,"$29,724.72 ",IP,"27,483.30","32,128.82",,,,,,,,,,,,,
Cigna,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$24,714.63 ",IP,"22,851.00","26,730.52",,,,,,,,,,,,,
Cigna,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$39,676.76 ",IP,"36,684.90","42,858.07",,,,,,,,,,,,,
Cigna,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$21,378.78 ",IP,"19,766.70","23,083.25",,,,,,,,,,,,,
Cigna,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,294.36 ",IP,"10,442.70","12,204.58",,,,,,,,,,,,,
Cigna,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Relative Weights,"$32,695.53 ",IP,"30,230.10","35,324.66",,,,,,,,,,,,,
Cigna,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical/Surgical,Relative Weights,"$22,956.67 ",IP,"21,225.60","24,801.66",,,,,,,,,,,,,
Cigna,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,613.67 ",IP,"16,285.50","19,039.26",,,,,,,,,,,,,
Cigna,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Medical/Surgical,Relative Weights,"$29,453.14 ",IP,"27,232.20","31,826.81",,,,,,,,,,,,,
Cigna,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Medical/Surgical,Relative Weights,"$20,403.44 ",IP,"18,864.90","22,050.95",,,,,,,,,,,,,
Cigna,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,020.22 ",IP,"14,812.20","17,329.28",,,,,,,,,,,,,
Cigna,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Medical/Surgical,Relative Weights,"$23,222.40 ",IP,"21,471.30","25,111.03",,,,,,,,,,,,,
Cigna,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Medical/Surgical,Relative Weights,"$33,189.05 ",IP,"30,686.40","35,858.17",,,,,,,,,,,,,
Cigna,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Medical/Surgical,Relative Weights,"$20,922.26 ",IP,"19,344.60","22,607.61",,,,,,,,,,,,,
Cigna,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,965.71 ",IP,"14,761.80","17,260.88",,,,,,,,,,,,,
Cigna,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Medical/Surgical,Relative Weights,"$19,231.46 ",IP,"17,781.30","20,778.72",,,,,,,,,,,,,
Cigna,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,636.68 ",IP,"11,683.80","13,660.96",,,,,,,,,,,,,
Cigna,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Medical/Surgical,Relative Weights,"$33,776.98 ",IP,"31,230.00","36,495.87",,,,,,,,,,,,,
Cigna,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Medical/Surgical,Relative Weights,"$22,639.34 ",IP,"20,932.20","24,468.08",,,,,,,,,,,,,
Cigna,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$18,024.45 ",IP,"16,665.30","19,487.54",,,,,,,,,,,,,
Cigna,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Medical/Surgical,Relative Weights,"$35,450.25 ",IP,"32,777.10","38,242.69",,,,,,,,,,,,,
Cigna,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Medical/Surgical,Relative Weights,"$19,335.62 ",IP,"17,877.60","20,894.47",,,,,,,,,,,,,
Cigna,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,128.90 ",IP,"13,063.50","15,349.90",,,,,,,,,,,,,
Cigna,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Medical/Surgical,Relative Weights,"$25,149.74 ",IP,"23,253.30","27,194.59",,,,,,,,,,,,,
Cigna,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,671.07 ",IP,"10,791.00","12,613.92",,,,,,,,,,,,,
Cigna,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$31,046.59 ",IP,"28,705.50","33,188.49",,,,,,,,,,,,,
Cigna,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$17,074.41 ",IP,"15,786.90","18,362.64",,,,,,,,,,,,,
Cigna,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,973.48 ",IP,"11,995.20","14,004.01",,,,,,,,,,,,,
Cigna,DRG,MS-503,FOOT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$25,703.60 ",IP,"23,765.40","27,661.81",,,,,,,,,,,,,
Cigna,DRG,MS-504,FOOT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$17,277.85 ",IP,"15,975.00","18,666.75",,,,,,,,,,,,,
Cigna,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,277.85 ",IP,"15,975.00","18,666.75",,,,,,,,,,,,,
Cigna,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Medical/Surgical,Relative Weights,"$14,441.36 ",IP,"13,352.40","15,528.79",,,,,,,,,,,,,
Cigna,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$20,060.80 ",IP,"18,548.10","21,280.66",,,,,,,,,,,,,
Cigna,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,722.02 ",IP,"12,687.30","14,879.52",,,,,,,,,,,,,
Cigna,DRG,MS-509,ARTHROSCOPY,Medical/Surgical,Relative Weights,"$16,416.39 ",IP,"15,178.50","17,613.40",,,,,,,,,,,,,
Cigna,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$26,707.18 ",IP,"24,693.30","28,735.16",,,,,,,,,,,,,
Cigna,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$19,150.67 ",IP,"17,706.60","20,714.53",,,,,,,,,,,,,
Cigna,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,131.50 ",IP,"13,990.50","16,375.89",,,,,,,,,,,,,
Cigna,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$15,301.85 ",IP,"14,148.00","16,405.36",,,,,,,,,,,,,
Cigna,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,725.24 ",IP,"8,991.90","10,461.97",,,,,,,,,,,,,
Cigna,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$30,570.60 ",IP,"28,265.40","33,010.65",,,,,,,,,,,,,
Cigna,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$19,105.90 ",IP,"17,665.20","20,636.66",,,,,,,,,,,,,
Cigna,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,610.08 ",IP,"12,583.80","14,697.47",,,,,,,,,,,,,
Cigna,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Medical/Surgical,Relative Weights,"$34,914.88 ",IP,"32,282.10","37,717.59",,,,,,,,,,,,,
Cigna,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Medical/Surgical,Relative Weights,"$19,078.64 ",IP,"17,640.00","20,600.88",,,,,,,,,,,,,
Cigna,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,805.73 ",IP,"12,764.70","14,915.30",,,,,,,,,,,,,
Cigna,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Medical/Surgical,Relative Weights,"$29,846.39 ",IP,"27,595.80","32,236.16",,,,,,,,,,,,,
Cigna,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Medical/Surgical,Relative Weights,"$21,311.62 ",IP,"19,704.60","23,035.90",,,,,,,,,,,,,
Cigna,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical/Surgical,Relative Weights,"$13,785.29 ",IP,"12,745.80","14,864.79",,,,,,,,,,,,,
Cigna,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,691.81 ",IP,"7,111.80","8,298.44",,,,,,,,,,,,,
Cigna,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical/Surgical,Relative Weights,"$12,000.08 ",IP,"11,095.20","12,983.28",,,,,,,,,,,,,
Cigna,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,511.73 ",IP,"6,945.30","8,119.55",,,,,,,,,,,,,
Cigna,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical/Surgical,Relative Weights,"$9,105.18 ",IP,"8,418.60","9,820.06",,,,,,,,,,,,,
Cigna,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,039.63 ",IP,"6,508.80","7,591.29",,,,,,,,,,,,,
Cigna,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical/Surgical,Relative Weights,"$18,958.91 ",IP,"17,529.30","20,427.25",,,,,,,,,,,,,
Cigna,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical/Surgical,Relative Weights,"$12,669.77 ",IP,"11,714.40","13,630.44",,,,,,,,,,,,,
Cigna,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,207.71 ",IP,"7,588.80","8,845.63",,,,,,,,,,,,,
Cigna,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$17,610.75 ",IP,"16,282.80","18,997.17",,,,,,,,,,,,,
Cigna,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$10,173.98 ",IP,"9,406.80","10,978.65",,,,,,,,,,,,,
Cigna,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,570.13 ",IP,"6,999.30","8,167.95",,,,,,,,,,,,,
Cigna,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$24,365.18 ",IP,"22,527.90","26,302.24",,,,,,,,,,,,,
Cigna,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$11,758.67 ",IP,"10,872.00","12,697.05",,,,,,,,,,,,,
Cigna,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,114.26 ",IP,"7,502.40","8,765.66",,,,,,,,,,,,,
Cigna,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical/Surgical,Relative Weights,"$19,962.49 ",IP,"18,457.20","21,357.48",,,,,,,,,,,,,
Cigna,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical/Surgical,Relative Weights,"$12,166.53 ",IP,"11,249.10","13,121.13",,,,,,,,,,,,,
Cigna,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,555.21 ",IP,"7,910.10","9,288.65",,,,,,,,,,,,,
Cigna,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical/Surgical,Relative Weights,"$15,841.11 ",IP,"14,646.60","17,079.88",,,,,,,,,,,,,
Cigna,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,183.06 ",IP,"8,490.60","9,912.67",,,,,,,,,,,,,
Cigna,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical/Surgical,Relative Weights,"$12,376.78 ",IP,"11,443.50","13,346.32",,,,,,,,,,,,,
Cigna,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,714.20 ",IP,"7,132.50","8,317.38",,,,,,,,,,,,,
Cigna,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Relative Weights,"$13,320.98 ",IP,"12,316.50","14,340.74",,,,,,,,,,,,,
Cigna,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,871.89 ",IP,"7,278.30","8,484.69",,,,,,,,,,,,,
Cigna,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical/Surgical,Relative Weights,"$13,618.84 ",IP,"12,591.90","14,668.01",,,,,,,,,,,,,
Cigna,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,384.87 ",IP,"7,752.60","9,031.89",,,,,,,,,,,,,
Cigna,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Relative Weights,"$18,156.83 ",IP,"16,787.70","19,655.91",,,,,,,,,,,,,
Cigna,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical/Surgical,Relative Weights,"$10,473.78 ",IP,"9,684.00","11,326.96",,,,,,,,,,,,,
Cigna,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,713.22 ",IP,"7,131.60","8,324.75",,,,,,,,,,,,,
Cigna,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical/Surgical,Relative Weights,"$13,742.46 ",IP,"12,706.20","14,816.38",,,,,,,,,,,,,
Cigna,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,489.99 ",IP,"7,849.80","9,163.43",,,,,,,,,,,,,
Cigna,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$14,830.72 ",IP,"13,712.40","15,929.72",,,,,,,,,,,,,
Cigna,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$9,824.53 ",IP,"9,083.70","10,589.29",,,,,,,,,,,,,
Cigna,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,318.99 ",IP,"6,767.10","7,908.03",,,,,,,,,,,,,
Cigna,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Medical/Surgical,Relative Weights,"$27,661.11 ",IP,"25,575.30","29,846.38",,,,,,,,,,,,,
Cigna,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Medical/Surgical,Relative Weights,"$15,918.98 ",IP,"14,718.60","17,181.95",,,,,,,,,,,,,
Cigna,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,750.23 ",IP,"9,939.60","11,602.66",,,,,,,,,,,,,
Cigna,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Medical/Surgical,Relative Weights,"$53,917.60 ",IP,"49,851.90","58,269.01",,,,,,,,,,,,,
Cigna,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Medical/Surgical,Relative Weights,"$31,601.43 ",IP,"29,218.50","34,181.86",,,,,,,,,,,,,
Cigna,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,162.99 ",IP,"15,868.80","18,536.26",,,,,,,,,,,,,
Cigna,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Medical/Surgical,Relative Weights,"$49,290.06 ",IP,"45,573.30","53,150.62",,,,,,,,,,,,,
Cigna,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Medical/Surgical,Relative Weights,"$24,817.81 ",IP,"22,946.40","26,873.64",,,,,,,,,,,,,
Cigna,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,527.68 ",IP,"14,356.80","17,159.86",,,,,,,,,,,,,
Cigna,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$30,612.46 ",IP,"28,304.10","30,809.24",,,,,,,,,,,,,
Cigna,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$16,828.14 ",IP,"15,559.20","16,839.96",,,,,,,,,,,,,
Cigna,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,401.77 ",IP,"12,391.20","13,401.77",,,,,,,,,,,,,
Cigna,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$15,993.94 ",IP,"14,787.90","17,213.52",,,,,,,,,,,,,
Cigna,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,004.96 ",IP,"13,873.50","16,183.32",,,,,,,,,,,,,
Cigna,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$17,878.44 ",IP,"16,530.30","19,197.11",,,,,,,,,,,,,
Cigna,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,933.27 ",IP,"15,656.40","18,274.24",,,,,,,,,,,,,
Cigna,DRG,MS-592,SKIN ULCERS WITH MCC,Medical/Surgical,Relative Weights,"$16,492.32 ",IP,"15,248.70","17,749.14",,,,,,,,,,,,,
Cigna,DRG,MS-593,SKIN ULCERS WITH CC,Medical/Surgical,Relative Weights,"$11,102.60 ",IP,"10,265.40","11,962.55",,,,,,,,,,,,,
Cigna,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,942.94 ",IP,"7,344.00","8,615.18",,,,,,,,,,,,,
Cigna,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$19,628.61 ",IP,"18,148.50","21,173.33",,,,,,,,,,,,,
Cigna,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,682.41 ",IP,"8,952.30","10,409.35",,,,,,,,,,,,,
Cigna,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$16,002.70 ",IP,"14,796.00","17,222.99",,,,,,,,,,,,,
Cigna,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$10,832.97 ",IP,"10,016.10","11,693.16",,,,,,,,,,,,,
Cigna,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,535.41 ",IP,"6,042.60","7,063.04",,,,,,,,,,,,,
Cigna,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical/Surgical,Relative Weights,"$9,703.82 ",IP,"8,972.10","10,477.75",,,,,,,,,,,,,
Cigna,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,685.31 ",IP,"6,181.20","7,235.61",,,,,,,,,,,,,
Cigna,DRG,MS-602,CELLULITIS WITH MCC,Medical/Surgical,Relative Weights,"$14,114.30 ",IP,"13,050.00","15,117.34",,,,,,,,,,,,,
Cigna,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,308.94 ",IP,"7,682.40","8,889.83",,,,,,,,,,,,,
Cigna,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical/Surgical,Relative Weights,"$14,385.88 ",IP,"13,301.10","15,692.95",,,,,,,,,,,,,
Cigna,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,798.56 ",IP,"8,135.10","9,567.51",,,,,,,,,,,,,
Cigna,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$14,718.78 ",IP,"13,608.90","15,900.25",,,,,,,,,,,,,
Cigna,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,061.70 ",IP,"7,453.80","8,687.79",,,,,,,,,,,,,
Cigna,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$23,261.34 ",IP,"21,507.30","25,116.30",,,,,,,,,,,,,
Cigna,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,331.05 ",IP,"14,175.00","16,564.25",,,,,,,,,,,,,
Cigna,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$38,606.99 ",IP,"35,695.80","41,974.14",,,,,,,,,,,,,
Cigna,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$19,758.07 ",IP,"18,268.20","21,404.83",,,,,,,,,,,,,
Cigna,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,685.35 ",IP,"11,728.80","13,711.47",,,,,,,,,,,,,
Cigna,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Medical/Surgical,Relative Weights,"$29,802.59 ",IP,"27,555.30","32,211.96",,,,,,,,,,,,,
Cigna,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Medical/Surgical,Relative Weights,"$17,158.12 ",IP,"15,864.30","18,532.06",,,,,,,,,,,,,
Cigna,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,546.17 ",IP,"14,373.90","16,798.92",,,,,,,,,,,,,
Cigna,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$35,187.44 ",IP,"32,534.10","38,017.49",,,,,,,,,,,,,
Cigna,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$18,217.18 ",IP,"16,843.50","19,708.53",,,,,,,,,,,,,
Cigna,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,696.69 ",IP,"9,890.10","11,515.32",,,,,,,,,,,,,
Cigna,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$27,646.51 ",IP,"25,561.80","29,897.95",,,,,,,,,,,,,
Cigna,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$16,089.33 ",IP,"14,876.10","17,387.15",,,,,,,,,,,,,
Cigna,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,513.38 ",IP,"10,645.20","12,436.08",,,,,,,,,,,,,
Cigna,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$35,815.28 ",IP,"33,114.60","38,915.11",,,,,,,,,,,,,
Cigna,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$22,829.15 ",IP,"21,107.70","24,695.38",,,,,,,,,,,,,
Cigna,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,718.13 ",IP,"12,683.70","14,804.81",,,,,,,,,,,,,
Cigna,DRG,MS-637,DIABETES WITH MCC,Medical/Surgical,Relative Weights,"$13,399.82 ",IP,"12,389.40","14,465.97",,,,,,,,,,,,,
Cigna,DRG,MS-638,DIABETES WITH CC,Medical/Surgical,Relative Weights,"$8,560.08 ",IP,"7,914.60","9,253.93",,,,,,,,,,,,,
Cigna,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,933.85 ",IP,"5,486.40","6,411.66",,,,,,,,,,,,,
Cigna,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical/Surgical,Relative Weights,"$11,980.61 ",IP,"11,077.20","12,920.14",,,,,,,,,,,,,
Cigna,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,341.38 ",IP,"6,787.80","7,923.82",,,,,,,,,,,,,
Cigna,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical/Surgical,Relative Weights,"$12,554.91 ",IP,"11,608.20","13,548.36",,,,,,,,,,,,,
Cigna,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$16,233.39 ",IP,"15,009.30","17,502.91",,,,,,,,,,,,,
Cigna,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$9,926.73 ",IP,"9,178.20","10,715.57",,,,,,,,,,,,,
Cigna,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,481.55 ",IP,"6,917.40","8,079.56",,,,,,,,,,,,,
Cigna,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Medical/Surgical,Relative Weights,"$44,004.49 ",IP,"40,686.30","47,491.35",,,,,,,,,,,,,
Cigna,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Medical/Surgical,Relative Weights,"$36,000.23 ",IP,"33,285.60","38,867.75",,,,,,,,,,,,,
Cigna,DRG,MS-652,KIDNEY TRANSPLANT,Medical/Surgical,Relative Weights,"$31,003.76 ",IP,"28,665.90","33,483.13",,,,,,,,,,,,,
Cigna,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$53,139.85 ",IP,"49,132.80","57,341.93",,,,,,,,,,,,,
Cigna,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$28,255.86 ",IP,"26,125.20","30,518.80",,,,,,,,,,,,,
Cigna,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$20,249.64 ",IP,"18,722.70","21,888.89",,,,,,,,,,,,,
Cigna,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Medical/Surgical,Relative Weights,"$31,976.19 ",IP,"29,565.00","34,533.33",,,,,,,,,,,,,
Cigna,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Medical/Surgical,Relative Weights,"$18,832.37 ",IP,"17,412.30","20,352.53",,,,,,,,,,,,,
Cigna,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,359.28 ",IP,"14,201.10","16,616.87",,,,,,,,,,,,,
Cigna,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Medical/Surgical,Relative Weights,"$25,954.74 ",IP,"23,997.60","28,041.69",,,,,,,,,,,,,
Cigna,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Medical/Surgical,Relative Weights,"$14,047.14 ",IP,"12,987.90","15,188.90",,,,,,,,,,,,,
Cigna,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,354.06 ",IP,"9,573.30","11,200.68",,,,,,,,,,,,,
Cigna,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$28,591.68 ",IP,"26,435.70","30,830.29",,,,,,,,,,,,,
Cigna,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$15,569.53 ",IP,"14,395.50","16,783.13",,,,,,,,,,,,,
Cigna,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,523.11 ",IP,"10,654.20","12,461.34",,,,,,,,,,,,,
Cigna,DRG,MS-665,PROSTATECTOMY WITH MCC,Medical/Surgical,Relative Weights,"$29,607.91 ",IP,"27,375.30","31,955.19",,,,,,,,,,,,,
Cigna,DRG,MS-666,PROSTATECTOMY WITH CC,Medical/Surgical,Relative Weights,"$16,934.24 ",IP,"15,657.30","18,250.04",,,,,,,,,,,,,
Cigna,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,709.67 ",IP,"8,977.50","10,469.33",,,,,,,,,,,,,
Cigna,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$27,316.52 ",IP,"25,256.70","28,991.92",,,,,,,,,,,,,
Cigna,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$15,219.11 ",IP,"14,071.50","16,120.18",,,,,,,,,,,,,
Cigna,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,524.72 ",IP,"8,806.50","10,275.71",,,,,,,,,,,,,
Cigna,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$17,339.17 ",IP,"16,031.70","18,696.21",,,,,,,,,,,,,
Cigna,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,197.99 ",IP,"10,353.60","12,110.92",,,,,,,,,,,,,
Cigna,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$33,760.43 ",IP,"31,214.70","36,442.20",,,,,,,,,,,,,
Cigna,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$23,198.07 ",IP,"21,448.80","25,048.95",,,,,,,,,,,,,
Cigna,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$17,080.25 ",IP,"15,792.30","18,436.30",,,,,,,,,,,,,
Cigna,DRG,MS-682,RENAL FAILURE WITH MCC,Medical/Surgical,Relative Weights,"$14,335.26 ",IP,"13,254.30","15,470.91",,,,,,,,,,,,,
Cigna,DRG,MS-683,RENAL FAILURE WITH CC,Medical/Surgical,Relative Weights,"$8,559.11 ",IP,"7,913.70","9,240.25",,,,,,,,,,,,,
Cigna,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,917.30 ",IP,"5,471.10","6,392.72",,,,,,,,,,,,,
Cigna,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical/Surgical,Relative Weights,"$18,254.17 ",IP,"16,877.70","19,711.68",,,,,,,,,,,,,
Cigna,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical/Surgical,Relative Weights,"$10,221.67 ",IP,"9,450.90","11,026.00",,,,,,,,,,,,,
Cigna,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,675.58 ",IP,"6,172.20","7,211.41",,,,,,,,,,,,,
Cigna,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical/Surgical,Relative Weights,"$10,845.62 ",IP,"10,027.80","11,694.21",,,,,,,,,,,,,
Cigna,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,728.80 ",IP,"7,146.00","8,336.32",,,,,,,,,,,,,
Cigna,DRG,MS-693,URINARY STONES WITH MCC,Medical/Surgical,Relative Weights,"$12,999.76 ",IP,"12,019.50","13,351.58",,,,,,,,,,,,,
Cigna,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,506.86 ",IP,"6,940.80","7,674.42",,,,,,,,,,,,,
Cigna,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical/Surgical,Relative Weights,"$11,074.37 ",IP,"10,239.30","11,957.28",,,,,,,,,,,,,
Cigna,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,734.95 ",IP,"6,227.10","7,257.71",,,,,,,,,,,,,
Cigna,DRG,MS-697,URETHRAL STRICTURE,Medical/Surgical,Relative Weights,"$9,727.19 ",IP,"8,993.70","10,491.43",,,,,,,,,,,,,
Cigna,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$15,677.58 ",IP,"14,495.40","16,907.30",,,,,,,,,,,,,
Cigna,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$9,996.82 ",IP,"9,243.00","10,788.18",,,,,,,,,,,,,
Cigna,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,266.43 ",IP,"6,718.50","7,837.53",,,,,,,,,,,,,
Cigna,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$18,710.69 ",IP,"17,299.80","20,210.47",,,,,,,,,,,,,
Cigna,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,515.34 ",IP,"13,420.80","15,694.00",,,,,,,,,,,,,
Cigna,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$22,542.97 ",IP,"20,843.10","24,328.12",,,,,,,,,,,,,
Cigna,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$15,589.97 ",IP,"14,414.40","16,835.75",,,,,,,,,,,,,
Cigna,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$20,748.99 ",IP,"19,184.40","22,417.15",,,,,,,,,,,,,
Cigna,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,318.04 ",IP,"9,540.00","11,128.07",,,,,,,,,,,,,
Cigna,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Medical/Surgical,Relative Weights,"$14,536.76 ",IP,"13,440.60","15,696.11",,,,,,,,,,,,,
Cigna,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,040.94 ",IP,"8,359.20","9,770.61",,,,,,,,,,,,,
Cigna,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$19,678.25 ",IP,"18,194.40","21,244.88",,,,,,,,,,,,,
Cigna,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,418.64 ",IP,"11,482.20","13,432.61",,,,,,,,,,,,,
Cigna,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$17,527.04 ",IP,"16,205.40","18,925.62",,,,,,,,,,,,,
Cigna,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,017.60 ",IP,"11,111.40","13,008.53",,,,,,,,,,,,,
Cigna,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$16,670.45 ",IP,"15,413.40","17,983.81",,,,,,,,,,,,,
Cigna,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$10,628.55 ",IP,"9,827.10","11,460.60",,,,,,,,,,,,,
Cigna,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,308.61 ",IP,"5,832.90","6,833.64",,,,,,,,,,,,,
Cigna,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical/Surgical,Relative Weights,"$12,513.06 ",IP,"11,569.50","13,489.43",,,,,,,,,,,,,
Cigna,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,248.91 ",IP,"6,702.30","7,821.75",,,,,,,,,,,,,
Cigna,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$13,832.01 ",IP,"12,789.00","14,922.67",,,,,,,,,,,,,
Cigna,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,842.68 ",IP,"7,251.30","8,455.23",,,,,,,,,,,,,
Cigna,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical/Surgical,Relative Weights,"$9,807.01 ",IP,"9,067.50","10,573.51",,,,,,,,,,,,,
Cigna,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,537.67 ",IP,"5,120.10","5,952.86",,,,,,,,,,,,,
Cigna,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Medical/Surgical,Relative Weights,"$21,651.34 ",IP,"20,018.70","23,390.52",,,,,,,,,,,,,
Cigna,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,759.98 ",IP,"12,722.40","14,874.26",,,,,,,,,,,,,
Cigna,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$41,473.65 ",IP,"38,346.30","44,809.04",,,,,,,,,,,,,
Cigna,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$20,033.55 ",IP,"18,522.90","21,658.44",,,,,,,,,,,,,
Cigna,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,366.41 ",IP,"13,283.10","15,538.26",,,,,,,,,,,,,
Cigna,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Medical/Surgical,Relative Weights,"$37,222.82 ",IP,"34,416.00","40,215.75",,,,,,,,,,,,,
Cigna,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Medical/Surgical,Relative Weights,"$17,536.77 ",IP,"16,214.40","18,941.40",,,,,,,,,,,,,
Cigna,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,458.55 ",IP,"11,519.10","13,464.18",,,,,,,,,,,,,
Cigna,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Medical/Surgical,Relative Weights,"$16,723.99 ",IP,"11,830.00","16,723.99",,,,,,,,,,,,,
Cigna,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,026.68 ",IP,"10,195.20","11,830.00",,,,,,,,,,,,,
Cigna,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Medical/Surgical,Relative Weights,"$17,476.42 ",IP,"16,158.60","18,878.26",,,,,,,,,,,,,
Cigna,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,388.78 ",IP,"10,530.00","12,317.17",,,,,,,,,,,,,
Cigna,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$15,686.34 ",IP,"14,503.50","16,935.72",,,,,,,,,,,,,
Cigna,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,141.20 ",IP,"8,451.90","9,870.57",,,,,,,,,,,,,
Cigna,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Medical/Surgical,Relative Weights,"$13,117.54 ",IP,"12,128.40","14,188.16",,,,,,,,,,,,,
Cigna,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$26,416.13 ",IP,"24,424.20","28,489.97",,,,,,,,,,,,,
Cigna,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,248.63 ",IP,"13,174.20","15,425.67",,,,,,,,,,,,,
Cigna,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$17,776.23 ",IP,"16,435.80","19,162.38",,,,,,,,,,,,,
Cigna,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$10,992.61 ",IP,"10,163.70","11,865.73",,,,,,,,,,,,,
Cigna,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,939.71 ",IP,"8,265.60","9,640.12",,,,,,,,,,,,,
Cigna,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Relative Weights,"$14,841.43 ",IP,"13,722.30","16,017.06",,,,,,,,,,,,,
Cigna,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Relative Weights,"$9,439.06 ",IP,"8,727.30","10,175.74",,,,,,,,,,,,,
Cigna,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,652.22 ",IP,"6,150.60","7,189.31",,,,,,,,,,,,,
Cigna,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical/Surgical,Relative Weights,"$8,956.25 ",IP,"8,280.90","9,708.52",,,,,,,,,,,,,
Cigna,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,750.85 ",IP,"5,317.20","6,208.57",,,,,,,,,,,,,
Cigna,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Vaginal Delivery,Per Diem,"$3,245.00 ",IP,"3,245.00","12,320.33",,,,,,,,,,,,,
Cigna,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$15,745.72 ",IP,"14,558.40","17,051.47",,,,,,,,,,,,,
Cigna,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Medical/Surgical,Relative Weights,"$8,661.31 ",IP,"8,008.20","9,345.48",,,,,,,,,,,,,
Cigna,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical/Surgical,Relative Weights,"$7,538.98 ",IP,"6,970.50","8,090.08",,,,,,,,,,,,,
Cigna,DRG,MS-779,ABORTION WITHOUT D&C,Medical/Surgical,Relative Weights,"$10,308.31 ",IP,"9,531.00","10,948.13",,,,,,,,,,,,,
Cigna,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,C-Section,Per Diem,"$5,408.00 ",IP,"4,275.00","19,706.42",,,,,,,,,,,,,
Cigna,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,C-Section,Per Diem,"$5,408.00 ",IP,"4,275.00","11,521.63",,,,,,,,,,,,,
Cigna,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$5,408.00 ",IP,"4,275.00","9,631.70",,,,,,,,,,,,,
Cigna,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,C-Section,Per Diem,"$5,408.00 ",IP,"4,275.00","16,743.15",,,,,,,,,,,,,
Cigna,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,C-Section,Per Diem,"$5,408.00 ",IP,"4,275.00","11,182.79",,,,,,,,,,,,,
Cigna,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$5,408.00 ",IP,"4,275.00","9,334.95",,,,,,,,,,,,,
Cigna,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Vaginal Delivery,Per Diem,"$3,245.00 ",IP,"3,245.00","11,237.51",,,,,,,,,,,,,
Cigna,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Vaginal Delivery,Per Diem,"$3,245.00 ",IP,"3,245.00","9,680.11",,,,,,,,,,,,,
Cigna,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Diem,"$3,245.00 ",IP,"3,245.00","8,705.68",,,,,,,,,,,,,
Cigna,DRG,MS-799,SPLENECTOMY WITH MCC,Medical/Surgical,Relative Weights,"$50,104.79 ",IP,"46,326.60","54,129.26",,,,,,,,,,,,,
Cigna,DRG,MS-800,SPLENECTOMY WITH CC,Medical/Surgical,Relative Weights,"$28,753.26 ",IP,"26,585.10","31,057.58",,,,,,,,,,,,,
Cigna,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,392.06 ",IP,"15,156.00","17,715.47",,,,,,,,,,,,,
Cigna,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Medical/Surgical,Relative Weights,"$36,129.69 ",IP,"33,405.30","39,026.65",,,,,,,,,,,,,
Cigna,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Medical/Surgical,Relative Weights,"$18,363.19 ",IP,"16,978.50","19,833.75",,,,,,,,,,,,,
Cigna,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,295.67 ",IP,"12,293.10","14,355.48",,,,,,,,,,,,,
Cigna,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Vaginal Delivery,Per Diem,"$3,245.00 ",IP,"3,245.00","10,805.02",,,,,,,,,,,,,
Cigna,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Vaginal Delivery,Per Diem,"$3,245.00 ",IP,"3,245.00","7,722.83",,,,,,,,,,,,,
Cigna,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Diem,"$3,245.00 ",IP,"3,245.00","6,746.30",,,,,,,,,,,,,
Cigna,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$21,276.58 ",IP,"19,672.20","22,918.04",,,,,,,,,,,,,
Cigna,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$11,908.58 ",IP,"11,010.60","12,855.95",,,,,,,,,,,,,
Cigna,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,361.19 ",IP,"8,655.30","10,109.45",,,,,,,,,,,,,
Cigna,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$13,426.11 ",IP,"12,413.70","14,496.48",,,,,,,,,,,,,
Cigna,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,568.84 ",IP,"7,922.70","9,257.08",,,,,,,,,,,,,
Cigna,DRG,MS-813,COAGULATION DISORDERS,Medical/Surgical,Relative Weights,"$15,040.00 ",IP,"13,905.90","16,254.88",,,,,,,,,,,,,
Cigna,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical/Surgical,Relative Weights,"$18,413.81 ",IP,"17,025.30","19,896.89",,,,,,,,,,,,,
Cigna,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical/Surgical,Relative Weights,"$9,669.76 ",IP,"8,940.60","10,444.08",,,,,,,,,,,,,
Cigna,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,435.15 ",IP,"5,949.90","6,954.65",,,,,,,,,,,,,
Cigna,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$22,454.39 ",IP,"20,761.20","24,221.84",,,,,,,,,,,,,
Cigna,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$13,236.29 ",IP,"12,238.20","13,853.53",,,,,,,,,,,,,
Cigna,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,609.40 ",IP,"8,884.80","10,500.90",,,,,,,,,,,,,
Cigna,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$55,403.01 ",IP,"51,225.30","59,847.46",,,,,,,,,,,,,
Cigna,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$20,978.72 ",IP,"19,396.80","22,678.12",,,,,,,,,,,,,
Cigna,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$12,182.10 ",IP,"11,263.50","13,170.59",,,,,,,,,,,,,
Cigna,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$43,820.52 ",IP,"40,516.20","47,322.98",,,,,,,,,,,,,
Cigna,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$23,015.07 ",IP,"21,279.60","24,862.69",,,,,,,,,,,,,
Cigna,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,642.20 ",IP,"12,613.50","14,739.57",,,,,,,,,,,,,
Cigna,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$49,103.16 ",IP,"45,400.50","53,002.25",,,,,,,,,,,,,
Cigna,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$24,340.84 ",IP,"22,505.40","26,282.24",,,,,,,,,,,,,
Cigna,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,294.72 ",IP,"15,066.00","17,654.44",,,,,,,,,,,,,
Cigna,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Medical/Surgical,Relative Weights,"$31,230.57 ",IP,"28,875.60","33,733.58",,,,,,,,,,,,,
Cigna,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,425.79 ",IP,"13,338.00","15,537.21",,,,,,,,,,,,,
Cigna,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$10,919.60 ",IP,"10,096.20","11,797.34",,,,,,,,,,,,,
Cigna,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$7,575.97 ",IP,"7,004.70","8,205.84",,,,,,,,,,,,,
Cigna,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$5,227.16 ",IP,"4,833.00","5,640.33",,,,,,,,,,,,,
Cigna,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$58,912.11 ",IP,"54,469.80","63,665.20",,,,,,,,,,,,,
Cigna,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$20,574.76 ",IP,"19,023.30","22,242.47",,,,,,,,,,,,,
Cigna,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,422.85 ",IP,"10,561.50","12,307.70",,,,,,,,,,,,,
Cigna,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical/Surgical,Relative Weights,"$55,476.99 ",IP,"51,293.70","59,972.68",,,,,,,,,,,,,
Cigna,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical/Surgical,Relative Weights,"$22,000.79 ",IP,"20,341.80","23,769.35",,,,,,,,,,,,,
Cigna,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,476.40 ",IP,"13,384.80","15,640.33",,,,,,,,,,,,,
Cigna,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical/Surgical,Relative Weights,"$31,348.35 ",IP,"28,984.50","33,838.81",,,,,,,,,,,,,
Cigna,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical/Surgical,Relative Weights,"$15,784.65 ",IP,"14,594.40","17,055.68",,,,,,,,,,,,,
Cigna,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,678.20 ",IP,"9,873.00","11,525.84",,,,,,,,,,,,,
Cigna,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$18,568.58 ",IP,"17,168.40","20,024.22",,,,,,,,,,,,,
Cigna,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$11,527.00 ",IP,"10,657.80","12,422.40",,,,,,,,,,,,,
Cigna,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,263.19 ",IP,"7,640.10","8,917.19",,,,,,,,,,,,,
Cigna,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$26,018.01 ",IP,"24,056.10","28,095.36",,,,,,,,,,,,,
Cigna,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$13,005.60 ",IP,"12,024.90","14,050.31",,,,,,,,,,,,,
Cigna,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,048.41 ",IP,"9,290.70","10,828.17",,,,,,,,,,,,,
Cigna,DRG,MS-849,RADIOTHERAPY,Medical/Surgical,Relative Weights,"$24,272.70 ",IP,"22,442.40","26,175.96",,,,,,,,,,,,,
Cigna,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$48,356.57 ",IP,"44,710.20","52,032.03",,,,,,,,,,,,,
Cigna,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$20,657.49 ",IP,"19,099.80","22,039.37",,,,,,,,,,,,,
Cigna,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$14,793.73 ",IP,"13,678.20","15,731.89",,,,,,,,,,,,,
Cigna,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$45,398.40 ",IP,"41,975.10","47,834.40",,,,,,,,,,,,,
Cigna,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Relative Weights,"$20,464.76 ",IP,"18,921.60","21,411.15",,,,,,,,,,,,,
Cigna,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,234.35 ",IP,"12,236.40","14,189.21",,,,,,,,,,,,,
Cigna,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical/Surgical,Relative Weights,"$18,462.48 ",IP,"17,070.30","19,770.61",,,,,,,,,,,,,
Cigna,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,844.97 ",IP,"9,102.60","10,285.18",,,,,,,,,,,,,
Cigna,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical/Surgical,Relative Weights,"$8,531.85 ",IP,"7,888.50","9,207.63",,,,,,,,,,,,,
Cigna,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical/Surgical,Relative Weights,"$14,384.91 ",IP,"13,300.20","15,562.46",,,,,,,,,,,,,
Cigna,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,166.83 ",IP,"7,551.00","8,809.86",,,,,,,,,,,,,
Cigna,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$21,775.93 ",IP,"20,133.90","23,461.03",,,,,,,,,,,,,
Cigna,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical/Surgical,Relative Weights,"$10,376.44 ",IP,"9,594.00","11,137.54",,,,,,,,,,,,,
Cigna,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,091.22 ",IP,"6,556.50","7,639.70",,,,,,,,,,,,,
Cigna,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical/Surgical,Relative Weights,"$62,677.23 ",IP,"57,951.00","67,608.17",,,,,,,,,,,,,
Cigna,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical/Surgical,Relative Weights,"$18,223.99 ",IP,"16,849.80","19,659.07",,,,,,,,,,,,,
Cigna,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,990.00 ",IP,"9,236.70","10,750.30",,,,,,,,,,,,,
Cigna,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Medical/Surgical,Relative Weights,"$31,810.71 ",IP,"29,412.00","34,318.66",,,,,,,,,,,,,
Cigna,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Medical/Surgical,Relative Weights,"$41,551.53 ",IP,"38,418.30","44,851.13",,,,,,,,,,,,,
Cigna,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Medical/Surgical,Relative Weights,"$19,120.50 ",IP,"17,678.70","20,650.34",,,,,,,,,,,,,
Cigna,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$11,051.01 ",IP,"10,217.70","11,937.29",,,,,,,,,,,,,
Cigna,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Medical/Surgical,Relative Weights,"$36,278.62 ",IP,"33,543.00","39,160.29",,,,,,,,,,,,,
Cigna,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,061.10 ",IP,"14,850.00","17,277.71",,,,,,,,,,,,,
Cigna,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Medical/Surgical,Relative Weights,"$17,558.19 ",IP,"16,234.20","18,876.16",,,,,,,,,,,,,
Cigna,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Medical/Surgical,Relative Weights,"$38,431.78 ",IP,"35,533.80","41,640.56",,,,,,,,,,,,,
Cigna,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Medical/Surgical,Relative Weights,"$19,958.59 ",IP,"18,453.60","21,471.13",,,,,,,,,,,,,
Cigna,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$13,345.31 ",IP,"12,339.00","14,468.07",,,,,,,,,,,,,
Cigna,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical/Surgical,Relative Weights,"$15,950.13 ",IP,"14,747.40","17,219.84",,,,,,,,,,,,,
Cigna,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical/Surgical,Relative Weights,"$8,633.08 ",IP,"7,982.10","9,350.74",,,,,,,,,,,,,
Cigna,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical/Surgical,Relative Weights,"$16,542.93 ",IP,"15,295.50","17,863.84",,,,,,,,,,,,,
Cigna,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical/Surgical,Relative Weights,"$6,408.87 ",IP,"5,925.60","6,916.77",,,,,,,,,,,,,
Cigna,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical/Surgical,Relative Weights,"$14,391.72 ",IP,"13,306.50","15,547.73",,,,,,,,,,,,,
Cigna,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,705.43 ",IP,"7,124.40","8,324.75",,,,,,,,,,,,,
Cigna,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical/Surgical,Relative Weights,"$17,950.47 ",IP,"16,596.90","19,303.39",,,,,,,,,,,,,
Cigna,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical/Surgical,Relative Weights,"$9,973.46 ",IP,"9,221.40","10,810.28",,,,,,,,,,,,,
Cigna,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$6,793.36 ",IP,"6,281.10","7,275.60",,,,,,,,,,,,,
Cigna,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical/Surgical,Relative Weights,"$15,459.54 ",IP,"14,293.80","16,706.31",,,,,,,,,,,,,
Cigna,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical/Surgical,Relative Weights,"$9,148.01 ",IP,"8,458.20","9,790.60",,,,,,,,,,,,,
Cigna,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Medical/Surgical,Relative Weights,"$205,302.71 ",IP,"189,821.70","221,308.16",,,,,,,,,,,,,
Cigna,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Medical/Surgical,Relative Weights,"$63,578.59 ",IP,"58,784.40","68,600.49",,,,,,,,,,,,,
Cigna,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$29,337.30 ",IP,"27,125.10","31,662.65",,,,,,,,,,,,,
Cigna,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical/Surgical,Relative Weights,"$22,027.07 ",IP,"20,366.10","23,756.72",,,,,,,,,,,,,
Cigna,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical/Surgical,Relative Weights,"$18,892.72 ",IP,"17,468.10","20,386.21",,,,,,,,,,,,,
Cigna,DRG,MS-935,NON-EXTENSIVE BURNS,Medical/Surgical,Relative Weights,"$18,814.85 ",IP,"17,396.10","20,344.12",,,,,,,,,,,,,
Cigna,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Medical/Surgical,Relative Weights,"$32,848.36 ",IP,"30,371.40","35,632.98",,,,,,,,,,,,,
Cigna,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Medical/Surgical,Relative Weights,"$21,618.24 ",IP,"19,988.10","23,335.80",,,,,,,,,,,,,
Cigna,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$18,719.46 ",IP,"17,307.90","20,253.62",,,,,,,,,,,,,
Cigna,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical/Surgical,Relative Weights,"$11,622.40 ",IP,"10,746.00","12,523.42",,,,,,,,,,,,,
Cigna,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical/Surgical,Relative Weights,"$7,661.63 ",IP,"7,083.90","8,266.87",,,,,,,,,,,,,
Cigna,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical/Surgical,Relative Weights,"$10,803.77 ",IP,"9,989.10","11,650.01",,,,,,,,,,,,,
Cigna,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$7,205.11 ",IP,"6,661.80","7,775.44",,,,,,,,,,,,,
Cigna,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical/Surgical,Relative Weights,"$5,447.15 ",IP,"5,036.40","5,873.94",,,,,,,,,,,,,
Cigna,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Medical/Surgical,Relative Weights,"$61,220.05 ",IP,"56,603.70","66,168.62",,,,,,,,,,,,,
Cigna,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Medical/Surgical,Relative Weights,"$37,475.90 ",IP,"34,650.00","40,500.92",,,,,,,,,,,,,
Cigna,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical/Surgical,Relative Weights,"$72,235.04 ",IP,"66,788.10","78,089.08",,,,,,,,,,,,,
Cigna,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical/Surgical,Relative Weights,"$40,938.28 ",IP,"37,851.30","44,253.42",,,,,,,,,,,,,
Cigna,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$26,633.20 ",IP,"24,624.90","28,771.99",,,,,,,,,,,,,
Cigna,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical/Surgical,Relative Weights,"$26,572.85 ",IP,"24,569.10","28,666.76",,,,,,,,,,,,,
Cigna,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical/Surgical,Relative Weights,"$14,521.18 ",IP,"13,426.20","15,662.43",,,,,,,,,,,,,
Cigna,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$8,882.28 ",IP,"8,212.50","9,606.45",,,,,,,,,,,,,
Cigna,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Medical/Surgical,Relative Weights,"$56,962.39 ",IP,"52,667.10","60,900.81",,,,,,,,,,,,,
Cigna,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Medical/Surgical,Relative Weights,"$29,092.01 ",IP,"26,898.30","30,991.29",,,,,,,,,,,,,
Cigna,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical/Surgical,Relative Weights,"$26,189.33 ",IP,"24,214.50","28,261.62",,,,,,,,,,,,,
Cigna,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical/Surgical,Relative Weights,"$12,479.96 ",IP,"11,538.90","13,459.97",,,,,,,,,,,,,
Cigna,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$9,243.41 ",IP,"8,546.40","9,987.38",,,,,,,,,,,,,
Cigna,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical/Surgical,Relative Weights,"$12,890.74 ",IP,"11,918.70","13,898.78",,,,,,,,,,,,,
Cigna,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$44,917.54 ",IP,"41,530.50","48,487.88",,,,,,,,,,,,,
Cigna,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$24,691.26 ",IP,"22,829.40","26,743.15",,,,,,,,,,,,,
Cigna,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$16,083.49 ",IP,"14,870.70","17,413.46",,,,,,,,,,,,,
Cigna,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Relative Weights,"$31,887.61 ",IP,"29,483.10","34,327.08",,,,,,,,,,,,,
Cigna,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Relative Weights,"$16,610.10 ",IP,"15,357.60","17,686.01",,,,,,,,,,,,,
Cigna,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Relative Weights,"$10,937.12 ",IP,"10,112.40","11,742.62",,,,,,,,,,,,,
Cigna,ExceptRevenueCode,274,Medical/Surgical Supplies: Prosthetic/Orthotic devices,Prosthetics and Orthotics,Straight Discount,50.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,275,Medical/Surgical Supplies: Pacemaker,Prosthetics and Orthotics,Straight Discount,50.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,276,Medical/Surgical Supplies: Intraocular lens,Prosthetics and Orthotics,Straight Discount,50.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,278,Medical/Surgical Supplies: Other implants,Implants,Straight Discount,50.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,300,Laboratory - Clinical Diagnostic,Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,301,Laboratory - Clinical Diagnostic: Chemistry,Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,302,Laboratory - Clinical Diagnostic: Immunology,Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,303,Laboratory - Clinical Diagnostic: Renal patient (home),Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,304,Laboratory - Clinical Diagnostic: Nonroutine dialysis,Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,305,Laboratory - Clinical Diagnostic: Hematology,Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,306,Laboratory - Clinical Diagnostic: Bacteriology/microbiology,Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,307,Laboratory - Clinical Diagnostic: Urology,Lab Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,320,Radiology - Diagnostic,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,321,Radiology - Diagnostic: Angiocardiography,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,322,Radiology - Diagnostic: Arthrography,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,323,Radiology - Diagnostic: Arteriography,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,324,Radiology - Diagnostic: Chest X-ray,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,329,Radiology - Diagnostic: Other,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,330,Radiology - Therapeutic,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,331,Radiology - Therapeutic: Chemotherapy - injected,Chemotherapy Administration,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,332,Radiology - Therapeutic: Chemotherapy - oral,Chemotherapy Administration,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,333,Radiology - Therapeutic: Radiation therapy,Radiation Therapy,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,335,Radiology - Therapeutic: Chemotherapy - IV,Chemotherapy Administration,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,339,Radiology - Therapeutic: Other,Radiology Services,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,340,Nuclear Medicine,Nuclear Medicine,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,341,Nuclear Medicine: Diagnostic,Nuclear Medicine,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,342,Nuclear Medicine: Therapeutic,Nuclear Medicine,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,349,Nuclear Medicine: Other,Nuclear Medicine,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,350,CT Scan,CT Scan,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,351,CT Scan: Head,CT Scan,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,352,CT Scan: Body,CT Scan,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,359,CT Scan: Other CT scans,CT Scan,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,360,Operating Room Services,Ambulatory Surgery,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,361,Operating Room Services: Minor surgery,Ambulatory Surgery,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,369,Operating Room Services: Other operating room services,Ambulatory Surgery,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,404,Other Imaging Services: PET scan,PET Scan,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,410,Respiratory Services,Respiratory Therapy,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,412,Respiratory Services: Inhalation services,Respiratory Therapy,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,413,Respiratory Services: Hyberbaric oxygen therapy,Respiratory Therapy,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,419,Respiratory Services: Other respiratory services,Respiratory Therapy,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,420,Physical Therapy,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,421,Physical Therapy: Visit charge,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,422,Physical Therapy: Hourly charge,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,423,Physical Therapy: Group rate,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,424,Physical Therapy: Evaluation/re-evaluation,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,429,Physical Therapy: Other physical therapy,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,430,Occupational Therapy,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,431,Occupational Therapy: Visit charge,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,432,Occupational Therapy: Hourly charge,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,433,Occupational Therapy: Group rate,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,434,Occupational Therapy: Evaluation/re-evaluation,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,439,Occupational Therapy: Other occupational therapy,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,440,Speech-Language Pathology,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,441,Speech-Language Pathology: Visit charge,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,442,Speech-Language Pathology: Hourly charge,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,443,Speech-Language Pathology: Group rate,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,444,Speech-Language Pathology: Evaluation/ re-evaluation,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,449,Speech-Language Pathology: Other speech language pathology,,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,450,Emergency Room,ER,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,451,Emergency Room: EM/EMTALA,ER,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,452,Emergency Room: ER/ Beyond EMTALA,ER,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,459,Emergency Room: Other emergency room,ER,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,481,Cardiology: Cardiac catheter lab,Cardiac Cath,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,490,Ambulatory Surgery,Ambulatory Surgery,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,499,Ambulatory Surgery: Other ambulatory surgical care,Ambulatory Surgery,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,610,Magnetic Resonance Tech. (MRT),MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,611,Magnetic Resonance Tech. (MRT): Brain (incl. Brainstem),MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,612,Magnetic Resonance Tech. (MRT): Spinal cord (incl. spine),MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,614,Magnetic Resonance Tech. (MRT): MRI - Other,MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,615,Magnetic Resonance Tech. (MRT): MRA - Head and Neck,MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,616,Magnetic Resonance Tech. (MRT): MRA - Lower Ext,MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,618,Magnetic Resonance Tech. (MRT): MRA - Other,MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,619,Magnetic Resonance Tech. (MRT): Other MRI,MRI,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,636,Drugs Require Specific ID: Drugs requiring detail coding,Drugs,Straight Discount,60.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,750,Gastrointestinal,Ambulatory Surgery,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,762,Treatment/Observation Room: Observation room,Observation,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,790,Extra-Corp Shock Wage Therapy,Ambulatory Surgery,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,821,Hemo OPD/Home: Hemodialysis comp or other rate,Dialysis,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,831,Peritoneal OPD/Home: Peritoneal comp or other rate,Dialysis,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,841,CAPD OPD/Home: CAPD comp or other rate,Dialysis,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,ExceptRevenueCode,851,CCPD OPD/Home: CCPD comp or other rate,Dialysis,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,CPT,59000,Amniocentesis diagnostic,Amniocentesis,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,CPT,59001,Amniocentesis therapeutic,Amniocentesis,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Cigna,CPT,59025,Fetal non-stress test,Fetal Non-Stress Test,Straight Discount,65.00%,OP,,,,,,,,,,,,,,,
Community Care Network,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"281,947.26",,,,,,,,,,,,,
Community Care Network,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"155,072.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"284,088.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"224,999.56",,,,,,,,,,,,,
Community Care Network,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Surgical,Straight Discount,90.00%,IP,930,"99,513.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"45,669.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-007,LUNG TRANSPLANT,Surgical,Straight Discount,90.00%,IP,930,"112,664.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Surgical,Straight Discount,90.00%,IP,930,"52,824.47",,,,,,,,,,,,,
Community Care Network,DRG,MS-010,PANCREAS TRANSPLANT,Surgical,Straight Discount,90.00%,IP,930,"35,214.69",,,,,,,,,,,,,
Community Care Network,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"48,829.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Surgical,Straight Discount,90.00%,IP,930,"74,654.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"29,317.87",,,,,,,,,,,,,
Community Care Network,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Surgical,Straight Discount,90.00%,IP,930,"124,388.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"65,472.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"47,017.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,Medical,Straight Discount,90.00%,IP,880,"363,360.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Surgical,Straight Discount,90.00%,IP,930,"64,846.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"100,455.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Surgical,Straight Discount,90.00%,IP,930,"73,312.59",,,,,,,,,,,,,
Community Care Network,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"47,303.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Surgical,Straight Discount,90.00%,IP,930,"73,951.33",,,,,,,,,,,,,
Community Care Network,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"39,702.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"100,858.36",,,,,,,,,,,,,
Community Care Network,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"47,469.26",,,,,,,,,,,,,
Community Care Network,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"29,826.86",,,,,,,,,,,,,
Community Care Network,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"56,651.88",,,,,,,,,,,,,
Community Care Network,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Surgical,Straight Discount,90.00%,IP,930,"39,621.18",,,,,,,,,,,,,
Community Care Network,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"29,340.89",,,,,,,,,,,,,
Community Care Network,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"42,499.62",,,,,,,,,,,,,
Community Care Network,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"24,825.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,749.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"38,688.76",,,,,,,,,,,,,
Community Care Network,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,749.33",,,,,,,,,,,,,
Community Care Network,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,019.58",,,,,,,,,,,,,
Community Care Network,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"33,522.99",,,,,,,,,,,,,
Community Care Network,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,772.44",,,,,,,,,,,,,
Community Care Network,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,297.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"74,748.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Surgical,Straight Discount,90.00%,IP,930,"22,882.69",,,,,,,,,,,,,
Community Care Network,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,244.51",,,,,,,,,,,,,
Community Care Network,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"17,960.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"11,058.80",,,,,,,,,,,,,
Community Care Network,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"26,640.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"16,029.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"21,291.18",,,,,,,,,,,,,
Community Care Network,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"12,305.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,905.04",,,,,,,,,,,,,
Community Care Network,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,554.38",,,,,,,,,,,,,
Community Care Network,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,686.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical,Straight Discount,90.00%,IP,880,"28,113.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical,Straight Discount,90.00%,IP,880,"19,343.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"16,644.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"29,588.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical,Straight Discount,90.00%,IP,880,"15,543.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"12,253.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,867.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"12,660.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical,Straight Discount,90.00%,IP,880,"9,563.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,318.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"9,839.13",,,,,,,,,,,,,
Community Care Network,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,341.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,444.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"9,913.11",,,,,,,,,,,,,
Community Care Network,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"15,827.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,548.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,911.51",,,,,,,,,,,,,
Community Care Network,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical,Straight Discount,90.00%,IP,880,"9,237.57",,,,,,,,,,,,,
Community Care Network,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,074.67",,,,,,,,,,,,,
Community Care Network,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical,Straight Discount,90.00%,IP,880,"20,363.53",,,,,,,,,,,,,
Community Care Network,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"10,010.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical,Straight Discount,90.00%,IP,880,"21,980.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical,Straight Discount,90.00%,IP,880,"16,494.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,801.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical,Straight Discount,90.00%,IP,880,"45,763.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical,Straight Discount,90.00%,IP,880,"17,459.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,138.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-088,CONCUSSION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,204.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-089,CONCUSSION WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,793.62",,,,,,,,,,,,,
Community Care Network,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"10,126.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,050.39",,,,,,,,,,,,,
Community Care Network,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical,Straight Discount,90.00%,IP,880,"12,405.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"10,377.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical,Straight Discount,90.00%,IP,880,"50,515.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical,Straight Discount,90.00%,IP,880,"33,641.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"22,694.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"36,527.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical,Straight Discount,90.00%,IP,880,"38,577.09",,,,,,,,,,,,,
Community Care Network,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"13,601.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-100,SEIZURES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"21,842.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-101,SEIZURES WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,634.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-102,HEADACHES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"11,210.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-103,HEADACHES WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,918.22",,,,,,,,,,,,,
Community Care Network,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"21,334.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,070.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Surgical,Straight Discount,90.00%,IP,930,"14,146.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,272.66",,,,,,,,,,,,,
Community Care Network,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"10,112.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"11,570.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"6,709.38",,,,,,,,,,,,,
Community Care Network,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical,Straight Discount,90.00%,IP,880,"8,500.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,615.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,131.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,836.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,221.04",,,,,,,,,,,,,
Community Care Network,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,295.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,787.56",,,,,,,,,,,,,
Community Care Network,DRG,MS-139,SALIVARY GLAND PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"11,941.67",,,,,,,,,,,,,
Community Care Network,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"38,747.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"21,487.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,660.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"28,849.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"17,039.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,812.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"19,790.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical,Straight Discount,90.00%,IP,880,"12,664.91",,,,,,,,,,,,,
Community Care Network,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,653.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-149,DYSEQUILIBRIUM,Medical,Straight Discount,90.00%,IP,880,"7,392.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-150,EPISTAXIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"12,894.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,173.96",,,,,,,,,,,,,
Community Care Network,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical,Straight Discount,90.00%,IP,880,"10,482.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"6,916.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,014.70",,,,,,,,,,,,,
Community Care Network,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical,Straight Discount,90.00%,IP,880,"8,892.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,456.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,305.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical,Straight Discount,90.00%,IP,880,"9,313.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"6,737.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"101,978.91",,,,,,,,,,,,,
Community Care Network,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"39,411.86",,,,,,,,,,,,,
Community Care Network,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,578.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"46,767.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"30,246.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"22,687.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical,Straight Discount,90.00%,IP,880,"18,304.55",,,,,,,,,,,,,
Community Care Network,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"15,051.96",,,,,,,,,,,,,
Community Care Network,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"28,695.97",,,,,,,,,,,,,
Community Care Network,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical,Straight Discount,90.00%,IP,880,"23,962.45",,,,,,,,,,,,,
Community Care Network,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"12,328.33",,,,,,,,,,,,,
Community Care Network,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"24,073.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical,Straight Discount,90.00%,IP,880,"16,177.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,666.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,222.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical,Straight Discount,90.00%,IP,880,"15,216.38",,,,,,,,,,,,,
Community Care Network,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,201.76",,,,,,,,,,,,,
Community Care Network,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"40,210.79",,,,,,,,,,,,,
Community Care Network,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical,Straight Discount,90.00%,IP,880,"12,210.89",,,,,,,,,,,,,
Community Care Network,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,884.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical,Straight Discount,90.00%,IP,880,"16,929.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,531.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,266.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,118.38",,,,,,,,,,,,,
Community Care Network,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"19,397.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,652.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,432.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,102.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical,Straight Discount,90.00%,IP,880,"17,659.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,378.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical,Straight Discount,90.00%,IP,880,"19,033.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical,Straight Discount,90.00%,IP,880,"15,173.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,175.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,399.15",,,,,,,,,,,,,
Community Care Network,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"6,867.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical,Straight Discount,90.00%,IP,880,"8,328.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"34,334.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,606.80",,,,,,,,,,,,,
Community Care Network,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical,Straight Discount,90.00%,IP,880,"76,148.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical,Straight Discount,90.00%,IP,880,"31,656.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Surgical,Straight Discount,90.00%,IP,930,"108,611.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"126,394.99",,,,,,,,,,,,,
Community Care Network,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Surgical,Straight Discount,90.00%,IP,930,"74,069.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"50,063.91",,,,,,,,,,,,,
Community Care Network,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"95,509.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Surgical,Straight Discount,90.00%,IP,930,"60,249.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"57,682.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"81,970.99",,,,,,,,,,,,,
Community Care Network,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"60,468.58",,,,,,,,,,,,,
Community Care Network,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"71,663.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"54,771.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"64,359.26",,,,,,,,,,,,,
Community Care Network,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"51,121.99",,,,,,,,,,,,,
Community Care Network,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"60,499.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"57,167.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"82,643.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"57,414.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"137,557.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"52,820.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"94,461.59",,,,,,,,,,,,,
Community Care Network,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"49,122.62",,,,,,,,,,,,,
Community Care Network,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"84,834.80",,,,,,,,,,,,,
Community Care Network,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Surgical,Straight Discount,90.00%,IP,930,"54,863.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"19,430.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"41,106.15",,,,,,,,,,,,,
Community Care Network,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Surgical,Straight Discount,90.00%,IP,930,"32,586.89",,,,,,,,,,,,,
Community Care Network,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,107.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-245,AICD GENERATOR PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"52,699.88",,,,,,,,,,,,,
Community Care Network,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Straight Discount,90.00%,IP,930,"30,425.56",,,,,,,,,,,,,
Community Care Network,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"19,353.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Straight Discount,90.00%,IP,930,"30,894.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"32,084.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"24,556.94",,,,,,,,,,,,,
Community Care Network,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"24,457.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"61,448.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"37,067.89",,,,,,,,,,,,,
Community Care Network,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"21,026.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"24,753.56",,,,,,,,,,,,,
Community Care Network,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"19,755.71",,,,,,,,,,,,,
Community Care Network,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,301.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"31,161.45",,,,,,,,,,,,,
Community Care Network,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"20,638.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"34,888.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Surgical,Straight Discount,90.00%,IP,930,"19,383.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,626.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-263,VEIN LIGATION AND STRIPPING,Surgical,Straight Discount,90.00%,IP,930,"22,439.79",,,,,,,,,,,,,
Community Care Network,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"31,614.09",,,,,,,,,,,,,
Community Care Network,DRG,MS-265,AICD LEAD PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"32,732.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"69,084.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"54,519.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"67,696.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"41,998.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"50,437.69",,,,,,,,,,,,,
Community Care Network,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"34,697.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"26,172.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"37,351.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"31,980.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"29,690.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical,Straight Discount,90.00%,IP,880,"23,082.57",,,,,,,,,,,,,
Community Care Network,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"20,276.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical,Straight Discount,90.00%,IP,880,"38,792.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical,Straight Discount,90.00%,IP,880,"25,216.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"4,831.96",,,,,,,,,,,,,
Community Care Network,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"31,281.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"20,170.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"47,943.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical,Straight Discount,90.00%,IP,880,"15,989.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,963.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical,Straight Discount,90.00%,IP,880,"24,955.04",,,,,,,,,,,,,
Community Care Network,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,086.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,312.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"12,745.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,551.97",,,,,,,,,,,,,
Community Care Network,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,523.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical,Straight Discount,90.00%,IP,880,"6,858.58",,,,,,,,,,,,,
Community Care Network,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"4,752.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,496.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"10,144.77",,,,,,,,,,,,,
Community Care Network,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,251.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,024.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"13,191.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-304,HYPERTENSION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"10,664.57",,,,,,,,,,,,,
Community Care Network,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,013.43",,,,,,,,,,,,,
Community Care Network,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,637.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,453.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,068.11",,,,,,,,,,,,,
Community Care Network,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"10,737.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,351.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-311,ANGINA PECTORIS,Medical,Straight Discount,90.00%,IP,880,"6,784.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical,Straight Discount,90.00%,IP,880,"8,308.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-313,CHEST PAIN,Medical,Straight Discount,90.00%,IP,880,"7,016.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"21,590.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical,Straight Discount,90.00%,IP,880,"14,251.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"10,062.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"42,010.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"23,786.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"72,806.55",,,,,,,,,,,,,
Community Care Network,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"36,840.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"21,222.70",,,,,,,,,,,,,
Community Care Network,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"58,786.79",,,,,,,,,,,,,
Community Care Network,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"32,076.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"22,739.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-332,RECTAL RESECTION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"40,490.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-333,RECTAL RESECTION WITH CC,Surgical,Straight Discount,90.00%,IP,930,"23,168.53",,,,,,,,,,,,,
Community Care Network,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"22,161.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"40,376.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"30,773.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"19,745.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"42,970.69",,,,,,,,,,,,,
Community Care Network,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"29,459.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,383.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"22,545.89",,,,,,,,,,,,,
Community Care Network,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"16,376.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,823.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"27,263.96",,,,,,,,,,,,,
Community Care Network,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"24,196.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,121.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"23,961.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"14,526.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"9,532.51",,,,,,,,,,,,,
Community Care Network,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"23,871.66",,,,,,,,,,,,,
Community Care Network,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"14,886.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"10,736.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"42,132.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,629.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,128.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"41,772.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"21,937.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,746.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,906.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"14,533.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,008.96",,,,,,,,,,,,,
Community Care Network,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"20,975.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical,Straight Discount,90.00%,IP,880,"14,263.75",,,,,,,,,,,,,
Community Care Network,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,237.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"20,879.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical,Straight Discount,90.00%,IP,880,"16,469.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,713.88",,,,,,,,,,,,,
Community Care Network,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,510.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,201.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,353.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,330.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical,Straight Discount,90.00%,IP,880,"16,393.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,875.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical,Straight Discount,90.00%,IP,880,"12,760.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,686.62",,,,,,,,,,,,,
Community Care Network,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,760.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical,Straight Discount,90.00%,IP,880,"12,619.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"11,388.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,414.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical,Straight Discount,90.00%,IP,880,"9,770.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,374.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,398.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,984.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,096.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical,Straight Discount,90.00%,IP,880,"10,892.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,654.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"112,898.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"41,825.91",,,,,,,,,,,,,
Community Care Network,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"27,794.09",,,,,,,,,,,,,
Community Care Network,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"39,095.75",,,,,,,,,,,,,
Community Care Network,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Surgical,Straight Discount,90.00%,IP,930,"20,580.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,240.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"36,525.86",,,,,,,,,,,,,
Community Care Network,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,151.66",,,,,,,,,,,,,
Community Care Network,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"24,838.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"47,586.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Surgical,Straight Discount,90.00%,IP,930,"25,671.18",,,,,,,,,,,,,
Community Care Network,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,836.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"23,590.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Surgical,Straight Discount,90.00%,IP,930,"19,926.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,420.41",,,,,,,,,,,,,
Community Care Network,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"34,206.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"18,581.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,127.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"40,678.39",,,,,,,,,,,,,
Community Care Network,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,209.09",,,,,,,,,,,,,
Community Care Network,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,022.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"19,308.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,980.70",,,,,,,,,,,,,
Community Care Network,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,045.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,484.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,731.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,707.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"25,887.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical,Straight Discount,90.00%,IP,880,"14,357.76",,,,,,,,,,,,,
Community Care Network,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,273.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"20,401.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical,Straight Discount,90.00%,IP,880,"14,680.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,700.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,244.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,433.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,848.68",,,,,,,,,,,,,
Community Care Network,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"89,490.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Surgical,Straight Discount,90.00%,IP,930,"59,358.91",,,,,,,,,,,,,
Community Care Network,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"46,635.59",,,,,,,,,,,,,
Community Care Network,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"83,693.91",,,,,,,,,,,,,
Community Care Network,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"63,290.47",,,,,,,,,,,,,
Community Care Network,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"48,839.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"65,527.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"38,280.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"59,145.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"30,605.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"103,000.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"33,683.44",,,,,,,,,,,,,
Community Care Network,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,945.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"52,028.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Surgical,Straight Discount,90.00%,IP,930,"34,810.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"27,294.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Surgical,Straight Discount,90.00%,IP,930,"31,852.97",,,,,,,,,,,,,
Community Care Network,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"18,493.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"48,833.53",,,,,,,,,,,,,
Community Care Network,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Surgical,Straight Discount,90.00%,IP,930,"29,719.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"24,726.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"39,644.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"25,444.94",,,,,,,,,,,,,
Community Care Network,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,391.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"32,676.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Surgical,Straight Discount,90.00%,IP,930,"41,472.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,611.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"33,955.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Surgical,Straight Discount,90.00%,IP,930,"27,785.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,467.71",,,,,,,,,,,,,
Community Care Network,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Surgical,Straight Discount,90.00%,IP,930,"23,228.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"33,169.58",,,,,,,,,,,,,
Community Care Network,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Surgical,Straight Discount,90.00%,IP,930,"37,924.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,429.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"19,220.76",,,,,,,,,,,,,
Community Care Network,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"13,956.09",,,,,,,,,,,,,
Community Care Network,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"33,759.46",,,,,,,,,,,,,
Community Care Network,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,633.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,026.39",,,,,,,,,,,,,
Community Care Network,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"35,375.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Surgical,Straight Discount,90.00%,IP,930,"19,327.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,198.99",,,,,,,,,,,,,
Community Care Network,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"25,155.58",,,,,,,,,,,,,
Community Care Network,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,668.15",,,,,,,,,,,,,
Community Care Network,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"30,700.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"18,582.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,954.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-503,FOOT PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"25,587.77",,,,,,,,,,,,,
Community Care Network,DRG,MS-504,FOOT PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"17,267.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,267.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"22,732.26",,,,,,,,,,,,,
Community Care Network,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"19,685.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"13,763.88",,,,,,,,,,,,,
Community Care Network,DRG,MS-509,ARTHROSCOPY,Surgical,Straight Discount,90.00%,IP,930,"16,292.77",,,,,,,,,,,,,
Community Care Network,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"26,580.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"19,161.38",,,,,,,,,,,,,
Community Care Network,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,148.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,495.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"9,677.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"30,535.56",,,,,,,,,,,,,
Community Care Network,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"20,939.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,164.18",,,,,,,,,,,,,
Community Care Network,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Surgical,Straight Discount,90.00%,IP,930,"34,889.58",,,,,,,,,,,,,
Community Care Network,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Surgical,Straight Discount,90.00%,IP,930,"19,056.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"13,796.97",,,,,,,,,,,,,
Community Care Network,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"29,819.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"21,308.70",,,,,,,,,,,,,
Community Care Network,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,750.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"9,003.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"12,009.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"10,296.75",,,,,,,,,,,,,
Community Care Network,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,083.77",,,,,,,,,,,,,
Community Care Network,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"11,438.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,895.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical,Straight Discount,90.00%,IP,880,"16,619.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"11,354.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"42,249.68",,,,,,,,,,,,,
Community Care Network,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical,Straight Discount,90.00%,IP,880,"21,655.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"12,656.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"28,263.70",,,,,,,,,,,,,
Community Care Network,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"17,348.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"10,953.43",,,,,,,,,,,,,
Community Care Network,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"19,756.13",,,,,,,,,,,,,
Community Care Network,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical,Straight Discount,90.00%,IP,880,"12,137.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,709.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"20,193.22",,,,,,,,,,,,,
Community Care Network,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"9,169.43",,,,,,,,,,,,,
Community Care Network,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"12,345.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,693.75",,,,,,,,,,,,,
Community Care Network,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,265.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,848.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,568.22",,,,,,,,,,,,,
Community Care Network,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,354.69",,,,,,,,,,,,,
Community Care Network,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,182.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,188.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,700.57",,,,,,,,,,,,,
Community Care Network,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,525.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"9,252.79",,,,,,,,,,,,,
Community Care Network,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,735.33",,,,,,,,,,,,,
Community Care Network,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical,Straight Discount,90.00%,IP,880,"17,516.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,315.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"27,608.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Surgical,Straight Discount,90.00%,IP,930,"15,893.68",,,,,,,,,,,,,
Community Care Network,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"10,732.71",,,,,,,,,,,,,
Community Care Network,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"53,900.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"31,618.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,146.44",,,,,,,,,,,,,
Community Care Network,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"49,165.46",,,,,,,,,,,,,
Community Care Network,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"40,864.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,873.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"28,499.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"15,577.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,187.94",,,,,,,,,,,,,
Community Care Network,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,922.88",,,,,,,,,,,,,
Community Care Network,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,969.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,757.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,904.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-592,SKIN ULCERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,418.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-593,SKIN ULCERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,065.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,969.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"19,585.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"9,628.87",,,,,,,,,,,,,
Community Care Network,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,931.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"10,816.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"6,533.46",,,,,,,,,,,,,
Community Care Network,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,692.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,644.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-602,CELLULITIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,311.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,223.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,516.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"10,528.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,708.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,036.39",,,,,,,,,,,,,
Community Care Network,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"23,233.11",,,,,,,,,,,,,
Community Care Network,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"30,961.86",,,,,,,,,,,,,
Community Care Network,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"38,826.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"24,974.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,683.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"46,417.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Surgical,Straight Discount,90.00%,IP,930,"29,276.15",,,,,,,,,,,,,
Community Care Network,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"21,824.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"35,167.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"20,650.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"10,651.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"27,656.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"16,454.94",,,,,,,,,,,,,
Community Care Network,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,627.38",,,,,,,,,,,,,
Community Care Network,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"35,997.31",,,,,,,,,,,,,
Community Care Network,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"42,844.13",,,,,,,,,,,,,
Community Care Network,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"62,529.13",,,,,,,,,,,,,
Community Care Network,DRG,MS-637,DIABETES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,384.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-638,DIABETES WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,497.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"6,523.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,032.71",,,,,,,,,,,,,
Community Care Network,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,705.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical,Straight Discount,90.00%,IP,880,"12,532.53",,,,,,,,,,,,,
Community Care Network,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,190.56",,,,,,,,,,,,,
Community Care Network,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"9,912.13",,,,,,,,,,,,,
Community Care Network,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,473.77",,,,,,,,,,,,,
Community Care Network,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"43,930.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"35,953.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-652,KIDNEY TRANSPLANT,Surgical,Straight Discount,90.00%,IP,930,"30,972.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"53,042.51",,,,,,,,,,,,,
Community Care Network,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"34,877.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,247.69",,,,,,,,,,,,,
Community Care Network,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"31,944.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Surgical,Straight Discount,90.00%,IP,930,"24,776.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,687.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"25,939.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,402.18",,,,,,,,,,,,,
Community Care Network,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,610.09",,,,,,,,,,,,,
Community Care Network,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"28,518.67",,,,,,,,,,,,,
Community Care Network,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"15,524.76",,,,,,,,,,,,,
Community Care Network,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,527.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-665,PROSTATECTOMY WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"29,559.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-666,PROSTATECTOMY WITH CC,Surgical,Straight Discount,90.00%,IP,930,"16,881.68",,,,,,,,,,,,,
Community Care Network,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"9,684.36",,,,,,,,,,,,,
Community Care Network,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"34,290.18",,,,,,,,,,,,,
Community Care Network,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"14,911.51",,,,,,,,,,,,,
Community Care Network,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"9,916.13",,,,,,,,,,,,,
Community Care Network,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,294.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,202.86",,,,,,,,,,,,,
Community Care Network,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"72,221.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"24,957.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,920.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-682,RENAL FAILURE WITH MCC,Medical,Straight Discount,90.00%,IP,880,"28,276.40",,,,,,,,,,,,,
Community Care Network,DRG,MS-683,RENAL FAILURE WITH CC,Medical,Straight Discount,90.00%,IP,880,"15,981.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"11,604.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,233.73",,,,,,,,,,,,,
Community Care Network,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical,Straight Discount,90.00%,IP,880,"15,308.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"6,670.71",,,,,,,,,,,,,
Community Care Network,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,266.88",,,,,,,,,,,,,
Community Care Network,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,711.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-693,URINARY STONES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,038.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,989.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"11,060.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"10,088.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-697,URETHRAL STRICTURE,Medical,Straight Discount,90.00%,IP,880,"9,704.80",,,,,,,,,,,,,
Community Care Network,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,964.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,322.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,322.67",,,,,,,,,,,,,
Community Care Network,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"19,671.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,904.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"22,504.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,135.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,736.34",,,,,,,,,,,,,
Community Care Network,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"10,293.71",,,,,,,,,,,,,
Community Care Network,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,519.23",,,,,,,,,,,,,
Community Care Network,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"9,038.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"19,651.97",,,,,,,,,,,,,
Community Care Network,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,425.45",,,,,,,,,,,,,
Community Care Network,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,506.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,033.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,635.41",,,,,,,,,,,,,
Community Care Network,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical,Straight Discount,90.00%,IP,880,"10,601.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"12,900.09",,,,,,,,,,,,,
Community Care Network,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"12,478.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,235.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Straight Discount,90.00%,IP,880,"13,803.79",,,,,,,,,,,,,
Community Care Network,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,821.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,780.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"5,506.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"21,636.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"13,759.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"41,449.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Surgical,Straight Discount,90.00%,IP,930,"24,678.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,233.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"37,200.43",,,,,,,,,,,,,
Community Care Network,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Surgical,Straight Discount,90.00%,IP,930,"17,521.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,454.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,713.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,021.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"17,462.80",,,,,,,,,,,,,
Community Care Network,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,393.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,985.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"10,529.41",,,,,,,,,,,,,
Community Care Network,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"13,124.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"26,353.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,269.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,725.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,542.79",,,,,,,,,,,,,
Community Care Network,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,899.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Straight Discount,90.00%,IP,880,"14,816.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Straight Discount,90.00%,IP,880,"9,412.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,933.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"12,819.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,742.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Vaginal Delivery,Straight Discount,90.00%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Surgical,Straight Discount,90.00%,IP,930,"16,800.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Surgical,Straight Discount,90.00%,IP,930,"8,928.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical,Straight Discount,90.00%,IP,880,"7,483.50",,,,,,,,,,,,,
Community Care Network,DRG,MS-779,ABORTION WITHOUT D&C,Medical,Straight Discount,90.00%,IP,880,"10,127.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,C-Section,Straight Discount,90.00%,IP,"2,975.00","17,026.59",,,,,,,,,,,,,
Community Care Network,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,C-Section,Straight Discount,90.00%,IP,"2,975.00","9,954.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,C-Section,Straight Discount,90.00%,IP,"2,975.00","8,321.91",,,,,,,,,,,,,
Community Care Network,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,C-Section,Straight Discount,90.00%,IP,"2,975.00","14,466.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,C-Section,Straight Discount,90.00%,IP,"2,975.00","9,662.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,C-Section,Straight Discount,90.00%,IP,"2,975.00","8,065.51",,,,,,,,,,,,,
Community Care Network,DRG,MS-789,NEONATES- DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY,Neonate,Straight Discount,90.00%,IP,"9,415.40","15,624.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-790,EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME- NEONATE,Neonate,Straight Discount,90.00%,IP,"31,049.47","59,778.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-791,PREMATURITY WITH MAJOR PROBLEMS,Neonate,Straight Discount,90.00%,IP,"18,126.50","35,189.68",,,,,,,,,,,,,
Community Care Network,DRG,MS-792,PREMATURITY WITHOUT MAJOR PROBLEMS,Neonate,Straight Discount,90.00%,IP,"8,021.48","21,232.55",,,,,,,,,,,,,
Community Care Network,DRG,MS-793,FULL TERM NEONATE WITH MAJOR PROBLEMS,Neonate,Straight Discount,90.00%,IP,"6,433.54","36,147.06",,,,,,,,,,,,,
Community Care Network,DRG,MS-794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,Neonate,Straight Discount,90.00%,IP,"2,637.93","12,794.26",,,,,,,,,,,,,
Community Care Network,DRG,MS-795,NORMAL NEWBORN,Normal Newborn,Straight Discount,90.00%,IP,280,"1,732.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Vaginal Delivery,Straight Discount,90.00%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Vaginal Delivery,Straight Discount,90.00%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Vaginal Delivery,Straight Discount,90.00%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-799,SPLENECTOMY WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"50,070.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-800,SPLENECTOMY WITH CC,Surgical,Straight Discount,90.00%,IP,930,"28,728.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"23,774.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"36,100.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"18,346.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"13,279.12",,,,,,,,,,,,,
Community Care Network,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Vaginal Delivery,Straight Discount,90.00%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Vaginal Delivery,Straight Discount,90.00%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Vaginal Delivery,Straight Discount,90.00%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"21,199.68",,,,,,,,,,,,,
Community Care Network,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,075.41",,,,,,,,,,,,,
Community Care Network,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"10,300.53",,,,,,,,,,,,,
Community Care Network,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,949.69",,,,,,,,,,,,,
Community Care Network,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,563.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-813,COAGULATION DISORDERS,Medical,Straight Discount,90.00%,IP,880,"15,036.11",,,,,,,,,,,,,
Community Care Network,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,405.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical,Straight Discount,90.00%,IP,880,"13,663.66",,,,,,,,,,,,,
Community Care Network,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"6,433.20",,,,,,,,,,,,,
Community Care Network,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"22,405.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"12,814.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"9,713.56",,,,,,,,,,,,,
Community Care Network,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"122,617.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"27,576.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"27,517.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"43,774.77",,,,,,,,,,,,,
Community Care Network,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"22,998.52",,,,,,,,,,,,,
Community Care Network,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"13,634.41",,,,,,,,,,,,,
Community Care Network,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"49,028.21",,,,,,,,,,,,,
Community Care Network,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"33,856.22",,,,,,,,,,,,,
Community Care Network,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"32,407.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"31,204.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,372.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"10,912.79",,,,,,,,,,,,,
Community Care Network,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical,Straight Discount,90.00%,IP,880,"7,590.57",,,,,,,,,,,,,
Community Care Network,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"5,217.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"151,525.57",,,,,,,,,,,,,
Community Care Network,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical,Straight Discount,90.00%,IP,880,"108,442.41",,,,,,,,,,,,,
Community Care Network,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"19,754.19",,,,,,,,,,,,,
Community Care Network,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical,Straight Discount,90.00%,IP,880,"55,476.01",,,,,,,,,,,,,
Community Care Network,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical,Straight Discount,90.00%,IP,880,"21,987.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"14,467.64",,,,,,,,,,,,,
Community Care Network,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical,Straight Discount,90.00%,IP,880,"38,835.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical,Straight Discount,90.00%,IP,880,"23,414.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"10,675.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,522.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical,Straight Discount,90.00%,IP,880,"21,166.22",,,,,,,,,,,,,
Community Care Network,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"15,814.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"25,988.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical,Straight Discount,90.00%,IP,880,"12,996.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"10,016.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-849,RADIOTHERAPY,Medical,Straight Discount,90.00%,IP,880,"24,213.33",,,,,,,,,,,,,
Community Care Network,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"91,309.54",,,,,,,,,,,,,
Community Care Network,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"37,668.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"27,510.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"119,992.39",,,,,,,,,,,,,
Community Care Network,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"20,964.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"20,693.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"64,183.43",,,,,,,,,,,,,
Community Care Network,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"11,618.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical,Straight Discount,90.00%,IP,880,"8,517.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,920.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,149.30",,,,,,,,,,,,,
Community Care Network,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"31,175.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical,Straight Discount,90.00%,IP,880,"20,802.66",,,,,,,,,,,,,
Community Care Network,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"9,060.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical,Straight Discount,90.00%,IP,880,"62,539.00",,,,,,,,,,,,,
Community Care Network,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"31,444.24",,,,,,,,,,,,,
Community Care Network,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"15,068.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Surgical,Straight Discount,90.00%,IP,930,"31,745.49",,,,,,,,,,,,,
Community Care Network,DRG,MS-880,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,Psychiatric,Straight Discount,90.00%,IP,485,"8,406.28",,,,,,,,,,,,,
Community Care Network,DRG,MS-881,DEPRESSIVE NEUROSES,Psychiatric,Straight Discount,90.00%,IP,485,"7,800.83",,,,,,,,,,,,,
Community Care Network,DRG,MS-882,NEUROSES EXCEPT DEPRESSIVE,Psychiatric,Straight Discount,90.00%,IP,485,"8,011.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-883,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,Psychiatric,Straight Discount,90.00%,IP,485,"15,363.17",,,,,,,,,,,,,
Community Care Network,DRG,MS-884,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,Psychiatric,Straight Discount,90.00%,IP,485,"14,053.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-885,PSYCHOSES,Psychiatric,Straight Discount,90.00%,IP,485,"12,041.93",,,,,,,,,,,,,
Community Care Network,DRG,MS-886,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,Psychiatric,Straight Discount,90.00%,IP,485,"11,890.08",,,,,,,,,,,,,
Community Care Network,DRG,MS-887,OTHER MENTAL DISORDER DIAGNOSES,Psychiatric,Straight Discount,90.00%,IP,485,"10,500.07",,,,,,,,,,,,,
Community Care Network,DRG,MS-894,ALCOHOL- DRUG ABUSE OR DEPENDENCE- LEFT AMA,Substance Abuse,Straight Discount,90.00%,IP,"3,005.26","5,329.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-895,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,Substance Abuse,Straight Discount,90.00%,IP,"8,754.13","21,100.96",,,,,,,,,,,,,
Community Care Network,DRG,MS-896,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC,Substance Abuse,Straight Discount,90.00%,IP,"9,745.49","17,297.32",,,,,,,,,,,,,
Community Care Network,DRG,MS-897,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC,Substance Abuse,Straight Discount,90.00%,IP,"4,527.06","8,035.42",,,,,,,,,,,,,
Community Care Network,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"41,488.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"23,640.59",,,,,,,,,,,,,
Community Care Network,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"11,230.37",,,,,,,,,,,,,
Community Care Network,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"36,224.11",,,,,,,,,,,,,
Community Care Network,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"15,982.25",,,,,,,,,,,,,
Community Care Network,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Surgical,Straight Discount,90.00%,IP,930,"17,460.85",,,,,,,,,,,,,
Community Care Network,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"52,333.81",,,,,,,,,,,,,
Community Care Network,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"23,274.39",,,,,,,,,,,,,
Community Care Network,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"14,200.04",,,,,,,,,,,,,
Community Care Network,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,928.72",,,,,,,,,,,,,
Community Care Network,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"8,649.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"16,524.44",,,,,,,,,,,,,
Community Care Network,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"6,398.16",,,,,,,,,,,,,
Community Care Network,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"18,792.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,700.57",,,,,,,,,,,,,
Community Care Network,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical,Straight Discount,90.00%,IP,880,"17,856.05",,,,,,,,,,,,,
Community Care Network,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical,Straight Discount,90.00%,IP,880,"11,715.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"8,817.98",,,,,,,,,,,,,
Community Care Network,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical,Straight Discount,90.00%,IP,880,"15,453.70",,,,,,,,,,,,,
Community Care Network,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"9,056.51",,,,,,,,,,,,,
Community Care Network,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Surgical,Straight Discount,90.00%,IP,930,"204,714.78",,,,,,,,,,,,,
Community Care Network,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"63,456.92",,,,,,,,,,,,,
Community Care Network,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"29,288.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical,Straight Discount,90.00%,IP,880,"21,975.48",,,,,,,,,,,,,
Community Care Network,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical,Straight Discount,90.00%,IP,880,"18,857.68",,,,,,,,,,,,,
Community Care Network,DRG,MS-935,NON-EXTENSIVE BURNS,Medical,Straight Discount,90.00%,IP,880,"18,818.74",,,,,,,,,,,,,
Community Care Network,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"32,961.27",,,,,,,,,,,,,
Community Care Network,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Surgical,Straight Discount,90.00%,IP,930,"35,826.95",,,,,,,,,,,,,
Community Care Network,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"18,735.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-945,REHABILITATION WITH CC/MCC,Rehabilitation,Straight Discount,90.00%,IP,"8,112.02","24,048.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-946,REHABILITATION WITHOUT CC/MCC,Rehabilitation,Straight Discount,90.00%,IP,"6,164.90","13,242.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical,Straight Discount,90.00%,IP,880,"11,584.43",,,,,,,,,,,,,
Community Care Network,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Straight Discount,90.00%,IP,880,"7,647.03",,,,,,,,,,,,,
Community Care Network,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical,Straight Discount,90.00%,IP,880,"16,233.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"7,192.45",,,,,,,,,,,,,
Community Care Network,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical,Straight Discount,90.00%,IP,880,"12,539.35",,,,,,,,,,,,,
Community Care Network,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Straight Discount,90.00%,IP,930,"99,563.62",,,,,,,,,,,,,
Community Care Network,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Straight Discount,90.00%,IP,930,"48,319.58",,,,,,,,,,,,,
Community Care Network,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"81,020.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Surgical,Straight Discount,90.00%,IP,930,"41,927.10",,,,,,,,,,,,,
Community Care Network,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"34,550.88",,,,,,,,,,,,,
Community Care Network,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical,Straight Discount,90.00%,IP,880,"41,610.90",,,,,,,,,,,,,
Community Care Network,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical,Straight Discount,90.00%,IP,880,"28,388.26",,,,,,,,,,,,,
Community Care Network,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"16,749.46",,,,,,,,,,,,,
Community Care Network,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"56,334.55",,,,,,,,,,,,,
Community Care Network,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Surgical,Straight Discount,90.00%,IP,930,"28,667.60",,,,,,,,,,,,,
Community Care Network,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical,Straight Discount,90.00%,IP,880,"95,225.61",,,,,,,,,,,,,
Community Care Network,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical,Straight Discount,90.00%,IP,880,"34,297.84",,,,,,,,,,,,,
Community Care Network,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical,Straight Discount,90.00%,IP,880,"20,273.82",,,,,,,,,,,,,
Community Care Network,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical,Straight Discount,90.00%,IP,880,"32,684.59",,,,,,,,,,,,,
Community Care Network,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"51,698.29",,,,,,,,,,,,,
Community Care Network,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"34,570.65",,,,,,,,,,,,,
Community Care Network,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"16,317.63",,,,,,,,,,,,,
Community Care Network,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Straight Discount,90.00%,IP,930,"55,966.14",,,,,,,,,,,,,
Community Care Network,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Straight Discount,90.00%,IP,930,"18,900.02",,,,,,,,,,,,,
Community Care Network,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Straight Discount,90.00%,IP,930,"12,784.87",,,,,,,,,,,,,
Community Care Network,DRG,MS-998,PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,Other,Straight Discount,90.00%,IP,0,0,,,,,,,,,,,,,
Community Care Network,DRG,MS-999,UNGROUPABLE,Other,Straight Discount,90.00%,IP,0,0,,,,,,,,,,,,,
Corvel,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"281,947.26",,,,,,,,,,,,,
Corvel,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"155,072.35",,,,,,,,,,,,,
Corvel,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Medical/Surgical,Per Case,"$284,088.40 ",IP,930,"284,088.40",,,,,,,,,,,,,
Corvel,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Medical/Surgical,Per Case,"$224,999.56 ",IP,930,"224,999.56",,,,,,,,,,,,,
Corvel,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Medical/Surgical,Straight Discount,53.20%,IP,930,"99,513.60",,,,,,,,,,,,,
Corvel,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"45,669.01",,,,,,,,,,,,,
Corvel,DRG,MS-007,LUNG TRANSPLANT,Medical/Surgical,Straight Discount,53.20%,IP,930,"112,664.24",,,,,,,,,,,,,
Corvel,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Medical/Surgical,Straight Discount,53.20%,IP,930,"52,824.47",,,,,,,,,,,,,
Corvel,DRG,MS-010,PANCREAS TRANSPLANT,Medical/Surgical,Straight Discount,53.20%,IP,930,"35,214.69",,,,,,,,,,,,,
Corvel,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"48,829.64",,,,,,,,,,,,,
Corvel,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Medical/Surgical,Per Case,"$74,654.63 ",IP,930,"74,654.63",,,,,,,,,,,,,
Corvel,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$29,317.87 ",IP,930,"29,317.87",,,,,,,,,,,,,
Corvel,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Medical/Surgical,Straight Discount,53.20%,IP,930,"124,388.84",,,,,,,,,,,,,
Corvel,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"65,472.83",,,,,,,,,,,,,
Corvel,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"47,017.17",,,,,,,,,,,,,
Corvel,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"100,455.85",,,,,,,,,,,,,
Corvel,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"73,312.59",,,,,,,,,,,,,
Corvel,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"47,303.35",,,,,,,,,,,,,
Corvel,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Medical/Surgical,Per Case,"$73,951.33 ",IP,930,"73,951.33",,,,,,,,,,,,,
Corvel,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Medical/Surgical,Per Case,"$39,702.52 ",IP,930,"39,702.52",,,,,,,,,,,,,
Corvel,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$100,858.36 ",IP,930,"100,858.36",,,,,,,,,,,,,
Corvel,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$47,469.26 ",IP,930,"47,469.26",,,,,,,,,,,,,
Corvel,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$29,826.86 ",IP,930,"29,826.86",,,,,,,,,,,,,
Corvel,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"56,651.88",,,,,,,,,,,,,
Corvel,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Medical/Surgical,Per Case,"$39,621.18 ",IP,930,"39,621.18",,,,,,,,,,,,,
Corvel,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$29,340.89 ",IP,930,"29,340.89",,,,,,,,,,,,,
Corvel,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"42,499.62",,,,,,,,,,,,,
Corvel,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Medical/Surgical,Per Case,"$24,825.12 ",IP,930,"24,825.12",,,,,,,,,,,,,
Corvel,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"16,749.29",,,,,,,,,,,,,
Corvel,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"38,688.76",,,,,,,,,,,,,
Corvel,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"22,749.33",,,,,,,,,,,,,
Corvel,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"18,019.58",,,,,,,,,,,,,
Corvel,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$33,522.99 ",IP,930,"33,522.99",,,,,,,,,,,,,
Corvel,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$22,772.44 ",IP,930,"22,772.44",,,,,,,,,,,,,
Corvel,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$14,297.42 ",IP,930,"14,297.42",,,,,,,,,,,,,
Corvel,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$74,748.54 ",IP,930,"74,748.54",,,,,,,,,,,,,
Corvel,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Medical/Surgical,Per Case,"$19,635.12 ",IP,930,"22,882.69",,,,,,,,,,,,,
Corvel,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$20,244.51 ",IP,930,"20,244.51",,,,,,,,,,,,,
Corvel,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"17,960.20",,,,,,,,,,,,,
Corvel,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"11,058.80",,,,,,,,,,,,,
Corvel,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical/Surgical,Per Case,"$26,640.61 ",IP,880,"26,640.61",,,,,,,,,,,,,
Corvel,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical/Surgical,Per Case,"$16,029.34 ",IP,880,"16,029.34",,,,,,,,,,,,,
Corvel,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical/Surgical,Per Case,"$8,760.54 ",IP,880,"21,291.18",,,,,,,,,,,,,
Corvel,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical/Surgical,Per Case,"$9,838.57 ",IP,880,"12,305.72",,,,,,,,,,,,,
Corvel,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"16,905.04",,,,,,,,,,,,,
Corvel,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical/Surgical,Per Case,"$11,554.38 ",IP,880,"11,554.38",,,,,,,,,,,,,
Corvel,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,686.73 ",IP,880,"9,686.73",,,,,,,,,,,,,
Corvel,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"28,113.74",,,,,,,,,,,,,
Corvel,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,880,"19,343.40",,,,,,,,,,,,,
Corvel,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"16,644.17",,,,,,,,,,,,,
Corvel,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical/Surgical,Per Case,"$29,588.12 ",IP,880,"29,588.12",,,,,,,,,,,,,
Corvel,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical/Surgical,Per Case,"$15,543.49 ",IP,880,"15,543.49",,,,,,,,,,,,,
Corvel,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,253.24 ",IP,880,"12,253.24",,,,,,,,,,,,,
Corvel,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical/Surgical,Per Case,"$11,659.34 ",IP,880,"13,867.06",,,,,,,,,,,,,
Corvel,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical/Surgical,Per Case,"$12,660.21 ",IP,880,"12,660.21",,,,,,,,,,,,,
Corvel,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical/Surgical,Per Case,"$9,563.81 ",IP,880,"9,563.81",,,,,,,,,,,,,
Corvel,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"16,318.08",,,,,,,,,,,,,
Corvel,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,880,"9,839.13",,,,,,,,,,,,,
Corvel,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,341.02 ",IP,880,"9,341.02",,,,,,,,,,,,,
Corvel,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical/Surgical,Per Case,"$17,444.02 ",IP,880,"17,444.02",,,,,,,,,,,,,
Corvel,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical/Surgical,Per Case,"$9,377.78 ",IP,880,"9,913.11",,,,,,,,,,,,,
Corvel,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical/Surgical,Per Case,"$14,378.37 ",IP,880,"15,827.48",,,,,,,,,,,,,
Corvel,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,717.51 ",IP,880,"9,548.08",,,,,,,,,,,,,
Corvel,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,911.51",,,,,,,,,,,,,
Corvel,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,880,"9,237.57",,,,,,,,,,,,,
Corvel,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"7,074.67",,,,,,,,,,,,,
Corvel,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"20,363.53",,,,,,,,,,,,,
Corvel,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical/Surgical,Per Case,"$10,010.00 ",IP,880,"10,010.00",,,,,,,,,,,,,
Corvel,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"21,980.35",,,,,,,,,,,,,
Corvel,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical/Surgical,Per Case,"$16,494.06 ",IP,880,"16,494.06",,,,,,,,,,,,,
Corvel,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical/Surgical,Per Case,"$6,864.95 ",IP,880,"8,801.48",,,,,,,,,,,,,
Corvel,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical/Surgical,Per Case,"$45,763.48 ",IP,880,"45,763.48",,,,,,,,,,,,,
Corvel,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical/Surgical,Per Case,"$17,459.30 ",IP,880,"17,459.30",,,,,,,,,,,,,
Corvel,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,138.82 ",IP,880,"9,138.82",,,,,,,,,,,,,
Corvel,DRG,MS-088,CONCUSSION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,204.83",,,,,,,,,,,,,
Corvel,DRG,MS-089,CONCUSSION WITH CC,Medical/Surgical,Per Case,"$13,793.62 ",IP,880,"13,793.62",,,,,,,,,,,,,
Corvel,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,126.16 ",IP,880,"10,126.16",,,,,,,,,,,,,
Corvel,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical/Surgical,Per Case,"$14,972.72 ",IP,880,"16,050.39",,,,,,,,,,,,,
Corvel,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical/Surgical,Per Case,"$12,405.34 ",IP,880,"12,405.34",,,,,,,,,,,,,
Corvel,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,377.01 ",IP,880,"10,377.01",,,,,,,,,,,,,
Corvel,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical/Surgical,Per Case,"$50,515.25 ",IP,880,"50,515.25",,,,,,,,,,,,,
Corvel,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical/Surgical,Per Case,"$33,641.40 ",IP,880,"33,641.40",,,,,,,,,,,,,
Corvel,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical/Surgical,Per Case,"$19,749.10 ",IP,880,"22,694.82",,,,,,,,,,,,,
Corvel,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"36,527.81",,,,,,,,,,,,,
Corvel,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical/Surgical,Per Case,"$38,577.09 ",IP,880,"38,577.09",,,,,,,,,,,,,
Corvel,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,334.75 ",IP,880,"13,601.32",,,,,,,,,,,,,
Corvel,DRG,MS-100,SEIZURES WITH MCC,Medical/Surgical,Per Case,"$21,842.48 ",IP,880,"21,842.48",,,,,,,,,,,,,
Corvel,DRG,MS-101,SEIZURES WITHOUT MCC,Medical/Surgical,Per Case,"$8,413.11 ",IP,880,"8,634.06",,,,,,,,,,,,,
Corvel,DRG,MS-102,HEADACHES WITH MCC,Medical/Surgical,Per Case,"$10,053.37 ",IP,880,"11,210.65",,,,,,,,,,,,,
Corvel,DRG,MS-103,HEADACHES WITHOUT MCC,Medical/Surgical,Per Case,"$8,918.22 ",IP,880,"8,918.22",,,,,,,,,,,,,
Corvel,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"21,334.98",,,,,,,,,,,,,
Corvel,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"14,070.50",,,,,,,,,,,,,
Corvel,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Medical/Surgical,Straight Discount,53.20%,IP,930,"14,146.42",,,,,,,,,,,,,
Corvel,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"18,272.66",,,,,,,,,,,,,
Corvel,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"10,112.65",,,,,,,,,,,,,
Corvel,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"11,570.81",,,,,,,,,,,,,
Corvel,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$6,709.38 ",IP,880,"6,709.38",,,,,,,,,,,,,
Corvel,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical/Surgical,Per Case,"$8,500.48 ",IP,880,"8,500.48",,,,,,,,,,,,,
Corvel,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"13,615.92",,,,,,,,,,,,,
Corvel,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical/Surgical,Per Case,"$7,349.60 ",IP,880,"8,131.78",,,,,,,,,,,,,
Corvel,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"20,836.60",,,,,,,,,,,,,
Corvel,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"12,221.04",,,,,,,,,,,,,
Corvel,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Medical/Surgical,Per Case,"$9,636.67 ",IP,930,"14,295.35",,,,,,,,,,,,,
Corvel,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,787.56 ",IP,930,"11,787.56",,,,,,,,,,,,,
Corvel,DRG,MS-139,SALIVARY GLAND PROCEDURES,Medical/Surgical,Per Case,"$9,547.65 ",IP,930,"11,941.67",,,,,,,,,,,,,
Corvel,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"19,790.20",,,,,,,,,,,,,
Corvel,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical/Surgical,Per Case,"$12,261.18 ",IP,880,"12,664.91",,,,,,,,,,,,,
Corvel,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"7,653.84",,,,,,,,,,,,,
Corvel,DRG,MS-149,DYSEQUILIBRIUM,Medical/Surgical,Per Case,"$7,392.20 ",IP,880,"7,392.20",,,,,,,,,,,,,
Corvel,DRG,MS-150,EPISTAXIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"12,894.63",,,,,,,,,,,,,
Corvel,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical/Surgical,Per Case,"$6,360.74 ",IP,880,"7,173.96",,,,,,,,,,,,,
Corvel,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical/Surgical,Per Case,"$8,247.55 ",IP,880,"10,482.54",,,,,,,,,,,,,
Corvel,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical/Surgical,Per Case,"$5,373.12 ",IP,880,"6,916.98",,,,,,,,,,,,,
Corvel,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"15,014.70",,,,,,,,,,,,,
Corvel,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical/Surgical,Per Case,"$8,892.05 ",IP,880,"8,892.05",,,,,,,,,,,,,
Corvel,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,456.74 ",IP,880,"7,456.74",,,,,,,,,,,,,
Corvel,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"15,305.74",,,,,,,,,,,,,
Corvel,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical/Surgical,Per Case,"$9,313.12 ",IP,880,"9,313.12",,,,,,,,,,,,,
Corvel,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$6,737.83 ",IP,880,"6,737.83",,,,,,,,,,,,,
Corvel,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$101,978.91 ",IP,930,"101,978.91",,,,,,,,,,,,,
Corvel,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Medical/Surgical,Per Case,"$39,411.86 ",IP,930,"39,411.86",,,,,,,,,,,,,
Corvel,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$18,115.92 ",IP,930,"18,578.31",,,,,,,,,,,,,
Corvel,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$46,767.64 ",IP,930,"46,767.64",,,,,,,,,,,,,
Corvel,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$30,246.95 ",IP,930,"30,246.95",,,,,,,,,,,,,
Corvel,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$22,687.30 ",IP,930,"22,687.30",,,,,,,,,,,,,
Corvel,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical/Surgical,Per Case,"$18,304.55 ",IP,880,"18,304.55",,,,,,,,,,,,,
Corvel,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical/Surgical,Per Case,"$15,051.96 ",IP,880,"15,051.96",,,,,,,,,,,,,
Corvel,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical/Surgical,Per Case,"$28,695.97 ",IP,880,"28,695.97",,,,,,,,,,,,,
Corvel,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical/Surgical,Per Case,"$23,962.45 ",IP,880,"23,962.45",,,,,,,,,,,,,
Corvel,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,328.33 ",IP,880,"12,328.33",,,,,,,,,,,,,
Corvel,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical/Surgical,Per Case,"$24,073.85 ",IP,880,"24,073.85",,,,,,,,,,,,,
Corvel,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical/Surgical,Per Case,"$16,177.48 ",IP,880,"16,177.48",,,,,,,,,,,,,
Corvel,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,666.54 ",IP,880,"9,666.54",,,,,,,,,,,,,
Corvel,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical/Surgical,Per Case,"$18,222.78 ",IP,880,"18,222.78",,,,,,,,,,,,,
Corvel,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical/Surgical,Per Case,"$15,216.38 ",IP,880,"15,216.38",,,,,,,,,,,,,
Corvel,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,201.76 ",IP,880,"8,201.76",,,,,,,,,,,,,
Corvel,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical/Surgical,Per Case,"$40,210.79 ",IP,880,"40,210.79",,,,,,,,,,,,,
Corvel,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical/Surgical,Per Case,"$12,210.89 ",IP,880,"12,210.89",,,,,,,,,,,,,
Corvel,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,884.27 ",IP,880,"9,884.27",,,,,,,,,,,,,
Corvel,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical/Surgical,Per Case,"$16,929.16 ",IP,880,"16,929.16",,,,,,,,,,,,,
Corvel,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical/Surgical,Per Case,"$14,531.37 ",IP,880,"14,531.37",,,,,,,,,,,,,
Corvel,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical/Surgical,Per Case,"$13,266.92 ",IP,880,"13,266.92",,,,,,,,,,,,,
Corvel,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,118.38 ",IP,880,"9,118.38",,,,,,,,,,,,,
Corvel,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical/Surgical,Per Case,"$19,397.17 ",IP,880,"19,397.17",,,,,,,,,,,,,
Corvel,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical/Surgical,Per Case,"$11,652.27 ",IP,880,"11,652.27",,,,,,,,,,,,,
Corvel,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,432.35 ",IP,880,"7,432.35",,,,,,,,,,,,,
Corvel,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical/Surgical,Per Case,"$17,102.27 ",IP,880,"17,102.27",,,,,,,,,,,,,
Corvel,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical/Surgical,Per Case,"$17,659.31 ",IP,880,"17,659.31",,,,,,,,,,,,,
Corvel,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,378.23 ",IP,880,"9,378.23",,,,,,,,,,,,,
Corvel,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical/Surgical,Per Case,"$19,033.93 ",IP,880,"19,033.93",,,,,,,,,,,,,
Corvel,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical/Surgical,Per Case,"$15,173.85 ",IP,880,"15,173.85",,,,,,,,,,,,,
Corvel,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,175.82 ",IP,880,"7,175.82",,,,,,,,,,,,,
Corvel,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical/Surgical,Per Case,"$8,431.85 ",IP,880,"9,399.15",,,,,,,,,,,,,
Corvel,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical/Surgical,Per Case,"$6,254.04 ",IP,880,"6,867.34",,,,,,,,,,,,,
Corvel,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical/Surgical,Per Case,"$8,328.52 ",IP,880,"8,328.52",,,,,,,,,,,,,
Corvel,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Per Case,"$34,334.93 ",IP,880,"34,334.93",,,,,,,,,,,,,
Corvel,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical/Surgical,Per Case,"$8,401.72 ",IP,880,"8,606.80",,,,,,,,,,,,,
Corvel,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical/Surgical,Per Case,"$76,148.21 ",IP,880,"76,148.21",,,,,,,,,,,,,
Corvel,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical/Surgical,Per Case,"$31,656.48 ",IP,880,"31,656.48",,,,,,,,,,,,,
Corvel,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Medical/Surgical,Straight Discount,53.20%,IP,930,"108,611.00",,,,,,,,,,,,,
Corvel,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Per Case,"$126,394.99 ",IP,930,"126,394.99",,,,,,,,,,,,,
Corvel,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Medical/Surgical,Per Case,"$74,069.31 ",IP,930,"74,069.31",,,,,,,,,,,,,
Corvel,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"50,063.91",,,,,,,,,,,,,
Corvel,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Per Case,"$95,509.16 ",IP,930,"95,509.16",,,,,,,,,,,,,
Corvel,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Medical/Surgical,Per Case,"$60,249.12 ",IP,930,"60,249.12",,,,,,,,,,,,,
Corvel,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$57,682.01 ",IP,930,"57,682.01",,,,,,,,,,,,,
Corvel,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"81,970.99",,,,,,,,,,,,,
Corvel,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"60,468.58",,,,,,,,,,,,,
Corvel,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"71,663.65",,,,,,,,,,,,,
Corvel,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Medical/Surgical,Per Case,"$41,284.90 ",IP,930,"54,771.27",,,,,,,,,,,,,
Corvel,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"64,359.26",,,,,,,,,,,,,
Corvel,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Per Case,"$40,162.87 ",IP,930,"51,121.99",,,,,,,,,,,,,
Corvel,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"60,499.73",,,,,,,,,,,,,
Corvel,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Medical/Surgical,Per Case,"$57,167.20 ",IP,930,"57,167.20",,,,,,,,,,,,,
Corvel,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"82,643.61",,,,,,,,,,,,,
Corvel,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"57,414.05",,,,,,,,,,,,,
Corvel,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Medical/Surgical,Per Case,"$137,557.16 ",IP,930,"137,557.16",,,,,,,,,,,,,
Corvel,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Medical/Surgical,Per Case,"$52,820.63 ",IP,930,"52,820.63",,,,,,,,,,,,,
Corvel,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Per Case,"$94,461.59 ",IP,930,"94,461.59",,,,,,,,,,,,,
Corvel,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Per Case,"$49,122.62 ",IP,930,"49,122.62",,,,,,,,,,,,,
Corvel,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Medical/Surgical,Per Case,"$84,834.80 ",IP,930,"84,834.80",,,,,,,,,,,,,
Corvel,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Medical/Surgical,Per Case,"$54,863.05 ",IP,930,"54,863.05",,,,,,,,,,,,,
Corvel,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$19,430.48 ",IP,930,"19,430.48",,,,,,,,,,,,,
Corvel,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Medical/Surgical,Per Case,"$41,106.15 ",IP,930,"41,106.15",,,,,,,,,,,,,
Corvel,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Medical/Surgical,Per Case,"$32,586.89 ",IP,930,"32,586.89",,,,,,,,,,,,,
Corvel,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Medical/Surgical,Per Case,"$18,329.14 ",IP,930,"20,107.52",,,,,,,,,,,,,
Corvel,DRG,MS-245,AICD GENERATOR PROCEDURES,Medical/Surgical,Straight Discount,53.20%,IP,930,"52,699.88",,,,,,,,,,,,,
Corvel,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Medical/Surgical,Straight Discount,53.20%,IP,930,"30,425.56",,,,,,,,,,,,,
Corvel,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"19,353.14",,,,,,,,,,,,,
Corvel,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Medical/Surgical,Straight Discount,53.20%,IP,930,"30,894.74",,,,,,,,,,,,,
Corvel,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Medical/Surgical,Per Case,"$32,084.95 ",IP,930,"32,084.95",,,,,,,,,,,,,
Corvel,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"24,556.94",,,,,,,,,,,,,
Corvel,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Medical/Surgical,Per Case,"$24,457.28 ",IP,930,"24,457.28",,,,,,,,,,,,,
Corvel,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$61,448.74 ",IP,930,"61,448.74",,,,,,,,,,,,,
Corvel,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Medical/Surgical,Per Case,"$37,067.89 ",IP,930,"37,067.89",,,,,,,,,,,,,
Corvel,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$21,026.90 ",IP,930,"21,026.90",,,,,,,,,,,,,
Corvel,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"24,753.56",,,,,,,,,,,,,
Corvel,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Medical/Surgical,Per Case,"$19,755.71 ",IP,930,"19,755.71",,,,,,,,,,,,,
Corvel,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"11,301.17",,,,,,,,,,,,,
Corvel,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"31,161.45",,,,,,,,,,,,,
Corvel,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"20,638.03",,,,,,,,,,,,,
Corvel,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"34,888.60",,,,,,,,,,,,,
Corvel,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"19,383.31",,,,,,,,,,,,,
Corvel,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,491.37 ",IP,930,"16,626.65",,,,,,,,,,,,,
Corvel,DRG,MS-263,VEIN LIGATION AND STRIPPING,Medical/Surgical,Straight Discount,53.20%,IP,930,"22,439.79",,,,,,,,,,,,,
Corvel,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Medical/Surgical,Per Case,"$25,824.69 ",IP,930,"31,614.09",,,,,,,,,,,,,
Corvel,DRG,MS-265,AICD LEAD PROCEDURES,Medical/Surgical,Straight Discount,53.20%,IP,930,"32,732.52",,,,,,,,,,,,,
Corvel,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"69,084.14",,,,,,,,,,,,,
Corvel,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"54,519.16",,,,,,,,,,,,,
Corvel,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"67,696.08",,,,,,,,,,,,,
Corvel,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"41,998.32",,,,,,,,,,,,,
Corvel,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"50,437.69",,,,,,,,,,,,,
Corvel,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"34,697.82",,,,,,,,,,,,,
Corvel,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"26,172.78",,,,,,,,,,,,,
Corvel,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"37,351.30",,,,,,,,,,,,,
Corvel,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"31,980.08",,,,,,,,,,,,,
Corvel,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical/Surgical,Per Case,"$29,690.32 ",IP,880,"29,690.32",,,,,,,,,,,,,
Corvel,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical/Surgical,Per Case,"$23,082.57 ",IP,880,"23,082.57",,,,,,,,,,,,,
Corvel,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$20,276.40 ",IP,880,"20,276.40",,,,,,,,,,,,,
Corvel,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical/Surgical,Per Case,"$38,792.07 ",IP,880,"38,792.07",,,,,,,,,,,,,
Corvel,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical/Surgical,Per Case,"$25,216.60 ",IP,880,"25,216.60",,,,,,,,,,,,,
Corvel,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"4,831.96",,,,,,,,,,,,,
Corvel,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical/Surgical,Per Case,"$31,281.17 ",IP,880,"31,281.17",,,,,,,,,,,,,
Corvel,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical/Surgical,Per Case,"$20,170.30 ",IP,880,"20,170.30",,,,,,,,,,,,,
Corvel,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical/Surgical,Per Case,"$47,943.17 ",IP,880,"47,943.17",,,,,,,,,,,,,
Corvel,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,880,"15,989.07",,,,,,,,,,,,,
Corvel,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"9,963.72",,,,,,,,,,,,,
Corvel,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical/Surgical,Per Case,"$24,955.04 ",IP,880,"24,955.04",,,,,,,,,,,,,
Corvel,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical/Surgical,Per Case,"$13,086.84 ",IP,880,"13,086.84",,,,,,,,,,,,,
Corvel,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,312.72 ",IP,880,"9,312.72",,,,,,,,,,,,,
Corvel,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical/Surgical,Per Case,"$12,745.74 ",IP,880,"12,745.74",,,,,,,,,,,,,
Corvel,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$6,592.79 ",IP,880,"9,551.97",,,,,,,,,,,,,
Corvel,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"15,523.78",,,,,,,,,,,,,
Corvel,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,880,"6,858.58",,,,,,,,,,,,,
Corvel,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"4,752.14",,,,,,,,,,,,,
Corvel,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical/Surgical,Per Case,"$17,496.95 ",IP,880,"17,496.95",,,,,,,,,,,,,
Corvel,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical/Surgical,Per Case,"$9,493.21 ",IP,880,"10,144.77",,,,,,,,,,,,,
Corvel,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,251.74 ",IP,880,"8,251.74",,,,,,,,,,,,,
Corvel,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical/Surgical,Per Case,"$17,024.54 ",IP,880,"17,024.54",,,,,,,,,,,,,
Corvel,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical/Surgical,Per Case,"$13,191.16 ",IP,880,"13,191.16",,,,,,,,,,,,,
Corvel,DRG,MS-304,HYPERTENSION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"10,664.57",,,,,,,,,,,,,
Corvel,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical/Surgical,Per Case,"$8,013.43 ",IP,880,"8,013.43",,,,,,,,,,,,,
Corvel,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,637.02",,,,,,,,,,,,,
Corvel,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical/Surgical,Per Case,"$7,237.39 ",IP,880,"8,453.01",,,,,,,,,,,,,
Corvel,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical/Surgical,Per Case,"$18,068.11 ",IP,880,"18,068.11",,,,,,,,,,,,,
Corvel,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical/Surgical,Per Case,"$10,737.34 ",IP,880,"10,737.34",,,,,,,,,,,,,
Corvel,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,351.27 ",IP,880,"7,351.27",,,,,,,,,,,,,
Corvel,DRG,MS-311,ANGINA PECTORIS,Medical/Surgical,Per Case,"$6,699.42 ",IP,880,"6,784.60",,,,,,,,,,,,,
Corvel,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical/Surgical,Per Case,"$8,308.48 ",IP,880,"8,308.48",,,,,,,,,,,,,
Corvel,DRG,MS-313,CHEST PAIN,Medical/Surgical,Per Case,"$6,556.72 ",IP,880,"7,016.27",,,,,,,,,,,,,
Corvel,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Per Case,"$21,590.85 ",IP,880,"21,590.85",,,,,,,,,,,,,
Corvel,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical/Surgical,Per Case,"$14,251.73 ",IP,880,"14,251.73",,,,,,,,,,,,,
Corvel,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,062.23 ",IP,880,"10,062.23",,,,,,,,,,,,,
Corvel,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"42,010.00",,,,,,,,,,,,,
Corvel,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"23,786.98",,,,,,,,,,,,,
Corvel,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$72,806.55 ",IP,930,"72,806.55",,,,,,,,,,,,,
Corvel,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$36,840.12 ",IP,930,"36,840.12",,,,,,,,,,,,,
Corvel,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$21,222.70 ",IP,930,"21,222.70",,,,,,,,,,,,,
Corvel,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$58,786.79 ",IP,930,"58,786.79",,,,,,,,,,,,,
Corvel,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$32,076.40 ",IP,930,"32,076.40",,,,,,,,,,,,,
Corvel,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$22,739.23 ",IP,930,"22,739.23",,,,,,,,,,,,,
Corvel,DRG,MS-332,RECTAL RESECTION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"40,490.52",,,,,,,,,,,,,
Corvel,DRG,MS-333,RECTAL RESECTION WITH CC,Medical/Surgical,Per Case,"$23,168.53 ",IP,930,"23,168.53",,,,,,,,,,,,,
Corvel,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$22,161.00 ",IP,930,"22,161.00",,,,,,,,,,,,,
Corvel,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Medical/Surgical,Per Case,"$40,376.90 ",IP,930,"40,376.90",,,,,,,,,,,,,
Corvel,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Medical/Surgical,Per Case,"$30,773.29 ",IP,930,"30,773.29",,,,,,,,,,,,,
Corvel,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$19,745.42 ",IP,930,"19,745.42",,,,,,,,,,,,,
Corvel,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Per Case,"$42,970.69 ",IP,930,"42,970.69",,,,,,,,,,,,,
Corvel,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Per Case,"$29,459.93 ",IP,930,"29,459.93",,,,,,,,,,,,,
Corvel,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$17,383.72 ",IP,930,"17,383.72",,,,,,,,,,,,,
Corvel,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Per Case,"$19,033.86 ",IP,930,"22,545.89",,,,,,,,,,,,,
Corvel,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Per Case,"$16,376.83 ",IP,930,"16,376.83",,,,,,,,,,,,,
Corvel,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,823.81 ",IP,930,"11,823.81",,,,,,,,,,,,,
Corvel,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"27,263.96",,,,,,,,,,,,,
Corvel,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$24,196.92 ",IP,930,"24,196.92",,,,,,,,,,,,,
Corvel,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$18,121.28 ",IP,930,"18,121.28",,,,,,,,,,,,,
Corvel,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"23,961.21",,,,,,,,,,,,,
Corvel,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$14,526.65 ",IP,930,"14,526.65",,,,,,,,,,,,,
Corvel,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,606.96 ",IP,930,"9,532.51",,,,,,,,,,,,,
Corvel,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"23,871.66",,,,,,,,,,,,,
Corvel,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Medical/Surgical,Per Case,"$14,886.17 ",IP,930,"14,886.17",,,,,,,,,,,,,
Corvel,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,020.91 ",IP,930,"10,736.60",,,,,,,,,,,,,
Corvel,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Medical/Surgical,Per Case,"$42,132.61 ",IP,930,"42,132.61",,,,,,,,,,,,,
Corvel,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Medical/Surgical,Per Case,"$22,629.92 ",IP,930,"22,629.92",,,,,,,,,,,,,
Corvel,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Medical/Surgical,Per Case,"$14,128.85 ",IP,930,"14,128.85",,,,,,,,,,,,,
Corvel,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$35,515.27 ",IP,930,"41,772.49",,,,,,,,,,,,,
Corvel,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$20,266.54 ",IP,930,"21,937.52",,,,,,,,,,,,,
Corvel,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,746.05 ",IP,930,"16,746.05",,,,,,,,,,,,,
Corvel,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,906.35",,,,,,,,,,,,,
Corvel,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical/Surgical,Per Case,"$14,533.08 ",IP,880,"14,533.08",,,,,,,,,,,,,
Corvel,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,008.96 ",IP,880,"9,008.96",,,,,,,,,,,,,
Corvel,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical/Surgical,Per Case,"$20,975.37 ",IP,880,"20,975.37",,,,,,,,,,,,,
Corvel,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical/Surgical,Per Case,"$14,263.75 ",IP,880,"14,263.75",,,,,,,,,,,,,
Corvel,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,230.47 ",IP,880,"7,237.23",,,,,,,,,,,,,
Corvel,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical/Surgical,Per Case,"$20,879.93 ",IP,880,"20,879.93",,,,,,,,,,,,,
Corvel,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical/Surgical,Per Case,"$16,469.98 ",IP,880,"16,469.98",,,,,,,,,,,,,
Corvel,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,134.63 ",IP,880,"8,713.88",,,,,,,,,,,,,
Corvel,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical/Surgical,Per Case,"$17,031.54 ",IP,880,"17,510.49",,,,,,,,,,,,,
Corvel,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical/Surgical,Per Case,"$11,201.61 ",IP,880,"11,201.61",,,,,,,,,,,,,
Corvel,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,353.90 ",IP,880,"8,353.90",,,,,,,,,,,,,
Corvel,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,330.10",,,,,,,,,,,,,
Corvel,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical/Surgical,Per Case,"$16,393.52 ",IP,880,"16,393.52",,,,,,,,,,,,,
Corvel,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,875.30 ",IP,880,"9,875.30",,,,,,,,,,,,,
Corvel,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"12,760.30",,,,,,,,,,,,,
Corvel,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical/Surgical,Per Case,"$8,670.05 ",IP,880,"8,686.62",,,,,,,,,,,,,
Corvel,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical/Surgical,Per Case,"$14,601.36 ",IP,880,"15,760.32",,,,,,,,,,,,,
Corvel,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical/Surgical,Per Case,"$12,619.40 ",IP,880,"12,619.40",,,,,,,,,,,,,
Corvel,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,388.25 ",IP,880,"11,388.25",,,,,,,,,,,,,
Corvel,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical/Surgical,Per Case,"$18,414.21 ",IP,880,"18,414.21",,,,,,,,,,,,,
Corvel,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical/Surgical,Per Case,"$9,770.05 ",IP,880,"9,770.05",,,,,,,,,,,,,
Corvel,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,374.52 ",IP,880,"7,374.52",,,,,,,,,,,,,
Corvel,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical/Surgical,Per Case,"$13,398.50 ",IP,880,"13,398.50",,,,,,,,,,,,,
Corvel,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical/Surgical,Per Case,"$7,984.14 ",IP,880,"7,984.14",,,,,,,,,,,,,
Corvel,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical/Surgical,Per Case,"$14,628.39 ",IP,880,"16,096.14",,,,,,,,,,,,,
Corvel,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical/Surgical,Per Case,"$10,892.02 ",IP,880,"10,892.02",,,,,,,,,,,,,
Corvel,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,654.63 ",IP,880,"9,654.63",,,,,,,,,,,,,
Corvel,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$112,898.03 ",IP,930,"112,898.03",,,,,,,,,,,,,
Corvel,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Medical/Surgical,Per Case,"$41,825.91 ",IP,930,"41,825.91",,,,,,,,,,,,,
Corvel,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$27,794.09 ",IP,930,"27,794.09",,,,,,,,,,,,,
Corvel,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Medical/Surgical,Per Case,"$39,095.75 ",IP,930,"39,095.75",,,,,,,,,,,,,
Corvel,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"20,580.60",,,,,,,,,,,,,
Corvel,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"15,240.52",,,,,,,,,,,,,
Corvel,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"36,525.86",,,,,,,,,,,,,
Corvel,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"22,151.66",,,,,,,,,,,,,
Corvel,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Medical/Surgical,Per Case,"$24,838.82 ",IP,930,"24,838.82",,,,,,,,,,,,,
Corvel,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Medical/Surgical,Per Case,"$47,586.29 ",IP,930,"47,586.29",,,,,,,,,,,,,
Corvel,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Medical/Surgical,Per Case,"$25,671.18 ",IP,930,"25,671.18",,,,,,,,,,,,,
Corvel,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Per Case,"$20,836.50 ",IP,930,"20,836.50",,,,,,,,,,,,,
Corvel,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Medical/Surgical,Per Case,"$21,731.33 ",IP,930,"23,590.35",,,,,,,,,,,,,
Corvel,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Medical/Surgical,Per Case,"$19,926.93 ",IP,930,"19,926.93",,,,,,,,,,,,,
Corvel,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Medical/Surgical,Per Case,"$15,420.41 ",IP,930,"15,420.41",,,,,,,,,,,,,
Corvel,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"34,206.25",,,,,,,,,,,,,
Corvel,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"18,581.23",,,,,,,,,,,,,
Corvel,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"14,127.93",,,,,,,,,,,,,
Corvel,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"40,678.39",,,,,,,,,,,,,
Corvel,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"22,209.09",,,,,,,,,,,,,
Corvel,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"15,022.48",,,,,,,,,,,,,
Corvel,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical/Surgical,Per Case,"$19,308.42 ",IP,880,"19,308.42",,,,,,,,,,,,,
Corvel,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical/Surgical,Per Case,"$11,980.70 ",IP,880,"11,980.70",,,,,,,,,,,,,
Corvel,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,045.84 ",IP,880,"9,045.84",,,,,,,,,,,,,
Corvel,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical/Surgical,Per Case,"$18,484.84 ",IP,880,"18,484.84",,,,,,,,,,,,,
Corvel,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical/Surgical,Per Case,"$13,731.29 ",IP,880,"13,731.29",,,,,,,,,,,,,
Corvel,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,521.35 ",IP,880,"8,707.06",,,,,,,,,,,,,
Corvel,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical/Surgical,Per Case,"$25,887.05 ",IP,880,"25,887.05",,,,,,,,,,,,,
Corvel,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical/Surgical,Per Case,"$14,357.76 ",IP,880,"14,357.76",,,,,,,,,,,,,
Corvel,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,273.14 ",IP,880,"9,273.14",,,,,,,,,,,,,
Corvel,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical/Surgical,Per Case,"$20,401.63 ",IP,880,"20,401.63",,,,,,,,,,,,,
Corvel,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical/Surgical,Per Case,"$14,680.14 ",IP,880,"14,680.14",,,,,,,,,,,,,
Corvel,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,700.74 ",IP,880,"8,700.74",,,,,,,,,,,,,
Corvel,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical/Surgical,Per Case,"$11,522.44 ",IP,880,"16,244.10",,,,,,,,,,,,,
Corvel,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical/Surgical,Per Case,"$13,433.84 ",IP,880,"13,433.84",,,,,,,,,,,,,
Corvel,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,848.68 ",IP,880,"8,848.68",,,,,,,,,,,,,
Corvel,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"89,490.50",,,,,,,,,,,,,
Corvel,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Medical/Surgical,Per Case,"$56,301.36 ",IP,930,"59,358.91",,,,,,,,,,,,,
Corvel,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$43,280.15 ",IP,930,"46,635.59",,,,,,,,,,,,,
Corvel,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"83,693.91",,,,,,,,,,,,,
Corvel,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"63,290.47",,,,,,,,,,,,,
Corvel,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$30,022.15 ",IP,930,"48,839.37",,,,,,,,,,,,,
Corvel,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Medical/Surgical,Per Case,"$50,752.46 ",IP,930,"65,527.34",,,,,,,,,,,,,
Corvel,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Medical/Surgical,Per Case,"$27,031.91 ",IP,930,"38,280.90",,,,,,,,,,,,,
Corvel,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"59,145.73",,,,,,,,,,,,,
Corvel,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Medical/Surgical,Per Case,"$21,007.81 ",IP,930,"30,605.64",,,,,,,,,,,,,
Corvel,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Per Case,"$103,000.01 ",IP,930,"103,000.01",,,,,,,,,,,,,
Corvel,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Per Case,"$33,683.44 ",IP,930,"33,683.44",,,,,,,,,,,,,
Corvel,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$17,861.06 ",IP,930,"17,945.60",,,,,,,,,,,,,
Corvel,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"52,028.23",,,,,,,,,,,,,
Corvel,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Medical/Surgical,Per Case,"$26,656.38 ",IP,930,"34,810.73",,,,,,,,,,,,,
Corvel,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Medical/Surgical,Per Case,"$20,636.49 ",IP,930,"27,294.14",,,,,,,,,,,,,
Corvel,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Medical/Surgical,Per Case,"$31,852.97 ",IP,930,"31,852.97",,,,,,,,,,,,,
Corvel,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Medical/Surgical,Per Case,"$17,787.46 ",IP,930,"18,493.63",,,,,,,,,,,,,
Corvel,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"48,833.53",,,,,,,,,,,,,
Corvel,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Medical/Surgical,Per Case,"$27,050.24 ",IP,930,"29,719.85",,,,,,,,,,,,,
Corvel,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$17,677.17 ",IP,930,"24,726.31",,,,,,,,,,,,,
Corvel,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"39,644.64",,,,,,,,,,,,,
Corvel,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Per Case,"$25,444.94 ",IP,930,"25,444.94",,,,,,,,,,,,,
Corvel,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$18,391.08 ",IP,930,"18,391.08",,,,,,,,,,,,,
Corvel,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"32,676.06",,,,,,,,,,,,,
Corvel,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical/Surgical,Per Case,"$41,472.74 ",IP,930,"41,472.74",,,,,,,,,,,,,
Corvel,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,799.90 ",IP,930,"17,611.73",,,,,,,,,,,,,
Corvel,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Medical/Surgical,Per Case,"$33,955.01 ",IP,930,"33,955.01",,,,,,,,,,,,,
Corvel,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Medical/Surgical,Per Case,"$27,785.60 ",IP,930,"27,785.60",,,,,,,,,,,,,
Corvel,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,467.71 ",IP,930,"16,467.71",,,,,,,,,,,,,
Corvel,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Medical/Surgical,Per Case,"$18,347.83 ",IP,930,"23,228.24",,,,,,,,,,,,,
Corvel,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"33,169.58",,,,,,,,,,,,,
Corvel,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Medical/Surgical,Per Case,"$37,924.73 ",IP,930,"37,924.73",,,,,,,,,,,,,
Corvel,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,429.40 ",IP,930,"16,429.40",,,,,,,,,,,,,
Corvel,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Medical/Surgical,Per Case,"$18,560.45 ",IP,930,"19,220.76",,,,,,,,,,,,,
Corvel,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$13,956.09 ",IP,930,"13,956.09",,,,,,,,,,,,,
Corvel,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Medical/Surgical,Per Case,"$27,279.88 ",IP,930,"33,759.46",,,,,,,,,,,,,
Corvel,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Medical/Surgical,Per Case,"$22,295.03 ",IP,930,"22,633.50",,,,,,,,,,,,,
Corvel,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Per Case,"$13,809.53 ",IP,930,"18,026.39",,,,,,,,,,,,,
Corvel,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"35,375.30",,,,,,,,,,,,,
Corvel,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Medical/Surgical,Per Case,"$18,532.03 ",IP,930,"19,327.83",,,,,,,,,,,,,
Corvel,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Per Case,"$13,651.16 ",IP,930,"14,198.99",,,,,,,,,,,,,
Corvel,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"25,155.58",,,,,,,,,,,,,
Corvel,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,255.81 ",IP,930,"11,668.15",,,,,,,,,,,,,
Corvel,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"30,700.06",,,,,,,,,,,,,
Corvel,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Medical/Surgical,Per Case,"$18,582.24 ",IP,930,"18,582.24",,,,,,,,,,,,,
Corvel,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,017.90 ",IP,930,"12,954.01",,,,,,,,,,,,,
Corvel,DRG,MS-503,FOOT PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"25,587.77",,,,,,,,,,,,,
Corvel,DRG,MS-504,FOOT PROCEDURES WITH CC,Medical/Surgical,Per Case,"$14,255.62 ",IP,930,"17,267.14",,,,,,,,,,,,,
Corvel,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,948.95 ",IP,930,"17,267.14",,,,,,,,,,,,,
Corvel,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Medical/Surgical,Per Case,"$22,732.26 ",IP,930,"22,732.26",,,,,,,,,,,,,
Corvel,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Medical/Surgical,Per Case,"$8,975.51 ",IP,930,"19,685.07",,,,,,,,,,,,,
Corvel,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,525.70 ",IP,930,"13,763.88",,,,,,,,,,,,,
Corvel,DRG,MS-509,ARTHROSCOPY,Medical/Surgical,Per Case,"$11,826.31 ",IP,930,"16,292.77",,,,,,,,,,,,,
Corvel,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"26,580.63",,,,,,,,,,,,,
Corvel,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Medical/Surgical,Per Case,"$16,330.56 ",IP,930,"19,161.38",,,,,,,,,,,,,
Corvel,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,036.09 ",IP,930,"15,148.05",,,,,,,,,,,,,
Corvel,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Medical/Surgical,Per Case,"$16,495.63 ",IP,930,"16,495.63",,,,,,,,,,,,,
Corvel,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,274.32 ",IP,930,"9,677.54",,,,,,,,,,,,,
Corvel,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"30,535.56",,,,,,,,,,,,,
Corvel,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$20,939.60 ",IP,930,"20,939.60",,,,,,,,,,,,,
Corvel,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$17,164.18 ",IP,930,"17,164.18",,,,,,,,,,,,,
Corvel,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Medical/Surgical,Straight Discount,53.20%,IP,930,"34,889.58",,,,,,,,,,,,,
Corvel,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"19,056.25",,,,,,,,,,,,,
Corvel,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"13,796.97",,,,,,,,,,,,,
Corvel,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"13,750.25",,,,,,,,,,,,,
Corvel,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical/Surgical,Per Case,"$9,003.64 ",IP,880,"9,003.64",,,,,,,,,,,,,
Corvel,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"12,009.81",,,,,,,,,,,,,
Corvel,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical/Surgical,Per Case,"$10,296.75 ",IP,880,"10,296.75",,,,,,,,,,,,,
Corvel,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"9,083.77",,,,,,,,,,,,,
Corvel,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,438.29 ",IP,880,"11,438.29",,,,,,,,,,,,,
Corvel,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,895.64",,,,,,,,,,,,,
Corvel,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical/Surgical,Per Case,"$16,619.21 ",IP,880,"16,619.21",,,,,,,,,,,,,
Corvel,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,354.93 ",IP,880,"11,354.93",,,,,,,,,,,,,
Corvel,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical/Surgical,Per Case,"$42,249.68 ",IP,880,"42,249.68",,,,,,,,,,,,,
Corvel,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical/Surgical,Per Case,"$21,655.34 ",IP,880,"21,655.34",,,,,,,,,,,,,
Corvel,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,656.85 ",IP,880,"12,656.85",,,,,,,,,,,,,
Corvel,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical/Surgical,Per Case,"$28,263.70 ",IP,880,"28,263.70",,,,,,,,,,,,,
Corvel,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical/Surgical,Per Case,"$17,348.98 ",IP,880,"17,348.98",,,,,,,,,,,,,
Corvel,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,953.43 ",IP,880,"10,953.43",,,,,,,,,,,,,
Corvel,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"19,756.13",,,,,,,,,,,,,
Corvel,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical/Surgical,Per Case,"$8,532.54 ",IP,880,"12,137.32",,,,,,,,,,,,,
Corvel,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,709.49 ",IP,880,"8,709.49",,,,,,,,,,,,,
Corvel,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical/Surgical,Per Case,"$20,193.22 ",IP,880,"20,193.22",,,,,,,,,,,,,
Corvel,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical/Surgical,Per Case,"$8,715.20 ",IP,880,"9,169.43",,,,,,,,,,,,,
Corvel,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"12,345.63",,,,,,,,,,,,,
Corvel,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical/Surgical,Per Case,"$7,523.31 ",IP,880,"7,693.75",,,,,,,,,,,,,
Corvel,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"13,265.50",,,,,,,,,,,,,
Corvel,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical/Surgical,Per Case,"$6,517.08 ",IP,880,"7,848.52",,,,,,,,,,,,,
Corvel,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"13,568.22",,,,,,,,,,,,,
Corvel,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical/Surgical,Per Case,"$7,620.96 ",IP,880,"8,354.69",,,,,,,,,,,,,
Corvel,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,182.14",,,,,,,,,,,,,
Corvel,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical/Surgical,Per Case,"$11,188.31 ",IP,880,"11,188.31",,,,,,,,,,,,,
Corvel,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,281.18 ",IP,880,"7,700.57",,,,,,,,,,,,,
Corvel,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical/Surgical,Per Case,"$18,525.24 ",IP,880,"18,525.24",,,,,,,,,,,,,
Corvel,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical/Surgical,Per Case,"$9,252.79 ",IP,880,"9,252.79",,,,,,,,,,,,,
Corvel,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,735.33",,,,,,,,,,,,,
Corvel,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical/Surgical,Per Case,"$17,516.01 ",IP,880,"17,516.01",,,,,,,,,,,,,
Corvel,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$6,721.34 ",IP,880,"7,315.10",,,,,,,,,,,,,
Corvel,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"27,608.54",,,,,,,,,,,,,
Corvel,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"15,893.68",,,,,,,,,,,,,
Corvel,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"10,732.71",,,,,,,,,,,,,
Corvel,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Medical/Surgical,Per Case,"$25,796.67 ",IP,930,"53,900.08",,,,,,,,,,,,,
Corvel,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Medical/Surgical,Per Case,"$17,918.09 ",IP,930,"31,618.95",,,,,,,,,,,,,
Corvel,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$15,260.65 ",IP,930,"17,146.44",,,,,,,,,,,,,
Corvel,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"49,165.46",,,,,,,,,,,,,
Corvel,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Medical/Surgical,Per Case,"$40,864.17 ",IP,930,"40,864.17",,,,,,,,,,,,,
Corvel,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$13,343.95 ",IP,930,"15,873.23",,,,,,,,,,,,,
Corvel,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"28,499.21",,,,,,,,,,,,,
Corvel,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Medical/Surgical,Per Case,"$13,373.16 ",IP,930,"15,577.32",,,,,,,,,,,,,
Corvel,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,395.12 ",IP,930,"12,187.94",,,,,,,,,,,,,
Corvel,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Medical/Surgical,Per Case,"$12,328.69 ",IP,930,"15,922.88",,,,,,,,,,,,,
Corvel,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,231.22 ",IP,930,"14,969.92",,,,,,,,,,,,,
Corvel,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Medical/Surgical,Per Case,"$16,676.00 ",IP,930,"17,757.74",,,,,,,,,,,,,
Corvel,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$13,232.22 ",IP,930,"16,904.06",,,,,,,,,,,,,
Corvel,DRG,MS-592,SKIN ULCERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"16,418.34",,,,,,,,,,,,,
Corvel,DRG,MS-593,SKIN ULCERS WITH CC,Medical/Surgical,Per Case,"$8,188.66 ",IP,880,"11,065.61",,,,,,,,,,,,,
Corvel,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"7,969.23",,,,,,,,,,,,,
Corvel,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"19,585.78",,,,,,,,,,,,,
Corvel,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical/Surgical,Per Case,"$9,420.05 ",IP,880,"9,628.87",,,,,,,,,,,,,
Corvel,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"15,931.64",,,,,,,,,,,,,
Corvel,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical/Surgical,Per Case,"$8,969.52 ",IP,880,"10,816.42",,,,,,,,,,,,,
Corvel,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"6,533.46",,,,,,,,,,,,,
Corvel,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"9,692.14",,,,,,,,,,,,,
Corvel,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,644.16 ",IP,880,"8,644.16",,,,,,,,,,,,,
Corvel,DRG,MS-602,CELLULITIS WITH MCC,Medical/Surgical,Per Case,"$17,311.08 ",IP,880,"17,311.08",,,,,,,,,,,,,
Corvel,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical/Surgical,Per Case,"$7,139.19 ",IP,880,"8,223.28",,,,,,,,,,,,,
Corvel,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,516.31",,,,,,,,,,,,,
Corvel,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical/Surgical,Per Case,"$10,528.82 ",IP,880,"10,528.82",,,,,,,,,,,,,
Corvel,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,708.07",,,,,,,,,,,,,
Corvel,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical/Surgical,Per Case,"$5,748.42 ",IP,880,"8,036.39",,,,,,,,,,,,,
Corvel,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"23,233.11",,,,,,,,,,,,,
Corvel,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$30,961.86 ",IP,930,"30,961.86",,,,,,,,,,,,,
Corvel,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"38,826.98",,,,,,,,,,,,,
Corvel,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Medical/Surgical,Per Case,"$24,974.72 ",IP,930,"24,974.72",,,,,,,,,,,,,
Corvel,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"12,683.40",,,,,,,,,,,,,
Corvel,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Medical/Surgical,Per Case,"$46,417.37 ",IP,930,"46,417.37",,,,,,,,,,,,,
Corvel,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Medical/Surgical,Per Case,"$29,276.15 ",IP,930,"29,276.15",,,,,,,,,,,,,
Corvel,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$21,824.05 ",IP,930,"21,824.05",,,,,,,,,,,,,
Corvel,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"35,167.00",,,,,,,,,,,,,
Corvel,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Medical/Surgical,Per Case,"$20,650.00 ",IP,930,"20,650.00",,,,,,,,,,,,,
Corvel,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"10,651.92",,,,,,,,,,,,,
Corvel,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"27,656.24",,,,,,,,,,,,,
Corvel,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$16,454.94 ",IP,930,"16,454.94",,,,,,,,,,,,,
Corvel,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,627.38 ",IP,930,"12,627.38",,,,,,,,,,,,,
Corvel,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"35,997.31",,,,,,,,,,,,,
Corvel,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$42,844.13 ",IP,930,"42,844.13",,,,,,,,,,,,,
Corvel,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$62,529.13 ",IP,930,"62,529.13",,,,,,,,,,,,,
Corvel,DRG,MS-637,DIABETES WITH MCC,Medical/Surgical,Per Case,"$16,384.92 ",IP,880,"16,384.92",,,,,,,,,,,,,
Corvel,DRG,MS-638,DIABETES WITH CC,Medical/Surgical,Per Case,"$11,497.32 ",IP,880,"11,497.32",,,,,,,,,,,,,
Corvel,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$6,523.28 ",IP,880,"6,523.28",,,,,,,,,,,,,
Corvel,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical/Surgical,Per Case,"$16,032.71 ",IP,880,"16,032.71",,,,,,,,,,,,,
Corvel,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical/Surgical,Per Case,"$8,705.74 ",IP,880,"8,705.74",,,,,,,,,,,,,
Corvel,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical/Surgical,Per Case,"$6,174.81 ",IP,880,"12,532.53",,,,,,,,,,,,,
Corvel,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"16,190.56",,,,,,,,,,,,,
Corvel,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical/Surgical,Per Case,"$8,322.64 ",IP,880,"9,912.13",,,,,,,,,,,,,
Corvel,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$5,828.85 ",IP,880,"7,473.77",,,,,,,,,,,,,
Corvel,DRG,MS-652,KIDNEY TRANSPLANT,Medical/Surgical,Straight Discount,53.20%,IP,930,"30,972.61",,,,,,,,,,,,,
Corvel,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"53,042.51",,,,,,,,,,,,,
Corvel,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Medical/Surgical,Per Case,"$34,877.16 ",IP,930,"34,877.16",,,,,,,,,,,,,
Corvel,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"20,247.69",,,,,,,,,,,,,
Corvel,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"31,944.07",,,,,,,,,,,,,
Corvel,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Medical/Surgical,Per Case,"$24,776.42 ",IP,930,"24,776.42",,,,,,,,,,,,,
Corvel,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Medical/Surgical,Per Case,"$18,687.10 ",IP,930,"18,687.10",,,,,,,,,,,,,
Corvel,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"25,939.16",,,,,,,,,,,,,
Corvel,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Medical/Surgical,Per Case,"$22,402.18 ",IP,930,"22,402.18",,,,,,,,,,,,,
Corvel,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,610.09 ",IP,930,"16,610.09",,,,,,,,,,,,,
Corvel,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"28,518.67",,,,,,,,,,,,,
Corvel,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Medical/Surgical,Per Case,"$11,309.35 ",IP,930,"15,524.76",,,,,,,,,,,,,
Corvel,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,392.38 ",IP,930,"11,527.00",,,,,,,,,,,,,
Corvel,DRG,MS-665,PROSTATECTOMY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"29,559.24",,,,,,,,,,,,,
Corvel,DRG,MS-666,PROSTATECTOMY WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"16,881.68",,,,,,,,,,,,,
Corvel,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"9,684.36",,,,,,,,,,,,,
Corvel,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$34,290.18 ",IP,930,"34,290.18",,,,,,,,,,,,,
Corvel,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Medical/Surgical,Per Case,"$11,379.09 ",IP,930,"14,911.51",,,,,,,,,,,,,
Corvel,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,916.13 ",IP,930,"9,916.13",,,,,,,,,,,,,
Corvel,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"17,294.40",,,,,,,,,,,,,
Corvel,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"11,202.86",,,,,,,,,,,,,
Corvel,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$72,221.90 ",IP,930,"72,221.90",,,,,,,,,,,,,
Corvel,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Medical/Surgical,Per Case,"$24,957.02 ",IP,930,"24,957.02",,,,,,,,,,,,,
Corvel,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$20,920.16 ",IP,930,"20,920.16",,,,,,,,,,,,,
Corvel,DRG,MS-682,RENAL FAILURE WITH MCC,Medical/Surgical,Per Case,"$28,276.40 ",IP,880,"28,276.40",,,,,,,,,,,,,
Corvel,DRG,MS-683,RENAL FAILURE WITH CC,Medical/Surgical,Per Case,"$15,981.82 ",IP,880,"15,981.82",,,,,,,,,,,,,
Corvel,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,604.95 ",IP,880,"11,604.95",,,,,,,,,,,,,
Corvel,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,233.73",,,,,,,,,,,,,
Corvel,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical/Surgical,Per Case,"$15,308.52 ",IP,880,"15,308.52",,,,,,,,,,,,,
Corvel,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"6,670.71",,,,,,,,,,,,,
Corvel,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical/Surgical,Per Case,"$13,266.88 ",IP,880,"13,266.88",,,,,,,,,,,,,
Corvel,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical/Surgical,Per Case,"$7,183.79 ",IP,880,"7,711.27",,,,,,,,,,,,,
Corvel,DRG,MS-693,URINARY STONES WITH MCC,Medical/Surgical,Per Case,"$16,038.03 ",IP,880,"16,038.03",,,,,,,,,,,,,
Corvel,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical/Surgical,Per Case,"$7,989.85 ",IP,880,"7,989.85",,,,,,,,,,,,,
Corvel,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"11,060.74",,,,,,,,,,,,,
Corvel,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical/Surgical,Per Case,"$10,088.21 ",IP,880,"10,088.21",,,,,,,,,,,,,
Corvel,DRG,MS-697,URETHRAL STRICTURE,Medical/Surgical,Straight Discount,53.20%,IP,880,"9,704.80",,,,,,,,,,,,,
Corvel,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical/Surgical,Per Case,"$16,964.20 ",IP,880,"16,964.20",,,,,,,,,,,,,
Corvel,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical/Surgical,Per Case,"$13,322.27 ",IP,880,"13,322.27",,,,,,,,,,,,,
Corvel,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,322.67 ",IP,880,"7,322.67",,,,,,,,,,,,,
Corvel,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Medical/Surgical,Per Case,"$19,671.63 ",IP,930,"19,671.63",,,,,,,,,,,,,
Corvel,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,904.02 ",IP,930,"16,904.02",,,,,,,,,,,,,
Corvel,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"22,504.03",,,,,,,,,,,,,
Corvel,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,135.78 ",IP,930,"16,135.78",,,,,,,,,,,,,
Corvel,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"20,736.34",,,,,,,,,,,,,
Corvel,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"10,293.71",,,,,,,,,,,,,
Corvel,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Medical/Surgical,Per Case,"$10,368.27 ",IP,930,"14,519.23",,,,,,,,,,,,,
Corvel,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,422.24 ",IP,930,"9,038.02",,,,,,,,,,,,,
Corvel,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"19,651.97",,,,,,,,,,,,,
Corvel,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"12,425.45",,,,,,,,,,,,,
Corvel,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"17,506.60",,,,,,,,,,,,,
Corvel,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"12,033.17",,,,,,,,,,,,,
Corvel,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"16,635.41",,,,,,,,,,,,,
Corvel,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Per Case,"$5,825.44 ",IP,880,"10,601.30",,,,,,,,,,,,,
Corvel,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,900.09 ",IP,880,"12,900.09",,,,,,,,,,,,,
Corvel,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"12,478.01",,,,,,,,,,,,,
Corvel,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"7,235.28",,,,,,,,,,,,,
Corvel,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"13,803.79",,,,,,,,,,,,,
Corvel,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical/Surgical,Per Case,"$7,197.55 ",IP,880,"7,821.27",,,,,,,,,,,,,
Corvel,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"9,780.72",,,,,,,,,,,,,
Corvel,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"5,506.52",,,,,,,,,,,,,
Corvel,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"21,636.74",,,,,,,,,,,,,
Corvel,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"13,759.01",,,,,,,,,,,,,
Corvel,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"41,449.32",,,,,,,,,,,,,
Corvel,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Medical/Surgical,Per Case,"$24,678.12 ",IP,930,"24,678.12",,,,,,,,,,,,,
Corvel,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,233.92 ",IP,930,"16,233.92",,,,,,,,,,,,,
Corvel,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"37,200.43",,,,,,,,,,,,,
Corvel,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Medical/Surgical,Per Case,"$17,412.34 ",IP,930,"17,521.20",,,,,,,,,,,,,
Corvel,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,241.46 ",IP,930,"12,454.65",,,,,,,,,,,,,
Corvel,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Medical/Surgical,Per Case,"$14,956.02 ",IP,930,"16,713.28",,,,,,,,,,,,,
Corvel,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,792.58 ",IP,930,"11,021.81",,,,,,,,,,,,,
Corvel,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Medical/Surgical,Per Case,"$13,805.67 ",IP,930,"17,462.80",,,,,,,,,,,,,
Corvel,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,142.11 ",IP,930,"11,393.65",,,,,,,,,,,,,
Corvel,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Medical/Surgical,Per Case,"$15,985.54 ",IP,930,"15,985.54",,,,,,,,,,,,,
Corvel,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,529.41 ",IP,930,"10,529.41",,,,,,,,,,,,,
Corvel,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Medical/Surgical,Per Case,"$9,496.56 ",IP,930,"13,124.35",,,,,,,,,,,,,
Corvel,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Medical/Surgical,Per Case,"$18,761.54 ",IP,930,"26,353.83",,,,,,,,,,,,,
Corvel,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,651.15 ",IP,930,"14,269.07",,,,,,,,,,,,,
Corvel,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"17,725.61",,,,,,,,,,,,,
Corvel,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Per Case,"$13,542.79 ",IP,880,"13,542.79",,,,,,,,,,,,,
Corvel,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,899.49 ",IP,880,"9,899.49",,,,,,,,,,,,,
Corvel,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,816.12",,,,,,,,,,,,,
Corvel,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical/Surgical,Per Case,"$8,798.45 ",IP,880,"9,412.78",,,,,,,,,,,,,
Corvel,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical/Surgical,Per Case,"$7,933.49 ",IP,880,"7,933.49",,,,,,,,,,,,,
Corvel,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical/Surgical,Per Case,"$12,819.20 ",IP,880,"12,819.20",,,,,,,,,,,,,
Corvel,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,742.10 ",IP,880,"9,742.10",,,,,,,,,,,,,
Corvel,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Medical/Surgical,Per Case,"$8,407.45 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Corvel,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Medical/Surgical,Per Case,"$16,800.08 ",IP,930,"16,800.08",,,,,,,,,,,,,
Corvel,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Medical/Surgical,Per Case,"$8,928.65 ",IP,930,"8,928.65",,,,,,,,,,,,,
Corvel,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical/Surgical,Per Case,"$7,059.95 ",IP,880,"7,483.50",,,,,,,,,,,,,
Corvel,DRG,MS-779,ABORTION WITHOUT D&C,Medical/Surgical,Per Case,"$6,348.60 ",IP,880,"10,127.25",,,,,,,,,,,,,
Corvel,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,975.00","17,026.59",,,,,,,,,,,,,
Corvel,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,"2,975.00","9,954.83",,,,,,,,,,,,,
Corvel,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,975.00","8,321.91",,,,,,,,,,,,,
Corvel,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,975.00","14,466.28",,,,,,,,,,,,,
Corvel,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,"2,975.00","9,662.07",,,,,,,,,,,,,
Corvel,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,975.00","8,065.51",,,,,,,,,,,,,
Corvel,DRG,MS-789,NEONATES- DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY,Medical/Surgical,Per Case,"$11,823.59 ",IP,"9,415.40","15,624.60",,,,,,,,,,,,,
Corvel,DRG,MS-790,EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME- NEONATE,Medical/Surgical,Per Case,"$59,778.37 ",IP,"31,049.47","59,778.37",,,,,,,,,,,,,
Corvel,DRG,MS-791,PREMATURITY WITH MAJOR PROBLEMS,Medical/Surgical,Per Case,"$18,126.50 ",IP,"18,126.50","35,189.68",,,,,,,,,,,,,
Corvel,DRG,MS-792,PREMATURITY WITHOUT MAJOR PROBLEMS,Medical/Surgical,Per Case,"$8,021.48 ",IP,"8,021.48","21,232.55",,,,,,,,,,,,,
Corvel,DRG,MS-793,FULL TERM NEONATE WITH MAJOR PROBLEMS,Medical/Surgical,Per Case,"$6,433.54 ",IP,"6,433.54","36,147.06",,,,,,,,,,,,,
Corvel,DRG,MS-794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,Medical/Surgical,Per Case,"$2,637.93 ",IP,"2,637.93","12,794.26",,,,,,,,,,,,,
Corvel,DRG,MS-795,NORMAL NEWBORN,Medical/Surgical,Per Case,"$1,683.66 ",IP,280,"1,732.03",,,,,,,,,,,,,
Corvel,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Corvel,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Corvel,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Corvel,DRG,MS-799,SPLENECTOMY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"50,070.72",,,,,,,,,,,,,
Corvel,DRG,MS-800,SPLENECTOMY WITH CC,Medical/Surgical,Per Case,"$25,320.56 ",IP,930,"28,728.93",,,,,,,,,,,,,
Corvel,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Medical/Surgical,Per Case,"$23,774.65 ",IP,930,"23,774.65",,,,,,,,,,,,,
Corvel,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"36,100.49",,,,,,,,,,,,,
Corvel,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"18,346.64",,,,,,,,,,,,,
Corvel,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,347.03 ",IP,930,"13,279.12",,,,,,,,,,,,,
Corvel,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Corvel,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Corvel,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Corvel,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"21,199.68",,,,,,,,,,,,,
Corvel,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical/Surgical,Per Case,"$13,075.41 ",IP,880,"13,075.41",,,,,,,,,,,,,
Corvel,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,300.53 ",IP,880,"10,300.53",,,,,,,,,,,,,
Corvel,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical/Surgical,Per Case,"$15,949.69 ",IP,880,"15,949.69",,,,,,,,,,,,,
Corvel,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical/Surgical,Per Case,"$8,371.16 ",IP,880,"8,563.00",,,,,,,,,,,,,
Corvel,DRG,MS-813,COAGULATION DISORDERS,Medical/Surgical,Per Case,"$11,374.87 ",IP,880,"15,036.11",,,,,,,,,,,,,
Corvel,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,405.05",,,,,,,,,,,,,
Corvel,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical/Surgical,Per Case,"$13,663.66 ",IP,880,"13,663.66",,,,,,,,,,,,,
Corvel,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$5,833.27 ",IP,880,"6,433.20",,,,,,,,,,,,,
Corvel,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"22,405.72",,,,,,,,,,,,,
Corvel,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,930,"12,814.81",,,,,,,,,,,,,
Corvel,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"9,713.56",,,,,,,,,,,,,
Corvel,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$122,617.90 ",IP,930,"122,617.90",,,,,,,,,,,,,
Corvel,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$27,576.90 ",IP,930,"27,576.90",,,,,,,,,,,,,
Corvel,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$27,517.90 ",IP,930,"27,517.90",,,,,,,,,,,,,
Corvel,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"43,774.77",,,,,,,,,,,,,
Corvel,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Medical/Surgical,Per Case,"$21,485.65 ",IP,930,"22,998.52",,,,,,,,,,,,,
Corvel,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"13,634.41",,,,,,,,,,,,,
Corvel,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"49,028.21",,,,,,,,,,,,,
Corvel,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$33,856.22 ",IP,930,"33,856.22",,,,,,,,,,,,,
Corvel,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$32,407.03 ",IP,930,"32,407.03",,,,,,,,,,,,,
Corvel,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"31,204.28",,,,,,,,,,,,,
Corvel,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"14,372.25",,,,,,,,,,,,,
Corvel,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"10,912.79",,,,,,,,,,,,,
Corvel,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,880,"7,590.57",,,,,,,,,,,,,
Corvel,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"5,217.42",,,,,,,,,,,,,
Corvel,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$151,525.57 ",IP,880,"151,525.57",,,,,,,,,,,,,
Corvel,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$108,442.41 ",IP,880,"108,442.41",,,,,,,,,,,,,
Corvel,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$19,754.19 ",IP,880,"19,754.19",,,,,,,,,,,,,
Corvel,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"55,476.01",,,,,,,,,,,,,
Corvel,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical/Surgical,Straight Discount,53.20%,IP,880,"21,987.16",,,,,,,,,,,,,
Corvel,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"14,467.64",,,,,,,,,,,,,
Corvel,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical/Surgical,Per Case,"$38,835.02 ",IP,880,"38,835.02",,,,,,,,,,,,,
Corvel,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical/Surgical,Per Case,"$23,414.24 ",IP,880,"23,414.24",,,,,,,,,,,,,
Corvel,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical/Surgical,Per Case,"$10,675.98 ",IP,880,"10,675.98",,,,,,,,,,,,,
Corvel,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,522.83",,,,,,,,,,,,,
Corvel,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical/Surgical,Per Case,"$21,166.22 ",IP,880,"21,166.22",,,,,,,,,,,,,
Corvel,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$15,814.63 ",IP,880,"15,814.63",,,,,,,,,,,,,
Corvel,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"25,988.81",,,,,,,,,,,,,
Corvel,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical/Surgical,Straight Discount,53.20%,IP,880,"12,996.84",,,,,,,,,,,,,
Corvel,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"10,016.29",,,,,,,,,,,,,
Corvel,DRG,MS-849,RADIOTHERAPY,Medical/Surgical,Straight Discount,53.20%,IP,880,"24,213.33",,,,,,,,,,,,,
Corvel,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$91,309.54 ",IP,930,"91,309.54",,,,,,,,,,,,,
Corvel,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$37,668.10 ",IP,930,"37,668.10",,,,,,,,,,,,,
Corvel,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$27,510.35 ",IP,930,"27,510.35",,,,,,,,,,,,,
Corvel,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Medical/Surgical,Per Case,"$119,992.39 ",IP,930,"119,992.39",,,,,,,,,,,,,
Corvel,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Medical/Surgical,Per Case,"$20,964.74 ",IP,930,"20,964.74",,,,,,,,,,,,,
Corvel,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$20,693.25 ",IP,930,"20,693.25",,,,,,,,,,,,,
Corvel,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical/Surgical,Per Case,"$64,183.43 ",IP,880,"64,183.43",,,,,,,,,,,,,
Corvel,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical/Surgical,Per Case,"$11,618.05 ",IP,880,"11,618.05",,,,,,,,,,,,,
Corvel,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical/Surgical,Straight Discount,53.20%,IP,880,"8,517.25",,,,,,,,,,,,,
Corvel,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical/Surgical,Per Case,"$15,920.29 ",IP,880,"15,920.29",,,,,,,,,,,,,
Corvel,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical/Surgical,Per Case,"$6,553.21 ",IP,880,"8,149.30",,,,,,,,,,,,,
Corvel,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical/Surgical,Per Case,"$31,175.95 ",IP,880,"31,175.95",,,,,,,,,,,,,
Corvel,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical/Surgical,Per Case,"$20,802.66 ",IP,880,"20,802.66",,,,,,,,,,,,,
Corvel,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$9,060.60 ",IP,880,"9,060.60",,,,,,,,,,,,,
Corvel,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical/Surgical,Straight Discount,53.20%,IP,880,"62,539.00",,,,,,,,,,,,,
Corvel,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical/Surgical,Per Case,"$31,444.24 ",IP,880,"31,444.24",,,,,,,,,,,,,
Corvel,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical/Surgical,Per Case,"$15,068.90 ",IP,880,"15,068.90",,,,,,,,,,,,,
Corvel,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Medical/Surgical,Per Case,"$20,766.40 ",IP,930,"31,745.49",,,,,,,,,,,,,
Corvel,DRG,MS-880,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,Medical/Surgical,Per Case,"$6,400.34 ",IP,485,"8,406.28",,,,,,,,,,,,,
Corvel,DRG,MS-881,DEPRESSIVE NEUROSES,Medical/Surgical,Per Case,"$7,116.12 ",IP,485,"7,800.83",,,,,,,,,,,,,
Corvel,DRG,MS-882,NEUROSES EXCEPT DEPRESSIVE,Medical/Surgical,Per Case,"$7,682.33 ",IP,485,"8,011.08",,,,,,,,,,,,,
Corvel,DRG,MS-883,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,Medical/Surgical,Per Case,"$11,429.50 ",IP,485,"15,363.17",,,,,,,,,,,,,
Corvel,DRG,MS-884,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,Medical/Surgical,Per Case,"$8,309.75 ",IP,485,"14,053.95",,,,,,,,,,,,,
Corvel,DRG,MS-885,PSYCHOSES,Medical/Surgical,Per Case,"$8,386.54 ",IP,485,"12,041.93",,,,,,,,,,,,,
Corvel,DRG,MS-886,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,Medical/Surgical,Per Case,"$10,595.31 ",IP,485,"11,890.08",,,,,,,,,,,,,
Corvel,DRG,MS-887,OTHER MENTAL DISORDER DIAGNOSES,Medical/Surgical,Per Case,"$5,786.27 ",IP,485,"10,500.07",,,,,,,,,,,,,
Corvel,DRG,MS-894,ALCOHOL- DRUG ABUSE OR DEPENDENCE- LEFT AMA,Medical/Surgical,Per Case,"$5,293.66 ",IP,"3,005.26","5,329.37",,,,,,,,,,,,,
Corvel,DRG,MS-895,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,Medical/Surgical,Per Case,"$21,100.96 ",IP,"8,754.13","21,100.96",,,,,,,,,,,,,
Corvel,DRG,MS-896,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC,Medical/Surgical,Per Case,"$12,366.29 ",IP,"9,745.49","17,297.32",,,,,,,,,,,,,
Corvel,DRG,MS-897,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC,Medical/Surgical,Per Case,"$7,058.75 ",IP,"4,527.06","8,035.42",,,,,,,,,,,,,
Corvel,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"41,488.25",,,,,,,,,,,,,
Corvel,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Medical/Surgical,Per Case,"$23,640.59 ",IP,930,"23,640.59",,,,,,,,,,,,,
Corvel,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$11,230.37 ",IP,930,"11,230.37",,,,,,,,,,,,,
Corvel,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"36,224.11",,,,,,,,,,,,,
Corvel,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,254.32 ",IP,930,"15,982.25",,,,,,,,,,,,,
Corvel,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Medical/Surgical,Per Case,"$13,485.33 ",IP,930,"17,460.85",,,,,,,,,,,,,
Corvel,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Medical/Surgical,Per Case,"$52,333.81 ",IP,930,"52,333.81",,,,,,,,,,,,,
Corvel,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Medical/Surgical,Per Case,"$23,274.39 ",IP,930,"23,274.39",,,,,,,,,,,,,
Corvel,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$14,200.04 ",IP,930,"14,200.04",,,,,,,,,,,,,
Corvel,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"15,928.72",,,,,,,,,,,,,
Corvel,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical/Surgical,Per Case,"$7,461.04 ",IP,880,"8,649.63",,,,,,,,,,,,,
Corvel,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"16,524.44",,,,,,,,,,,,,
Corvel,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical/Surgical,Per Case,"$4,353.43 ",IP,880,"6,398.16",,,,,,,,,,,,,
Corvel,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical/Surgical,Per Case,"$18,792.48 ",IP,880,"18,792.48",,,,,,,,,,,,,
Corvel,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical/Surgical,Per Case,"$6,147.36 ",IP,880,"7,700.57",,,,,,,,,,,,,
Corvel,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical/Surgical,Per Case,"$14,669.70 ",IP,880,"17,856.05",,,,,,,,,,,,,
Corvel,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical/Surgical,Per Case,"$11,715.10 ",IP,880,"11,715.10",,,,,,,,,,,,,
Corvel,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical/Surgical,Per Case,"$8,817.98 ",IP,880,"8,817.98",,,,,,,,,,,,,
Corvel,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"15,453.70",,,,,,,,,,,,,
Corvel,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical/Surgical,Per Case,"$6,898.48 ",IP,880,"9,056.51",,,,,,,,,,,,,
Corvel,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Medical/Surgical,Straight Discount,53.20%,IP,930,"204,714.78",,,,,,,,,,,,,
Corvel,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"63,456.92",,,,,,,,,,,,,
Corvel,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"29,288.63",,,,,,,,,,,,,
Corvel,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical/Surgical,Straight Discount,53.20%,IP,880,"21,975.48",,,,,,,,,,,,,
Corvel,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical/Surgical,Straight Discount,53.20%,IP,880,"18,857.68",,,,,,,,,,,,,
Corvel,DRG,MS-935,NON-EXTENSIVE BURNS,Medical/Surgical,Per Case,"$10,828.31 ",IP,880,"18,818.74",,,,,,,,,,,,,
Corvel,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"32,961.27",,,,,,,,,,,,,
Corvel,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Medical/Surgical,Per Case,"$35,826.95 ",IP,930,"35,826.95",,,,,,,,,,,,,
Corvel,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Medical/Surgical,Per Case,"$18,172.90 ",IP,930,"18,735.03",,,,,,,,,,,,,
Corvel,DRG,MS-945,REHABILITATION WITH CC/MCC,Medical/Surgical,Per Case,"$24,048.61 ",IP,"8,112.02","24,048.61",,,,,,,,,,,,,
Corvel,DRG,MS-946,REHABILITATION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$13,242.60 ",IP,"6,164.90","13,242.60",,,,,,,,,,,,,
Corvel,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,880,"11,584.43",,,,,,,,,,,,,
Corvel,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical/Surgical,Per Case,"$7,392.57 ",IP,880,"7,647.03",,,,,,,,,,,,,
Corvel,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical/Surgical,Per Case,"$16,233.61 ",IP,880,"16,233.61",,,,,,,,,,,,,
Corvel,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical/Surgical,Per Case,"$2,575.95 ",IP,880,"7,192.45",,,,,,,,,,,,,
Corvel,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical/Surgical,Per Case,"$12,539.35 ",IP,880,"12,539.35",,,,,,,,,,,,,
Corvel,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Medical/Surgical,Per Case,"$99,563.62 ",IP,930,"99,563.62",,,,,,,,,,,,,
Corvel,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Medical/Surgical,Per Case,"$48,319.58 ",IP,930,"48,319.58",,,,,,,,,,,,,
Corvel,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical/Surgical,Per Case,"$81,020.82 ",IP,930,"81,020.82",,,,,,,,,,,,,
Corvel,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical/Surgical,Per Case,"$41,927.10 ",IP,930,"41,927.10",,,,,,,,,,,,,
Corvel,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical/Surgical,Per Case,"$34,550.88 ",IP,930,"34,550.88",,,,,,,,,,,,,
Corvel,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical/Surgical,Per Case,"$41,610.90 ",IP,880,"41,610.90",,,,,,,,,,,,,
Corvel,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical/Surgical,Per Case,"$28,388.26 ",IP,880,"28,388.26",,,,,,,,,,,,,
Corvel,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,749.46 ",IP,880,"16,749.46",,,,,,,,,,,,,
Corvel,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"56,334.55",,,,,,,,,,,,,
Corvel,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Medical/Surgical,Straight Discount,53.20%,IP,930,"28,667.60",,,,,,,,,,,,,
Corvel,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical/Surgical,Per Case,"$95,225.61 ",IP,880,"95,225.61",,,,,,,,,,,,,
Corvel,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical/Surgical,Per Case,"$34,297.84 ",IP,880,"34,297.84",,,,,,,,,,,,,
Corvel,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical/Surgical,Per Case,"$20,273.82 ",IP,880,"20,273.82",,,,,,,,,,,,,
Corvel,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical/Surgical,Per Case,"$32,684.59 ",IP,880,"32,684.59",,,,,,,,,,,,,
Corvel,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Per Case,"$51,698.29 ",IP,930,"51,698.29",,,,,,,,,,,,,
Corvel,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Per Case,"$34,570.65 ",IP,930,"34,570.65",,,,,,,,,,,,,
Corvel,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$16,317.63 ",IP,930,"16,317.63",,,,,,,,,,,,,
Corvel,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Medical/Surgical,Per Case,"$55,966.14 ",IP,930,"55,966.14",,,,,,,,,,,,,
Corvel,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Medical/Surgical,Per Case,"$18,900.02 ",IP,930,"18,900.02",,,,,,,,,,,,,
Corvel,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Medical/Surgical,Per Case,"$12,784.87 ",IP,930,"12,784.87",,,,,,,,,,,,,
Corvel,CPT,10005,Fna bx w/us gdn 1st les,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,10007,Fna bx w/fluor gdn 1st les,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,10009,Fna bx w/ct gdn 1st les,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,10011,Fna bx w/mr gdn 1st les,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,10021,Fna bx w/o img gdn 1st les,OP Fee Schedule,Per Unit,$220.23 ,OP,220.23,335.15,,,,,,,,,,,,,
Corvel,CPT,10030,Guide cathet fluid drainage,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,10035,Perq dev soft tiss 1st imag,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,10060,Drainage of skin abscess,OP Fee Schedule,Per Unit,$288.27 ,OP,173.99,288.27,,,,,,,,,,,,,
Corvel,CPT,10061,Drainage of skin abscess,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,335.15,,,,,,,,,,,,,
Corvel,CPT,10080,Drainage of pilonidal cyst,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,602.74,,,,,,,,,,,,,
Corvel,CPT,10081,Drainage of pilonidal cyst,OP Fee Schedule,Per Unit,"$2,234.05 ",OP,602.74,"2,234.05",,,,,,,,,,,,,
Corvel,CPT,10120,Remove foreign body,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,335.15,,,,,,,,,,,,,
Corvel,CPT,10121,Remove foreign body,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,10140,Drainage of hematoma/fluid,OP Fee Schedule,Per Unit,"$2,234.05 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Corvel,CPT,10160,Puncture drainage of lesion,OP Fee Schedule,Per Unit,$205.50 ,OP,205.5,335.15,,,,,,,,,,,,,
Corvel,CPT,10180,Complex drainage wound,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,11000,Debride infected skin,OP Fee Schedule,Per Unit,$218.70 ,OP,218.7,507.97,,,,,,,,,,,,,
Corvel,CPT,11010,Debride skin at fx site,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11011,Debride skin musc at fx site,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11012,Deb skin bone at fx site,OP Fee Schedule,Per Unit,$819.60 ,OP,819.6,"2,296.73",,,,,,,,,,,,,
Corvel,CPT,11042,Deb subq tissue 20 sq cm/<,OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,11043,Deb musc/fascia 20 sq cm/<,OP Fee Schedule,Per Unit,$535.80 ,OP,507.97,535.8,,,,,,,,,,,,,
Corvel,CPT,11044,Deb bone 20 sq cm/<,OP Fee Schedule,Per Unit,"$1,378.71 ",OP,"1,363.50","1,378.71",,,,,,,,,,,,,
Corvel,CPT,11057,Trim skin lesions over 4,OP Fee Schedule,Per Unit,$218.70 ,OP,173.99,218.7,,,,,,,,,,,,,
Corvel,CPT,11102,Tangntl bx skin single les,OP Fee Schedule,Straight Discount,53.20%,OP,173.99,173.99,,,,,,,,,,,,,
Corvel,CPT,11104,Punch bx skin single lesion,OP Fee Schedule,Straight Discount,53.20%,OP,335.15,335.15,,,,,,,,,,,,,
Corvel,CPT,11106,Incal bx skn single les,OP Fee Schedule,Straight Discount,53.20%,OP,507.97,507.97,,,,,,,,,,,,,
Corvel,CPT,11307,Shave skin lesion 1.1-2.0 cm,OP Fee Schedule,Per Unit,$218.70 ,OP,173.99,218.7,,,,,,,,,,,,,
Corvel,CPT,11310,Shave skin lesion 0.5 cm/<,OP Fee Schedule,Per Unit,$218.70 ,OP,173.99,218.7,,,,,,,,,,,,,
Corvel,CPT,11311,Shave skin lesion 0.6-1.0 cm,OP Fee Schedule,Per Unit,$218.70 ,OP,173.99,218.7,,,,,,,,,,,,,
Corvel,CPT,11312,Shave skin lesion 1.1-2.0 cm,OP Fee Schedule,Per Unit,$218.70 ,OP,218.7,335.15,,,,,,,,,,,,,
Corvel,CPT,11313,Shave skin lesion >2.0 cm,OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,11400,Exc tr-ext b9+marg 0.5 cm<,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11401,Exc tr-ext b9+marg 0.6-1 cm,OP Fee Schedule,Per Unit,$819.60 ,OP,335.15,819.6,,,,,,,,,,,,,
Corvel,CPT,11402,Exc tr-ext b9+marg 1.1-2 cm,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11403,Exc tr-ext b9+marg 2.1-3cm,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11404,Exc tr-ext b9+marg 3.1-4 cm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11406,Exc tr-ext b9+marg >4.0 cm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11420,Exc h-f-nk-sp b9+marg 0.5/<,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,11421,Exc h-f-nk-sp b9+marg 0.6-1,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11422,Exc h-f-nk-sp b9+marg 1.1-2,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,11423,Exc h-f-nk-sp b9+marg 2.1-3,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11424,Exc h-f-nk-sp b9+marg 3.1-4,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11426,Exc h-f-nk-sp b9+marg >4 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11440,Exc face-mm b9+marg 0.5 cm/<,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11441,Exc face-mm b9+marg 0.6-1 cm,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11442,Exc face-mm b9+marg 1.1-2 cm,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11443,Exc face-mm b9+marg 2.1-3 cm,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,11444,Exc face-mm b9+marg 3.1-4 cm,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,11446,Exc face-mm b9+marg >4 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11450,Removal sweat gland lesion,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11451,Removal sweat gland lesion,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11462,Removal sweat gland lesion,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11463,Removal sweat gland lesion,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11470,Removal sweat gland lesion,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11471,Removal sweat gland lesion,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11600,Exc tr-ext mal+marg 0.5 cm/<,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11601,Exc tr-ext mal+marg 0.6-1 cm,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11602,Exc tr-ext mal+marg 1.1-2 cm,OP Fee Schedule,Per Unit,$819.60 ,OP,335.15,819.6,,,,,,,,,,,,,
Corvel,CPT,11603,Exc tr-ext mal+marg 2.1-3 cm,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11604,Exc tr-ext mal+marg 3.1-4 cm,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11606,Exc tr-ext mal+marg >4 cm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11620,Exc h-f-nk-sp mal+marg 0.5/<,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,11621,Exc s/n/h/f/g mal+mrg 0.6-1,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11622,Exc s/n/h/f/g mal+mrg 1.1-2,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11623,Exc s/n/h/f/g mal+mrg 2.1-3,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11624,Exc s/n/h/f/g mal+mrg 3.1-4,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11626,Exc s/n/h/f/g mal+mrg >4 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11640,Exc f/e/e/n/l mal+mrg 0.5cm<,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11641,Exc f/e/e/n/l mal+mrg 0.6-1,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11642,Exc f/e/e/n/l mal+mrg 1.1-2,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,11643,Exc f/e/e/n/l mal+mrg 2.1-3,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,11644,Exc f/e/e/n/l mal+mrg 3.1-4,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,11646,Exc f/e/e/n/l mal+mrg >4 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11750,Removal of nail bed,OP Fee Schedule,Per Unit,$819.60 ,OP,335.15,819.6,,,,,,,,,,,,,
Corvel,CPT,11755,Biopsy nail unit,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,11760,Repair of nail bed,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,11762,Reconstruction of nail bed,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,"1,662.33",,,,,,,,,,,,,
Corvel,CPT,11770,Remove pilonidal cyst simple,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11771,Remove pilonidal cyst exten,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11772,Remove pilonidal cyst compl,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,11920,Correct skin color 6.0 cm/<,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,11921,Correct skn color 6.1-20.0cm,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,11950,Tx contour defects 1 cc/<,OP Fee Schedule,Per Unit,$297.30 ,OP,173.99,297.3,,,,,,,,,,,,,
Corvel,CPT,11951,Tx contour defects 1.1-5.0cc,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,11952,Tx contour defects 5.1-10cc,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,11954,Tx contour defects >10.0 cc,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,11960,Insert tissue expander(s),OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,11970,Rplcmt tiss xpndr perm implt,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,12007,Rpr s/n/ax/gen/trnk >30.0 cm,OP Fee Schedule,Per Unit,$297.30 ,OP,173.99,297.3,,,,,,,,,,,,,
Corvel,CPT,12020,Closure of split wound,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,12021,Closure of split wound,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12031,Intmd rpr s/a/t/ext 2.5 cm/<,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12032,Intmd rpr s/a/t/ext 2.6-7.5,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12034,Intmd rpr s/tr/ext 7.6-12.5,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12035,Intmd rpr s/a/t/ext 12.6-20,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12036,Intmd rpr s/a/t/ext 20.1-30,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,12037,Intmd rpr s/tr/ext >30.0 cm,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Corvel,CPT,12042,Intmd rpr n-hf/genit2.6-7.5,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12044,Intmd rpr n-hf/genit7.6-12.5,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,12045,Intmd rpr n-hf/genit12.6-20,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,12046,Intmd rpr n-hf/genit20.1-30,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,12047,Intmd rpr n-hf/genit >30.0cm,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Corvel,CPT,12051,Intmd rpr face/mm 2.5 cm/<,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12052,Intmd rpr face/mm 2.6-5.0 cm,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12053,Intmd rpr face/mm 5.1-7.5 cm,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12055,Intmd rpr face/mm 12.6-20 cm,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,12057,Intmd rpr face/mm >30.0 cm,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,335.15,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,13100,Cmplx rpr trunk 1.1-2.5 cm,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,507.97,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,13101,Cmplx rpr trunk 2.6-7.5 cm,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,507.97,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,13120,Cmplx rpr s/a/l 1.1-2.5 cm,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,13121,Cmplx rpr s/a/l 2.6-7.5 cm,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,13131,Cmplx rpr f/c/c/m/n/ax/g/h/f,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,335.15,,,,,,,,,,,,,
Corvel,CPT,13132,Cmplx rpr f/c/c/m/n/ax/g/h/f,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,507.97,,,,,,,,,,,,,
Corvel,CPT,13151,Cmplx rpr e/n/e/l 1.1-2.5 cm,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,507.97,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,13152,Cmplx rpr e/n/e/l 2.6-7.5 cm,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,507.97,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,13160,Late closure of wound,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,14000,Tis trnfr trunk 10 sq cm/<,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,14001,Tis trnfr trunk 10.1-30sqcm,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,14020,Tis trnfr s/a/l 10 sq cm/<,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,14021,Tis trnfr s/a/l 10.1-30 sqcm,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,14040,Tis trnfr f/c/c/m/n/a/g/h/f,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,14041,Tis trnfr f/c/c/m/n/a/g/h/f,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,14060,Tis trnfr e/n/e/l 10 sq cm/<,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,14061,Tis trnfr e/n/e/l10.1-30sqcm,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,14301,Tis trnfr any 30.1-60 sq cm,OP Fee Schedule,Straight Discount,53.20%,OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Corvel,CPT,14350,Filleted finger/toe flap,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15002,Wound prep trk/arm/leg,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Corvel,CPT,15004,Wound prep f/n/hf/g,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,507.97,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,15040,Harvest cultured skin graft,OP Fee Schedule,Per Unit,$297.30 ,OP,297.3,"1,662.33",,,,,,,,,,,,,
Corvel,CPT,15050,Skin pinch graft,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,507.97,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,15100,Skin splt grft trnk/arm/leg,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15110,Epidrm autogrft trnk/arm/leg,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15115,Epidrm a-grft face/nck/hf/g,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15120,Skn splt a-grft fac/nck/hf/g,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15130,Derm autograft trnk/arm/leg,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15135,Derm autograft face/nck/hf/g,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15150,Cult skin grft t/arm/leg,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15155,Cult skin graft f/n/hf/g,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15200,Skin full graft trunk,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15220,Skin full graft sclp/arm/leg,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15240,Skin full grft face/genit/hf,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15260,Skin full graft een & lips,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15271,Skin sub graft trnk/arm/leg,OP Fee Schedule,Straight Discount,53.20%,OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Corvel,CPT,15273,Skin sub grft t/arm/lg child,OP Fee Schedule,Straight Discount,53.20%,OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Corvel,CPT,15275,Skin sub graft face/nk/hf/g,OP Fee Schedule,Straight Discount,53.20%,OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Corvel,CPT,15277,Skn sub grft f/n/hf/g child,OP Fee Schedule,Straight Discount,53.20%,OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Corvel,CPT,15570,Skin pedicle flap trunk,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15572,Skin pedicle flap arms/legs,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15574,Pedcle fh/ch/ch/m/n/ax/g/h/f,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15576,Pedicle e/n/e/l/ntroral,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15600,Delay flap trunk,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15610,Delay flap arms/legs,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15620,Delay flap f/c/c/n/ax/g/h/f,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15630,Delay flap eye/nos/ear/lip,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15650,Transfer skin pedicle flap,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15730,Mdfc flap w/prsrv vasc pedcl,OP Fee Schedule,Straight Discount,53.20%,OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Corvel,CPT,15731,Forehead flap w/vasc pedicle,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"2,811.11","3,413.26",,,,,,,,,,,,,
Corvel,CPT,15733,Musc myoq/fscq flp h&n pedcl,OP Fee Schedule,Straight Discount,53.20%,OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Corvel,CPT,15734,Muscle-skin graft trunk,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15736,Muscle-skin graft arm,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15738,Muscle-skin graft leg,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15740,Island pedicle flap graft,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15750,Neurovascular pedicle flap,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15760,Composite skin graft,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15769,Grfg autol soft tiss dir exc,OP Fee Schedule,Straight Discount,53.20%,OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Corvel,CPT,15770,Derma-fat-fascia graft,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15771,Grfg autol fat lipo 50 cc/<,OP Fee Schedule,Straight Discount,53.20%,OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Corvel,CPT,15773,Grfg autol fat lipo 25 cc/<,OP Fee Schedule,Straight Discount,53.20%,OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Corvel,CPT,15775,Hair trnspl 1-15 punch grfts,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,335.15,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,15776,Hair trnspl >15 punch grafts,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,335.15,"1,053.46",,,,,,,,,,,,,
Corvel,CPT,15780,Dermabrasion total face,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15781,Dermabrasion segmental face,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,15782,Dermabrasion other than face,OP Fee Schedule,Per Unit,$819.60 ,OP,819.6,"2,296.73",,,,,,,,,,,,,
Corvel,CPT,15783,Dermabrasion suprfl any site,OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,15789,Chemical peel face dermal,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,507.97,,,,,,,,,,,,,
Corvel,CPT,15819,Plastic surgery neck,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Corvel,CPT,15820,Revision of lower eyelid,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15821,Revision of lower eyelid,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15822,Revision of upper eyelid,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15823,Revision of upper eyelid,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15824,Removal of forehead wrinkles,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15825,Removal of neck wrinkles,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15826,Removal of brow wrinkles,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15828,Removal of face wrinkles,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15829,Removal of skin wrinkles,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15830,Exc skin abd,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"4,019.12","5,362.86",,,,,,,,,,,,,
Corvel,CPT,15832,Excise excessive skin thigh,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15833,Excise excessive skin leg,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15834,Excise excessive skin hip,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15835,Excise excessive skin buttck,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,"1,053.46","2,296.73",,,,,,,,,,,,,
Corvel,CPT,15836,Excise excessive skin arm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,15837,Excise excess skin arm/hand,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,15838,Excise excess skin fat pad,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,15839,Excise excess skin & tissue,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,15840,Nerve palsy fascial graft,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15841,Nerve palsy muscle graft,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15842,Nerve palsy microsurg graft,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15845,Skin and muscle repair face,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15850,Remove sutures same surgeon,OP Fee Schedule,Per Unit,$535.80 ,OP,507.97,535.8,,,,,,,,,,,,,
Corvel,CPT,15851,Remove sutures diff surgeon,OP Fee Schedule,Per Unit,$535.80 ,OP,535.8,"1,662.33",,,,,,,,,,,,,
Corvel,CPT,15876,Suction lipectomy head&neck,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15877,Suction lipectomy trunk,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15878,Suction lipectomy upr extrem,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,15879,Suction lipectomy lwr extrem,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15920,Removal of tail bone ulcer,OP Fee Schedule,Per Unit,$819.60 ,OP,819.6,"2,296.73",,,,,,,,,,,,,
Corvel,CPT,15922,Removal of tail bone ulcer,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15931,Remove sacrum pressure sore,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15933,Remove sacrum pressure sore,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15934,Remove sacrum pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15935,Remove sacrum pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15936,Remove sacrum pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15937,Remove sacrum pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15940,Remove hip pressure sore,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15941,Remove hip pressure sore,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15944,Remove hip pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15945,Remove hip pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15946,Remove hip pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15950,Remove thigh pressure sore,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15951,Remove thigh pressure sore,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,15952,Remove thigh pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15953,Remove thigh pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15956,Remove thigh pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15958,Remove thigh pressure sore,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,15999,Removal of pressure sore,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,16025,Dress/debrid p-thick burn m,OP Fee Schedule,Per Unit,$218.70 ,OP,173.99,218.7,,,,,,,,,,,,,
Corvel,CPT,16030,Dress/debrid p-thick burn l,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,335.15,,,,,,,,,,,,,
Corvel,CPT,16035,Incision of burn scab initi,OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,17004,Destroy premal lesions 15/>,OP Fee Schedule,Per Unit,$514.08 ,OP,335.15,514.08,,,,,,,,,,,,,
Corvel,CPT,17106,Destruction of skin lesions,OP Fee Schedule,Per Unit,$514.08 ,OP,335.15,514.08,,,,,,,,,,,,,
Corvel,CPT,17107,Destruction of skin lesions,OP Fee Schedule,Per Unit,$514.08 ,OP,507.97,514.08,,,,,,,,,,,,,
Corvel,CPT,17108,Destruction of skin lesions,OP Fee Schedule,Per Unit,$514.08 ,OP,514.08,"1,662.33",,,,,,,,,,,,,
Corvel,CPT,17264,Destruction of skin lesions,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,335.15,,,,,,,,,,,,,
Corvel,CPT,17266,Destruction of skin lesions,OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,17270,Destruction of skin lesions,OP Fee Schedule,Per Unit,$325.32 ,OP,173.99,325.32,,,,,,,,,,,,,
Corvel,CPT,17271,Destruction of skin lesions,OP Fee Schedule,Per Unit,$218.70 ,OP,173.99,218.7,,,,,,,,,,,,,
Corvel,CPT,17273,Destruction of skin lesions,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,335.15,,,,,,,,,,,,,
Corvel,CPT,17274,Destruction of skin lesions,OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,17276,Destruction of skin lesions,OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,17281,Destruction of skin lesions,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,335.15,,,,,,,,,,,,,
Corvel,CPT,17282,Destruction of skin lesions,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,335.15,,,,,,,,,,,,,
Corvel,CPT,17283,Destruction of skin lesions,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,335.15,,,,,,,,,,,,,
Corvel,CPT,17284,Destruction of skin lesions,OP Fee Schedule,Per Unit,$535.80 ,OP,507.97,535.8,,,,,,,,,,,,,
Corvel,CPT,17286,Destruction of skin lesions,OP Fee Schedule,Per Unit,$325.32 ,OP,325.32,507.97,,,,,,,,,,,,,
Corvel,CPT,17311,Mohs 1 stage h/n/hf/g,OP Fee Schedule,Per Unit,$746.97 ,OP,507.97,746.97,,,,,,,,,,,,,
Corvel,CPT,17313,Mohs 1 stage t/a/l,OP Fee Schedule,Per Unit,$746.97 ,OP,507.97,746.97,,,,,,,,,,,,,
Corvel,CPT,17380,Hair removal by electrolysis,OP Fee Schedule,Per Unit,$218.70 ,OP,218.7,507.97,,,,,,,,,,,,,
Corvel,CPT,19000,Drainage of breast lesion,OP Fee Schedule,Per Unit,$414.36 ,OP,414.36,602.74,,,,,,,,,,,,,
Corvel,CPT,19020,Incision of breast lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Corvel,CPT,19081,Bx breast 1st lesion strtctc,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,19083,Bx breast 1st lesion us imag,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,19085,Bx breast 1st lesion mr imag,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,19100,Bx breast percut w/o image,OP Fee Schedule,Per Unit,$782.08 ,OP,782.08,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,19101,Biopsy of breast open,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19105,Cryosurg ablate fa each,OP Fee Schedule,Per Unit,"$5,611.72 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Corvel,CPT,19110,Nipple exploration,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19112,Excise breast duct fistula,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19120,Removal of breast lesion,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19125,Excision breast lesion,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19296,Place po breast cath for rad,OP Fee Schedule,Per Unit,"$10,260.73 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
Corvel,CPT,19298,Place breast rad tube/caths,OP Fee Schedule,Straight Discount,53.20%,OP,"5,362.86","5,362.86",,,,,,,,,,,,,
Corvel,CPT,19300,Removal of breast tissue,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19301,Partial mastectomy,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19302,P-mastectomy w/ln removal,OP Fee Schedule,Per Unit,"$7,410.86 ",OP,"5,362.86","7,410.86",,,,,,,,,,,,,
Corvel,CPT,19303,Mast simple complete,OP Fee Schedule,Per Unit,"$5,611.72 ",OP,"5,362.86","5,611.72",,,,,,,,,,,,,
Corvel,CPT,19307,Mast mod rad,OP Fee Schedule,Per Unit,"$7,585.18 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
Corvel,CPT,19316,Suspension of breast,OP Fee Schedule,Per Unit,"$5,611.72 ",OP,"5,362.86","5,611.72",,,,,,,,,,,,,
Corvel,CPT,19318,Breast reduction,OP Fee Schedule,Per Unit,"$7,410.86 ",OP,"5,362.86","7,410.86",,,,,,,,,,,,,
Corvel,CPT,19325,Breast augmentation w/implt,OP Fee Schedule,Per Unit,"$10,260.73 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
Corvel,CPT,19340,Insj breast implt sm d mast,OP Fee Schedule,Per Unit,"$7,585.18 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
Corvel,CPT,19342,Insj/rplcmt brst implt sep d,OP Fee Schedule,Per Unit,"$10,260.73 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
Corvel,CPT,19350,Breast reconstruction,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,19355,Correct inverted nipple(s),OP Fee Schedule,Per Unit,"$5,611.72 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Corvel,CPT,19357,Tiss xpndr plmt brst rcnstj,OP Fee Schedule,Per Unit,"$10,260.73 ",OP,"10,260.73","14,467.16",,,,,,,,,,,,,
Corvel,CPT,19370,Revj peri-implt capsule brst,OP Fee Schedule,Per Unit,"$5,611.72 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Corvel,CPT,19371,Peri-implt capslc brst compl,OP Fee Schedule,Per Unit,"$5,611.72 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Corvel,CPT,19380,Revj reconstructed breast,OP Fee Schedule,Per Unit,"$7,585.18 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
Corvel,CPT,19396,Design custom breast implant,OP Fee Schedule,Per Unit,"$5,611.72 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Corvel,CPT,19499,Breast surgery procedure,OP Fee Schedule,Per Unit,"$3,861.54 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Corvel,CPT,20100,Explore wound neck,OP Fee Schedule,Per Unit,$845.49 ,OP,438.38,845.49,,,,,,,,,,,,,
Corvel,CPT,20101,Explore wound chest,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,20102,Explore wound abdomen,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,20103,Explore wound extremity,OP Fee Schedule,Per Unit,$845.49 ,OP,602.74,845.49,,,,,,,,,,,,,
Corvel,CPT,20150,Excise epiphyseal bar,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,20200,Muscle biopsy,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,20205,Deep muscle biopsy,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,20206,Needle biopsy muscle,OP Fee Schedule,Per Unit,$782.08 ,OP,782.08,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,20220,Bone biopsy trocar/needle,OP Fee Schedule,Per Unit,$819.60 ,OP,819.6,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,20225,Bone biopsy trocar/needle,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,20240,Bone biopsy open superficial,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,20245,Bone biopsy open deep,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,20250,Open bone biopsy,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,20251,Open bone biopsy,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20500,Injection of sinus tract,OP Fee Schedule,Per Unit,$491.14 ,OP,491.14,"1,310.96",,,,,,,,,,,,,
Corvel,CPT,20520,Removal of foreign body,OP Fee Schedule,Per Unit,$819.60 ,OP,819.6,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,20525,Removal of foreign body,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,20526,Ther injection carp tunnel,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20527,Inj dupuytren cord w/enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,20550,Inj tendon sheath/ligament,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20551,Inj tendon origin/insertion,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20552,Inj trigger point 1/2 muscl,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20553,Inject trigger points 3/>,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20555,Place ndl musc/tis for rt,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,20560,Ndl insj w/o njx 1 or 2 musc,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,20561,Ndl insj w/o njx 3+ musc,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,20600,Drain/inj joint/bursa w/o us,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20604,Drain/inj joint/bursa w/us,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,20605,Drain/inj joint/bursa w/o us,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20606,Drain/inj joint/bursa w/us,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,20610,Drain/inj joint/bursa w/o us,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20611,Drain/inj joint/bursa w/us,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,20612,Aspirate/inj ganglion cyst,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,20615,Treatment of bone cyst,OP Fee Schedule,Per Unit,$414.36 ,OP,414.36,602.74,,,,,,,,,,,,,
Corvel,CPT,20650,Insert and remove bone pin,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,20662,Application of pelvis brace,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,20663,Application of thigh brace,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,20690,Apply bone fixation device,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20692,Apply bone fixation device,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Corvel,CPT,20693,Adjust bone fixation device,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20696,Comp multiplane ext fixation,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,20697,Comp ext fixate strut change,OP Fee Schedule,Straight Discount,53.20%,OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Corvel,CPT,20802,Replantation arm complete,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,20805,Replant forearm complete,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,20808,Replantation hand complete,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,20816,Replantation digit complete,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20822,Replantation digit complete,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"1,349.30","5,182.91",,,,,,,,,,,,,
Corvel,CPT,20824,Replantation thumb complete,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20827,Replantation thumb complete,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20838,Replantation foot complete,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,20900,Removal of bone for graft,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20902,Removal of bone for graft,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20910,Remove cartilage for graft,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,507.97,"4,292.48",,,,,,,,,,,,,
Corvel,CPT,20912,Remove cartilage for graft,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,20920,Removal of fascia for graft,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,20922,Removal of fascia for graft,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,20924,Removal of tendon for graft,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20950,Fluid pressure muscle,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,602.74,,,,,,,,,,,,,
Corvel,CPT,20955,Fibula bone graft microvasc,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20956,Iliac bone graft microvasc,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20957,Mt bone graft microvasc,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20962,Other bone graft microvasc,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20969,Bone/skin graft microvasc,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20970,Bone/skin graft iliac crest,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20972,Bone/skin graft metatarsal,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,20973,Bone/skin graft great toe,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,20982,Ablate bone tumor(s) perq,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,20983,Ablate bone tumor(s) perq,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,20999,Musculoskeletal surgery,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,199.81,"4,180.37",,,,,,,,,,,,,
Corvel,CPT,21010,Incision of jaw joint,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21011,Exc face les sc <2 cm,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,21012,Exc face les sbq 2 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,21013,Exc face tum deep < 2 cm,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,21014,Exc face tum deep 2 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21015,Resect face/scalp tum < 2 cm,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,296.73","3,290.24",,,,,,,,,,,,,
Corvel,CPT,21016,Resect face/scalp tum 2 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21025,Excision of bone lower jaw,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21026,Excision of facial bone(s),OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21029,Contour of face bone lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21030,Excise max/zygoma b9 tumor,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21031,Remove exostosis mandible,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21032,Remove exostosis maxilla,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21034,Excise max/zygoma mal tumor,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21040,Excise mandible lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21044,Removal of jaw bone lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21045,Extensive jaw surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21046,Remove mandible cyst complex,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21047,Excise lwr jaw cyst w/repair,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21048,Remove maxilla cyst complex,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21049,Excis uppr jaw cyst w/repair,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21050,Removal of jaw joint,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21060,Remove jaw joint cartilage,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21070,Remove coronoid process,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21073,Mnpj of tmj w/anesth,OP Fee Schedule,Straight Discount,53.20%,OP,"1,310.96","1,310.96",,,,,,,,,,,,,
Corvel,CPT,21076,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21077,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21079,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21080,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21081,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21082,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21083,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21084,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21085,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,205.06,"3,290.24",,,,,,,,,,,,,
Corvel,CPT,21086,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21087,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21088,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21089,Prepare face/oral prosthesis,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,21100,Maxillofacial fixation,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21120,Reconstruction of chin,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21121,Reconstruction of chin,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21122,Reconstruction of chin,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21123,Reconstruction of chin,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21125,Augmentation lower jaw bone,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21127,Augmentation lower jaw bone,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21137,Reduction of forehead,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21138,Reduction of forehead,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21139,Reduction of forehead,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21141,Lefort i-1 piece w/o graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21142,Lefort i-2 piece w/o graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21143,Lefort i-3/> piece w/o graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21145,Lefort i-1 piece w/ graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21146,Lefort i-2 piece w/ graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21147,Lefort i-3/> piece w/ graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21150,Lefort ii anterior intrusion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21151,Lefort ii w/bone grafts,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21154,Lefort iii w/o lefort i,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21155,Lefort iii w/ lefort i,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21159,Lefort iii w/fhdw/o lefort i,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21160,Lefort iii w/fhd w/ lefort i,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21172,Reconstruct orbit/forehead,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21175,Reconstruct orbit/forehead,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21179,Reconstruct entire forehead,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21180,Reconstruct entire forehead,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21181,Contour cranial bone lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21182,Reconstruct cranial bone,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21183,Reconstruct cranial bone,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21184,Reconstruct cranial bone,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21188,Reconstruction of midface,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21193,Reconst lwr jaw w/o graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21194,Reconst lwr jaw w/graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21195,Reconst lwr jaw w/o fixation,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21196,Reconst lwr jaw w/fixation,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21198,Reconstr lwr jaw segment,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21199,Reconstr lwr jaw w/advance,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21206,Reconstruct upper jaw bone,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21208,Augmentation of facial bones,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21209,Reduction of facial bones,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21210,Face bone graft,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21215,Lower jaw bone graft,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21230,Rib cartilage graft,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21235,Ear cartilage graft,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21240,Reconstruction of jaw joint,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21242,Reconstruction of jaw joint,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21243,Reconstruction of jaw joint,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"7,651.26","15,377.54",,,,,,,,,,,,,
Corvel,CPT,21244,Reconstruction of lower jaw,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21245,Reconstruction of jaw,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21246,Reconstruction of jaw,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21247,Reconstruct lower jaw bone,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21248,Reconstruction of jaw,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21249,Reconstruction of jaw,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21255,Reconstruct lower jaw bone,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21256,Reconstruction of orbit,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21260,Revise eye sockets,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21261,Revise eye sockets,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21263,Revise eye sockets,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21267,Revise eye sockets,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21268,Revise eye sockets,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21270,Augmentation cheek bone,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21275,Revision orbitofacial bones,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21280,Revision of eyelid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21282,Revision of eyelid,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,21295,Revision of jaw muscle/bone,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,21296,Revision of jaw muscle/bone,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21299,Cranio/maxillofacial surgery,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,21310,Closed tx nose fx w/o manj,OP Fee Schedule,Per Unit,$491.14 ,OP,199.81,491.14,,,,,,,,,,,,,
Corvel,CPT,21315,Closed tx nose fx w/o stablj,OP Fee Schedule,Per Unit,$491.14 ,OP,491.14,"1,310.96",,,,,,,,,,,,,
Corvel,CPT,21320,Closed tx nose fx w/ stablj,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Corvel,CPT,21325,Open tx nose fx uncomplicatd,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21330,Open tx nose fx w/skele fixj,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21335,Open tx nose & septal fx,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21336,Open tx septal fx w/wo stabj,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,21337,Closed tx septal&nose fx,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,21338,Open nasoethmoid fx w/o fixj,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21339,Open nasoethmoid fx w/ fixj,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21340,Perq tx nasoethmoid fx,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21343,Open tx dprsd front sinus fx,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21344,Open tx compl front sinus fx,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21345,Closed tx nose/jaw fx,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21346,Opn tx nasomax fx w/fixj,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21347,Opn tx nasomax fx multple,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21348,Opn tx nasomax fx w/graft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21355,Perq tx malar fracture,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21356,Opn tx dprsd zygomatic arch,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21360,Opn tx dprsd malar fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21365,Opn tx complx malar fx,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21366,Opn tx complx malar w/grft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21385,Opn tx orbit fx transantral,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21386,Opn tx orbit fx periorbital,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21387,Opn tx orbit fx combined,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21390,Opn tx orbit periorbtl implt,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21395,Opn tx orbit periorbt w/grft,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21400,Closed tx orbit w/o manipulj,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,21401,Closed tx orbit w/manipulj,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,21406,Opn tx orbit fx w/o implant,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21407,Opn tx orbit fx w/implant,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21408,Opn tx orbit fx w/bone grft,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21421,Treat mouth roof fracture,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21422,Treat mouth roof fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21423,Treat mouth roof fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21431,Treat craniofacial fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21432,Treat craniofacial fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21433,Treat craniofacial fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21435,Treat craniofacial fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21436,Treat craniofacial fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21440,Treat dental ridge fracture,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,21445,Treat dental ridge fracture,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21450,Treat lower jaw fracture,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,21451,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,21452,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21453,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21454,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21461,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21462,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21465,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21470,Treat lower jaw fracture,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21480,Reset dislocated jaw,OP Fee Schedule,Per Unit,$491.14 ,OP,199.81,491.14,,,,,,,,,,,,,
Corvel,CPT,21485,Reset dislocated jaw,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,21490,Repair dislocated jaw,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,21497,Interdental wiring,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,21499,Head surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,21501,Drain neck/chest lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,21502,Drain chest lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,21510,Drainage of bone lesion,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21550,Biopsy of neck/chest,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,21552,Exc neck les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21554,Exc neck tum deep 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21555,Exc neck les sc < 3 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,21556,Exc neck tum deep < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,21557,Resect neck thorax tumor<5cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,21558,Resect neck tumor 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21600,Partial removal of rib,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21601,Exc chest wall tumor w/ribs,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21602,Exc ch wal tum w/o lymphadec,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21603,Exc ch wal tum w/lymphadec,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21610,Partial removal of rib,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,21615,Removal of rib,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21616,Removal of rib and nerves,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21620,Partial removal of sternum,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21627,Sternal debridement,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21630,Extensive sternum surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21632,Extensive sternum surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21685,Hyoid myotomy & suspension,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
Corvel,CPT,21700,Revision of neck muscle,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21705,Revision of neck muscle/rib,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21720,Revision of neck muscle,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,21725,Revision of neck muscle,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,602.74,,,,,,,,,,,,,
Corvel,CPT,21740,Reconstruction of sternum,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21742,Repair stern/nuss w/o scope,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,21743,Repair sternum/nuss w/scope,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,21750,Repair of sternum separation,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21811,Optx of rib fx w/fixj scope,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21812,Treatment of rib fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21813,Treatment of rib fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Corvel,CPT,21820,Treat sternum fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,21825,Treat sternum fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,21899,Neck/chest surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,21920,Biopsy soft tissue of back,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,21925,Biopsy soft tissue of back,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,21930,Exc back les sc < 3 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,21931,Exc back les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,21932,Exc back tum deep < 5 cm,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21933,Exc back tum deep 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,21935,Resect back tum < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,21936,Resect back tum 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,22010,I&d p-spine c/t/cerv-thor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22015,I&d abscess p-spine l/s/ls,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22100,Remove part of neck vertebra,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,22101,Remove part thorax vertebra,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,22102,Remove part lumbar vertebra,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,22110,Remove part of neck vertebra,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22112,Remove part thorax vertebra,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22114,Remove part lumbar vertebra,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22206,Incis spine 3 column thorac,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22207,Incis spine 3 column lumbar,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22210,Incis 1 vertebral seg cerv,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22212,Incis 1 vertebral seg thorac,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22214,Incis 1 vertebral seg lumbar,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22220,Incis w/discectomy cervical,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22222,Incis w/discectomy thoracic,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22224,Incis w/discectomy lumbar,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22310,Closed tx vert fx w/o manj,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,22315,Closed tx vert fx w/manj,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"2,742.89",,,,,,,,,,,,,
Corvel,CPT,22318,Treat odontoid fx w/o graft,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22319,Treat odontoid fx w/graft,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22325,Treat spine fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22326,Treat neck spine fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22327,Treat thorax spine fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22505,Manipulation of spine,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,22510,Perq cervicothoracic inject,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,22511,Perq lumbosacral injection,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,22513,Perq vertebral augmentation,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22514,Perq vertebral augmentation,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,22532,Lat thorax spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22533,Lat lumbar spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22548,Neck spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22551,Neck spine fuse&remov bel c2,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22554,Neck spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22556,Thorax spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22558,Lumbar spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22586,Prescrl fuse w/ instr l5-s1,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22590,Spine & skull spinal fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22595,Neck spinal fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22600,Neck spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22610,Thorax spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22612,Lumbar spine fusion,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"8,843.00","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22630,Lumbar spine fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22633,Lumbar spine fusion combined,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22800,Post fusion 6 vert seg,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22802,Post fusion 7-12 vert seg,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22804,Post fusion 13/> vert seg,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22808,Ant fusion 2-3 vert seg,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22810,Ant fusion 4-7 vert seg,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22812,Ant fusion 8/> vert seg,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22818,Kyphectomy 1-2 segments,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22819,Kyphectomy 3 or more,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22830,Exploration of spinal fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22849,Reinsert spinal fixation,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22850,Remove spine fixation device,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22852,Remove spine fixation device,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22855,Remove spine fixation device,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22856,Cerv artific diskectomy,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22857,Lumbar artif diskectomy,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22861,Revise cerv artific disc,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22862,Revise lumbar artif disc,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22864,Remove cerv artif disc,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22865,Remove lumb artif disc,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22867,Insj stablj dev w/dcmprn,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,22869,Insj stablj dev w/o dcmprn,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,22899,Spine surgery procedure,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,199.81,"4,180.37",,,,,,,,,,,,,
Corvel,CPT,22900,Exc abdl tum deep < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,22901,Exc abdl tum deep 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,22902,Exc abd les sc < 3 cm,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,22903,Exc abd les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,22904,Radical resect abd tumor<5cm,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,22905,Rad resect abd tumor 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,22999,Abdomen surgery procedure,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,199.81,"4,180.37",,,,,,,,,,,,,
Corvel,CPT,23000,Removal of calcium deposits,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,23020,Release shoulder joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23030,Drain shoulder lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,23031,Drain shoulder bursa,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,23035,Drain shoulder bone lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,23040,Exploratory shoulder surgery,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23044,Exploratory shoulder surgery,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23065,Biopsy shoulder tissues,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,23066,Biopsy shoulder tissues,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,23071,Exc shoulder les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,23073,Exc shoulder tum deep 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,23075,Exc shoulder les sc < 3 cm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,23076,Exc shoulder tum deep < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,23077,Resect shoulder tumor < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,23078,Resect shoulder tumor 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,23100,Biopsy of shoulder joint,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,23101,Shoulder joint surgery,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23105,Remove shoulder joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23106,Incision of collarbone joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23107,Explore treat shoulder joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23120,Partial removal collar bone,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23125,Removal of collar bone,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23130,Remove shoulder bone part,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23140,Removal of bone lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,23145,Removal of bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23146,Removal of bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23150,Removal of humerus lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23155,Removal of humerus lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23156,Removal of humerus lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23170,Remove collar bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23172,Remove shoulder blade lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23174,Remove humerus lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23180,Remove collar bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23182,Remove shoulder blade lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23184,Remove humerus lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23190,Partial removal of scapula,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,23195,Removal of head of humerus,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23200,Resect clavicle tumor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23210,Resect scapula tumor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23220,Resect prox humerus tumor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23330,Remove shoulder foreign body,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,602.74,"1,363.70",,,,,,,,,,,,,
Corvel,CPT,23333,Remove shoulder fb deep,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,23334,Shoulder prosthesis removal,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,23335,Shoulder prosthesis removal,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,23395,Muscle transfer shoulder/arm,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23397,Muscle transfers,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23400,Fixation of shoulder blade,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23405,Incision of tendon & muscle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23406,Incise tendon(s) & muscle(s),OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23410,Repair rotator cuff acute,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23412,Repair rotator cuff chronic,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23415,Release of shoulder ligament,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23420,Repair of shoulder,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23430,Repair biceps tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23440,Remove/transplant tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23450,Repair shoulder capsule,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23455,Repair shoulder capsule,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23460,Repair shoulder capsule,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23462,Repair shoulder capsule,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23465,Repair shoulder capsule,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23466,Repair shoulder capsule,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23470,Reconstruct shoulder joint,OP Fee Schedule,Per Unit,"$21,470.92 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
Corvel,CPT,23472,Reconstruct shoulder joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23473,Revis reconst shoulder joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23474,Revis reconst shoulder joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23480,Revision of collar bone,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23485,Revision of collar bone,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23490,Reinforce clavicle,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,23491,Reinforce shoulder bones,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23500,Treat clavicle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23505,Treat clavicle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,23515,Treat clavicle fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,23520,Treat clavicle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,23525,Treat clavicle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23530,Treat clavicle dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,23532,Treat clavicle dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,23540,Treat clavicle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23545,Treat clavicle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23550,Treat clavicle dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,23552,Treat clavicle dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,23570,Treat shoulder blade fx,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23575,Treat shoulder blade fx,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,23585,Treat scapula fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,23600,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23605,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,23615,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23616,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","15,377.54",,,,,,,,,,,,,
Corvel,CPT,23620,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23625,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,23630,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,23650,Treat shoulder dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23655,Treat shoulder dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,23660,Treat shoulder dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,23665,Treat dislocation/fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,23670,Treat dislocation/fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,23675,Treat dislocation/fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,23680,Treat dislocation/fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23700,Fixation of shoulder,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,23800,Fusion of shoulder joint,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,23802,Fusion of shoulder joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23900,Amputation of arm & girdle,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23920,Amputation at shoulder joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,23921,Amputation follow-up surgery,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Corvel,CPT,23929,Shoulder surgery procedure,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,23930,Drainage of arm lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,23931,Drainage of arm bursa,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Corvel,CPT,23935,Drain arm/elbow bone lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24000,Exploratory elbow surgery,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24006,Release elbow joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24065,Biopsy arm/elbow soft tissue,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,24066,Biopsy arm/elbow soft tissue,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,24071,Exc arm/elbow les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,24073,Ex arm/elbow tum deep 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,24075,Exc arm/elbow les sc < 3 cm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,24076,Ex arm/elbow tum deep < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,24077,Resect arm/elbow tum < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,24079,Resect arm/elbow tum 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,24100,Biopsy elbow joint lining,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24101,Explore/treat elbow joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24102,Remove elbow joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24105,Removal of elbow bursa,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24110,Remove humerus lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24115,Remove/graft bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24116,Remove/graft bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24120,Remove elbow lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24125,Remove/graft bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24126,Remove/graft bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24130,Removal of head of radius,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24134,Removal of arm bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24136,Remove radius bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24138,Remove elbow bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24140,Partial removal of arm bone,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24145,Partial removal of radius,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24147,Partial removal of elbow,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24149,Radical resection of elbow,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24150,Resect distal humerus tumor,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24152,Resect radius tumor,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24155,Removal of elbow joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24200,Removal of arm foreign body,OP Fee Schedule,Per Unit,$819.60 ,OP,819.6,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,24201,Removal of arm foreign body,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,24300,Manipulate elbow w/anesth,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,24301,Muscle/tendon transfer,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24305,Arm tendon lengthening,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24310,Revision of arm tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24320,Repair of arm tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24330,Revision of arm muscles,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,24331,Revision of arm muscles,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24332,Tenolysis triceps,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24340,Repair of biceps tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24341,Repair arm tendon/muscle,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24342,Repair of ruptured tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24343,Repr elbow lat ligmnt w/tiss,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,24344,Reconstruct elbow lat ligmnt,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,24345,Repr elbw med ligmnt w/tissu,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24346,Reconstruct elbow med ligmnt,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24357,Repair elbow perc,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,24358,Repair elbow w/deb open,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,24359,Repair elbow deb/attch open,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,24360,Reconstruct elbow joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Corvel,CPT,24361,Reconstruct elbow joint,OP Fee Schedule,Per Unit,"$21,470.92 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Corvel,CPT,24362,Reconstruct elbow joint,OP Fee Schedule,Per Unit,"$9,501.79 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24363,Replace elbow joint,OP Fee Schedule,Per Unit,"$21,470.92 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Corvel,CPT,24365,Reconstruct head of radius,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24366,Reconstruct head of radius,OP Fee Schedule,Per Unit,"$21,470.92 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
Corvel,CPT,24370,Revise reconst elbow joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24371,Revise reconst elbow joint,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,24400,Revision of humerus,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24410,Revision of humerus,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24420,Revision of humerus,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24430,Repair of humerus,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,24435,Repair humerus with graft,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,24470,Revision of elbow joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24495,Decompression of forearm,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24498,Reinforce humerus,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,24500,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24505,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,24515,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24516,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24530,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24535,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,24538,Treat humerus fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24545,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24546,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","15,377.54",,,,,,,,,,,,,
Corvel,CPT,24560,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24565,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,24566,Treat humerus fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"1,349.30","5,112.93",,,,,,,,,,,,,
Corvel,CPT,24575,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24576,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24577,Treat humerus fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,24579,Treat humerus fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24582,Treat humerus fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24586,Treat elbow fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24587,Treat elbow fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24600,Treat elbow dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24605,Treat elbow dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,24615,Treat elbow dislocation,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,24620,Treat elbow fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,24635,Treat elbow fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,24640,Treat elbow dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24650,Treat radius fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24655,Treat radius fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,24665,Treat radius fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,24666,Treat radius fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24670,Treat ulnar fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,24675,Treat ulnar fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,24685,Treat ulnar fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,24800,Fusion of elbow joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,24802,Fusion/graft of elbow joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24900,Amputation of upper arm,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24920,Amputation of upper arm,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24925,Amputation follow-up surgery,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,24930,Amputation follow-up surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,24931,Amputate upper arm & implant,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24935,Revision of amputation,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,24940,Revision of upper arm,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,24999,Upper arm/elbow surgery,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25000,Incision of tendon sheath,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25001,Incise flexor carpi radialis,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25020,Decompress forearm 1 space,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25023,Decompress forearm 1 space,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25024,Decompress forearm 2 spaces,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25025,Decompress forearm 2 spaces,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25028,Drainage of forearm lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25031,Drainage of forearm bursa,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25035,Treat forearm bone lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25040,Explore/treat wrist joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25065,Biopsy forearm soft tissues,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,25066,Biopsy forearm soft tissues,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,25071,Exc forearm les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,25073,Exc forearm tum deep 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,25075,Exc forearm les sc < 3 cm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,25076,Exc forearm tum deep < 3 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,25077,Resect forearm/wrist tum<3cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,25078,Resect forarm/wrist tum 3cm>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,25085,Incision of wrist capsule,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25100,Biopsy of wrist joint,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25101,Explore/treat wrist joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25105,Remove wrist joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25107,Remove wrist joint cartilage,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25109,Excise tendon forearm/wrist,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25110,Remove wrist tendon lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25111,Remove wrist tendon lesion,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,25112,Reremove wrist tendon lesion,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,25115,Remove wrist/forearm lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25116,Remove wrist/forearm lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25118,Excise wrist tendon sheath,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25119,Partial removal of ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25120,Removal of forearm lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25125,Remove/graft forearm lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25126,Remove/graft forearm lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25130,Removal of wrist lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25135,Remove & graft wrist lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25136,Remove & graft wrist lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25145,Remove forearm bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25150,Partial removal of ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25151,Partial removal of radius,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25170,Resect radius/ulnar tumor,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25210,Removal of wrist bone,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,25215,Removal of wrist bones,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,25230,Partial removal of radius,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25240,Partial removal of ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25248,Remove forearm foreign body,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25259,Manipulate wrist w/anesthes,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25260,Repair forearm tendon/muscle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25263,Repair forearm tendon/muscle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25265,Repair forearm tendon/muscle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25270,Repair forearm tendon/muscle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25272,Repair forearm tendon/muscle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25274,Repair forearm tendon/muscle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25275,Repair forearm tendon sheath,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25280,Revise wrist/forearm tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25290,Incise wrist/forearm tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25295,Release wrist/forearm tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25300,Fusion of tendons at wrist,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25301,Fusion of tendons at wrist,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,25310,Transplant forearm tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25312,Transplant forearm tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25315,Revise palsy hand tendon(s),OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25316,Revise palsy hand tendon(s),OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,25320,Repair/revise wrist joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25332,Revise wrist joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
Corvel,CPT,25335,Realignment of hand,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25337,Reconstruct ulna/radioulnar,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25350,Revision of radius,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,25355,Revision of radius,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25360,Revision of ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25365,Revise radius & ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Corvel,CPT,25370,Revise radius or ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25375,Revise radius & ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25390,Shorten radius or ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25391,Lengthen radius or ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Corvel,CPT,25392,Shorten radius & ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25393,Lengthen radius & ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25394,Repair carpal bone shorten,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,25400,Repair radius or ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25405,Repair/graft radius or ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25415,Repair radius & ulna,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25420,Repair/graft radius & ulna,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,25425,Repair/graft radius or ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25426,Repair/graft radius & ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25430,Vasc graft into carpal bone,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,25431,Repair nonunion carpal bone,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25440,Repair/graft wrist bone,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,25441,Reconstruct wrist joint,OP Fee Schedule,Per Unit,"$21,470.92 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
Corvel,CPT,25442,Reconstruct wrist joint,OP Fee Schedule,Per Unit,"$21,470.92 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Corvel,CPT,25443,Reconstruct wrist joint,OP Fee Schedule,Per Unit,"$9,501.79 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Corvel,CPT,25444,Reconstruct wrist joint,OP Fee Schedule,Per Unit,"$9,501.79 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
Corvel,CPT,25445,Reconstruct wrist joint,OP Fee Schedule,Per Unit,"$9,501.79 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Corvel,CPT,25446,Wrist replacement,OP Fee Schedule,Per Unit,"$21,470.92 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Corvel,CPT,25447,Repair wrist joints,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
Corvel,CPT,25449,Remove wrist joint implant,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Corvel,CPT,25450,Revision of wrist joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25455,Revision of wrist joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25490,Reinforce radius,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25491,Reinforce ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Corvel,CPT,25492,Reinforce radius and ulna,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25500,Treat fracture of radius,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25505,Treat fracture of radius,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25515,Treat fracture of radius,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,25520,Treat fracture of radius,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25525,Treat fracture of radius,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,25526,Treat fracture of radius,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,25530,Treat fracture of ulna,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25535,Treat fracture of ulna,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25545,Treat fracture of ulna,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,25560,Treat fracture radius & ulna,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25565,Treat fracture radius & ulna,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25574,Treat fracture radius & ulna,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,25575,Treat fracture radius/ulna,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,25600,Treat fracture radius/ulna,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25605,Treat fracture radius/ulna,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25606,Treat fx distal radial,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,25607,Treat fx rad extra-articul,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,25608,Treat fx rad intra-articul,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,25609,Treat fx radial 3+ frag,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,25622,Treat wrist bone fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25624,Treat wrist bone fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25628,Treat wrist bone fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,25630,Treat wrist bone fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25635,Treat wrist bone fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25645,Treat wrist bone fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,25650,Treat wrist bone fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25651,Pin ulnar styloid fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,25652,Treat fracture ulnar styloid,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,25660,Treat wrist dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25670,Treat wrist dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25671,Pin radioulnar dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,25675,Treat wrist dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25676,Treat wrist dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25680,Treat wrist fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,25685,Treat wrist fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25690,Treat wrist dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,25695,Treat wrist dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25800,Fusion of wrist joint,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,25805,Fusion/graft of wrist joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,25810,Fusion/graft of wrist joint,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,25820,Fusion of hand bones,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"3,235.63","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25825,Fuse hand bones with graft,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25830,Fusion radioulnar jnt/ulna,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,25900,Amputation of forearm,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,25905,Amputation of forearm,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,25907,Amputation follow-up surgery,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25909,Amputation follow-up surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25915,Amputation of forearm,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25920,Amputate hand at wrist,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25922,Amputate hand at wrist,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,25924,Amputation follow-up surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,25927,Amputation of hand,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,25929,Amputation follow-up surgery,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Corvel,CPT,25931,Amputation follow-up surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,25999,Forearm or wrist surgery,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26010,Drainage of finger abscess,OP Fee Schedule,Per Unit,$288.27 ,OP,173.99,288.27,,,,,,,,,,,,,
Corvel,CPT,26011,Drainage of finger abscess,OP Fee Schedule,Per Unit,"$2,234.05 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Corvel,CPT,26020,Drain hand tendon sheath,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26025,Drainage of palm bursa,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26030,Drainage of palm bursas,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26034,Treat hand bone lesion,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26035,Decompress fingers/hand,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26037,Decompress fingers/hand,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26040,Release palm contracture,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"1,349.30","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26045,Release palm contracture,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26055,Incise finger tendon sheath,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26060,Incision of finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26070,Explore/treat hand joint,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26075,Explore/treat finger joint,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26080,Explore/treat finger joint,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26100,Biopsy hand joint lining,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26105,Biopsy finger joint lining,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26110,Biopsy finger joint lining,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26111,Exc hand les sc 1.5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,26113,Exc hand tum deep 1.5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,26115,Exc hand les sc < 1.5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,26116,Exc hand tum deep < 1.5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,26117,Rad resect hand tumor < 3 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,26118,Rad resect hand tumor 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,26121,Release palm contracture,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26123,Release palm contracture,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26130,Remove wrist joint lining,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26135,Revise finger joint each,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26140,Revise finger joint each,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26145,Tendon excision palm/finger,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26160,Remove tendon sheath lesion,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26170,Removal of palm tendon each,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26180,Removal of finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26185,Remove finger bone,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26200,Remove hand bone lesion,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26205,Remove/graft bone lesion,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26210,Removal of finger lesion,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26215,Remove/graft finger lesion,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26230,Partial removal of hand bone,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26235,Partial removal finger bone,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26236,Partial removal finger bone,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26250,Extensive hand surgery,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26260,Resect prox finger tumor,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26262,Resect distal finger tumor,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26340,Manipulate finger w/anesth,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,26341,Manipulat palm cord post inj,OP Fee Schedule,Straight Discount,53.20%,OP,199.81,199.81,,,,,,,,,,,,,
Corvel,CPT,26350,Repair finger/hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26352,Repair/graft hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26356,Repair finger/hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26357,Repair finger/hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26358,Repair/graft hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26370,Repair finger/hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26372,Repair/graft hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26373,Repair finger/hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26390,Revise hand/finger tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26392,Repair/graft hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26410,Repair hand tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26412,Repair/graft hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26415,Excision hand/finger tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26416,Graft hand or finger tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26418,Repair finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26420,Repair/graft finger tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26426,Repair finger/hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26428,Repair/graft finger tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26432,Repair finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26433,Repair finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26434,Repair/graft finger tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26437,Realignment of tendons,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26440,Release palm/finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26442,Release palm & finger tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26445,Release hand/finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26449,Release forearm/hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26450,Incision of palm tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26455,Incision of finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26460,Incise hand/finger tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26471,Fusion of finger tendons,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26474,Fusion of finger tendons,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26476,Tendon lengthening,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26477,Tendon shortening,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26478,Lengthening of hand tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26479,Shortening of hand tendon,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26480,Transplant hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26483,Transplant/graft hand tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26485,Transplant palm tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26489,Transplant/graft palm tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26490,Revise thumb tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26492,Tendon transfer with graft,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26494,Hand tendon/muscle transfer,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26496,Revise thumb tendon,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26497,Finger tendon transfer,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26498,Finger tendon transfer,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26499,Revision of finger,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26500,Hand tendon reconstruction,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"3,235.63","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26502,Hand tendon reconstruction,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26508,Release thumb contracture,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26510,Thumb tendon transfer,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26516,Fusion of knuckle joint,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26517,Fusion of knuckle joints,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26518,Fusion of knuckle joints,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26520,Release knuckle contracture,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26525,Release finger contracture,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26530,Revise knuckle joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Corvel,CPT,26531,Revise knuckle with implant,OP Fee Schedule,Per Unit,"$9,501.79 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Corvel,CPT,26535,Revise finger joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
Corvel,CPT,26536,Revise/implant finger joint,OP Fee Schedule,Per Unit,"$9,501.79 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Corvel,CPT,26540,Repair hand joint,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26541,Repair hand joint with graft,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26542,Repair hand joint with graft,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26545,Reconstruct finger joint,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26546,Repair nonunion hand,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26548,Reconstruct finger joint,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26550,Construct thumb replacement,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26551,Great toe-hand transfer,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26553,Single transfer toe-hand,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26554,Double transfer toe-hand,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26555,Positional change of finger,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26556,Toe joint transfer,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26560,Repair of web finger,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26561,Repair of web finger,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26562,Repair of web finger,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26565,Correct metacarpal flaw,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26567,Correct finger deformity,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26568,Lengthen metacarpal/finger,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26580,Repair hand deformity,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26587,Reconstruct extra finger,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26590,Repair finger deformity,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26591,Repair muscles of hand,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26593,Release muscles of hand,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26596,Excision constricting tissue,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26600,Treat metacarpal fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26605,Treat metacarpal fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26607,Treat metacarpal fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"2,742.89",,,,,,,,,,,,,
Corvel,CPT,26608,Treat metacarpal fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,26615,Treat metacarpal fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,26641,Treat thumb dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26645,Treat thumb fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,26650,Treat thumb fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,26665,Treat thumb fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,26670,Treat hand dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26675,Treat hand dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,26676,Pin hand dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,26685,Treat hand dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,26686,Treat hand dislocation,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"2,742.89","11,460.57",,,,,,,,,,,,,
Corvel,CPT,26700,Treat knuckle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26705,Treat knuckle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,26706,Pin knuckle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"2,742.89",,,,,,,,,,,,,
Corvel,CPT,26715,Treat knuckle dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,26720,Treat finger fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26725,Treat finger fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26727,Treat finger fracture each,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,26735,Treat finger fracture each,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,26740,Treat finger fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26742,Treat finger fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,26746,Treat finger fracture each,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,26750,Treat finger fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26755,Treat finger fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26756,Pin finger fracture each,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,26765,Treat finger fracture each,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,26770,Treat finger dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26775,Treat finger dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,233.72,"2,923.32",,,,,,,,,,,,,
Corvel,CPT,26776,Pin finger dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,26785,Treat finger dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,26820,Thumb fusion with graft,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26841,Fusion of thumb,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26842,Thumb fusion with graft,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26843,Fusion of hand joint,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26844,Fusion/graft of hand joint,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26850,Fusion of knuckle,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26852,Fusion of knuckle with graft,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Corvel,CPT,26860,Fusion of finger joint,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26862,Fusion/graft of finger joint,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26910,Amputate metacarpal bone,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,26951,Amputation of finger/thumb,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26952,Amputation of finger/thumb,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,26989,Hand/finger surgery,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,26990,Drainage of pelvis lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,26991,Drainage of pelvis bursa,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,26992,Drainage of bone lesion,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27000,Incision of hip tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27001,Incision of hip tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27003,Incision of hip tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27005,Incision of hip tendon,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27006,Incision of hip tendons,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27025,Incision of hip/thigh fascia,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27027,Buttock fasciotomy,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27030,Drainage of hip joint,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27033,Exploration of hip joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27035,Denervation of hip joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27036,Excision of hip joint/muscle,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27040,Biopsy of soft tissues,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,27041,Biopsy of soft tissues,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,27043,Exc hip pelvis les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27045,Exc hip/pelv tum deep 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27047,Exc hip/pelvis les sc < 3 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27048,Exc hip/pelv tum deep < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27049,Resect hip/pelv tum < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27050,Biopsy of sacroiliac joint,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27052,Biopsy of hip joint,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27054,Removal of hip joint lining,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27057,Buttock fasciotomy w/dbrdmt,OP Fee Schedule,Straight Discount,53.20%,OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Corvel,CPT,27059,Resect hip/pelv tum 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27060,Removal of ischial bursa,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27062,Remove femur lesion/bursa,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27065,Remove hip bone les super,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27066,Remove hip bone les deep,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27067,Remove/graft hip bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27070,Part remove hip bone super,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27071,Part removal hip bone deep,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27075,Resect hip tumor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27076,Resect hip tum incl acetabul,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27077,Resect hip tum w/innom bone,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27078,Rsect hip tum incl femur,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27080,Removal of tail bone,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27086,Remove hip foreign body,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.70","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27087,Remove hip foreign body,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27090,Removal of hip prosthesis,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27091,Removal of hip prosthesis,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27097,Revision of hip tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27098,Transfer tendon to pelvis,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27100,Transfer of abdominal muscle,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27105,Transfer of spinal muscle,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27110,Transfer of iliopsoas muscle,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27111,Transfer of iliopsoas muscle,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27120,Reconstruction of hip socket,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27122,Reconstruction of hip socket,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27125,Partial hip replacement,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27130,Total hip arthroplasty,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27132,Total hip arthroplasty,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27134,Revise hip joint replacement,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27137,Revise hip joint replacement,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27138,Revise hip joint replacement,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27140,Transplant femur ridge,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27146,Incision of hip bone,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27147,Revision of hip bone,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27151,Incision of hip bones,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27156,Revision of hip bones,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27158,Revision of pelvis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27161,Incision of neck of femur,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27165,Incision/fixation of femur,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27170,Repair/graft femur head/neck,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27175,Treat slipped epiphysis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27176,Treat slipped epiphysis,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27177,Treat slipped epiphysis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27178,Treat slipped epiphysis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27179,Revise head/neck of femur,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27181,Treat slipped epiphysis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27185,Revision of femur epiphysis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27187,Reinforce hip bones,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27197,Clsd tx pelvic ring fx,OP Fee Schedule,Straight Discount,53.20%,OP,199.81,199.81,,,,,,,,,,,,,
Corvel,CPT,27198,Clsd tx pelvic ring fx,OP Fee Schedule,Straight Discount,53.20%,OP,199.81,199.81,,,,,,,,,,,,,
Corvel,CPT,27200,Treat tail bone fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27202,Treat tail bone fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27220,Treat hip socket fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27222,Treat hip socket fracture,OP Fee Schedule,Straight Discount,53.20%,OP,199.81,199.81,,,,,,,,,,,,,
Corvel,CPT,27226,Treat hip wall fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27227,Treat hip fracture(s),OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27228,Treat hip fracture(s),OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27230,Treat thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27232,Treat thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Corvel,CPT,27235,Treat thigh fracture,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27236,Treat thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27238,Treat thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27240,Treat thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Corvel,CPT,27244,Treat thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27245,Treat thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27246,Treat thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27248,Treat thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27250,Treat hip dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27252,Treat hip dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27253,Treat hip dislocation,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27254,Treat hip dislocation,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27256,Treat hip dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27257,Treat hip dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27258,Treat hip dislocation,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27259,Treat hip dislocation,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27265,Treat hip dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27266,Treat hip dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27267,Cltx thigh fx,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27268,Cltx thigh fx w/mnpj,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,27269,Optx thigh fx,OP Fee Schedule,Straight Discount,53.20%,OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Corvel,CPT,27275,Manipulation of hip joint,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27279,Arthrodesis sacroiliac joint,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27280,Fusion of sacroiliac joint,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27282,Fusion of pubic bones,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27284,Fusion of hip joint,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27286,Fusion of hip joint,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27290,Amputation of leg at hip,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27295,Amputation of leg at hip,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27299,Pelvis/hip joint surgery,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27301,Drain thigh/knee lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,27303,Drainage of bone lesion,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27305,Incise thigh tendon & fascia,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27306,Incision of thigh tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27307,Incision of thigh tendons,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27310,Exploration of knee joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27323,Biopsy thigh soft tissues,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,27324,Biopsy thigh soft tissues,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27325,Neurectomy hamstring,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,27326,Neurectomy popliteal,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,27327,Exc thigh/knee les sc < 3 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27328,Exc thigh/knee tum deep <5cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27329,Resect thigh/knee tum < 5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27330,Biopsy knee joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27331,Explore/treat knee joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27332,Removal of knee cartilage,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27333,Removal of knee cartilage,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27334,Remove knee joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27335,Remove knee joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27337,Exc thigh/knee les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27339,Exc thigh/knee tum dep 5cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27340,Removal of kneecap bursa,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27345,Removal of knee cyst,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27347,Remove knee cyst,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27350,Removal of kneecap,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27355,Remove femur lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27356,Remove femur lesion/graft,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27357,Remove femur lesion/graft,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27360,Partial removal leg bone(s),OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27364,Resect thigh/knee tum 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27365,Resect femur/knee tumor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27372,Removal of foreign body,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27380,Repair of kneecap tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27381,Repair/graft kneecap tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27385,Repair of thigh muscle,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27386,Repair/graft of thigh muscle,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27390,Incision of thigh tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27391,Incision of thigh tendons,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27392,Incision of thigh tendons,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27393,Lengthening of thigh tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27394,Lengthening of thigh tendons,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27395,Lengthening of thigh tendons,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27396,Transplant of thigh tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27397,Transplants of thigh tendons,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27400,Revise thigh muscles/tendons,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27403,Repair of knee cartilage,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27405,Repair of knee ligament,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27407,Repair of knee ligament,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,27409,Repair of knee ligaments,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27412,Autochondrocyte implant knee,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,27415,Osteochondral knee allograft,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27416,Osteochondral knee autograft,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27418,Repair degenerated kneecap,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27420,Revision of unstable kneecap,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27422,Revision of unstable kneecap,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27424,Revision/removal of kneecap,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27425,Lat retinacular release open,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27427,Reconstruction knee,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27428,Reconstruction knee,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,27429,Reconstruction knee,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,27430,Revision of thigh muscles,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27435,Incision of knee joint,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27437,Revise kneecap,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Corvel,CPT,27438,Revise kneecap with implant,OP Fee Schedule,Per Unit,"$9,501.79 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27440,Revision of knee joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27441,Revision of knee joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27442,Revision of knee joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27443,Revision of knee joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27445,Revision of knee joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27446,Revision of knee joint,OP Fee Schedule,Per Unit,"$41,197.92 ",OP,"11,934.03","41,197.92",,,,,,,,,,,,,
Corvel,CPT,27447,Total knee arthroplasty,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27448,Incision of thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27450,Incision of thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27454,Realignment of thigh bone,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27455,Realignment of knee,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27457,Realignment of knee,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27465,Shortening of thigh bone,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27466,Lengthening of thigh bone,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27468,Shorten/lengthen thighs,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27470,Repair of thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27472,Repair/graft of thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27475,Surgery to stop leg growth,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27477,Surgery to stop leg growth,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27479,Surgery to stop leg growth,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27485,Surgery to stop leg growth,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27486,Revise/replace knee joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27487,Revise/replace knee joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27488,Removal of knee prosthesis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27495,Reinforce thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27496,Decompression of thigh/knee,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27497,Decompression of thigh/knee,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27498,Decompression of thigh/knee,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27499,Decompression of thigh/knee,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27500,Treatment of thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27501,Treatment of thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27502,Treatment of thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27503,Treatment of thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27506,Treatment of thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27507,Treatment of thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27508,Treatment of thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27509,Treatment of thigh fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27510,Treatment of thigh fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27511,Treatment of thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27513,Treatment of thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27514,Treatment of thigh fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27516,Treat thigh fx growth plate,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27517,Treat thigh fx growth plate,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27519,Treat thigh fx growth plate,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27520,Treat kneecap fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27524,Treat kneecap fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27530,Treat knee fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27532,Treat knee fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"2,742.89",,,,,,,,,,,,,
Corvel,CPT,27535,Treat knee fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27536,Treat knee fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27538,Treat knee fracture(s),OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27540,Treat knee fracture,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27550,Treat knee dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27552,Treat knee dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27556,Treat knee dislocation,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27557,Treat knee dislocation,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27558,Treat knee dislocation,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27560,Treat kneecap dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27562,Treat kneecap dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,199.81,"2,923.32",,,,,,,,,,,,,
Corvel,CPT,27566,Treat kneecap dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27570,Fixation of knee joint,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27580,Fusion of knee,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27590,Amputate leg at thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27591,Amputate leg at thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27592,Amputate leg at thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27594,Amputation follow-up surgery,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27596,Amputation follow-up surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27598,Amputate lower leg at knee,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27599,Leg surgery procedure,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27600,Decompression of lower leg,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27601,Decompression of lower leg,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27602,Decompression of lower leg,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27603,Drain lower leg lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,27604,Drain lower leg bursa,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27605,Incision of achilles tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,27606,Incision of achilles tendon,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27607,Treat lower leg bone lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27610,Explore/treat ankle joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27612,Exploration of ankle joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27613,Biopsy lower leg soft tissue,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,27614,Biopsy lower leg soft tissue,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27615,Resect leg/ankle tum < 5 cm,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,296.73","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27616,Resect leg/ankle tum 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27618,Exc leg/ankle tum < 3 cm,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,27619,Exc leg/ankle tum deep <5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,27620,Explore/treat ankle joint,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27625,Remove ankle joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27626,Remove ankle joint lining,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27630,Removal of tendon lesion,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27632,Exc leg/ankle les sc 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27634,Exc leg/ankle tum dep 5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,27635,Remove lower leg bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27637,Remove/graft leg bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27638,Remove/graft leg bone lesion,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27640,Partial removal of tibia,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27641,Partial removal of fibula,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27645,Resect tibia tumor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27646,Resect fibula tumor,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27647,Resect talus/calcaneus tum,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27650,Repair achilles tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27652,Repair/graft achilles tendon,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,27654,Repair of achilles tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27656,Repair leg fascia defect,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27658,Repair of leg tendon each,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27659,Repair of leg tendon each,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27664,Repair of leg tendon each,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27665,Repair of leg tendon each,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27675,Repair lower leg tendons,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27676,Repair lower leg tendons,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27680,Release of lower leg tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27681,Release of lower leg tendons,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27685,Revision of lower leg tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27686,Revise lower leg tendons,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27687,Revision of calf tendon,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27690,Revise lower leg tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27691,Revise lower leg tendon,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27695,Repair of ankle ligament,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27696,Repair of ankle ligaments,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27698,Repair of ankle ligament,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27700,Revision of ankle joint,OP Fee Schedule,Per Unit,"$6,700.13 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Corvel,CPT,27702,Reconstruct ankle joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27703,Reconstruction ankle joint,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27705,Incision of tibia,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27707,Incision of fibula,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27709,Incision of tibia & fibula,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27712,Realignment of lower leg,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27715,Revision of lower leg,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27720,Repair of tibia,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27722,Repair/graft of tibia,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27724,Repair/graft of tibia,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27725,Repair of lower leg,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27726,Repair fibula nonunion,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27727,Repair of lower leg,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27730,Repair of tibia epiphysis,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27732,Repair of fibula epiphysis,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27734,Repair lower leg epiphyses,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27740,Repair of leg epiphyses,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Corvel,CPT,27742,Repair of leg epiphyses,OP Fee Schedule,Per Unit,"$8,230.16 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Corvel,CPT,27745,Reinforce tibia,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Corvel,CPT,27750,Treatment of tibia fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27752,Treatment of tibia fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27756,Treatment of tibia fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27758,Treatment of tibia fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27759,Treatment of tibia fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27760,Cltx medial ankle fx,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27762,Cltx med ankle fx w/mnpj,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27766,Optx medial ankle fx,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27767,Cltx post ankle fx,OP Fee Schedule,Straight Discount,53.20%,OP,199.81,199.81,,,,,,,,,,,,,
Corvel,CPT,27768,Cltx post ankle fx w/mnpj,OP Fee Schedule,Straight Discount,53.20%,OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Corvel,CPT,27769,Optx post ankle fx,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27780,Treatment of fibula fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27781,Treatment of fibula fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27784,Treatment of fibula fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27786,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27788,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27792,Treatment of ankle fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27808,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27810,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27814,Treatment of ankle fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27816,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27818,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27822,Treatment of ankle fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27823,Treatment of ankle fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Corvel,CPT,27824,Treat lower leg fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27825,Treat lower leg fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,27826,Treat lower leg fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27827,Treat lower leg fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27828,Treat lower leg fracture,OP Fee Schedule,Per Unit,"$11,460.57 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27829,Treat lower leg joint,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27830,Treat lower leg dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27831,Treat lower leg dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"2,742.89",,,,,,,,,,,,,
Corvel,CPT,27832,Treat lower leg dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27840,Treat ankle dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,27842,Treat ankle dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27846,Treat ankle dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27848,Treat ankle dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,27860,Fixation of ankle joint,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"2,742.89","2,923.32",,,,,,,,,,,,,
Corvel,CPT,27870,Fusion of ankle joint open,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,27871,Fusion of tibiofibular joint,OP Fee Schedule,Per Unit,"$13,335.94 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Corvel,CPT,27880,Amputation of lower leg,OP Fee Schedule,Straight Discount,53.20%,OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Corvel,CPT,27881,Amputation of lower leg,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27882,Amputation of lower leg,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27884,Amputation follow-up surgery,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27886,Amputation follow-up surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27888,Amputation of foot at ankle,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,27889,Amputation of foot at ankle,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27892,Decompression of leg,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27893,Decompression of leg,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Corvel,CPT,27894,Decompression of leg,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,27899,Leg/ankle surgery procedure,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28001,Drainage of bursa of foot,OP Fee Schedule,Per Unit,"$2,234.05 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Corvel,CPT,28002,Treatment of foot infection,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Corvel,CPT,28003,Treatment of foot infection,OP Fee Schedule,Per Unit,"$4,180.37 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Corvel,CPT,28005,Treat foot bone lesion,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28008,Incision of foot fascia,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28010,Incision of toe tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28011,Incision of toe tendons,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28020,Exploration of foot joint,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28022,Exploration of foot joint,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28024,Exploration of toe joint,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28035,Decompression of tibia nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,28039,Exc foot/toe tum sc 1.5 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,28041,Exc foot/toe tum dep 1.5cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,28043,Exc foot/toe tum sc < 1.5 cm,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,28045,Exc foot/toe tum deep <1.5cm,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,296.73","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28046,Resect foot/toe tumor < 3 cm,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,296.73","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28047,Resect foot/toe tumor 3 cm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,28050,Biopsy of foot joint lining,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28052,Biopsy of foot joint lining,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28054,Biopsy of toe joint lining,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28055,Neurectomy foot,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,28060,Partial removal foot fascia,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28062,Removal of foot fascia,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28070,Removal of foot joint lining,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28072,Removal of foot joint lining,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28080,Removal of foot lesion,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28086,Excise foot tendon sheath,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28088,Excise foot tendon sheath,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28090,Removal of foot lesion,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28092,Removal of toe lesions,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28100,Removal of ankle/heel lesion,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28102,Remove/graft foot lesion,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28103,Remove/graft foot lesion,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28104,Removal of foot lesion,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28106,Remove/graft foot lesion,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28107,Remove/graft foot lesion,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28108,Removal of toe lesions,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28110,Part removal of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28111,Part removal of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28112,Part removal of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28113,Part removal of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28114,Removal of metatarsal heads,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28116,Revision of foot,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28118,Removal of heel bone,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28119,Removal of heel spur,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28120,Part removal of ankle/heel,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28122,Partial removal of foot bone,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28124,Partial removal of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28126,Partial removal of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28130,Removal of ankle bone,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28140,Removal of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28150,Removal of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28153,Partial removal of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28160,Partial removal of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28171,Resect tarsal tumor,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28173,Resect metatarsal tumor,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28175,Resect phalanx of toe tumor,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28190,Removal of foot foreign body,OP Fee Schedule,Per Unit,$819.60 ,OP,602.74,819.6,,,,,,,,,,,,,
Corvel,CPT,28192,Removal of foot foreign body,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,28193,Removal of foot foreign body,OP Fee Schedule,Per Unit,"$1,363.70 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Corvel,CPT,28200,Repair of foot tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28202,Repair/graft of foot tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28208,Repair of foot tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28210,Repair/graft of foot tendon,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28220,Release of foot tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28222,Release of foot tendons,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28225,Release of foot tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28226,Release of foot tendons,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28230,Incision of foot tendon(s),OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28232,Incision of toe tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28234,Incision of foot tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28238,Revision of foot tendon,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28240,Release of big toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28250,Revision of foot fascia,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28260,Release of midfoot joint,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28261,Revision of foot tendon,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28262,Revision of foot and ankle,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28264,Release of midfoot joint,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"1,349.30","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28270,Release of foot contracture,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28272,Release of toe joint each,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28280,Fusion of toes,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28285,Repair of hammertoe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28286,Repair of hammertoe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28288,Partial removal of foot bone,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28289,Corrj halux rigdus w/o implt,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28291,Corrj halux rigdus w/implt,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28292,Correction hallux valgus,OP Fee Schedule,Per Unit,"$5,655.45 ",OP,"2,742.89","5,655.45",,,,,,,,,,,,,
Corvel,CPT,28295,Correction hallux valgus,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,28296,Correction hallux valgus,OP Fee Schedule,Per Unit,"$5,655.45 ",OP,"2,742.89","5,655.45",,,,,,,,,,,,,
Corvel,CPT,28297,Correction hallux valgus,OP Fee Schedule,Per Unit,"$5,655.45 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28298,Correction hallux valgus,OP Fee Schedule,Per Unit,"$5,655.45 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28299,Correction hallux valgus,OP Fee Schedule,Per Unit,"$5,655.45 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28300,Incision of heel bone,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28302,Incision of ankle bone,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28304,Incision of midfoot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28305,Incise/graft midfoot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28306,Incision of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28307,Incision of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28308,Incision of metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28309,Incision of metatarsals,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28310,Revision of big toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28312,Revision of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28313,Repair deformity of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28315,Removal of sesamoid bone,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28320,Repair of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Corvel,CPT,28322,Repair of metatarsals,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28340,Resect enlarged toe tissue,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28341,Resect enlarged toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28344,Repair extra toe(s),OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28345,Repair webbed toe(s),OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28360,Reconstruct cleft foot,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28400,Treatment of heel fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28405,Treatment of heel fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28406,Treatment of heel fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28415,Treat heel fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28420,Treat/graft heel fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
Corvel,CPT,28430,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28435,Treatment of ankle fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,28436,Treatment of ankle fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28445,Treat ankle fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28446,Osteochondral talus autogrft,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28450,Treat midfoot fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28455,Treat midfoot fracture each,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"1,349.30",,,,,,,,,,,,,
Corvel,CPT,28456,Treat midfoot fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28465,Treat midfoot fracture each,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28470,Treat metatarsal fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28475,Treat metatarsal fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28476,Treat metatarsal fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,28485,Treat metatarsal fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28490,Treat big toe fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28495,Treat big toe fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28496,Treat big toe fracture,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,28505,Treat big toe fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28510,Treatment of toe fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28515,Treatment of toe fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28525,Treat toe fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28530,Treat sesamoid bone fracture,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28531,Treat sesamoid bone fracture,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28540,Treat foot dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28545,Treat foot dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,28546,Treat foot dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"1,349.30","5,112.93",,,,,,,,,,,,,
Corvel,CPT,28555,Repair foot dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28570,Treat foot dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28575,Treat foot dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,337.64,"2,742.89",,,,,,,,,,,,,
Corvel,CPT,28576,Treat foot dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28585,Repair foot dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28600,Treat foot dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28605,Treat foot dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28606,Treat foot dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,28615,Repair foot dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28630,Treat toe dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28635,Treat toe dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Corvel,CPT,28636,Treat toe dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,28645,Repair toe dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28660,Treat toe dislocation,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,28665,Treat toe dislocation,OP Fee Schedule,Per Unit,"$2,923.32 ",OP,233.72,"2,923.32",,,,,,,,,,,,,
Corvel,CPT,28666,Treat toe dislocation,OP Fee Schedule,Per Unit,"$5,112.93 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Corvel,CPT,28675,Repair of toe dislocation,OP Fee Schedule,Per Unit,"$7,518.88 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Corvel,CPT,28705,Fusion of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"8,183.43","15,377.54",,,,,,,,,,,,,
Corvel,CPT,28715,Fusion of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Corvel,CPT,28725,Fusion of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Corvel,CPT,28730,Fusion of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Corvel,CPT,28735,Fusion of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Corvel,CPT,28737,Revision of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Corvel,CPT,28740,Fusion of foot bones,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28750,Fusion of big toe joint,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28755,Fusion of big toe joint,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Corvel,CPT,28760,Fusion of big toe joint,OP Fee Schedule,Per Unit,"$8,183.43 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Corvel,CPT,28800,Amputation of midfoot,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,28805,Amputation thru metatarsal,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,28810,Amputation toe & metatarsal,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28820,Amputation of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28825,Partial amputation of toe,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,28890,Hi enrgy eswt plantar fascia,OP Fee Schedule,Per Unit,"$5,033.44 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Corvel,CPT,28899,Foot/toes surgery procedure,OP Fee Schedule,Per Unit,$337.64 ,OP,199.81,337.64,,,,,,,,,,,,,
Corvel,CPT,29000,Application of body cast,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29010,Application of body cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29015,Application of body cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29035,Application of body cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29040,Application of body cast,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29044,Application of body cast,OP Fee Schedule,Per Unit,$456.24 ,OP,136.81,456.24,,,,,,,,,,,,,
Corvel,CPT,29046,Application of body cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29049,Application of figure eight,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29055,Application of shoulder cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29058,Application of shoulder cast,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29065,Application of long arm cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29075,Application of forearm cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29085,Apply hand/wrist cast,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29086,Apply finger cast,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29105,Apply long arm splint,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29200,Strapping of chest,OP Fee Schedule,Straight Discount,53.20%,OP,136.81,136.81,,,,,,,,,,,,,
Corvel,CPT,29305,Application of hip cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29325,Application of hip casts,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29345,Application of long leg cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29355,Application of long leg cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29358,Apply long leg cast brace,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29365,Application of long leg cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29405,Apply short leg cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29425,Apply short leg cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29435,Apply short leg cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29440,Addition of walker to cast,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29445,Apply rigid leg cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29450,Application of leg cast,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29505,Application long leg splint,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29515,Application lower leg splint,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29540,Strapping of ankle and/or ft,OP Fee Schedule,Straight Discount,53.20%,OP,136.81,136.81,,,,,,,,,,,,,
Corvel,CPT,29580,Application of paste boot,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29581,Apply multlay comprs lwr leg,OP Fee Schedule,Straight Discount,53.20%,OP,136.81,136.81,,,,,,,,,,,,,
Corvel,CPT,29584,Appl multlay comprs arm/hand,OP Fee Schedule,Straight Discount,53.20%,OP,136.81,136.81,,,,,,,,,,,,,
Corvel,CPT,29700,Removal/revision of cast,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29705,Removal/revision of cast,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29710,Removal/revision of cast,OP Fee Schedule,Per Unit,$456.24 ,OP,233.72,456.24,,,,,,,,,,,,,
Corvel,CPT,29720,Repair of body cast,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29730,Windowing of cast,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29740,Wedging of cast,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29750,Wedging of clubfoot cast,OP Fee Schedule,Per Unit,$212.47 ,OP,212.47,233.72,,,,,,,,,,,,,
Corvel,CPT,29799,Casting/strapping procedure,OP Fee Schedule,Per Unit,$212.47 ,OP,136.81,212.47,,,,,,,,,,,,,
Corvel,CPT,29800,Jaw arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29804,Jaw arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29805,Sho arthrs dx +- synovial bx,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29806,Sho arthrs srg capsulorpaphy,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29807,Sho arthrs srg rpr slap les,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29819,Sho arthrs srg rmvl loose/fb,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29820,Sho arthrs srg prtl synvct,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29821,Sho arthrs srg compl synvct,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29822,Sho arthrs srg lmtd dbrdmt,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29823,Sho arthrs srg xtnsv dbrdmt,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29824,Sho arthrs srg dstl claviclc,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29825,Sho arthrs srg lss&rescj ads,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29827,Sho arthrs srg rt8tr cuf rpr,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29828,Sho arthrs srg bicp tenodsis,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29830,Elbow arthroscopy,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29834,Elbow arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29835,Elbow arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29836,Elbow arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29837,Elbow arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29838,Elbow arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29840,Wrist arthroscopy,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29843,Wrist arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29844,Wrist arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29845,Wrist arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29846,Wrist arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29847,Wrist arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29848,Wrist endoscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"1,349.30","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29850,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"1,349.30","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29851,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"1,349.30","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29855,Tibial arthroscopy/surgery,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29856,Tibial arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","11,934.03",,,,,,,,,,,,,
Corvel,CPT,29860,Hip arthroscopy dx,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29861,Hip arthro w/fb removal,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29862,Hip arthr0 w/debridement,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29863,Hip arthr0 w/synovectomy,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"2,742.89","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29866,Autgrft implnt knee w/scope,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29867,Allgrft implnt knee w/scope,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
Corvel,CPT,29868,Meniscal trnspl knee w/scpe,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29870,Knee arthroscopy dx,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29871,Knee arthroscopy/drainage,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29873,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29874,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29875,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29876,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29877,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29879,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29880,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29881,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29882,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29883,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29884,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29885,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29886,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29887,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29888,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29889,Knee arthroscopy/surgery,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
Corvel,CPT,29891,Ankle arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29892,Ankle arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29893,Scope plantar fasciotomy,OP Fee Schedule,Per Unit,"$4,091.38 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Corvel,CPT,29894,Ankle arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29895,Ankle arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29897,Ankle arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29898,Ankle arthroscopy/surgery,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Corvel,CPT,29899,Ankle arthroscopy/surgery,OP Fee Schedule,Per Unit,"$9,114.17 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Corvel,CPT,29900,Mcp joint arthroscopy dx,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,29901,Mcp joint arthroscopy surg,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Corvel,CPT,29902,Mcp joint arthroscopy surg,OP Fee Schedule,Per Unit,"$3,235.63 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Corvel,CPT,29904,Subtalar arthro w/fb rmvl,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,29905,Subtalar arthro w/exc,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29906,Subtalar arthro w/deb,OP Fee Schedule,Straight Discount,53.20%,OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Corvel,CPT,29907,Subtalar arthro w/fusion,OP Fee Schedule,Straight Discount,53.20%,OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Corvel,CPT,29914,Hip arthro w/femoroplasty,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29915,Hip arthro acetabuloplasty,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29916,Hip arthro w/labral repair,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,29999,Arthroscopy of joint,OP Fee Schedule,Per Unit,"$5,733.49 ",OP,199.81,"5,733.49",,,,,,,,,,,,,
Corvel,CPT,30000,Drainage of nose lesion,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,30020,Drainage of nose lesion,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,30100,Intranasal biopsy,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,30110,Removal of nose polyp(s),OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30115,Removal of nose polyp(s),OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30117,Removal of intranasal lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30118,Removal of intranasal lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,30120,Revision of nose,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30124,Removal of nose lesion,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,30125,Removal of nose lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30130,Excise inferior turbinate,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30140,Resect inferior turbinate,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,30150,Partial removal of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30160,Removal of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30200,Injection treatment of nose,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,30210,Nasal sinus therapy,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,30220,Insert nasal septal button,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,30310,Remove nasal foreign body,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30320,Remove nasal foreign body,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30400,Reconstruction of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30410,Reconstruction of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30420,Reconstruction of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30430,Revision of nose,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,30435,Revision of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30450,Revision of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30460,Revision of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30462,Revision of nose,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30465,Repair nasal stenosis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30468,Rpr nsl vlv collapse w/implt,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,30520,Repair of nasal septum,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,30540,Repair nasal defect,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30545,Repair nasal defect,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30560,Release of nasal adhesions,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,30580,Repair upper jaw fistula,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30600,Repair mouth/nose fistula,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30620,Intranasal reconstruction,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,30630,Repair nasal septum defect,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,30801,Ablate inf turbinate superf,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,30802,Ablate inf turbinate submuc,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,30903,Control of nosebleed,OP Fee Schedule,Per Unit,$236.18 ,OP,108.49,236.18,,,,,,,,,,,,,
Corvel,CPT,30905,Control of nosebleed,OP Fee Schedule,Per Unit,$236.18 ,OP,108.49,236.18,,,,,,,,,,,,,
Corvel,CPT,30906,Repeat control of nosebleed,OP Fee Schedule,Per Unit,$236.18 ,OP,205.06,236.18,,,,,,,,,,,,,
Corvel,CPT,30915,Ligation nasal sinus artery,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,30920,Ligation upper jaw artery,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,30930,Ther fx nasal inf turbinate,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,30999,Nasal surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,31000,Irrigation maxillary sinus,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,31002,Irrigation sphenoid sinus,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,31020,Exploration maxillary sinus,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31030,Exploration maxillary sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31032,Explore sinus remove polyps,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31040,Exploration behind upper jaw,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31050,Exploration sphenoid sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31051,Sphenoid sinus surgery,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31070,Exploration of frontal sinus,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31075,Exploration of frontal sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31080,Removal of frontal sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31081,Removal of frontal sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31084,Removal of frontal sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31085,Removal of frontal sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31086,Removal of frontal sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31087,Removal of frontal sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31090,Exploration of sinuses,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31200,Removal of ethmoid sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31201,Removal of ethmoid sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31205,Removal of ethmoid sinus,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31231,Nasal endoscopy dx,OP Fee Schedule,Per Unit,$281.52 ,OP,159.31,281.52,,,,,,,,,,,,,
Corvel,CPT,31233,Nsl/sins ndsc dx max sinusc,OP Fee Schedule,Per Unit,$281.52 ,OP,281.52,364.87,,,,,,,,,,,,,
Corvel,CPT,31235,Nsl/sins ndsc dx sphn sinusc,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Corvel,CPT,31237,Nasal/sinus endoscopy surg,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Corvel,CPT,31238,Nasal/sinus endoscopy surg,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Corvel,CPT,31239,Nasal/sinus endoscopy surg,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31240,Nasal/sinus endoscopy surg,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Corvel,CPT,31241,Nsl/sins ndsc w/artery lig,OP Fee Schedule,Straight Discount,53.20%,OP,"1,450.13","1,450.13",,,,,,,,,,,,,
Corvel,CPT,31253,Nsl/sins ndsc total,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31254,Nsl/sins ndsc w/prtl ethmdct,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31255,Nsl/sins ndsc w/tot ethmdct,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31256,Exploration maxillary sinus,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31257,Nsl/sins ndsc tot w/sphendt,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31259,Nsl/sins ndsc sphn tiss rmvl,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31267,Endoscopy maxillary sinus,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31276,Nsl/sins ndsc frnt tiss rmvl,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31287,Nasal/sinus endoscopy surg,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31288,Nasal/sinus endoscopy surg,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31292,Nsl/sins ndsc med/inf dcmprn,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31293,Nsl/sins ndsc med&inf dcmprn,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31294,Nsl/sins ndsc surg on dcmprn,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31295,Nsl/sins ndsc surg max sins,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31296,Nsl/sins ndsc surg frnt sins,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31297,Nsl/sins ndsc surg sphn sins,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31298,Nsl/sins ndsc surg frnt&sphn,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31299,Sinus surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,31300,Removal of larynx lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31400,Revision of larynx,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31420,Removal of epiglottis,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31500,Insert emergency airway,OP Fee Schedule,Per Unit,$485.40 ,OP,205.06,485.4,,,,,,,,,,,,,
Corvel,CPT,31502,Change of windpipe airway,OP Fee Schedule,Per Unit,$472.44 ,OP,205.06,472.44,,,,,,,,,,,,,
Corvel,CPT,31505,Diagnostic laryngoscopy,OP Fee Schedule,Per Unit,$154.19 ,OP,154.19,159.31,,,,,,,,,,,,,
Corvel,CPT,31510,Laryngoscopy with biopsy,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31511,Remove foreign body larynx,OP Fee Schedule,Per Unit,$281.52 ,OP,159.31,281.52,,,,,,,,,,,,,
Corvel,CPT,31512,Removal of larynx lesion,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31513,Injection into vocal cord,OP Fee Schedule,Per Unit,$281.52 ,OP,281.52,364.87,,,,,,,,,,,,,
Corvel,CPT,31515,Laryngoscopy for aspiration,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,364.87,"2,962.98",,,,,,,,,,,,,
Corvel,CPT,31520,Dx laryngoscopy newborn,OP Fee Schedule,Per Unit,$281.52 ,OP,281.52,364.87,,,,,,,,,,,,,
Corvel,CPT,31525,Dx laryngoscopy excl nb,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Corvel,CPT,31526,Dx laryngoscopy w/oper scope,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31527,Laryngoscopy for treatment,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31528,Laryngoscopy and dilation,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31529,Laryngoscopy and dilation,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31530,Laryngoscopy w/fb removal,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31531,Laryngoscopy w/fb & op scope,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31535,Laryngoscopy w/biopsy,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31536,Laryngoscopy w/bx & op scope,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31540,Laryngoscopy w/exc of tumor,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31541,Larynscop w/tumr exc + scope,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31545,Remove vc lesion w/scope,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31546,Remove vc lesion scope/graft,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31551,Laryngoplasty laryngeal sten,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31552,Laryngoplasty laryngeal sten,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31553,Laryngoplasty laryngeal sten,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31554,Laryngoplasty laryngeal sten,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31560,Laryngoscop w/arytenoidectom,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31561,Larynscop remve cart + scop,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31570,Laryngoscope w/vc inj,OP Fee Schedule,Per Unit,"$2,962.98 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31571,Laryngoscop w/vc inj + scope,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31572,Largsc w/laser dstrj les,OP Fee Schedule,Straight Discount,53.20%,OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31573,Largsc w/ther injection,OP Fee Schedule,Straight Discount,53.20%,OP,"1,450.13","1,450.13",,,,,,,,,,,,,
Corvel,CPT,31574,Largsc w/njx augmentation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,450.13","1,450.13",,,,,,,,,,,,,
Corvel,CPT,31575,Diagnostic laryngoscopy,OP Fee Schedule,Per Unit,$281.52 ,OP,159.31,281.52,,,,,,,,,,,,,
Corvel,CPT,31576,Laryngoscopy with biopsy,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31577,Largsc w/rmvl foreign bdy(s),OP Fee Schedule,Per Unit,$770.41 ,OP,364.87,770.41,,,,,,,,,,,,,
Corvel,CPT,31578,Largsc w/removal lesion,OP Fee Schedule,Per Unit,"$4,396.81 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Corvel,CPT,31579,Laryngoscopy telescopic,OP Fee Schedule,Per Unit,$770.41 ,OP,364.87,770.41,,,,,,,,,,,,,
Corvel,CPT,31580,Laryngoplasty laryngeal web,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31584,Laryngoplasty fx rdctj fixj,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31587,Laryngoplasty cricoid split,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31590,Reinnervate larynx,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31591,Laryngoplasty medialization,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31592,Cricotracheal resection,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31599,Larynx surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,31600,Incision of windpipe,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31601,Incision of windpipe,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31603,Incision of windpipe,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,31605,Incision of windpipe,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,205.06,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,31610,Incision of windpipe,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31611,Surgery/speech prosthesis,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31612,Puncture/clear windpipe,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31613,Repair windpipe opening,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31614,Repair windpipe opening,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31615,Visualization of windpipe,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,438.38,"1,907.43",,,,,,,,,,,,,
Corvel,CPT,31622,Dx bronchoscope/wash,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Corvel,CPT,31623,Dx bronchoscope/brush,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Corvel,CPT,31624,Dx bronchoscope/lavage,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Corvel,CPT,31625,Bronchoscopy w/biopsy(s),OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Corvel,CPT,31626,Bronchoscopy w/markers,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31628,Bronchoscopy/lung bx each,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,907.43","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31629,Bronchoscopy/needle bx each,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,907.43","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31630,Bronchoscopy dilate/fx repr,OP Fee Schedule,Per Unit,"$4,408.58 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
Corvel,CPT,31631,Bronchoscopy dilate w/stent,OP Fee Schedule,Per Unit,"$4,408.58 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31634,Bronch w/balloon occlusion,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31635,Bronchoscopy w/fb removal,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Corvel,CPT,31636,Bronchoscopy bronch stents,OP Fee Schedule,Per Unit,"$4,408.58 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31638,Bronchoscopy revise stent,OP Fee Schedule,Per Unit,"$4,408.58 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31640,Bronchoscopy w/tumor excise,OP Fee Schedule,Per Unit,"$4,408.58 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
Corvel,CPT,31641,Bronchoscopy treat blockage,OP Fee Schedule,Per Unit,"$4,408.58 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
Corvel,CPT,31643,Diag bronchoscope/catheter,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Corvel,CPT,31645,Brnchsc w/ther aspir 1st,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Corvel,CPT,31646,Brnchsc w/ther aspir sbsq,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,364.87,"1,907.43",,,,,,,,,,,,,
Corvel,CPT,31647,Bronchial valve init insert,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31648,Bronchial valve remov init,OP Fee Schedule,Straight Discount,53.20%,OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31652,Bronch ebus samplng 1/2 node,OP Fee Schedule,Straight Discount,53.20%,OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31653,Bronch ebus samplng 3/> node,OP Fee Schedule,Straight Discount,53.20%,OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Corvel,CPT,31660,Bronch thermoplsty 1 lobe,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31661,Bronch thermoplsty 2/> lobes,OP Fee Schedule,Straight Discount,53.20%,OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Corvel,CPT,31717,Bronchial brush biopsy,OP Fee Schedule,Per Unit,$770.41 ,OP,364.87,770.41,,,,,,,,,,,,,
Corvel,CPT,31730,Intro windpipe wire/tube,OP Fee Schedule,Per Unit,$770.41 ,OP,770.41,"1,450.13",,,,,,,,,,,,,
Corvel,CPT,31750,Repair of windpipe,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31755,Repair of windpipe,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,31785,Remove windpipe lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,31820,Closure of windpipe lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,31825,Repair of windpipe defect,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31830,Revise windpipe scar,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,31899,Airways surgical procedure,OP Fee Schedule,Per Unit,"$1,907.43 ",OP,159.31,"1,907.43",,,,,,,,,,,,,
Corvel,CPT,32400,Needle biopsy chest lining,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Corvel,CPT,32408,Core ndl bx lng/med perq,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,32550,Insert pleural cath,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,32551,Insertion of chest tube,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,32553,Ins mark thor for rt perq,OP Fee Schedule,Straight Discount,53.20%,OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Corvel,CPT,32554,Aspirate pleura w/o imaging,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,32555,Aspirate pleura w/ imaging,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,32556,Insert cath pleura w/o image,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,32557,Insert cath pleura w/ image,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,32560,Treat pleurodesis w/agent,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,32561,Lyse chest fibrin init day,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,32562,Lyse chest fibrin subq day,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,32601,Thoracoscopy diagnostic,OP Fee Schedule,Per Unit,"$6,398.42 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
Corvel,CPT,32604,Thoracoscopy wbx sac,OP Fee Schedule,Per Unit,"$6,398.42 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
Corvel,CPT,32606,Thoracoscopy w/bx med space,OP Fee Schedule,Per Unit,"$6,398.42 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
Corvel,CPT,32607,Thoracoscopy w/bx infiltrate,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,32608,Thoracoscopy w/bx nodule,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,32609,Thoracoscopy w/bx pleura,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,32960,Therapeutic pneumothorax,OP Fee Schedule,Per Unit,$725.96 ,OP,524.87,725.96,,,,,,,,,,,,,
Corvel,CPT,32994,Ablate pulm tumor perq crybl,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,32998,Ablate pulm tumor perq rf,OP Fee Schedule,Per Unit,"$7,483.26 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
Corvel,CPT,32999,Chest surgery procedure,OP Fee Schedule,Per Unit,$725.96 ,OP,524.87,725.96,,,,,,,,,,,,,
Corvel,CPT,33016,Pericardiocentesis w/imaging,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,33206,Insert heart pm atrial,OP Fee Schedule,Per Unit,"$24,770.88 ",OP,"10,078.61","24,770.88",,,,,,,,,,,,,
Corvel,CPT,33207,Insert heart pm ventricular,OP Fee Schedule,Per Unit,"$24,770.88 ",OP,"10,078.61","24,770.88",,,,,,,,,,,,,
Corvel,CPT,33208,Insrt heart pm atrial & vent,OP Fee Schedule,Per Unit,"$30,573.59 ",OP,"10,078.61","30,573.59",,,,,,,,,,,,,
Corvel,CPT,33210,Insert electrd/pm cath sngl,OP Fee Schedule,Per Unit,"$11,789.51 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Corvel,CPT,33211,Insert card electrodes dual,OP Fee Schedule,Per Unit,"$11,789.51 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Corvel,CPT,33212,Insert pulse gen sngl lead,OP Fee Schedule,Per Unit,"$19,689.92 ",OP,"7,900.53","19,689.92",,,,,,,,,,,,,
Corvel,CPT,33213,Insert pulse gen dual leads,OP Fee Schedule,Per Unit,"$22,588.15 ",OP,"10,078.61","22,588.15",,,,,,,,,,,,,
Corvel,CPT,33214,Upgrade of pacemaker system,OP Fee Schedule,Per Unit,"$30,573.59 ",OP,"10,078.61","30,573.59",,,,,,,,,,,,,
Corvel,CPT,33215,Reposition pacing-defib lead,OP Fee Schedule,Per Unit,"$5,130.52 ",OP,"2,773.19","5,130.52",,,,,,,,,,,,,
Corvel,CPT,33216,Insert 1 electrode pm-defib,OP Fee Schedule,Per Unit,"$11,789.51 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Corvel,CPT,33217,Insert 2 electrode pm-defib,OP Fee Schedule,Per Unit,"$11,789.51 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Corvel,CPT,33218,Repair lead pace-defib one,OP Fee Schedule,Per Unit,"$5,130.52 ",OP,"3,334.01","5,130.52",,,,,,,,,,,,,
Corvel,CPT,33220,Repair lead pace-defib dual,OP Fee Schedule,Per Unit,"$5,130.52 ",OP,"3,334.01","5,130.52",,,,,,,,,,,,,
Corvel,CPT,33221,Insert pulse gen mult leads,OP Fee Schedule,Straight Discount,53.20%,OP,"18,035.87","18,035.87",,,,,,,,,,,,,
Corvel,CPT,33222,Relocation pocket pacemaker,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,33223,Relocate pocket for defib,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Corvel,CPT,33224,Insert pacing lead & connect,OP Fee Schedule,Per Unit,"$61,548.59 ",OP,"10,078.61","61,548.59",,,,,,,,,,,,,
Corvel,CPT,33226,Reposition l ventric lead,OP Fee Schedule,Per Unit,"$5,130.52 ",OP,"2,773.19","5,130.52",,,,,,,,,,,,,
Corvel,CPT,33227,Remove&replace pm gen singl,OP Fee Schedule,Straight Discount,53.20%,OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Corvel,CPT,33228,Remv&replc pm gen dual lead,OP Fee Schedule,Straight Discount,53.20%,OP,"10,078.61","10,078.61",,,,,,,,,,,,,
Corvel,CPT,33229,Remv&replc pm gen mult leads,OP Fee Schedule,Straight Discount,53.20%,OP,"18,035.87","18,035.87",,,,,,,,,,,,,
Corvel,CPT,33230,Insrt pulse gen w/dual leads,OP Fee Schedule,Straight Discount,53.20%,OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Corvel,CPT,33231,Insrt pulse gen w/mult leads,OP Fee Schedule,Straight Discount,53.20%,OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Corvel,CPT,33240,Insrt pulse gen w/singl lead,OP Fee Schedule,Straight Discount,53.20%,OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Corvel,CPT,33249,Insj/rplcmt defib w/lead(s),OP Fee Schedule,Straight Discount,53.20%,OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Corvel,CPT,33262,Rmvl& replc pulse gen 1 lead,OP Fee Schedule,Straight Discount,53.20%,OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Corvel,CPT,33263,Rmvl & rplcmt dfb gen 2 lead,OP Fee Schedule,Straight Discount,53.20%,OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Corvel,CPT,33264,Rmvl & rplcmt dfb gen mlt ld,OP Fee Schedule,Straight Discount,53.20%,OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Corvel,CPT,33270,Ins/rep subq defibrillator,OP Fee Schedule,Straight Discount,53.20%,OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Corvel,CPT,33271,Insj subq impltbl dfb elctrd,OP Fee Schedule,Straight Discount,53.20%,OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Corvel,CPT,33273,Repos prev impltbl subq dfb,OP Fee Schedule,Straight Discount,53.20%,OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Corvel,CPT,33274,Tcat insj/rpl perm ldls pm,OP Fee Schedule,Straight Discount,53.20%,OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Corvel,CPT,33275,Tcat rmvl perm ldls pm w/img,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,33285,Insj subq car rhythm mntr,OP Fee Schedule,Straight Discount,53.20%,OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Corvel,CPT,33289,Tcat impl wrls p-art prs snr,OP Fee Schedule,Straight Discount,53.20%,OP,"27,924.53","27,924.53",,,,,,,,,,,,,
Corvel,CPT,33999,Cardiac surgery procedure,OP Fee Schedule,Per Unit,$725.96 ,OP,524.87,725.96,,,,,,,,,,,,,
Corvel,CPT,34101,Removal of artery clot,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34111,Removal of arm artery clot,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34201,Removal of artery clot,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34203,Removal of leg artery clot,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34421,Removal of vein clot,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34471,Removal of vein clot,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,524.87,"7,559.11",,,,,,,,,,,,,
Corvel,CPT,34490,Removal of vein clot,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34501,Repair valve femoral vein,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34510,Transposition of vein valve,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34520,Cross-over vein graft,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,34530,Leg vein fusion,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35011,Repair defect of artery,OP Fee Schedule,Per Unit,"$6,486.08 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
Corvel,CPT,35045,Repair defect of arm artery,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35180,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"1,362.67","4,579.90",,,,,,,,,,,,,
Corvel,CPT,35184,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Corvel,CPT,35188,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35190,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35201,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35206,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Corvel,CPT,35207,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35226,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,602.74,"4,579.90",,,,,,,,,,,,,
Corvel,CPT,35231,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Corvel,CPT,35236,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35256,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35261,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$6,486.08 ",OP,"2,773.19","6,486.08",,,,,,,,,,,,,
Corvel,CPT,35266,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$6,486.08 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
Corvel,CPT,35286,Repair blood vessel lesion,OP Fee Schedule,Per Unit,"$6,486.08 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
Corvel,CPT,35321,Rechanneling of artery,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35372,Rechanneling of artery,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35800,Explore neck vessels,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,35860,Explore limb vessels,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Corvel,CPT,35875,Removal of clot in graft,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35876,Removal of clot in graft,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35879,Revise graft w/vein,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35881,Revise graft w/vein,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35883,Revise graft w/nonauto graft,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35884,Revise graft w/vein,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,35903,Excision graft extremity,OP Fee Schedule,Per Unit,"$5,851.41 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
Corvel,CPT,36002,Pseudoaneurysm injection trt,OP Fee Schedule,Per Unit,$492.86 ,OP,492.86,524.87,,,,,,,,,,,,,
Corvel,CPT,36260,Insertion of infusion pump,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36261,Revision of infusion pump,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"3,334.01","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36430,Blood transfusion service,OP Fee Schedule,Per Unit,$692.71 ,OP,384.79,692.71,,,,,,,,,,,,,
Corvel,CPT,36440,Bl push transfuse 2 yr/<,OP Fee Schedule,Per Unit,$692.71 ,OP,384.79,692.71,,,,,,,,,,,,,
Corvel,CPT,36450,Bl exchange/transfuse nb,OP Fee Schedule,Per Unit,$692.71 ,OP,384.79,692.71,,,,,,,,,,,,,
Corvel,CPT,36455,Bl exchange/transfuse non-nb,OP Fee Schedule,Per Unit,$692.71 ,OP,384.79,692.71,,,,,,,,,,,,,
Corvel,CPT,36456,Prtl exchange transfuse nb,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,36460,Transfusion service fetal,OP Fee Schedule,Per Unit,$692.71 ,OP,384.79,692.71,,,,,,,,,,,,,
Corvel,CPT,36465,Njx noncmpnd sclrsnt 1 vein,OP Fee Schedule,Straight Discount,53.20%,OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Corvel,CPT,36466,Njx noncmpnd sclrsnt mlt vn,OP Fee Schedule,Straight Discount,53.20%,OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Corvel,CPT,36470,Njx sclrsnt 1 incmptnt vein,OP Fee Schedule,Per Unit,$216.30 ,OP,216.3,335.15,,,,,,,,,,,,,
Corvel,CPT,36471,Njx sclrsnt mlt incmptnt vn,OP Fee Schedule,Per Unit,$216.30 ,OP,216.3,335.15,,,,,,,,,,,,,
Corvel,CPT,36473,Endovenous mchnchem 1st vein,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,36475,Endovenous rf 1st vein,OP Fee Schedule,Per Unit,"$6,956.17 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Corvel,CPT,36478,Endovenous laser 1st vein,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,36482,Endoven ther chem adhes 1st,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,36511,Apheresis wbc,OP Fee Schedule,Per Unit,"$2,346.20 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Corvel,CPT,36512,Apheresis rbc,OP Fee Schedule,Per Unit,"$2,346.20 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Corvel,CPT,36513,Apheresis platelets,OP Fee Schedule,Per Unit,"$2,346.20 ",OP,384.79,"2,346.20",,,,,,,,,,,,,
Corvel,CPT,36514,Apheresis plasma,OP Fee Schedule,Per Unit,"$2,346.20 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Corvel,CPT,36516,Apheresis immunoads slctv,OP Fee Schedule,Per Unit,"$6,053.68 ",OP,"3,912.88","6,053.68",,,,,,,,,,,,,
Corvel,CPT,36522,Photopheresis,OP Fee Schedule,Per Unit,"$6,053.68 ",OP,"3,912.88","6,053.68",,,,,,,,,,,,,
Corvel,CPT,36555,Insert non-tunnel cv cath,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,759.54","2,773.19",,,,,,,,,,,,,
Corvel,CPT,36556,Insert non-tunnel cv cath,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,759.54","2,773.19",,,,,,,,,,,,,
Corvel,CPT,36557,Insert tunneled cv cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"4,540.10","4,622.89",,,,,,,,,,,,,
Corvel,CPT,36558,Insert tunneled cv cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Corvel,CPT,36560,Insert tunneled cv cath,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36561,Insert tunneled cv cath,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36563,Insert tunneled cv cath,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36565,Insert tunneled cv cath,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36566,Insert tunneled cv cath,OP Fee Schedule,Per Unit,"$16,717.18 ",OP,"4,622.89","16,717.18",,,,,,,,,,,,,
Corvel,CPT,36568,Insj picc <5 yr w/o imaging,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Corvel,CPT,36569,Insj picc 5 yr+ w/o imaging,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Corvel,CPT,36570,Insert picvad cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Corvel,CPT,36571,Insert picvad cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Corvel,CPT,36572,Insj picc rs&i <5 yr,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,36573,Insj picc rs&i 5 yr+,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,36575,Repair tunneled cv cath,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,524.87,"1,759.54",,,,,,,,,,,,,
Corvel,CPT,36576,Repair tunneled cv cath,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Corvel,CPT,36578,Replace tunneled cv cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Corvel,CPT,36580,Replace cvad cath,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Corvel,CPT,36581,Replace tunneled cv cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Corvel,CPT,36582,Replace tunneled cv cath,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36583,Replace tunneled cv cath,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36584,Compl rplcmt picc rs&i,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Corvel,CPT,36585,Replace picvad cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Corvel,CPT,36593,Declot vascular device,OP Fee Schedule,Straight Discount,53.20%,OP,301.15,301.15,,,,,,,,,,,,,
Corvel,CPT,36595,Mech remov tunneled cv cath,OP Fee Schedule,Per Unit,"$4,540.10 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Corvel,CPT,36596,Mech remov tunneled cv cath,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Corvel,CPT,36597,Reposition venous catheter,OP Fee Schedule,Per Unit,"$1,759.54 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Corvel,CPT,36598,Inj w/fluor eval cv device,OP Fee Schedule,Per Unit,$122.24 ,OP,122.24,197.21,,,,,,,,,,,,,
Corvel,CPT,36640,Insertion catheter artery,OP Fee Schedule,Per Unit,"$5,709.18 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Corvel,CPT,36800,Insertion of cannula,OP Fee Schedule,Per Unit,"$5,851.41 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Corvel,CPT,36810,Insertion of cannula,OP Fee Schedule,Per Unit,"$5,851.41 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
Corvel,CPT,36815,Insertion of cannula,OP Fee Schedule,Per Unit,"$5,851.41 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Corvel,CPT,36818,Av fuse uppr arm cephalic,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36819,Av fuse uppr arm basilic,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36820,Av fusion/forearm vein,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36821,Av fusion direct any site,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36825,Artery-vein autograft,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36830,Artery-vein nonautograft,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36831,Open thrombect av fistula,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36832,Av fistula revision open,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36833,Av fistula revision,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36835,Artery to vein shunt,OP Fee Schedule,Per Unit,"$5,851.41 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
Corvel,CPT,36838,Dist revas ligation hemo,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Corvel,CPT,36860,External cannula declotting,OP Fee Schedule,Per Unit,$415.14 ,OP,415.14,"1,362.67",,,,,,,,,,,,,
Corvel,CPT,36861,Cannula declotting,OP Fee Schedule,Per Unit,"$5,851.41 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Corvel,CPT,36901,Intro cath dialysis circuit,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,36902,Intro cath dialysis circuit,OP Fee Schedule,Straight Discount,53.20%,OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Corvel,CPT,36903,Intro cath dialysis circuit,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,36904,Thrmbc/nfs dialysis circuit,OP Fee Schedule,Straight Discount,53.20%,OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Corvel,CPT,36905,Thrmbc/nfs dialysis circuit,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,36906,Thrmbc/nfs dialysis circuit,OP Fee Schedule,Straight Discount,53.20%,OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Corvel,CPT,37182,Insert hepatic shunt (tips),OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37183,Remove hepatic shunt (tips),OP Fee Schedule,Per Unit,"$13,714.47 ",OP,"4,803.59","13,714.47",,,,,,,,,,,,,
Corvel,CPT,37184,Prim art m-thrmbc 1st vsl,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"7,559.11","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37187,Venous mech thrombectomy,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"7,559.11","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37188,Ven mechnl thrmbc repeat tx,OP Fee Schedule,Per Unit,"$7,559.11 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Corvel,CPT,37191,Ins endovas vena cava filtr,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,37192,Redo endovas vena cava filtr,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37193,Rem endovas vena cava filter,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37195,Thrombolytic therapy stroke,OP Fee Schedule,Per Unit,$415.14 ,OP,301.15,415.14,,,,,,,,,,,,,
Corvel,CPT,37197,Remove intrvas foreign body,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37200,Transcatheter biopsy,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,"1,229.52","4,622.89",,,,,,,,,,,,,
Corvel,CPT,37211,Thrombolytic art therapy,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,37212,Thrombolytic venous therapy,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37213,Thromblytic art/ven therapy,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37214,Cessj therapy cath removal,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37220,Iliac revasc,OP Fee Schedule,Straight Discount,53.20%,OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Corvel,CPT,37221,Iliac revasc w/stent,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37224,Fem/popl revas w/tla,OP Fee Schedule,Straight Discount,53.20%,OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Corvel,CPT,37225,Fem/popl revas w/ather,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37226,Fem/popl revasc w/stent,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37227,Fem/popl revasc stnt & ather,OP Fee Schedule,Straight Discount,53.20%,OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Corvel,CPT,37228,Tib/per revasc w/tla,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37229,Tib/per revasc w/ather,OP Fee Schedule,Straight Discount,53.20%,OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Corvel,CPT,37230,Tib/per revasc w/stent,OP Fee Schedule,Straight Discount,53.20%,OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Corvel,CPT,37231,Tib/per revasc stent & ather,OP Fee Schedule,Straight Discount,53.20%,OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Corvel,CPT,37236,Open/perq place stent 1st,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37238,Open/perq place stent same,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37241,Vasc embolize/occlude venous,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37242,Vasc embolize/occlude artery,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37243,Vasc embolize/occlude organ,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37244,Vasc embolize/occlude bleed,OP Fee Schedule,Straight Discount,53.20%,OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Corvel,CPT,37246,Trluml balo angiop 1st art,OP Fee Schedule,Straight Discount,53.20%,OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Corvel,CPT,37248,Trluml balo angiop 1st vein,OP Fee Schedule,Straight Discount,53.20%,OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Corvel,CPT,37500,Endoscopy ligate perf veins,OP Fee Schedule,Per Unit,"$6,956.17 ",OP,"4,622.89","6,956.17",,,,,,,,,,,,,
Corvel,CPT,37501,Vascular endoscopy procedure,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,524.87,"4,983.65",,,,,,,,,,,,,
Corvel,CPT,37565,Ligation of neck vein,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Corvel,CPT,37600,Ligation of neck artery,OP Fee Schedule,Per Unit,"$4,579.90 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Corvel,CPT,37605,Ligation of neck artery,OP Fee Schedule,Per Unit,"$6,956.17 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Corvel,CPT,37606,Ligation of neck artery,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37607,Ligation of a-v fistula,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37609,Temporal artery procedure,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,37615,Ligation of neck artery,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37617,Ligation of abdomen artery,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37619,Ligation of inf vena cava,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,37650,Revision of major vein,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37700,Revise leg vein,OP Fee Schedule,Per Unit,"$6,956.17 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Corvel,CPT,37718,Ligate/strip short leg vein,OP Fee Schedule,Per Unit,"$6,956.17 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Corvel,CPT,37722,Ligate/strip long leg vein,OP Fee Schedule,Per Unit,"$6,956.17 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Corvel,CPT,37735,Removal of leg veins/lesion,OP Fee Schedule,Per Unit,"$6,956.17 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Corvel,CPT,37760,Ligate leg veins radical,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37761,Ligate leg veins open,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,37765,Stab phleb veins xtr 10-20,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37766,Phleb veins - extrem 20+,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37780,Revision of leg vein,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37785,Ligate/divide/excise vein,OP Fee Schedule,Per Unit,"$4,983.65 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Corvel,CPT,37790,Penile venous occlusion,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,37799,Vascular surgery procedure,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,38120,Laparoscopy splenectomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,38129,Laparoscope proc spleen,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,38206,Harvest auto stem cells,OP Fee Schedule,Per Unit,"$2,346.20 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Corvel,CPT,38207,Cryopreserve stem cells,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38208,Thaw preserved stem cells,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38209,Wash harvest stem cells,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38210,T-cell depletion of harvest,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38211,Tumor cell deplete of harvst,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38212,Rbc depletion of harvest,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38213,Platelet deplete of harvest,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38214,Volume deplete of harvest,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38215,Harvest stem cell concentrte,OP Fee Schedule,Straight Discount,53.20%,OP,384.79,384.79,,,,,,,,,,,,,
Corvel,CPT,38220,Dx bone marrow aspirations,OP Fee Schedule,Per Unit,$480.94 ,OP,480.94,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,38221,Dx bone marrow biopsies,OP Fee Schedule,Per Unit,$480.94 ,OP,480.94,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,38222,Dx bone marrow bx & aspir,OP Fee Schedule,Straight Discount,53.20%,OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Corvel,CPT,38230,Bone marrow harvest allogen,OP Fee Schedule,Per Unit,"$4,077.73 ",OP,"1,321.02","4,077.73",,,,,,,,,,,,,
Corvel,CPT,38232,Bone marrow harvest autolog,OP Fee Schedule,Straight Discount,53.20%,OP,"3,912.88","3,912.88",,,,,,,,,,,,,
Corvel,CPT,38240,Transplt allo hct/donor,OP Fee Schedule,Per Unit,"$4,077.73 ",OP,"4,077.73","30,853.81",,,,,,,,,,,,,
Corvel,CPT,38241,Transplt autol hct/donor,OP Fee Schedule,Per Unit,"$4,077.73 ",OP,"1,321.02","4,077.73",,,,,,,,,,,,,
Corvel,CPT,38242,Transplt allo lymphocytes,OP Fee Schedule,Per Unit,"$2,346.20 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Corvel,CPT,38243,Transplj hematopoietic boost,OP Fee Schedule,Straight Discount,53.20%,OP,"1,321.02","1,321.02",,,,,,,,,,,,,
Corvel,CPT,38300,Drainage lymph node lesion,OP Fee Schedule,Per Unit,"$2,234.05 ",OP,"2,234.05","2,296.73",,,,,,,,,,,,,
Corvel,CPT,38305,Drainage lymph node lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,38308,Incision of lymph channels,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Corvel,CPT,38500,Biopsy/removal lymph nodes,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Corvel,CPT,38505,Needle biopsy lymph nodes,OP Fee Schedule,Per Unit,$782.08 ,OP,782.08,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,38510,Biopsy/removal lymph nodes,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Corvel,CPT,38520,Biopsy/removal lymph nodes,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Corvel,CPT,38525,Biopsy/removal lymph nodes,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Corvel,CPT,38530,Biopsy/removal lymph nodes,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Corvel,CPT,38531,Open bx/exc inguinofem nodes,OP Fee Schedule,Straight Discount,53.20%,OP,"3,060.11","3,060.11",,,,,,,,,,,,,
Corvel,CPT,38542,Explore deep node(s) neck,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,38550,Removal neck/armpit lesion,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Corvel,CPT,38555,Removal neck/armpit lesion,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
Corvel,CPT,38562,Removal pelvic lymph nodes,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,38570,Laparoscopy lymph node biop,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,38571,Laparoscopy lymphadenectomy,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Corvel,CPT,38572,Laparoscopy lymphadenectomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,38573,Laps pelvic lymphadec,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,38589,Laparoscope proc lymphatic,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,38700,Removal of lymph nodes neck,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
Corvel,CPT,38720,Removal of lymph nodes neck,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"4,258.79","8,644.27",,,,,,,,,,,,,
Corvel,CPT,38740,Remove armpit lymph nodes,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,38745,Remove armpit lymph nodes,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,38760,Remove groin lymph nodes,OP Fee Schedule,Per Unit,"$4,258.79 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
Corvel,CPT,38999,Blood/lymph system procedure,OP Fee Schedule,Per Unit,$692.71 ,OP,384.79,692.71,,,,,,,,,,,,,
Corvel,CPT,39401,Mediastinoscpy w/medstnl bx,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,39402,Mediastinoscpy w/lmph nod bx,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,40490,Biopsy of lip,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,40500,Partial excision of lip,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,40510,Partial excision of lip,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,40520,Partial excision of lip,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,40525,Reconstruct lip with flap,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,40527,Reconstruct lip with flap,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,40530,Partial removal of lip,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,40650,Repair lip,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,40652,Repair lip,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,40654,Repair lip,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,40700,Repair cleft lip/nasal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,40701,Repair cleft lip/nasal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,40702,Repair cleft lip/nasal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,40720,Repair cleft lip/nasal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,40761,Repair cleft lip/nasal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,40799,Lip surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,40800,Drainage of mouth lesion,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,602.74,,,,,,,,,,,,,
Corvel,CPT,40801,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,40805,Removal foreign body mouth,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,40806,Incision of lip fold,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,40808,Biopsy of mouth lesion,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,40810,Excision of mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,40812,Excise/repair mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,40814,Excise/repair mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,40816,Excision of mouth lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,40818,Excise oral mucosa for graft,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,40819,Excise lip or cheek fold,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,40820,Treatment of mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,40830,Repair mouth laceration,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,40831,Repair mouth laceration,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,40840,Reconstruction of mouth,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,40842,Reconstruction of mouth,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,40843,Reconstruction of mouth,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,40844,Reconstruction of mouth,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,40845,Reconstruction of mouth,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,40899,Mouth surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,41000,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,438.38,"3,290.24",,,,,,,,,,,,,
Corvel,CPT,41005,Drainage of mouth lesion,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,41006,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Corvel,CPT,41007,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41008,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41009,Drainage of mouth lesion,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,41010,Incision of tongue fold,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,41015,Drainage of mouth lesion,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,41016,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
Corvel,CPT,41017,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Corvel,CPT,41018,Drainage of mouth lesion,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,41019,Place needles h&n for rt,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,41100,Biopsy of tongue,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,41105,Biopsy of tongue,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41108,Biopsy of floor of mouth,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,363.50","1,512.50",,,,,,,,,,,,,
Corvel,CPT,41110,Excision of tongue lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41112,Excision of tongue lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41113,Excision of tongue lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41114,Excision of tongue lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,41115,Excision of tongue fold,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,41116,Excision of mouth lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41120,Partial removal of tongue,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,41251,Repair tongue laceration,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,41252,Repair tongue laceration,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,205.06,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,41510,Tongue to lip surgery,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41512,Tongue suspension,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,41520,Reconstruction tongue fold,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Corvel,CPT,41530,Tongue base vol reduction,OP Fee Schedule,Straight Discount,53.20%,OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Corvel,CPT,41599,Tongue and mouth surgery,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,41805,Removal foreign body gum,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Corvel,CPT,41806,Removal foreign body jawbone,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41820,Excision gum each quadrant,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Corvel,CPT,41821,Excision of gum flap,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,41822,Excision of gum lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41823,Excision of gum lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,41825,Excision of gum lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41826,Excision of gum lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41827,Excision of gum lesion,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,41828,Excision of gum lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41830,Removal of gum tissue,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41850,Treatment of gum lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41870,Gum graft,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Corvel,CPT,41872,Repair gum,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,41874,Repair tooth socket,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,41899,Dental surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,42000,Drainage mouth roof lesion,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,42100,Biopsy roof of mouth,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,42104,Excision lesion mouth roof,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42106,Excision lesion mouth roof,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42107,Excision lesion mouth roof,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42120,Remove palate/lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42140,Excision of uvula,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Corvel,CPT,42145,Repair palate pharynx/uvula,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42160,Treatment mouth roof lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42180,Repair palate,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,42182,Repair palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42200,Reconstruct cleft palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42205,Reconstruct cleft palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42210,Reconstruct cleft palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42215,Reconstruct cleft palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42220,Reconstruct cleft palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42225,Reconstruct cleft palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42226,Lengthening of palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42227,Lengthening of palate,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42235,Repair palate,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42260,Repair nose to lip fistula,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42280,Preparation palate mold,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,42281,Insertion palate prosthesis,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42299,Palate/uvula surgery,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,42300,Drainage of salivary gland,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42305,Drainage of salivary gland,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42310,Drainage of salivary gland,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,42320,Drainage of salivary gland,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,42330,Removal of salivary stone,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42335,Removal of salivary stone,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42340,Removal of salivary stone,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42400,Biopsy of salivary gland,OP Fee Schedule,Per Unit,$782.08 ,OP,602.74,782.08,,,,,,,,,,,,,
Corvel,CPT,42405,Biopsy of salivary gland,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42408,Excision of salivary cyst,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42409,Drainage of salivary cyst,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42410,Excise parotid gland/lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42415,Excise parotid gland/lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42420,Excise parotid gland/lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42425,Excise parotid gland/lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42440,Excise submaxillary gland,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42450,Excise sublingual gland,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42500,Repair salivary duct,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42505,Repair salivary duct,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42507,Parotid duct diversion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42509,Parotid duct diversion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42510,Parotid duct diversion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42600,Closure of salivary fistula,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42650,Dilation of salivary duct,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,42660,Dilation of salivary duct,OP Fee Schedule,Per Unit,$491.14 ,OP,438.38,491.14,,,,,,,,,,,,,
Corvel,CPT,42665,Ligation of salivary duct,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,42699,Salivary surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,42700,Drainage of tonsil abscess,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,42720,Drainage of throat abscess,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42725,Drainage of throat abscess,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42800,Biopsy of throat,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,42804,Biopsy of upper nose/throat,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42806,Biopsy of upper nose/throat,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,42808,Excise pharynx lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42810,Excision of neck cyst,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,42815,Excision of neck cyst,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42820,Remove tonsils and adenoids,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42821,Remove tonsils and adenoids,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Corvel,CPT,42825,Removal of tonsils,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42826,Removal of tonsils,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Corvel,CPT,42830,Removal of adenoids,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Corvel,CPT,42831,Removal of adenoids,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Corvel,CPT,42835,Removal of adenoids,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Corvel,CPT,42836,Removal of adenoids,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Corvel,CPT,42842,Extensive surgery of throat,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42844,Extensive surgery of throat,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42860,Excision of tonsil tags,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Corvel,CPT,42870,Excision of lingual tonsil,OP Fee Schedule,Per Unit,"$4,429.92 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42890,Partial removal of pharynx,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42892,Revision of pharyngeal walls,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42900,Repair throat wound,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,42950,Reconstruction of throat,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,42955,Surgical opening of throat,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Corvel,CPT,42960,Control throat bleeding,OP Fee Schedule,Per Unit,$236.18 ,OP,236.18,438.38,,,,,,,,,,,,,
Corvel,CPT,42962,Control throat bleeding,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,42970,Control nose/throat bleeding,OP Fee Schedule,Per Unit,$236.18 ,OP,205.06,236.18,,,,,,,,,,,,,
Corvel,CPT,42972,Control nose/throat bleeding,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,42999,Throat surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,43020,Incision of esophagus,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,43030,Throat muscle surgery,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Corvel,CPT,43130,Removal of esophagus pouch,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,43180,Esophagoscopy rigid trnso,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,43191,Esophagoscopy rigid trnso dx,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43192,Esophagoscp rig trnso inject,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43193,Esophagoscp rig trnso biopsy,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43194,Esophagoscp rig trnso rem fb,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43195,Esophagoscopy rigid balloon,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43196,Esophagoscp guide wire dilat,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43197,Esophagoscopy flex dx brush,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,43198,Esophagosc flex trnsn biopsy,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,43200,Esophagoscopy flexible brush,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43201,Esoph scope w/submucous inj,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43202,Esophagoscopy flex biopsy,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43204,Esoph scope w/sclerosis inj,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43205,Esophagus endoscopy/ligation,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43206,Esoph optical endomicroscopy,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43210,Egd esophagogastrc fndoplsty,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,43211,Esophagoscop mucosal resect,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43212,Esophagoscop stent placement,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,43213,Esophagoscopy retro balloon,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43214,Esophagosc dilate balloon 30,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43215,Esophagoscopy flex remove fb,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43216,Esophagoscopy lesion removal,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43217,Esophagoscopy snare les remv,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43220,Esophagoscopy balloon <30mm,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43226,Esoph endoscopy dilation,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43227,Esophagoscopy control bleed,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43229,Esophagoscopy lesion ablate,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43231,Esophagoscop ultrasound exam,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43232,Esophagoscopy w/us needle bx,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43233,Egd balloon dil esoph30 mm/>,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43235,Egd diagnostic brush wash,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43236,Uppr gi scope w/submuc inj,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43237,Endoscopic us exam esoph,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43238,Egd us fine needle bx/aspir,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43239,Egd biopsy single/multiple,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43240,Egd w/transmural drain cyst,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,665.98","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43241,Egd tube/cath insertion,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43242,Egd us fine needle bx/aspir,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43243,Egd injection varices,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43244,Egd varices ligation,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43245,Egd dilate stricture,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43246,Egd place gastrostomy tube,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43247,Egd remove foreign body,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43248,Egd guide wire insertion,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43249,Esoph egd dilation <30 mm,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43250,Egd cautery tumor polyp,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43251,Egd remove lesion snare,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43252,Egd optical endomicroscopy,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43253,Egd us transmural injxn/mark,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43254,Egd endo mucosal resection,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43255,Egd control bleeding any,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43257,Egd w/thrml txmnt gerd,OP Fee Schedule,Per Unit,"$5,158.77 ",OP,"2,985.55","5,158.77",,,,,,,,,,,,,
Corvel,CPT,43259,Egd us exam duodenum/jejunum,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Corvel,CPT,43260,Ercp w/specimen collection,OP Fee Schedule,Per Unit,"$3,973.57 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Corvel,CPT,43261,Endo cholangiopancreatograph,OP Fee Schedule,Per Unit,"$3,973.57 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Corvel,CPT,43262,Endo cholangiopancreatograph,OP Fee Schedule,Per Unit,"$3,973.57 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Corvel,CPT,43263,Ercp sphincter pressure meas,OP Fee Schedule,Per Unit,"$3,973.57 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Corvel,CPT,43264,Ercp remove duct calculi,OP Fee Schedule,Per Unit,"$3,973.57 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Corvel,CPT,43265,Ercp lithotripsy calculi,OP Fee Schedule,Per Unit,"$3,973.57 ",OP,"3,973.57","4,873.06",,,,,,,,,,,,,
Corvel,CPT,43266,Egd endoscopic stent place,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,43270,Egd lesion ablation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43274,Ercp duct stent placement,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,43275,Ercp remove forgn body duct,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43276,Ercp stent exchange w/dilate,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,43277,Ercp ea duct/ampulla dilate,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43278,Ercp lesion ablate w/dilate,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43280,Laparoscopy fundoplasty,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Corvel,CPT,43281,Lap paraesophag hern repair,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,43282,Lap paraesoph her rpr w/mesh,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,43284,Laps esophgl sphnctr agmntj,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,43289,Laparoscope proc esoph,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,43420,Repair esophagus opening,OP Fee Schedule,Straight Discount,53.20%,OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Corvel,CPT,43450,Dilate esophagus 1/mult pass,OP Fee Schedule,Per Unit,"$1,092.95 ",OP,784.57,"1,092.95",,,,,,,,,,,,,
Corvel,CPT,43453,Dilate esophagus,OP Fee Schedule,Per Unit,"$1,092.95 ",OP,"1,092.95","1,574.78",,,,,,,,,,,,,
Corvel,CPT,43499,Esophagus surgery procedure,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43510,Surgical opening of stomach,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43647,Lap impl electrode antrum,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"6,434.45","10,888.82",,,,,,,,,,,,,
Corvel,CPT,43648,Lap revise/remv eltrd antrum,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,43651,Laparoscopy vagus nerve,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Corvel,CPT,43652,Laparoscopy vagus nerve,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Corvel,CPT,43653,Laparoscopy gastrostomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,43659,Laparoscope proc stom,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,43755,Dx gastr intub w/asp specs,OP Fee Schedule,Straight Discount,53.20%,OP,135.23,135.23,,,,,,,,,,,,,
Corvel,CPT,43757,Dx duod intub w/asp specs,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,43761,Reposition gastrostomy tube,OP Fee Schedule,Per Unit,"$1,498.24 ",OP,257.91,"1,498.24",,,,,,,,,,,,,
Corvel,CPT,43762,Rplc gtube no revj trc,OP Fee Schedule,Straight Discount,53.20%,OP,257.91,257.91,,,,,,,,,,,,,
Corvel,CPT,43763,Rplc gtube revj gstrst trc,OP Fee Schedule,Straight Discount,53.20%,OP,257.91,257.91,,,,,,,,,,,,,
Corvel,CPT,43770,Lap place gastr adj device,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,43772,Lap rmvl gastr adj device,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43773,Lap replace gastr adj device,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,43774,Lap rmvl gastr adj all parts,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43830,Place gastrostomy tube,OP Fee Schedule,Per Unit,"$5,158.77 ",OP,"1,574.78","5,158.77",,,,,,,,,,,,,
Corvel,CPT,43831,Place gastrostomy tube,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,43840,Repair of stomach lesion,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,43870,Repair stomach opening,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,"1,665.98","2,985.55",,,,,,,,,,,,,
Corvel,CPT,43886,Revise gastric port open,OP Fee Schedule,Per Unit,"$1,053.46 ",OP,"1,053.46","3,413.26",,,,,,,,,,,,,
Corvel,CPT,43888,Change gastric port open,OP Fee Schedule,Per Unit,"$2,811.11 ",OP,"2,811.11","3,413.26",,,,,,,,,,,,,
Corvel,CPT,43999,Stomach surgery procedure,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,44100,Biopsy of bowel,OP Fee Schedule,Per Unit,"$1,665.98 ",OP,784.57,"1,665.98",,,,,,,,,,,,,
Corvel,CPT,44180,Lap enterolysis,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,44186,Lap jejunostomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,44238,Laparoscope proc intestine,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,44300,Open bowel to skin,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,44312,Revision of ileostomy,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,44314,Revision of ileostomy,OP Fee Schedule,Straight Discount,53.20%,OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Corvel,CPT,44340,Revision of colostomy,OP Fee Schedule,Per Unit,"$4,292.48 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Corvel,CPT,44345,Revision of colostomy,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,44346,Revision of colostomy,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,44360,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44361,Small bowel endoscopy/biopsy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44363,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44364,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44365,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44366,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44369,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44370,Small bowel endoscopy/stent,OP Fee Schedule,Per Unit,"$4,596.38 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
Corvel,CPT,44372,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44373,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44376,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44377,Small bowel endoscopy/biopsy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44378,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Corvel,CPT,44379,S bowel endoscope w/stent,OP Fee Schedule,Per Unit,"$4,596.38 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
Corvel,CPT,44380,Small bowel endoscopy br/wa,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,784.57,"1,901.76",,,,,,,,,,,,,
Corvel,CPT,44381,Small bowel endoscopy br/wa,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,44382,Small bowel endoscopy,OP Fee Schedule,Per Unit,"$1,901.76 ",OP,784.57,"1,901.76",,,,,,,,,,,,,
Corvel,CPT,44384,Small bowel endoscopy,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,44385,Endoscopy of bowel pouch,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,769.11,"1,756.34",,,,,,,,,,,,,
Corvel,CPT,44386,Endoscopy bowel pouch/biop,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,769.11,"1,756.34",,,,,,,,,,,,,
Corvel,CPT,44388,Colonoscopy thru stoma spx,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,769.11,"1,756.34",,,,,,,,,,,,,
Corvel,CPT,44389,Colonoscopy with biopsy,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,44390,Colonoscopy for foreign body,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,769.11,"1,756.34",,,,,,,,,,,,,
Corvel,CPT,44391,Colonoscopy for bleeding,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,44392,Colonoscopy & polypectomy,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,44394,Colonoscopy w/snare,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,44401,Colonoscopy with ablation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,44402,Colonoscopy w/stent plcmt,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,44403,Colonoscopy w/resection,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,44404,Colonoscopy w/injection,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,44405,Colonoscopy w/dilation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,44406,Colonoscopy w/ultrasound,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,44407,Colonoscopy w/ndl aspir/bx,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,44408,Colonoscopy w/decompression,OP Fee Schedule,Straight Discount,53.20%,OP,769.11,769.11,,,,,,,,,,,,,
Corvel,CPT,44500,Intro gastrointestinal tube,OP Fee Schedule,Per Unit,$472.44 ,OP,472.44,784.57,,,,,,,,,,,,,
Corvel,CPT,44602,Suture small intestine,OP Fee Schedule,Straight Discount,53.20%,OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Corvel,CPT,44799,Unlisted px small intestine,OP Fee Schedule,Per Unit,"$4,423.26 ",OP,784.57,"4,423.26",,,,,,,,,,,,,
Corvel,CPT,44950,Appendectomy,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,44970,Laparoscopy appendectomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,44979,Laparoscope proc app,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,45000,Drainage of pelvic abscess,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Corvel,CPT,45005,Drainage of rectal abscess,OP Fee Schedule,Per Unit,"$2,551.59 ",OP,"1,004.90","2,551.59",,,,,,,,,,,,,
Corvel,CPT,45020,Drainage of rectal abscess,OP Fee Schedule,Per Unit,"$2,551.59 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Corvel,CPT,45100,Biopsy of rectum,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45108,Removal of anorectal lesion,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45150,Excision of rectal stricture,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45160,Excision of rectal lesion,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45171,Exc rect tum transanal part,OP Fee Schedule,Straight Discount,53.20%,OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Corvel,CPT,45172,Exc rect tum transanal full,OP Fee Schedule,Straight Discount,53.20%,OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Corvel,CPT,45190,Destruction rectal tumor,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45300,Proctosigmoidoscopy dx,OP Fee Schedule,Per Unit,$975.12 ,OP,769.11,975.12,,,,,,,,,,,,,
Corvel,CPT,45303,Proctosigmoidoscopy dilate,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45305,Proctosigmoidoscopy w/bx,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45307,Proctosigmoidoscopy fb,OP Fee Schedule,Per Unit,"$4,133.71 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Corvel,CPT,45308,Proctosigmoidoscopy removal,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,712.09","2,367.85",,,,,,,,,,,,,
Corvel,CPT,45309,Proctosigmoidoscopy removal,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45315,Proctosigmoidoscopy removal,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45317,Proctosigmoidoscopy bleed,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45320,Proctosigmoidoscopy ablate,OP Fee Schedule,Per Unit,"$4,133.71 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Corvel,CPT,45321,Proctosigmoidoscopy volvul,OP Fee Schedule,Per Unit,"$4,133.71 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Corvel,CPT,45327,Proctosigmoidoscopy w/stent,OP Fee Schedule,Per Unit,"$4,596.38 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
Corvel,CPT,45330,Diagnostic sigmoidoscopy,OP Fee Schedule,Per Unit,$975.12 ,OP,769.11,975.12,,,,,,,,,,,,,
Corvel,CPT,45331,Sigmoidoscopy and biopsy,OP Fee Schedule,Per Unit,$975.12 ,OP,769.11,975.12,,,,,,,,,,,,,
Corvel,CPT,45332,Sigmoidoscopy w/fb removal,OP Fee Schedule,Per Unit,$975.12 ,OP,975.12,"1,004.90",,,,,,,,,,,,,
Corvel,CPT,45333,Sigmoidoscopy & polypectomy,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,769.11,"1,712.09",,,,,,,,,,,,,
Corvel,CPT,45334,Sigmoidoscopy for bleeding,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45335,Sigmoidoscopy w/submuc inj,OP Fee Schedule,Per Unit,$975.12 ,OP,769.11,975.12,,,,,,,,,,,,,
Corvel,CPT,45337,Sigmoidoscopy & decompress,OP Fee Schedule,Per Unit,$975.12 ,OP,769.11,975.12,,,,,,,,,,,,,
Corvel,CPT,45338,Sigmoidoscopy w/tumr remove,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45340,Sig w/tndsc balloon dilation,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45341,Sigmoidoscopy w/ultrasound,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,769.11,"1,712.09",,,,,,,,,,,,,
Corvel,CPT,45342,Sigmoidoscopy w/us guide bx,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,45346,Sigmoidoscopy w/ablation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,45347,Sigmoidoscopy w/plcmt stent,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,45349,Sigmoidoscopy w/resection,OP Fee Schedule,Straight Discount,53.20%,OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Corvel,CPT,45350,Sgmdsc w/band ligation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,45378,Diagnostic colonoscopy,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,769.11,"1,756.34",,,,,,,,,,,,,
Corvel,CPT,45379,Colonoscopy w/fb removal,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45380,Colonoscopy and biopsy,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45381,Colonoscopy submucous njx,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45382,Colonoscopy w/control bleed,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45384,Colonoscopy w/lesion removal,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45385,Colonoscopy w/lesion removal,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45386,Colonoscopy w/balloon dilat,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45388,Colonoscopy w/ablation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,45389,Colonoscopy w/stent plcmt,OP Fee Schedule,Straight Discount,53.20%,OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Corvel,CPT,45390,Colonoscopy w/resection,OP Fee Schedule,Straight Discount,53.20%,OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Corvel,CPT,45391,Colonoscopy w/endoscope us,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45392,Colonoscopy w/endoscopic fnb,OP Fee Schedule,Per Unit,"$1,756.34 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Corvel,CPT,45393,Colonoscopy w/decompression,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,45398,Colonoscopy w/band ligation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,45399,Unlisted procedure colon,OP Fee Schedule,Straight Discount,53.20%,OP,769.11,769.11,,,,,,,,,,,,,
Corvel,CPT,45499,Laparoscope proc rectum,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,45500,Repair of rectum,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45505,Repair of rectum,OP Fee Schedule,Per Unit,"$5,932.66 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Corvel,CPT,45541,Correct rectal prolapse,OP Fee Schedule,Per Unit,"$5,932.66 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Corvel,CPT,45560,Repair of rectocele,OP Fee Schedule,Per Unit,"$5,932.66 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Corvel,CPT,45900,Reduction of rectal prolapse,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,769.11,"1,016.91",,,,,,,,,,,,,
Corvel,CPT,45905,Dilation of anal sphincter,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45910,Dilation of rectal narrowing,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Corvel,CPT,45915,Remove rectal obstruction,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Corvel,CPT,45990,Surg dx exam anorectal,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,"1,016.91","2,367.85",,,,,,,,,,,,,
Corvel,CPT,45999,Rectum surgery procedure,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,769.11,"1,016.91",,,,,,,,,,,,,
Corvel,CPT,46020,Placement of seton,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46030,Removal of rectal marker,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Corvel,CPT,46040,Incision of rectal abscess,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46045,Incision of rectal abscess,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46050,Incision of anal abscess,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,769.11,"1,016.91",,,,,,,,,,,,,
Corvel,CPT,46060,Incision of rectal abscess,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46070,Incision of anal septum,OP Fee Schedule,Per Unit,"$2,551.59 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Corvel,CPT,46080,Incision of anal sphincter,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46083,Incise external hemorrhoid,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,46200,Removal of anal fissure,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46220,Excise anal ext tag/papilla,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46221,Ligation of hemorrhoid(s),OP Fee Schedule,Per Unit,"$1,016.91 ",OP,769.11,"1,016.91",,,,,,,,,,,,,
Corvel,CPT,46230,Removal of anal tags,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46250,Remove ext hem groups 2+,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46255,Remove int/ext hem 1 group,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46257,Remove in/ex hem grp & fiss,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46258,Remove in/ex hem grp w/fistu,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46260,Remove in/ex hem groups 2+,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46261,Remove in/ex hem grps & fiss,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46262,Remove in/ex hem grps w/fist,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46270,Remove anal fist subq,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46275,Remove anal fist inter,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46280,Remove anal fist complex,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46285,Remove anal fist 2 stage,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46288,Repair anal fistula,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46320,Removal of hemorrhoid clot,OP Fee Schedule,Per Unit,"$2,551.59 ",OP,"1,004.90","2,551.59",,,,,,,,,,,,,
Corvel,CPT,46500,Injection into hemorrhoid(s),OP Fee Schedule,Per Unit,"$2,551.59 ",OP,769.11,"2,551.59",,,,,,,,,,,,,
Corvel,CPT,46505,Chemodenervation anal musc,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Corvel,CPT,46604,Anoscopy and dilation,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Corvel,CPT,46606,Anoscopy and biopsy,OP Fee Schedule,Per Unit,$975.12 ,OP,975.12,"1,004.90",,,,,,,,,,,,,
Corvel,CPT,46607,Diagnostic anoscopy & biopsy,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,46608,Anoscopy remove for body,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,769.11,"1,712.09",,,,,,,,,,,,,
Corvel,CPT,46610,Anoscopy remove lesion,OP Fee Schedule,Per Unit,"$4,133.71 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Corvel,CPT,46611,Anoscopy,OP Fee Schedule,Per Unit,"$1,712.09 ",OP,769.11,"1,712.09",,,,,,,,,,,,,
Corvel,CPT,46612,Anoscopy remove lesions,OP Fee Schedule,Per Unit,"$4,133.71 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Corvel,CPT,46614,Anoscopy control bleeding,OP Fee Schedule,Per Unit,$975.12 ,OP,975.12,"1,004.90",,,,,,,,,,,,,
Corvel,CPT,46615,Anoscopy,OP Fee Schedule,Per Unit,"$4,133.71 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Corvel,CPT,46700,Repair of anal stricture,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46706,Repr of anal fistula w/glue,OP Fee Schedule,Per Unit,"$5,932.66 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Corvel,CPT,46707,Repair anorectal fist w/plug,OP Fee Schedule,Straight Discount,53.20%,OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Corvel,CPT,46750,Repair of anal sphincter,OP Fee Schedule,Per Unit,"$7,591.16 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
Corvel,CPT,46753,Reconstruction of anus,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46754,Removal of suture from anus,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46760,Repair of anal sphincter,OP Fee Schedule,Per Unit,"$7,591.16 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
Corvel,CPT,46761,Repair of anal sphincter,OP Fee Schedule,Per Unit,"$7,591.16 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
Corvel,CPT,46900,Destruction anal lesion(s),OP Fee Schedule,Per Unit,$535.80 ,OP,335.15,535.8,,,,,,,,,,,,,
Corvel,CPT,46910,Destruction anal lesion(s),OP Fee Schedule,Per Unit,"$3,493.68 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Corvel,CPT,46916,Cryosurgery anal lesion(s),OP Fee Schedule,Per Unit,$218.70 ,OP,173.99,218.7,,,,,,,,,,,,,
Corvel,CPT,46917,Laser surgery anal lesions,OP Fee Schedule,Per Unit,"$4,091.65 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
Corvel,CPT,46922,Excision of anal lesion(s),OP Fee Schedule,Per Unit,"$4,091.65 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
Corvel,CPT,46924,Destruction anal lesion(s),OP Fee Schedule,Per Unit,"$4,091.65 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
Corvel,CPT,46930,Destroy internal hemorrhoids,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,46940,Treatment of anal fissure,OP Fee Schedule,Per Unit,"$4,460.32 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Corvel,CPT,46942,Treatment of anal fissure,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,769.11,"1,016.91",,,,,,,,,,,,,
Corvel,CPT,46945,Int hrhc lig 1 hroid w/o img,OP Fee Schedule,Per Unit,"$2,551.59 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Corvel,CPT,46946,Int hrhc lig 2+hroid w/o img,OP Fee Schedule,Per Unit,"$2,551.59 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Corvel,CPT,46947,Hemorrhoidopexy by stapling,OP Fee Schedule,Per Unit,"$5,932.66 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Corvel,CPT,46948,Int hrhc tranal dartlzj 2+,OP Fee Schedule,Straight Discount,53.20%,OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Corvel,CPT,46999,Anus surgery procedure,OP Fee Schedule,Per Unit,"$1,016.91 ",OP,769.11,"1,016.91",,,,,,,,,,,,,
Corvel,CPT,47000,Needle biopsy of liver,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Corvel,CPT,47370,Laparo ablate liver tumor rf,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Corvel,CPT,47371,Laparo ablate liver cryosurg,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,47379,Laparoscope procedure liver,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,47382,Percut ablate liver rf,OP Fee Schedule,Per Unit,"$7,483.26 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
Corvel,CPT,47383,Perq abltj lvr cryoablation,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,47399,Liver surgery procedure,OP Fee Schedule,Per Unit,$414.36 ,OP,414.36,602.74,,,,,,,,,,,,,
Corvel,CPT,47490,Incision of gallbladder,OP Fee Schedule,Per Unit,"$4,059.72 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Corvel,CPT,47533,Plmt biliary drainage cath,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,47534,Plmt biliary drainage cath,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,47535,Conversion ext bil drg cath,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,47536,Exchange biliary drg cath,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,47538,Perq plmt bile duct stent,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,47539,Perq plmt bile duct stent,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,47540,Perq plmt bile duct stent,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,47541,Plmt access bil tree sm bwl,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,47552,Biliary endo perq dx w/speci,OP Fee Schedule,Per Unit,"$4,059.72 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Corvel,CPT,47553,Biliary endoscopy thru skin,OP Fee Schedule,Per Unit,"$4,059.72 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Corvel,CPT,47554,Biliary endoscopy thru skin,OP Fee Schedule,Per Unit,"$4,059.72 ",OP,"4,059.72","4,903.99",,,,,,,,,,,,,
Corvel,CPT,47555,Biliary endoscopy thru skin,OP Fee Schedule,Per Unit,"$4,059.72 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Corvel,CPT,47556,Biliary endoscopy thru skin,OP Fee Schedule,Per Unit,"$4,059.72 ",OP,"4,059.72","4,903.99",,,,,,,,,,,,,
Corvel,CPT,47562,Laparoscopic cholecystectomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
Corvel,CPT,47563,Laparo cholecystectomy/graph,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
Corvel,CPT,47564,Laparo cholecystectomy/explr,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
Corvel,CPT,47579,Laparoscope proc biliary,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,47999,Bile tract surgery procedure,OP Fee Schedule,Per Unit,"$4,059.72 ",OP,784.57,"4,059.72",,,,,,,,,,,,,
Corvel,CPT,48102,Needle biopsy pancreas,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Corvel,CPT,48999,Pancreas surgery procedure,OP Fee Schedule,Per Unit,$414.36 ,OP,414.36,602.74,,,,,,,,,,,,,
Corvel,CPT,49010,Exploration behind abdomen,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,49082,Abd paracentesis,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,49083,Abd paracentesis w/imaging,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,49084,Peritoneal lavage,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,49180,Biopsy abdominal mass,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Corvel,CPT,49185,Sclerotx fluid collection,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,49250,Excision of umbilicus,OP Fee Schedule,Per Unit,"$4,423.26 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
Corvel,CPT,49255,Removal of omentum,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49320,Diag laparo separate proc,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49321,Laparoscopy biopsy,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49322,Laparoscopy aspiration,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49323,Laparo drain lymphocele,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49324,Lap insert tunnel ip cath,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49325,Lap revision perm ip cath,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49329,Laparo proc abdm/per/oment,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49402,Remove foreign body adbomen,OP Fee Schedule,Per Unit,"$4,423.26 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
Corvel,CPT,49405,Image cath fluid colxn visc,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,49406,Image cath fluid peri/retro,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,49407,Image cath fluid trns/vgnl,OP Fee Schedule,Straight Discount,53.20%,OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Corvel,CPT,49411,Ins mark abd/pel for rt perq,OP Fee Schedule,Straight Discount,53.20%,OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Corvel,CPT,49418,Insert tun ip cath perc,OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,49419,Insert tun ip cath w/port,OP Fee Schedule,Per Unit,"$5,851.41 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Corvel,CPT,49421,Ins tun ip cath for dial opn,OP Fee Schedule,Per Unit,"$5,917.16 ",OP,"3,084.99","5,917.16",,,,,,,,,,,,,
Corvel,CPT,49423,Exchange drainage catheter,OP Fee Schedule,Per Unit,"$2,334.99 ",OP,"1,574.78","2,334.99",,,,,,,,,,,,,
Corvel,CPT,49426,Revise abdomen-venous shunt,OP Fee Schedule,Per Unit,"$4,423.26 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
Corvel,CPT,49436,Embedded ip cath exit-site,OP Fee Schedule,Per Unit,"$2,334.99 ",OP,"1,574.78","2,334.99",,,,,,,,,,,,,
Corvel,CPT,49440,Place gastrostomy tube perc,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,49441,Place duod/jej tube perc,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,49442,Place cecostomy tube perc,OP Fee Schedule,Straight Discount,53.20%,OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Corvel,CPT,49446,Change g-tube to g-j perc,OP Fee Schedule,Straight Discount,53.20%,OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Corvel,CPT,49450,Replace g/c tube perc,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,49451,Replace duod/jej tube perc,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,49452,Replace g-j tube perc,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,49460,Fix g/colon tube w/device,OP Fee Schedule,Straight Discount,53.20%,OP,784.57,784.57,,,,,,,,,,,,,
Corvel,CPT,49491,Rpr hern preemie reduc,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"4,903.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49492,Rpr ing hern premie blocked,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49495,Rpr ing hernia baby reduc,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49496,Rpr ing hernia baby blocked,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49500,Rpr ing hernia init reduce,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49501,Rpr ing hernia init blocked,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49505,Prp i/hern init reduc >5 yr,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49507,Prp i/hern init block >5 yr,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49520,Rerepair ing hernia reduce,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49521,Rerepair ing hernia blocked,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Corvel,CPT,49525,Repair ing hernia sliding,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49540,Repair lumbar hernia,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49550,Rpr rem hernia init reduce,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49553,Rpr fem hernia init blocked,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49555,Rerepair fem hernia reduce,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49557,Rerepair fem hernia blocked,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49560,Rpr ventral hern init reduc,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49561,Rpr ventral hern init block,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49565,Rerepair ventrl hern reduce,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49566,Rerepair ventrl hern block,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49570,Rpr epigastric hern reduce,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49572,Rpr epigastric hern blocked,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49580,Rpr umbil hern reduc < 5 yr,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49582,Rpr umbil hern block < 5 yr,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49585,Rpr umbil hern reduc > 5 yr,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49587,Rpr umbil hern block > 5 yr,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49590,Repair spigelian hernia,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49600,Repair umbilical lesion,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,49650,Lap ing hernia repair init,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,49651,Lap ing hernia repair recur,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,49652,Lap vent/abd hernia repair,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,49653,Lap vent/abd hern proc comp,OP Fee Schedule,Straight Discount,53.20%,OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Corvel,CPT,49654,Lap inc hernia repair,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,49655,Lap inc hern repair comp,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,49656,Lap inc hernia repair recur,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,49657,Lap inc hern recur comp,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,49659,Laparo proc hernia repair,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,49999,Abdomen surgery procedure,OP Fee Schedule,Per Unit,"$4,423.26 ",OP,784.57,"4,423.26",,,,,,,,,,,,,
Corvel,CPT,50020,Renal abscess open drain,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"1,737.55","4,781.15",,,,,,,,,,,,,
Corvel,CPT,50080,Removal of kidney stone,OP Fee Schedule,Per Unit,"$8,632.98 ",OP,"8,002.82","8,632.98",,,,,,,,,,,,,
Corvel,CPT,50081,Removal of kidney stone,OP Fee Schedule,Per Unit,"$8,632.98 ",OP,"8,002.82","8,632.98",,,,,,,,,,,,,
Corvel,CPT,50200,Renal biopsy perq,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Corvel,CPT,50382,Change ureter stent percut,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,50385,Change stent via transureth,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,50387,Change nephroureteral cath,OP Fee Schedule,Per Unit,"$1,498.24 ",OP,"1,498.24","1,737.55",,,,,,,,,,,,,
Corvel,CPT,50390,Drainage of kidney lesion,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,602.74,"1,229.52",,,,,,,,,,,,,
Corvel,CPT,50391,Instll rx agnt into rnal tub,OP Fee Schedule,Per Unit,$218.06 ,OP,218.06,257.91,,,,,,,,,,,,,
Corvel,CPT,50396,Measure kidney pressure,OP Fee Schedule,Per Unit,$428.48 ,OP,428.48,557,,,,,,,,,,,,,
Corvel,CPT,50432,Plmt nephrostomy catheter,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,50433,Plmt nephroureteral catheter,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50434,Convert nephrostomy catheter,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,50435,Exchange nephrostomy cath,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,50436,Dilat xst trc ndurlgc px,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50437,Dilat xst trc new access rcs,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50541,Laparo ablate renal cyst,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,50542,Laparo ablate renal mass,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Corvel,CPT,50543,Laparo partial nephrectomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,50544,Laparoscopy pyeloplasty,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"6,434.45","8,632.26",,,,,,,,,,,,,
Corvel,CPT,50549,Laparoscope proc renal,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,50551,Kidney endoscopy,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50553,Kidney endoscopy,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50555,Kidney endoscopy & biopsy,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","8,002.82",,,,,,,,,,,,,
Corvel,CPT,50557,Kidney endoscopy & treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,781.15","8,002.82",,,,,,,,,,,,,
Corvel,CPT,50561,Kidney endoscopy & treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50562,Renal scope w/tumor resect,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","8,002.82",,,,,,,,,,,,,
Corvel,CPT,50570,Kidney endoscopy,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50572,Kidney endoscopy,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,557,"1,300.97",,,,,,,,,,,,,
Corvel,CPT,50574,Kidney endoscopy & biopsy,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50575,Kidney endoscopy,OP Fee Schedule,Per Unit,"$6,995.68 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Corvel,CPT,50576,Kidney endoscopy & treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50580,Kidney endoscopy & treatment,OP Fee Schedule,Straight Discount,53.20%,OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50590,Fragmenting of kidney stone,OP Fee Schedule,Per Unit,"$8,721.00 ",OP,"2,981.23","8,721.00",,,,,,,,,,,,,
Corvel,CPT,50592,Perc rf ablate renal tumor,OP Fee Schedule,Per Unit,"$7,483.26 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
Corvel,CPT,50593,Perc cryo ablate renal tum,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,50686,Measure ureter pressure,OP Fee Schedule,Per Unit,$218.06 ,OP,135.23,218.06,,,,,,,,,,,,,
Corvel,CPT,50688,Change of ureter tube/stent,OP Fee Schedule,Per Unit,"$1,498.24 ",OP,"1,498.24","1,737.55",,,,,,,,,,,,,
Corvel,CPT,50693,Plmt ureteral stent prq,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50694,Plmt ureteral stent prq,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50695,Plmt ureteral stent prq,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50727,Revise ureter,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50945,Laparoscopy ureterolithotomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,50947,Laparo new ureter/bladder,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,50948,Laparo new ureter/bladder,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,50949,Laparoscope proc ureter,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,50951,Endoscopy of ureter,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50953,Endoscopy of ureter,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50955,Ureter endoscopy & biopsy,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50957,Ureter endoscopy & treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50961,Ureter endoscopy & treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50970,Ureter endoscopy,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50972,Ureter endoscopy & catheter,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Corvel,CPT,50974,Ureter endoscopy & biopsy,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50976,Ureter endoscopy & treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,50980,Ureter endoscopy & treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,51020,Incise & treat bladder,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,51030,Incise & treat bladder,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,51040,Incise & drain bladder,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"1,737.55","4,781.15",,,,,,,,,,,,,
Corvel,CPT,51045,Incise bladder/drain ureter,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
Corvel,CPT,51050,Removal of bladder stone,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Corvel,CPT,51060,Removal of ureter stone,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,51065,Remove ureter calculus,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,51080,Drainage of bladder abscess,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,51100,Drain bladder by needle,OP Fee Schedule,Straight Discount,53.20%,OP,257.91,257.91,,,,,,,,,,,,,
Corvel,CPT,51101,Drain bladder by trocar/cath,OP Fee Schedule,Straight Discount,53.20%,OP,891.38,891.38,,,,,,,,,,,,,
Corvel,CPT,51102,Drain bl w/cath insertion,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,51500,Removal of bladder cyst,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,51520,Removal of bladder lesion,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,51535,Repair of ureter lesion,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,51700,Irrigation of bladder,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,51703,Insert bladder cath complex,OP Fee Schedule,Per Unit,$218.06 ,OP,135.23,218.06,,,,,,,,,,,,,
Corvel,CPT,51705,Change of bladder tube,OP Fee Schedule,Per Unit,$472.44 ,OP,257.91,472.44,,,,,,,,,,,,,
Corvel,CPT,51710,Change of bladder tube,OP Fee Schedule,Per Unit,"$1,498.24 ",OP,557,"1,498.24",,,,,,,,,,,,,
Corvel,CPT,51715,Endoscopic injection/implant,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Corvel,CPT,51720,Treatment of bladder lesion,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,51725,Simple cystometrogram,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,51726,Complex cystometrogram,OP Fee Schedule,Per Unit,$682.60 ,OP,257.91,682.6,,,,,,,,,,,,,
Corvel,CPT,51727,Cystometrogram w/up,OP Fee Schedule,Straight Discount,53.20%,OP,557,557,,,,,,,,,,,,,
Corvel,CPT,51728,Cystometrogram w/vp,OP Fee Schedule,Straight Discount,53.20%,OP,557,557,,,,,,,,,,,,,
Corvel,CPT,51729,Cystometrogram w/vp&up,OP Fee Schedule,Straight Discount,53.20%,OP,557,557,,,,,,,,,,,,,
Corvel,CPT,51784,Anal/urinary muscle study,OP Fee Schedule,Per Unit,$218.06 ,OP,135.23,218.06,,,,,,,,,,,,,
Corvel,CPT,51785,Anal/urinary muscle study,OP Fee Schedule,Per Unit,$218.06 ,OP,218.06,257.91,,,,,,,,,,,,,
Corvel,CPT,51840,Attach bladder/urethra,OP Fee Schedule,Straight Discount,53.20%,OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Corvel,CPT,51845,Repair bladder neck,OP Fee Schedule,Straight Discount,53.20%,OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Corvel,CPT,51860,Repair of bladder wound,OP Fee Schedule,Straight Discount,53.20%,OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Corvel,CPT,51880,Repair of bladder opening,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,51990,Laparo urethral suspension,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,51992,Laparo sling operation,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,51999,Laparoscope proc bla,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,52000,Cystoscopy,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,557,"1,300.97",,,,,,,,,,,,,
Corvel,CPT,52001,Cystoscopy removal of clots,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Corvel,CPT,52005,Cystoscopy & ureter catheter,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52007,Cystoscopy and biopsy,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52010,Cystoscopy & duct catheter,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,557,"1,300.97",,,,,,,,,,,,,
Corvel,CPT,52204,Cystoscopy w/biopsy(s),OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52214,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52224,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52234,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52235,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52240,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52250,Cystoscopy and radiotracer,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52260,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52265,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
Corvel,CPT,52270,Cystoscopy & revise urethra,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52275,Cystoscopy & revise urethra,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52276,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52277,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52281,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52282,Cystoscopy implant stent,OP Fee Schedule,Per Unit,"$6,995.68 ",OP,"2,981.23","6,995.68",,,,,,,,,,,,,
Corvel,CPT,52283,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52285,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,557,"3,850.78",,,,,,,,,,,,,
Corvel,CPT,52287,Cystoscopy chemodenervation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,52290,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52300,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52301,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52305,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Corvel,CPT,52310,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$1,300.97 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
Corvel,CPT,52315,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52317,Remove bladder stone,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52318,Remove bladder stone,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52320,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52325,Cystoscopy stone removal,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52327,Cystoscopy inject material,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52330,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52332,Cystoscopy and treatment,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52334,Create passage to kidney,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52341,Cysto w/ureter stricture tx,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52342,Cysto w/up stricture tx,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52343,Cysto w/renal stricture tx,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52344,Cysto/uretero stricture tx,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52345,Cysto/uretero w/up stricture,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52346,Cystouretero w/renal strict,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52351,Cystouretero & or pyeloscope,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Corvel,CPT,52352,Cystouretero w/stone remove,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52353,Cystouretero w/lithotripsy,OP Fee Schedule,Per Unit,"$6,995.68 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Corvel,CPT,52354,Cystouretero w/biopsy,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52355,Cystouretero w/excise tumor,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52356,Cysto/uretero w/lithotripsy,OP Fee Schedule,Straight Discount,53.20%,OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Corvel,CPT,52400,Cystouretero w/congen repr,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52402,Cystourethro cut ejacul duct,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52450,Incision of prostate,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52500,Revision of bladder neck,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52601,Prostatectomy (turp),OP Fee Schedule,Per Unit,"$6,995.68 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Corvel,CPT,52630,Remove prostate regrowth,OP Fee Schedule,Per Unit,"$6,995.68 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Corvel,CPT,52640,Relieve bladder contracture,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,52647,Laser surgery of prostate,OP Fee Schedule,Per Unit,"$8,632.98 ",OP,"4,277.44","8,632.98",,,,,,,,,,,,,
Corvel,CPT,52648,Laser surgery of prostate,OP Fee Schedule,Per Unit,"$8,632.98 ",OP,"4,277.44","8,632.98",,,,,,,,,,,,,
Corvel,CPT,52649,Prostate laser enucleation,OP Fee Schedule,Straight Discount,53.20%,OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Corvel,CPT,52700,Drainage of prostate abscess,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,53000,Incision of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53010,Incision of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Corvel,CPT,53020,Incision of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53025,Incision of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53040,Drainage of urethra abscess,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53060,Drainage of urethra abscess,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53080,Drainage of urinary leakage,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,557,"3,684.70",,,,,,,,,,,,,
Corvel,CPT,53085,Drainage of urinary leakage,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53200,Biopsy of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53210,Removal of urethra,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53215,Removal of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Corvel,CPT,53220,Treatment of urethra lesion,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53230,Removal of urethra lesion,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53235,Removal of urethra lesion,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Corvel,CPT,53240,Surgery for urethra pouch,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53250,Removal of urethra gland,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53260,Treatment of urethra lesion,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53265,Treatment of urethra lesion,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53270,Removal of urethra gland,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53275,Repair of urethra defect,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53400,Revise urethra stage 1,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53405,Revise urethra stage 2,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53410,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53420,Reconstruct urethra stage 1,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53425,Reconstruct urethra stage 2,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53430,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53431,Reconstruct urethra/bladder,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53440,Male sling procedure,OP Fee Schedule,Per Unit,"$15,865.56 ",OP,"11,132.85","15,865.56",,,,,,,,,,,,,
Corvel,CPT,53442,Remove/revise male sling,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53444,Insert tandem cuff,OP Fee Schedule,Per Unit,"$15,865.56 ",OP,"15,865.56","17,693.87",,,,,,,,,,,,,
Corvel,CPT,53445,Insert uro/ves nck sphincter,OP Fee Schedule,Per Unit,"$27,519.08 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Corvel,CPT,53447,Remove/replace ur sphincter,OP Fee Schedule,Per Unit,"$27,519.08 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Corvel,CPT,53449,Repair uro sphincter,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53450,Revision of urethra,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53460,Revision of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53500,Urethrlys transvag w/ scope,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53502,Repair of urethra injury,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53505,Repair of urethra injury,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53510,Repair of urethra injury,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Corvel,CPT,53515,Repair of urethra injury,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53520,Repair of urethra defect,OP Fee Schedule,Per Unit,"$5,813.75 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Corvel,CPT,53600,Dilate urethra stricture,OP Fee Schedule,Per Unit,$682.60 ,OP,257.91,682.6,,,,,,,,,,,,,
Corvel,CPT,53605,Dilate urethra stricture,OP Fee Schedule,Per Unit,"$3,850.78 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Corvel,CPT,53620,Dilate urethra stricture,OP Fee Schedule,Per Unit,"$3,639.02 ",OP,557,"3,639.02",,,,,,,,,,,,,
Corvel,CPT,53621,Dilate urethra stricture,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,53660,Dilation of urethra,OP Fee Schedule,Per Unit,$218.06 ,OP,135.23,218.06,,,,,,,,,,,,,
Corvel,CPT,53665,Dilation of urethra,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,53850,Prostatic microwave thermotx,OP Fee Schedule,Per Unit,"$8,239.83 ",OP,"2,981.23","8,239.83",,,,,,,,,,,,,
Corvel,CPT,53852,Prostatic rf thermotx,OP Fee Schedule,Per Unit,"$8,239.83 ",OP,"2,981.23","8,239.83",,,,,,,,,,,,,
Corvel,CPT,53854,Trurl dstrj prst8 tiss rf wv,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,53855,Insert prost urethral stent,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,53860,Transurethral rf treatment,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,53899,Urology surgery procedure,OP Fee Schedule,Per Unit,$218.06 ,OP,218.06,257.91,,,,,,,,,,,,,
Corvel,CPT,54000,Slitting of prepuce,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Corvel,CPT,54001,Slitting of prepuce,OP Fee Schedule,Per Unit,"$3,684.70 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Corvel,CPT,54015,Drain penis lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Corvel,CPT,54055,Destruction penis lesion(s),OP Fee Schedule,Per Unit,"$3,493.68 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Corvel,CPT,54057,Laser surg penis lesion(s),OP Fee Schedule,Per Unit,"$3,493.68 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Corvel,CPT,54060,Excision of penis lesion(s),OP Fee Schedule,Per Unit,"$3,493.68 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Corvel,CPT,54065,Destruction penis lesion(s),OP Fee Schedule,Per Unit,"$4,091.65 ",OP,"1,662.33","4,091.65",,,,,,,,,,,,,
Corvel,CPT,54100,Biopsy of penis,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Corvel,CPT,54105,Biopsy of penis,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Corvel,CPT,54110,Treatment of penis lesion,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54111,Treat penis lesion graft,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54112,Treat penis lesion graft,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"6,607.35","8,002.82",,,,,,,,,,,,,
Corvel,CPT,54115,Treatment of penis lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,54120,Partial removal of penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54150,Circumcision w/regionl block,OP Fee Schedule,Per Unit,"$4,116.41 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Corvel,CPT,54160,Circumcision neonate,OP Fee Schedule,Per Unit,"$4,116.41 ",OP,557,"4,116.41",,,,,,,,,,,,,
Corvel,CPT,54161,Circum 28 days or older,OP Fee Schedule,Per Unit,"$4,116.41 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Corvel,CPT,54162,Lysis penil circumic lesion,OP Fee Schedule,Per Unit,"$4,116.41 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Corvel,CPT,54163,Repair of circumcision,OP Fee Schedule,Per Unit,"$4,116.41 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Corvel,CPT,54164,Frenulotomy of penis,OP Fee Schedule,Per Unit,"$4,116.41 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Corvel,CPT,54200,Treatment of penis lesion,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,54205,Treatment of penis lesion,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54220,Treatment of penis lesion,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,54231,Dynamic cavernosometry,OP Fee Schedule,Per Unit,"$3,639.02 ",OP,257.91,"3,639.02",,,,,,,,,,,,,
Corvel,CPT,54235,Penile injection,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,54240,Penis study,OP Fee Schedule,Per Unit,$218.06 ,OP,218.06,256.27,,,,,,,,,,,,,
Corvel,CPT,54250,Penis study,OP Fee Schedule,Per Unit,$428.48 ,OP,257.91,428.48,,,,,,,,,,,,,
Corvel,CPT,54300,Revision of penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54304,Revision of penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54308,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54312,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54316,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54318,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54322,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54324,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54326,Reconstruction of urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54328,Revise penis/urethra,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54332,Revise penis/urethra,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,54336,Revise penis/urethra,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,54340,Secondary urethral surgery,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54344,Secondary urethral surgery,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54348,Secondary urethral surgery,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54352,Reconstruct urethra/penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54360,Penis plastic surgery,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54380,Repair penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"1,737.55","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54385,Repair penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"1,737.55","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54400,Insert semi-rigid prosthesis,OP Fee Schedule,Per Unit,"$15,865.56 ",OP,"11,132.85","15,865.56",,,,,,,,,,,,,
Corvel,CPT,54401,Insert self-contd prosthesis,OP Fee Schedule,Per Unit,"$27,519.08 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Corvel,CPT,54405,Insert multi-comp penis pros,OP Fee Schedule,Per Unit,"$27,519.08 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Corvel,CPT,54408,Repair multi-comp penis pros,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54410,Remove/replace penis prosth,OP Fee Schedule,Per Unit,"$27,519.08 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Corvel,CPT,54411,Remov/replc penis pros comp,OP Fee Schedule,Straight Discount,53.20%,OP,"17,693.87","17,693.87",,,,,,,,,,,,,
Corvel,CPT,54416,Remv/repl penis contain pros,OP Fee Schedule,Per Unit,"$27,519.08 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Corvel,CPT,54417,Remv/replc penis pros compl,OP Fee Schedule,Straight Discount,53.20%,OP,"11,132.85","11,132.85",,,,,,,,,,,,,
Corvel,CPT,54420,Revision of penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54435,Revision of penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54437,Repair corporeal tear,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,54440,Repair of penis,OP Fee Schedule,Per Unit,"$6,607.35 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Corvel,CPT,54450,Preputial stretching,OP Fee Schedule,Per Unit,$682.60 ,OP,257.91,682.6,,,,,,,,,,,,,
Corvel,CPT,54500,Biopsy of testis,OP Fee Schedule,Per Unit,"$2,056.18 ",OP,"2,056.18","2,296.73",,,,,,,,,,,,,
Corvel,CPT,54505,Biopsy of testis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54512,Excise lesion testis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54520,Removal of testis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54522,Orchiectomy partial,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54530,Removal of testis,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,54535,Extensive testis surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,54550,Exploration for testis,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,54560,Exploration for testis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54600,Reduce testis torsion,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54620,Suspension of testis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54640,Orchiopexy ingun/scrot appr,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,54650,Orchiopexy (fowler-stephens),OP Fee Schedule,Straight Discount,53.20%,OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Corvel,CPT,54660,Revision of testis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"4,277.44","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54670,Repair testis injury,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54680,Relocation of testis(es),OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54690,Laparoscopy orchiectomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,54692,Laparoscopy orchiopexy,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Corvel,CPT,54699,Laparoscope proc testis,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,54700,Drainage of scrotum,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54800,Biopsy of epididymis,OP Fee Schedule,Per Unit,$414.36 ,OP,414.36,"1,363.50",,,,,,,,,,,,,
Corvel,CPT,54830,Remove epididymis lesion,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54840,Remove epididymis lesion,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54860,Removal of epididymis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54861,Removal of epididymis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54865,Explore epididymis,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54900,Fusion of spermatic ducts,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Corvel,CPT,54901,Fusion of spermatic ducts,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55000,Drainage of hydrocele,OP Fee Schedule,Per Unit,$414.36 ,OP,414.36,602.74,,,,,,,,,,,,,
Corvel,CPT,55040,Removal of hydrocele,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,55041,Removal of hydroceles,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,55060,Repair of hydrocele,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55100,Drainage of scrotum abscess,OP Fee Schedule,Per Unit,"$2,234.05 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Corvel,CPT,55110,Explore scrotum,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55120,Removal of scrotum lesion,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55150,Removal of scrotum,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55175,Revision of scrotum,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55180,Revision of scrotum,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"4,277.44","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55200,Incision of sperm duct,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55250,Removal of sperm duct(s),OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55400,Repair of sperm duct,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55500,Removal of hydrocele,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55520,Removal of sperm cord lesion,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55530,Revise spermatic cord veins,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55535,Revise spermatic cord veins,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,55540,Revise hernia & sperm veins,OP Fee Schedule,Per Unit,"$5,852.38 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Corvel,CPT,55550,Laparo ligate spermatic vein,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,55559,Laparo proc spermatic cord,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,55600,Incise sperm duct pouch,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55680,Remove sperm pouch lesion,OP Fee Schedule,Per Unit,"$4,713.27 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Corvel,CPT,55700,Biopsy of prostate,OP Fee Schedule,Per Unit,"$1,126.92 ",OP,"1,126.92","1,737.55",,,,,,,,,,,,,
Corvel,CPT,55705,Biopsy of prostate,OP Fee Schedule,Per Unit,"$1,126.92 ",OP,"1,126.92","2,981.23",,,,,,,,,,,,,
Corvel,CPT,55706,Prostate saturation sampling,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,55720,Drainage of prostate abscess,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,55725,Drainage of prostate abscess,OP Fee Schedule,Per Unit,"$4,781.15 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Corvel,CPT,55860,Surgical exposure prostate,OP Fee Schedule,Per Unit,"$3,639.02 ",OP,"3,639.02","4,277.44",,,,,,,,,,,,,
Corvel,CPT,55866,Laparo radical prostatectomy,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,55870,Electroejaculation,OP Fee Schedule,Per Unit,$801.35 ,OP,613.82,801.35,,,,,,,,,,,,,
Corvel,CPT,55873,Cryoablate prostate,OP Fee Schedule,Per Unit,"$21,783.91 ",OP,"8,002.82","21,783.91",,,,,,,,,,,,,
Corvel,CPT,55874,Tprnl plmt biodegrdabl matrl,OP Fee Schedule,Straight Discount,53.20%,OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Corvel,CPT,55875,Transperi needle place pros,OP Fee Schedule,Straight Discount,53.20%,OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Corvel,CPT,55876,Place rt device/marker pros,OP Fee Schedule,Straight Discount,53.20%,OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Corvel,CPT,55880,Abltj mal prst8 tiss hifu,OP Fee Schedule,Straight Discount,53.20%,OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Corvel,CPT,55899,Genital surgery procedure,OP Fee Schedule,Per Unit,$218.06 ,OP,218.06,257.91,,,,,,,,,,,,,
Corvel,CPT,55920,Place needles pelvic for rt,OP Fee Schedule,Straight Discount,53.20%,OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Corvel,CPT,55970,Sex transformation m to f,OP Fee Schedule,Straight Discount,53.20%,OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Corvel,CPT,55980,Sex transformation f to m,OP Fee Schedule,Straight Discount,53.20%,OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Corvel,CPT,56405,I & d of vulva/perineum,OP Fee Schedule,Per Unit,$580.19 ,OP,272.78,580.19,,,,,,,,,,,,,
Corvel,CPT,56420,Drainage of gland abscess,OP Fee Schedule,Per Unit,$258.38 ,OP,165.06,258.38,,,,,,,,,,,,,
Corvel,CPT,56440,Surgery for vulva lesion,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,56441,Lysis of labial lesion(s),OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,56442,Hymenotomy,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,56501,Destroy vulva lesions sim,OP Fee Schedule,Per Unit,"$3,493.68 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Corvel,CPT,56515,Destroy vulva lesion/s compl,OP Fee Schedule,Per Unit,"$4,091.65 ",OP,"1,662.33","4,091.65",,,,,,,,,,,,,
Corvel,CPT,56605,Biopsy of vulva/perineum,OP Fee Schedule,Per Unit,$819.60 ,OP,613.82,819.6,,,,,,,,,,,,,
Corvel,CPT,56620,Partial removal of vulva,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,56625,Complete removal of vulva,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,56630,Extensive vulva surgery,OP Fee Schedule,Straight Discount,53.20%,OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Corvel,CPT,56700,Partial removal of hymen,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,56740,Remove vagina gland lesion,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,56800,Repair of vagina,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,56805,Repair clitoris,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,56810,Repair of perineum,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,56820,Exam of vulva w/scope,OP Fee Schedule,Per Unit,$258.38 ,OP,165.06,258.38,,,,,,,,,,,,,
Corvel,CPT,56821,Exam/biopsy of vulva w/scope,OP Fee Schedule,Per Unit,$580.19 ,OP,272.78,580.19,,,,,,,,,,,,,
Corvel,CPT,57000,Exploration of vagina,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,57010,Drainage of pelvic abscess,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,57020,Drainage of pelvic fluid,OP Fee Schedule,Per Unit,"$1,333.83 ",OP,"1,333.83","4,273.21",,,,,,,,,,,,,
Corvel,CPT,57022,I & d vaginal hematoma pp,OP Fee Schedule,Per Unit,"$2,234.05 ",OP,"2,234.05","2,296.73",,,,,,,,,,,,,
Corvel,CPT,57023,I & d vag hematoma non-ob,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Corvel,CPT,57061,Destroy vag lesions simple,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57065,Destroy vag lesions complex,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57100,Biopsy of vagina,OP Fee Schedule,Per Unit,"$1,333.83 ",OP,613.82,"1,333.83",,,,,,,,,,,,,
Corvel,CPT,57105,Biopsy of vagina,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57106,Remove vagina wall partial,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57107,Remove vagina tissue part,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57109,Vaginectomy partial w/nodes,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57120,Closure of vagina,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57130,Remove vagina lesion,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57135,Remove vagina lesion,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57155,Insert uteri tandem/ovoids,OP Fee Schedule,Per Unit,"$1,333.83 ",OP,"1,333.83","4,273.21",,,,,,,,,,,,,
Corvel,CPT,57156,Ins vag brachytx device,OP Fee Schedule,Straight Discount,53.20%,OP,272.78,272.78,,,,,,,,,,,,,
Corvel,CPT,57160,Insert pessary/other device,OP Fee Schedule,Per Unit,$258.38 ,OP,165.06,258.38,,,,,,,,,,,,,
Corvel,CPT,57170,Fitting of diaphragm/cap,OP Fee Schedule,Per Unit,$29.41 ,OP,29.41,165.06,,,,,,,,,,,,,
Corvel,CPT,57180,Treat vaginal bleeding,OP Fee Schedule,Per Unit,$580.19 ,OP,165.06,580.19,,,,,,,,,,,,,
Corvel,CPT,57200,Repair of vagina,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57210,Repair vagina/perineum,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57220,Revision of urethra,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57230,Repair of urethral lesion,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57240,Anterior colporrhaphy,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57250,Repair rectum & vagina,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57260,Cmbn ant pst colprhy,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57265,Cmbn ap colprhy w/ntrcl rpr,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57268,Repair of bowel bulge,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57282,Colpopexy extraperitoneal,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57283,Colpopexy intraperitoneal,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57284,Repair paravag defect open,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57285,Repair paravag defect vag,OP Fee Schedule,Straight Discount,53.20%,OP,"6,584.25","6,584.25",,,,,,,,,,,,,
Corvel,CPT,57288,Repair bladder defect,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57289,Repair bladder & vagina,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
Corvel,CPT,57291,Construction of vagina,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57292,Construct vagina with graft,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57295,Revise vag graft via vagina,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57300,Repair rectum-vagina fistula,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57310,Repair urethrovaginal lesion,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57320,Repair bladder-vagina lesion,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57330,Repair bladder-vagina lesion,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
Corvel,CPT,57335,Repair vagina,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57400,Dilation of vagina,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57410,Pelvic examination,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,57415,Remove vaginal foreign body,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57420,Exam of vagina w/scope,OP Fee Schedule,Per Unit,$580.19 ,OP,272.78,580.19,,,,,,,,,,,,,
Corvel,CPT,57421,Exam/biopsy of vag w/scope,OP Fee Schedule,Per Unit,$580.19 ,OP,580.19,613.82,,,,,,,,,,,,,
Corvel,CPT,57423,Repair paravag defect lap,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,57425,Laparoscopy surg colpopexy,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"6,434.45","8,632.26",,,,,,,,,,,,,
Corvel,CPT,57426,Revise prosth vag graft lap,OP Fee Schedule,Straight Discount,53.20%,OP,"6,584.25","6,584.25",,,,,,,,,,,,,
Corvel,CPT,57452,Exam of cervix w/scope,OP Fee Schedule,Per Unit,$258.38 ,OP,165.06,258.38,,,,,,,,,,,,,
Corvel,CPT,57454,Bx/curett of cervix w/scope,OP Fee Schedule,Per Unit,$580.19 ,OP,272.78,580.19,,,,,,,,,,,,,
Corvel,CPT,57455,Biopsy of cervix w/scope,OP Fee Schedule,Per Unit,$580.19 ,OP,272.78,580.19,,,,,,,,,,,,,
Corvel,CPT,57456,Endocerv curettage w/scope,OP Fee Schedule,Per Unit,$580.19 ,OP,272.78,580.19,,,,,,,,,,,,,
Corvel,CPT,57460,Bx of cervix w/scope leep,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,57461,Conz of cervix w/scope leep,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57500,Biopsy of cervix,OP Fee Schedule,Per Unit,$580.19 ,OP,580.19,613.82,,,,,,,,,,,,,
Corvel,CPT,57505,Endocervical curettage,OP Fee Schedule,Per Unit,$580.19 ,OP,580.19,613.82,,,,,,,,,,,,,
Corvel,CPT,57510,Cauterization of cervix,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,57511,Cryocautery of cervix,OP Fee Schedule,Per Unit,$258.38 ,OP,258.38,272.78,,,,,,,,,,,,,
Corvel,CPT,57513,Laser surgery of cervix,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,57520,Conization of cervix,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57522,Conization of cervix,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57530,Removal of cervix,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57550,Removal of residual cervix,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57555,Remove cervix/repair vagina,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,57556,Remove cervix repair bowel,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,57558,D&c of cervical stump,OP Fee Schedule,Per Unit,"$3,555.30 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
Corvel,CPT,57700,Revision of cervix,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57720,Revision of cervix,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,57800,Dilation of cervical canal,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,58100,Biopsy of uterus lining,OP Fee Schedule,Per Unit,$258.38 ,OP,165.06,258.38,,,,,,,,,,,,,
Corvel,CPT,58120,Dilation and curettage,OP Fee Schedule,Per Unit,"$3,555.30 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
Corvel,CPT,58145,Myomectomy vag method,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58260,Vaginal hysterectomy,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58262,Vag hyst including t/o,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58263,Vag hyst w/t/o & vag repair,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58270,Vag hyst w/enterocele repair,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58290,Vag hyst complex,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Corvel,CPT,58291,Vag hyst incl t/o complex,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,58292,Vag hyst t/o & repair compl,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Corvel,CPT,58294,Vag hyst w/enterocele compl,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,58321,Artificial insemination,OP Fee Schedule,Per Unit,$801.35 ,OP,272.78,801.35,,,,,,,,,,,,,
Corvel,CPT,58322,Artificial insemination,OP Fee Schedule,Per Unit,$801.35 ,OP,165.06,801.35,,,,,,,,,,,,,
Corvel,CPT,58323,Sperm washing,OP Fee Schedule,Per Unit,$801.35 ,OP,165.06,801.35,,,,,,,,,,,,,
Corvel,CPT,58345,Reopen fallopian tube,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,58346,Insert heyman uteri capsule,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,974.23","4,273.21",,,,,,,,,,,,,
Corvel,CPT,58350,Reopen fallopian tube,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58353,Endometr ablate thermal,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58356,Endometrial cryoablation,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,58541,Lsh uterus 250 g or less,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58542,Lsh w/t/o ut 250 g or less,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58543,Lsh uterus above 250 g,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58544,Lsh w/t/o uterus above 250 g,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58545,Laparoscopic myomectomy,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,58546,Laparo-myomectomy complex,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58550,Laparo-asst vag hysterectomy,OP Fee Schedule,Per Unit,"$14,122.45 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Corvel,CPT,58552,Laparo-vag hyst incl t/o,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58553,Laparo-vag hyst complex,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58554,Laparo-vag hyst w/t/o compl,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58555,Hysteroscopy dx sep proc,OP Fee Schedule,Per Unit,"$4,278.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
Corvel,CPT,58558,Hysteroscopy biopsy,OP Fee Schedule,Per Unit,"$4,278.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
Corvel,CPT,58559,Hysteroscopy lysis,OP Fee Schedule,Per Unit,"$4,278.11 ",OP,"4,273.21","4,278.11",,,,,,,,,,,,,
Corvel,CPT,58560,Hysteroscopy resect septum,OP Fee Schedule,Per Unit,"$6,813.31 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
Corvel,CPT,58561,Hysteroscopy remove myoma,OP Fee Schedule,Per Unit,"$6,813.31 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
Corvel,CPT,58562,Hysteroscopy remove fb,OP Fee Schedule,Per Unit,"$4,278.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
Corvel,CPT,58563,Hysteroscopy ablation,OP Fee Schedule,Per Unit,"$6,813.31 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
Corvel,CPT,58565,Hysteroscopy sterilization,OP Fee Schedule,Per Unit,"$8,610.80 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Corvel,CPT,58570,Tlh uterus 250 g or less,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,58571,Tlh w/t/o 250 g or less,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,58572,Tlh uterus over 250 g,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,58573,Tlh w/t/o uterus over 250 g,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,58578,Laparo proc uterus,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,58579,Hysteroscope procedure,OP Fee Schedule,Per Unit,"$4,278.11 ",OP,165.06,"4,278.11",,,,,,,,,,,,,
Corvel,CPT,58600,Division of fallopian tube,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58615,Occlude fallopian tube(s),OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,58660,Laparoscopy lysis,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58661,Laparoscopy remove adnexa,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58662,Laparoscopy excise lesions,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58670,Laparoscopy tubal cautery,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58671,Laparoscopy tubal block,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58672,Laparoscopy fimbrioplasty,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58673,Laparoscopy salpingostomy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,58674,Laps abltj uterine fibroids,OP Fee Schedule,Straight Discount,53.20%,OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Corvel,CPT,58679,Laparo proc oviduct-ovary,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,58770,Create new tubal opening,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58800,Drainage of ovarian cyst(s),OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,58805,Drainage of ovarian cyst(s),OP Fee Schedule,Straight Discount,53.20%,OP,"2,542.11","2,542.11",,,,,,,,,,,,,
Corvel,CPT,58820,Drain ovary abscess open,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58900,Biopsy of ovary(s),OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,58920,Partial removal of ovary(s),OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
Corvel,CPT,58925,Removal of ovarian cyst(s),OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,58970,Retrieval of oocyte,OP Fee Schedule,Per Unit,$801.35 ,OP,613.82,801.35,,,,,,,,,,,,,
Corvel,CPT,58974,Transfer of embryo,OP Fee Schedule,Per Unit,$801.35 ,OP,613.82,801.35,,,,,,,,,,,,,
Corvel,CPT,58976,Transfer of embryo,OP Fee Schedule,Per Unit,$801.35 ,OP,272.78,801.35,,,,,,,,,,,,,
Corvel,CPT,58999,Genital surgery procedure,OP Fee Schedule,Per Unit,$29.41 ,OP,29.41,165.06,,,,,,,,,,,,,
Corvel,CPT,59000,Amniocentesis diagnostic,OP Fee Schedule,Per Unit,$284.88 ,OP,284.88,613.82,,,,,,,,,,,,,
Corvel,CPT,59001,Amniocentesis therapeutic,OP Fee Schedule,Per Unit,"$1,333.83 ",OP,272.78,"1,333.83",,,,,,,,,,,,,
Corvel,CPT,59012,Fetal cord puncture prenatal,OP Fee Schedule,Per Unit,$284.88 ,OP,272.78,284.88,,,,,,,,,,,,,
Corvel,CPT,59015,Chorion biopsy,OP Fee Schedule,Per Unit,$284.88 ,OP,284.88,613.82,,,,,,,,,,,,,
Corvel,CPT,59020,Fetal contract stress test,OP Fee Schedule,Per Unit,$580.19 ,OP,165.06,580.19,,,,,,,,,,,,,
Corvel,CPT,59025,Fetal non-stress test,OP Fee Schedule,Per Unit,$284.88 ,OP,165.06,284.88,,,,,,,,,,,,,
Corvel,CPT,59030,Fetal scalp blood sample,OP Fee Schedule,Per Unit,$284.88 ,OP,272.78,284.88,,,,,,,,,,,,,
Corvel,CPT,59070,Transabdom amnioinfus w/us,OP Fee Schedule,Per Unit,$284.88 ,OP,272.78,284.88,,,,,,,,,,,,,
Corvel,CPT,59072,Umbilical cord occlud w/us,OP Fee Schedule,Per Unit,$284.88 ,OP,272.78,284.88,,,,,,,,,,,,,
Corvel,CPT,59074,Fetal fluid drainage w/us,OP Fee Schedule,Per Unit,$284.88 ,OP,272.78,284.88,,,,,,,,,,,,,
Corvel,CPT,59076,Fetal shunt placement w/us,OP Fee Schedule,Per Unit,$284.88 ,OP,272.78,284.88,,,,,,,,,,,,,
Corvel,CPT,59100,Remove uterus lesion,OP Fee Schedule,Per Unit,"$5,710.44 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Corvel,CPT,59150,Treat ectopic pregnancy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,59151,Treat ectopic pregnancy,OP Fee Schedule,Per Unit,"$8,722.79 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Corvel,CPT,59160,D & c after delivery,OP Fee Schedule,Per Unit,"$3,555.30 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
Corvel,CPT,59200,Insert cervical dilator,OP Fee Schedule,Per Unit,$580.19 ,OP,272.78,580.19,,,,,,,,,,,,,
Corvel,CPT,59300,Episiotomy or vaginal repair,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,59320,Revision of cervix,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,59409,Obstetrical care,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,59412,Antepartum manipulation,OP Fee Schedule,Per Unit,$477.99 ,OP,477.99,"2,542.11",,,,,,,,,,,,,
Corvel,CPT,59414,Deliver placenta,OP Fee Schedule,Per Unit,"$2,974.23 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Corvel,CPT,59612,Vbac delivery only,OP Fee Schedule,Per Unit,"$4,107.77 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Corvel,CPT,59812,Treatment of miscarriage,OP Fee Schedule,Per Unit,"$3,709.56 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Corvel,CPT,59820,Care of miscarriage,OP Fee Schedule,Per Unit,"$3,709.56 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Corvel,CPT,59821,Treatment of miscarriage,OP Fee Schedule,Per Unit,"$3,709.56 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Corvel,CPT,59840,Abortion,OP Fee Schedule,Per Unit,"$3,391.64 ",OP,"2,542.11","3,391.64",,,,,,,,,,,,,
Corvel,CPT,59841,Abortion,OP Fee Schedule,Per Unit,"$3,391.64 ",OP,"2,542.11","3,391.64",,,,,,,,,,,,,
Corvel,CPT,59866,Abortion (mpr),OP Fee Schedule,Per Unit,$284.88 ,OP,272.78,284.88,,,,,,,,,,,,,
Corvel,CPT,59870,Evacuate mole of uterus,OP Fee Schedule,Per Unit,"$3,709.56 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Corvel,CPT,59897,Fetal invas px w/us,OP Fee Schedule,Per Unit,$284.88 ,OP,165.06,284.88,,,,,,,,,,,,,
Corvel,CPT,59898,Laparo proc ob care/deliver,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,59899,Maternity care procedure,OP Fee Schedule,Per Unit,$284.88 ,OP,165.06,284.88,,,,,,,,,,,,,
Corvel,CPT,60000,Drain thyroid/tongue cyst,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Corvel,CPT,60100,Biopsy of thyroid,OP Fee Schedule,Per Unit,$414.36 ,OP,414.36,602.74,,,,,,,,,,,,,
Corvel,CPT,60200,Remove thyroid lesion,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60210,Partial thyroid excision,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60212,Partial thyroid excision,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60220,Partial removal of thyroid,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60225,Partial removal of thyroid,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60240,Removal of thyroid,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60252,Removal of thyroid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,60260,Repeat thyroid surgery,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,60271,Removal of thyroid,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,60280,Remove thyroid duct lesion,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60281,Remove thyroid duct lesion,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,60300,Aspir/inj thyroid cyst,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,60500,Explore parathyroid glands,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,60502,Re-explore parathyroids,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,60520,Removal of thymus gland,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,60659,Laparo proc endocrine,OP Fee Schedule,Per Unit,"$6,434.45 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Corvel,CPT,60699,Endocrine surgery procedure,OP Fee Schedule,Per Unit,"$7,555.79 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Corvel,CPT,61000,Remove cranial cavity fluid,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,614.97,,,,,,,,,,,,,
Corvel,CPT,61001,Remove cranial cavity fluid,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,614.97,,,,,,,,,,,,,
Corvel,CPT,61020,Remove brain cavity fluid,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,797.03,,,,,,,,,,,,,
Corvel,CPT,61026,Injection into brain canal,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,614.97,,,,,,,,,,,,,
Corvel,CPT,61050,Remove brain canal fluid,OP Fee Schedule,Per Unit,$599.04 ,OP,253.09,599.04,,,,,,,,,,,,,
Corvel,CPT,61055,Injection into brain canal,OP Fee Schedule,Per Unit,$599.04 ,OP,253.09,599.04,,,,,,,,,,,,,
Corvel,CPT,61070,Brain canal shunt procedure,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,614.97,,,,,,,,,,,,,
Corvel,CPT,61215,Insert brain-fluid device,OP Fee Schedule,Per Unit,"$9,420.94 ",OP,"5,524.06","9,420.94",,,,,,,,,,,,,
Corvel,CPT,61330,Decompress eye socket,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,61623,Endovasc tempory vessel occl,OP Fee Schedule,Per Unit,"$8,600.07 ",OP,"8,600.07","9,732.45",,,,,,,,,,,,,
Corvel,CPT,61624,Transcath occlusion cns,OP Fee Schedule,Straight Discount,53.20%,OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Corvel,CPT,61626,Transcath occlusion non-cns,OP Fee Schedule,Per Unit,"$8,600.07 ",OP,"8,600.07","9,732.45",,,,,,,,,,,,,
Corvel,CPT,61720,Incise skull/brain surgery,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,61770,Incise skull for treatment,OP Fee Schedule,Straight Discount,53.20%,OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Corvel,CPT,61790,Treat trigeminal nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,61791,Treat trigeminal tract,OP Fee Schedule,Per Unit,"$1,146.78 ",OP,"1,146.78","1,700.15",,,,,,,,,,,,,
Corvel,CPT,61880,Revise/remove neuroelectrode,OP Fee Schedule,Straight Discount,53.20%,OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Corvel,CPT,61885,Insrt/redo neurostim 1 array,OP Fee Schedule,Per Unit,"$37,532.54 ",OP,"19,846.62","37,532.54",,,,,,,,,,,,,
Corvel,CPT,61886,Implant neurostim arrays,OP Fee Schedule,Per Unit,"$48,660.02 ",OP,"28,534.20","48,660.02",,,,,,,,,,,,,
Corvel,CPT,61888,Revise/remove neuroreceiver,OP Fee Schedule,Straight Discount,53.20%,OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Corvel,CPT,62000,Treat skull fracture,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,62194,Replace/irrigate catheter,OP Fee Schedule,Per Unit,"$2,334.99 ",OP,"1,700.15","2,334.99",,,,,,,,,,,,,
Corvel,CPT,62225,Replace/irrigate catheter,OP Fee Schedule,Per Unit,"$2,334.99 ",OP,"2,334.99","5,524.06",,,,,,,,,,,,,
Corvel,CPT,62230,Replace/revise brain shunt,OP Fee Schedule,Per Unit,"$9,420.94 ",OP,"5,524.06","9,420.94",,,,,,,,,,,,,
Corvel,CPT,62252,Csf shunt reprogram,OP Fee Schedule,Per Unit,$579.71 ,OP,264.04,579.71,,,,,,,,,,,,,
Corvel,CPT,62263,Epidural lysis mult sessions,OP Fee Schedule,Per Unit,"$2,437.69 ",OP,797.03,"2,437.69",,,,,,,,,,,,,
Corvel,CPT,62264,Epidural lysis on single day,OP Fee Schedule,Per Unit,"$2,437.69 ",OP,797.03,"2,437.69",,,,,,,,,,,,,
Corvel,CPT,62267,Interdiscal perq aspir dx,OP Fee Schedule,Straight Discount,53.20%,OP,602.74,602.74,,,,,,,,,,,,,
Corvel,CPT,62268,Drain spinal cord cyst,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,797.03,,,,,,,,,,,,,
Corvel,CPT,62269,Needle biopsy spinal cord,OP Fee Schedule,Per Unit,"$1,229.52 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Corvel,CPT,62270,Dx lmbr spi pnxr,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,62272,Ther spi pnxr drg csf,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,62273,Inject epidural patch,OP Fee Schedule,Per Unit,"$1,146.78 ",OP,614.97,"1,146.78",,,,,,,,,,,,,
Corvel,CPT,62280,Treat spinal cord lesion,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,62281,Treat spinal cord lesion,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,62282,Treat spinal canal lesion,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,62287,Percutaneous diskectomy,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Corvel,CPT,62292,Njx chemonucleolysis lmbr,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,"1,700.15",,,,,,,,,,,,,
Corvel,CPT,62294,Injection into spinal artery,OP Fee Schedule,Per Unit,$599.04 ,OP,599.04,797.03,,,,,,,,,,,,,
Corvel,CPT,62320,Njx interlaminar crv/thrc,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,62321,Njx interlaminar crv/thrc,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,62322,Njx interlaminar lmbr/sac,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,62323,Njx interlaminar lmbr/sac,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,62324,Njx interlaminar crv/thrc,OP Fee Schedule,Straight Discount,53.20%,OP,797.03,797.03,,,,,,,,,,,,,
Corvel,CPT,62325,Njx interlaminar crv/thrc,OP Fee Schedule,Straight Discount,53.20%,OP,797.03,797.03,,,,,,,,,,,,,
Corvel,CPT,62326,Njx interlaminar lmbr/sac,OP Fee Schedule,Straight Discount,53.20%,OP,797.03,797.03,,,,,,,,,,,,,
Corvel,CPT,62327,Njx interlaminar lmbr/sac,OP Fee Schedule,Straight Discount,53.20%,OP,797.03,797.03,,,,,,,,,,,,,
Corvel,CPT,62328,Dx lmbr spi pnxr w/fluor/ct,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,62329,Ther spi pnxr csf fluor/ct,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,62350,Implant spinal canal cath,OP Fee Schedule,Per Unit,"$6,177.12 ",OP,"5,524.06","6,177.12",,,,,,,,,,,,,
Corvel,CPT,62351,Implant spinal canal cath,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,62360,Insert spine infusion device,OP Fee Schedule,Per Unit,"$22,560.19 ",OP,"16,505.33","22,560.19",,,,,,,,,,,,,
Corvel,CPT,62361,Implant spine infusion pump,OP Fee Schedule,Per Unit,"$34,933.34 ",OP,"16,505.33","34,933.34",,,,,,,,,,,,,
Corvel,CPT,62362,Implant spine infusion pump,OP Fee Schedule,Per Unit,"$34,933.34 ",OP,"16,505.33","34,933.34",,,,,,,,,,,,,
Corvel,CPT,62367,Analyze spine infus pump,OP Fee Schedule,Per Unit,$579.71 ,OP,264.04,579.71,,,,,,,,,,,,,
Corvel,CPT,62368,Analyze sp inf pump w/reprog,OP Fee Schedule,Per Unit,$579.71 ,OP,264.04,579.71,,,,,,,,,,,,,
Corvel,CPT,62369,Anal sp inf pmp w/reprg&fill,OP Fee Schedule,Straight Discount,53.20%,OP,264.04,264.04,,,,,,,,,,,,,
Corvel,CPT,62370,Anl sp inf pmp w/mdreprg&fil,OP Fee Schedule,Straight Discount,53.20%,OP,264.04,264.04,,,,,,,,,,,,,
Corvel,CPT,62380,Ndsc dcmprn 1 ntrspc lumbar,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,63001,Remove spine lamina 1/2 crvl,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63003,Remove spine lamina 1/2 thrc,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63005,Remove spine lamina 1/2 lmbr,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63011,Remove spine lamina 1/2 scrl,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63012,Remove lamina/facets lumbar,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63015,Remove spine lamina >2 crvcl,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63016,Remove spine lamina >2 thrc,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63017,Remove spine lamina >2 lmbr,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63020,Neck spine disk surgery,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63030,Low back disk surgery,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63040,Laminotomy single cervical,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63042,Laminotomy single lumbar,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63045,Remove spine lamina 1 crvl,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63046,Remove spine lamina 1 thrc,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63047,Remove spine lamina 1 lmbr,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63055,Decompress spinal cord thrc,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63056,Decompress spinal cord lmbr,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63064,Decompress spinal cord thrc,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63075,Neck spine disk surgery,OP Fee Schedule,Per Unit,"$8,843.00 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Corvel,CPT,63265,Excise intraspinl lesion crv,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,63266,Excise intrspinl lesion thrc,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,63267,Excise intrspinl lesion lmbr,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,63268,Excise intrspinl lesion scrl,OP Fee Schedule,Straight Discount,53.20%,OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Corvel,CPT,63600,Remove spinal cord lesion,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,63610,Stimulation of spinal cord,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,63650,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$11,331.06 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
Corvel,CPT,63655,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$16,864.55 ",OP,"16,864.55","19,846.62",,,,,,,,,,,,,
Corvel,CPT,63662,Remove spine eltrd plate,OP Fee Schedule,Straight Discount,53.20%,OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Corvel,CPT,63663,Revise spine eltrd perq aray,OP Fee Schedule,Straight Discount,53.20%,OP,"5,970.22","5,970.22",,,,,,,,,,,,,
Corvel,CPT,63664,Revise spine eltrd plate,OP Fee Schedule,Straight Discount,53.20%,OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Corvel,CPT,63685,Insrt/redo spine n generator,OP Fee Schedule,Per Unit,"$36,379.39 ",OP,"28,534.20","36,379.39",,,,,,,,,,,,,
Corvel,CPT,63688,Revise/remove neuroreceiver,OP Fee Schedule,Straight Discount,53.20%,OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Corvel,CPT,63741,Install spinal shunt,OP Fee Schedule,Per Unit,"$7,864.40 ",OP,"5,524.06","7,864.40",,,,,,,,,,,,,
Corvel,CPT,63744,Revision of spinal shunt,OP Fee Schedule,Per Unit,"$7,864.40 ",OP,"5,524.06","7,864.40",,,,,,,,,,,,,
Corvel,CPT,64400,Njx aa&/strd trigeminal nrv,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,64405,Njx aa&/strd gr ocpl nrv,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,64408,Njx aa&/strd vagus nrv,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,64415,Njx aa&/strd brach plexus,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,797.03,,,,,,,,,,,,,
Corvel,CPT,64416,Njx aa&/strd brach plex nfs,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,797.03,,,,,,,,,,,,,
Corvel,CPT,64417,Njx aa&/strd axillary nrv,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,797.03,,,,,,,,,,,,,
Corvel,CPT,64418,Njx aa&/strd sprscap nrv,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,64420,Njx aa&/strd ntrcost nrv 1,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,64421,Njx aa&/strd ntrcost nrv ea,OP Fee Schedule,Per Unit,"$1,146.78 ",OP,797.03,"1,146.78",,,,,,,,,,,,,
Corvel,CPT,64425,Njx aa&/strd ii ih nerves,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,64430,Njx aa&/strd pudendal nerve,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,797.03,,,,,,,,,,,,,
Corvel,CPT,64435,Njx aa&/strd paracrv nrv,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,64445,Njx aa&/strd sciatic nerve,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,64446,Njx aa&/strd sciatic nrv nfs,OP Fee Schedule,Per Unit,"$1,146.78 ",OP,797.03,"1,146.78",,,,,,,,,,,,,
Corvel,CPT,64447,Njx aa&/strd femoral nerve,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,64448,Njx aa&/strd fem nerve nfs,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,797.03,,,,,,,,,,,,,
Corvel,CPT,64449,Njx aa&/strd lmbr plex nfs,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,797.03,,,,,,,,,,,,,
Corvel,CPT,64450,Njx aa&/strd other pn/branch,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,614.97,,,,,,,,,,,,,
Corvel,CPT,64451,Njx aa&/strd nrv nrvtg si jt,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64454,Njx aa&/strd gnclr nrv brnch,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64455,Njx aa&/strd pltr com dg nrv,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,64461,Pvb thoracic single inj site,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64463,Pvb thoracic cont infusion,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64479,Njx aa&/strd tfrm epi c/t 1,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,64483,Njx aa&/strd tfrm epi l/s 1,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,64490,Inj paravert f jnt c/t 1 lev,OP Fee Schedule,Straight Discount,53.20%,OP,797.03,797.03,,,,,,,,,,,,,
Corvel,CPT,64493,Inj paravert f jnt l/s 1 lev,OP Fee Schedule,Straight Discount,53.20%,OP,797.03,797.03,,,,,,,,,,,,,
Corvel,CPT,64505,N block spenopalatine gangl,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,64510,N block stellate ganglion,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,64517,N block inj hypogas plxs,OP Fee Schedule,Per Unit,$452.95 ,OP,452.95,797.03,,,,,,,,,,,,,
Corvel,CPT,64520,N block lumbar/thoracic,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,64530,N block inj celiac pelus,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,64553,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$44,296.48 ",OP,"10,888.82","44,296.48",,,,,,,,,,,,,
Corvel,CPT,64555,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$11,331.06 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
Corvel,CPT,64561,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$11,331.06 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
Corvel,CPT,64566,Neuroeltrd stim post tibial,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,64568,Inc for vagus n elect impl,OP Fee Schedule,Straight Discount,53.20%,OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Corvel,CPT,64569,Revise/repl vagus n eltrd,OP Fee Schedule,Straight Discount,53.20%,OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Corvel,CPT,64575,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$16,864.55 ",OP,"10,888.82","16,864.55",,,,,,,,,,,,,
Corvel,CPT,64580,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$16,864.55 ",OP,"16,864.55","19,846.62",,,,,,,,,,,,,
Corvel,CPT,64581,Implant neuroelectrodes,OP Fee Schedule,Per Unit,"$16,864.55 ",OP,"5,970.22","16,864.55",,,,,,,,,,,,,
Corvel,CPT,64585,Revise/remove neuroelectrode,OP Fee Schedule,Straight Discount,53.20%,OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Corvel,CPT,64590,Insrt/redo pn/gastr stimul,OP Fee Schedule,Per Unit,"$36,379.39 ",OP,"19,846.62","36,379.39",,,,,,,,,,,,,
Corvel,CPT,64595,Revise/rmv pn/gastr stimul,OP Fee Schedule,Straight Discount,53.20%,OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Corvel,CPT,64600,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$2,437.69 ",OP,797.03,"2,437.69",,,,,,,,,,,,,
Corvel,CPT,64605,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$2,437.69 ",OP,"1,700.15","2,437.69",,,,,,,,,,,,,
Corvel,CPT,64610,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$2,437.69 ",OP,"1,700.15","2,437.69",,,,,,,,,,,,,
Corvel,CPT,64611,Chemodenerv saliv glands,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,64612,Destroy nerve face muscle,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,64615,Chemodenerv musc migraine,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,64616,Chemodenerv musc neck dyston,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,64617,Chemodener muscle larynx emg,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,64620,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$2,437.69 ",OP,797.03,"2,437.69",,,,,,,,,,,,,
Corvel,CPT,64624,Dstrj nulyt agt gnclr nrv,OP Fee Schedule,Straight Discount,53.20%,OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Corvel,CPT,64625,Rf abltj nrv nrvtg si jt,OP Fee Schedule,Straight Discount,53.20%,OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Corvel,CPT,64630,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$1,146.78 ",OP,797.03,"1,146.78",,,,,,,,,,,,,
Corvel,CPT,64632,N block inj common digit,OP Fee Schedule,Straight Discount,53.20%,OP,253.09,253.09,,,,,,,,,,,,,
Corvel,CPT,64633,Destroy cerv/thor facet jnt,OP Fee Schedule,Straight Discount,53.20%,OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Corvel,CPT,64635,Destroy lumb/sac facet jnt,OP Fee Schedule,Straight Discount,53.20%,OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Corvel,CPT,64640,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$1,146.78 ",OP,797.03,"1,146.78",,,,,,,,,,,,,
Corvel,CPT,64642,Chemodenerv 1 extremity 1-4,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64644,Chemodenerv 1 extrem 5/> mus,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64646,Chemodenerv trunk musc 1-5,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64647,Chemodenerv trunk musc 6/>,OP Fee Schedule,Straight Discount,53.20%,OP,614.97,614.97,,,,,,,,,,,,,
Corvel,CPT,64650,Chemodenerv eccrine glands,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,64653,Chemodenerv eccrine glands,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,64680,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$1,273.96 ",OP,797.03,"1,273.96",,,,,,,,,,,,,
Corvel,CPT,64681,Injection treatment of nerve,OP Fee Schedule,Per Unit,"$2,437.69 ",OP,797.03,"2,437.69",,,,,,,,,,,,,
Corvel,CPT,64702,Revise finger/toe nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64704,Revise hand/foot nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64708,Revise arm/leg nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64712,Revision of sciatic nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64713,Revision of arm nerve(s),OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64714,Revise low back nerve(s),OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64716,Revision of cranial nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64718,Revise ulnar nerve at elbow,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64719,Revise ulnar nerve at wrist,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64721,Carpal tunnel surgery,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64722,Relieve pressure on nerve(s),OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64726,Release foot/toe nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64732,Incision of brow nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64734,Incision of cheek nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64736,Incision of chin nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64738,Incision of jaw nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64740,Incision of tongue nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64742,Incision of facial nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64744,Incise nerve back of head,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64746,Incise diaphragm nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64763,Incise hip/thigh nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64766,Incise hip/thigh nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64771,Sever cranial nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64772,Incision of spinal nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64774,Remove skin nerve lesion,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64776,Remove digit nerve lesion,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64782,Remove limb nerve lesion,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64784,Remove nerve lesion,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64786,Remove sciatic nerve lesion,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64788,Remove skin nerve lesion,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64790,Removal of nerve lesion,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64792,Removal of nerve lesion,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64795,Biopsy of nerve,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64802,Sympathectomy cervical,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64804,Remove sympathetic nerves,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64820,Sympathectomy digital artery,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Corvel,CPT,64821,Remove sympathetic nerves,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,64822,Remove sympathetic nerves,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,64823,Sympathectomy supfc palmar,OP Fee Schedule,Per Unit,"$5,182.91 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Corvel,CPT,64831,Repair of digit nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64834,Repair of hand or foot nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64835,Repair of hand or foot nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64836,Repair of hand or foot nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64840,Repair of leg nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64856,Repair/transpose nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64857,Repair arm/leg nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64858,Repair sciatic nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64861,Repair of arm nerves,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64862,Repair of low back nerves,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64864,Repair of facial nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64865,Repair of facial nerve,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64885,Nerve graft head/neck 4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64886,Nerve graft head/neck >4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64890,Nerve graft hand/foot 4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64891,Nerve graft hand/foot >4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64892,Nerve graft arm/leg <4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64893,Nerve graft arm/leg >4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64895,Nerve graft hand/foot 4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64896,Nerve graft hand/foot >4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64897,Nerve graft arm/leg 4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64898,Nerve graft arm/leg >4 cm,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64905,Nerve pedicle transfer,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64907,Nerve pedicle transfer,OP Fee Schedule,Per Unit,"$6,640.33 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Corvel,CPT,64910,Nerve repair w/allograft,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"3,575.33","5,524.06",,,,,,,,,,,,,
Corvel,CPT,64911,Neurorraphy w/vein autograft,OP Fee Schedule,Per Unit,"$3,575.33 ",OP,"3,575.33","5,524.06",,,,,,,,,,,,,
Corvel,CPT,64912,Nrv rpr w/nrv algrft 1st,OP Fee Schedule,Straight Discount,53.20%,OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Corvel,CPT,64999,Nervous system surgery,OP Fee Schedule,Per Unit,$452.95 ,OP,253.09,452.95,,,,,,,,,,,,,
Corvel,CPT,65091,Revise eye,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65093,Revise eye with implant,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65101,Removal of eye,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65103,Remove eye/insert implant,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65105,Remove eye/attach implant,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65110,Removal of eye,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65112,Remove eye/revise socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65114,Remove eye/revise socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65125,Revise ocular implant,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,65130,Insert ocular implant,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,65135,Insert ocular implant,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,65140,Attach ocular implant,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65150,Revise ocular implant,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,65155,Reinsert ocular implant,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,65175,Removal of ocular implant,OP Fee Schedule,Straight Discount,53.20%,OP,"3,203.25","3,203.25",,,,,,,,,,,,,
Corvel,CPT,65235,Remove foreign body from eye,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65260,Remove foreign body from eye,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Corvel,CPT,65265,Remove foreign body from eye,OP Fee Schedule,Per Unit,"$5,528.66 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Corvel,CPT,65270,Repair of eye wound,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,65272,Repair of eye wound,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65275,Repair of eye wound,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"3,203.25","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65280,Repair of eye wound,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,"3,309.75","3,796.62",,,,,,,,,,,,,
Corvel,CPT,65285,Repair of eye wound,OP Fee Schedule,Per Unit,"$7,497.01 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Corvel,CPT,65286,Repair of eye wound,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,65290,Repair of eye socket wound,OP Fee Schedule,Per Unit,"$4,262.40 ",OP,"3,203.25","4,262.40",,,,,,,,,,,,,
Corvel,CPT,65400,Removal of eye lesion,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,784.51,"3,049.73",,,,,,,,,,,,,
Corvel,CPT,65410,Biopsy of cornea,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65420,Removal of eye lesion,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65426,Removal of eye lesion,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65435,Curette/treat cornea,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,784.51,"1,458.56",,,,,,,,,,,,,
Corvel,CPT,65436,Curette/treat cornea,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65450,Treatment of corneal lesion,OP Fee Schedule,Per Unit,$429.68 ,OP,253.2,429.68,,,,,,,,,,,,,
Corvel,CPT,65600,Revision of cornea,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,65710,Corneal transplant,OP Fee Schedule,Per Unit,"$7,665.60 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Corvel,CPT,65730,Corneal transplant,OP Fee Schedule,Per Unit,"$7,665.60 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Corvel,CPT,65750,Corneal transplant,OP Fee Schedule,Per Unit,"$7,665.60 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Corvel,CPT,65755,Corneal transplant,OP Fee Schedule,Per Unit,"$7,665.60 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Corvel,CPT,65756,Corneal trnspl endothelial,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,65770,Revise cornea with implant,OP Fee Schedule,Per Unit,"$10,413.45 ",OP,"7,109.07","10,413.45",,,,,,,,,,,,,
Corvel,CPT,65772,Correction of astigmatism,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,784.51,"3,049.73",,,,,,,,,,,,,
Corvel,CPT,65775,Correction of astigmatism,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65780,Ocular reconst transplant,OP Fee Schedule,Per Unit,"$7,665.60 ",OP,"3,203.25","7,665.60",,,,,,,,,,,,,
Corvel,CPT,65781,Ocular reconst transplant,OP Fee Schedule,Per Unit,"$7,665.60 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Corvel,CPT,65782,Ocular reconst transplant,OP Fee Schedule,Per Unit,"$7,665.60 ",OP,"3,203.25","7,665.60",,,,,,,,,,,,,
Corvel,CPT,65785,Impltj ntrstrml crnl rng seg,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,65800,Drainage of eye,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65810,Drainage of eye,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65815,Drainage of eye,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65820,Relieve inner eye pressure,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","3,796.62",,,,,,,,,,,,,
Corvel,CPT,65850,Incision of eye,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65855,Trabeculoplasty laser surg,OP Fee Schedule,Per Unit,"$1,018.32 ",OP,488.28,"1,018.32",,,,,,,,,,,,,
Corvel,CPT,65860,Incise inner eye adhesions,OP Fee Schedule,Per Unit,"$1,018.32 ",OP,488.28,"1,018.32",,,,,,,,,,,,,
Corvel,CPT,65865,Incise inner eye adhesions,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65870,Incise inner eye adhesions,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65875,Incise inner eye adhesions,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,65880,Incise inner eye adhesions,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"3,049.73","3,796.62",,,,,,,,,,,,,
Corvel,CPT,65900,Remove eye lesion,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Corvel,CPT,65920,Remove implant of eye,OP Fee Schedule,Straight Discount,53.20%,OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Corvel,CPT,65930,Remove blood clot from eye,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66020,Injection treatment of eye,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Corvel,CPT,66030,Injection treatment of eye,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,66130,Remove eye lesion,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66150,Glaucoma surgery,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66155,Glaucoma surgery,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66160,Glaucoma surgery,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66170,Glaucoma surgery,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66172,Incision of eye,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66174,Translum dil eye canal,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,66175,Trnslum dil eye canal w/stnt,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,66179,Aqueous shunt eye w/o graft,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,66180,Aqueous shunt eye w/graft,OP Fee Schedule,Per Unit,"$7,590.68 ",OP,"3,796.62","7,590.68",,,,,,,,,,,,,
Corvel,CPT,66183,Insert ant drainage device,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,66184,Revision of aqueous shunt,OP Fee Schedule,Straight Discount,53.20%,OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Corvel,CPT,66185,Revise aqueous shunt eye,OP Fee Schedule,Per Unit,"$7,590.68 ",OP,"2,014.88","7,590.68",,,,,,,,,,,,,
Corvel,CPT,66225,Repair/graft eye lesion,OP Fee Schedule,Per Unit,"$7,590.68 ",OP,"3,796.62","7,590.68",,,,,,,,,,,,,
Corvel,CPT,66250,Follow-up surgery of eye,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,66500,Incision of iris,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,66505,Incision of iris,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,66600,Remove iris and lesion,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66605,Removal of iris,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66625,Removal of iris,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,66630,Removal of iris,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66635,Removal of iris,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66680,Repair iris & ciliary body,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66682,Repair iris & ciliary body,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66700,Destruction ciliary body,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Corvel,CPT,66710,Ciliary transsleral therapy,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,66711,Ecp ciliary body destruction,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Corvel,CPT,66720,Destruction ciliary body,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,66740,Destruction ciliary body,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66761,Revision of iris,OP Fee Schedule,Per Unit,"$1,018.32 ",OP,488.28,"1,018.32",,,,,,,,,,,,,
Corvel,CPT,66762,Revision of iris,OP Fee Schedule,Per Unit,"$1,018.32 ",OP,488.28,"1,018.32",,,,,,,,,,,,,
Corvel,CPT,66770,Removal of inner eye lesion,OP Fee Schedule,Per Unit,"$1,018.32 ",OP,488.28,"1,018.32",,,,,,,,,,,,,
Corvel,CPT,66820,Incision secondary cataract,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,66821,After cataract laser surgery,OP Fee Schedule,Per Unit,"$1,018.32 ",OP,488.28,"1,018.32",,,,,,,,,,,,,
Corvel,CPT,66825,Reposition intraocular lens,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,66830,Removal of lens lesion,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,66840,Removal of lens material,OP Fee Schedule,Per Unit,"$2,978.49 ",OP,"2,014.88","2,978.49",,,,,,,,,,,,,
Corvel,CPT,66850,Removal of lens material,OP Fee Schedule,Per Unit,"$5,854.37 ",OP,"2,014.88","5,854.37",,,,,,,,,,,,,
Corvel,CPT,66852,Removal of lens material,OP Fee Schedule,Per Unit,"$5,854.37 ",OP,"3,796.62","5,854.37",,,,,,,,,,,,,
Corvel,CPT,66920,Extraction of lens,OP Fee Schedule,Per Unit,"$5,854.37 ",OP,"2,014.88","5,854.37",,,,,,,,,,,,,
Corvel,CPT,66930,Extraction of lens,OP Fee Schedule,Per Unit,"$5,854.37 ",OP,"3,796.62","5,854.37",,,,,,,,,,,,,
Corvel,CPT,66940,Extraction of lens,OP Fee Schedule,Per Unit,"$2,978.49 ",OP,"2,014.88","2,978.49",,,,,,,,,,,,,
Corvel,CPT,66982,Xcapsl ctrc rmvl cplx wo ecp,OP Fee Schedule,Per Unit,"$4,733.35 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Corvel,CPT,66983,Cataract surg w/iol 1 stage,OP Fee Schedule,Per Unit,"$4,733.35 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Corvel,CPT,66984,Xcapsl ctrc rmvl w/o ecp,OP Fee Schedule,Per Unit,"$4,733.35 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Corvel,CPT,66985,Insert lens prosthesis,OP Fee Schedule,Per Unit,"$4,733.35 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Corvel,CPT,66986,Exchange lens prosthesis,OP Fee Schedule,Per Unit,"$4,733.35 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Corvel,CPT,66987,Xcapsl ctrc rmvl cplx w/ecp,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,66988,Xcapsl ctrc rmvl w/ecp,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,66999,Eye surgery procedure,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Corvel,CPT,67005,Partial removal of eye fluid,OP Fee Schedule,Per Unit,"$5,528.66 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Corvel,CPT,67010,Partial removal of eye fluid,OP Fee Schedule,Per Unit,"$5,528.66 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Corvel,CPT,67015,Release of eye fluid,OP Fee Schedule,Per Unit,"$5,528.66 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Corvel,CPT,67025,Replace eye fluid,OP Fee Schedule,Per Unit,"$5,528.66 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Corvel,CPT,67027,Implant eye drug system,OP Fee Schedule,Per Unit,"$7,497.01 ",OP,"7,497.01","14,545.35",,,,,,,,,,,,,
Corvel,CPT,67028,Injection eye drug,OP Fee Schedule,Per Unit,$787.83 ,OP,301.15,787.83,,,,,,,,,,,,,
Corvel,CPT,67030,Incise inner eye strands,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Corvel,CPT,67031,Laser surgery eye strands,OP Fee Schedule,Per Unit,"$1,018.32 ",OP,488.28,"1,018.32",,,,,,,,,,,,,
Corvel,CPT,67036,Removal of inner eye fluid,OP Fee Schedule,Per Unit,"$7,497.01 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Corvel,CPT,67039,Laser treatment of retina,OP Fee Schedule,Per Unit,"$7,497.01 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Corvel,CPT,67040,Laser treatment of retina,OP Fee Schedule,Per Unit,"$7,497.01 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Corvel,CPT,67041,Vit for macular pucker,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,67042,Vit for macular hole,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,67043,Vit for membrane dissect,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,67101,Repair detached retina crtx,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Corvel,CPT,67105,Repair detached retina pc,OP Fee Schedule,Per Unit,"$1,018.36 ",OP,488.28,"1,018.36",,,,,,,,,,,,,
Corvel,CPT,67107,Repair detached retina,OP Fee Schedule,Per Unit,"$7,497.01 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Corvel,CPT,67108,Repair detached retina,OP Fee Schedule,Per Unit,"$7,497.01 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Corvel,CPT,67110,Repair detached retina,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Corvel,CPT,67113,Repair retinal detach cplx,OP Fee Schedule,Straight Discount,53.20%,OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Corvel,CPT,67115,Release encircling material,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,"3,309.75","3,796.62",,,,,,,,,,,,,
Corvel,CPT,67120,Remove eye implant material,OP Fee Schedule,Straight Discount,53.20%,OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Corvel,CPT,67121,Remove eye implant material,OP Fee Schedule,Straight Discount,53.20%,OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Corvel,CPT,67141,Treatment of retina,OP Fee Schedule,Per Unit,$787.83 ,OP,253.2,787.83,,,,,,,,,,,,,
Corvel,CPT,67145,Treatment of retina,OP Fee Schedule,Per Unit,"$1,018.36 ",OP,488.28,"1,018.36",,,,,,,,,,,,,
Corvel,CPT,67208,Treatment of retinal lesion,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,253.2,"3,309.75",,,,,,,,,,,,,
Corvel,CPT,67210,Treatment of retinal lesion,OP Fee Schedule,Per Unit,"$1,018.36 ",OP,488.28,"1,018.36",,,,,,,,,,,,,
Corvel,CPT,67218,Treatment of retinal lesion,OP Fee Schedule,Per Unit,"$3,309.75 ",OP,"3,203.25","3,309.75",,,,,,,,,,,,,
Corvel,CPT,67220,Treatment of choroid lesion,OP Fee Schedule,Per Unit,$787.83 ,OP,488.28,787.83,,,,,,,,,,,,,
Corvel,CPT,67221,Ocular photodynamic ther,OP Fee Schedule,Per Unit,$787.83 ,OP,488.28,787.83,,,,,,,,,,,,,
Corvel,CPT,67227,Dstrj extensive retinopathy,OP Fee Schedule,Per Unit,"$5,528.66 ",OP,"3,203.25","5,528.66",,,,,,,,,,,,,
Corvel,CPT,67228,Treatment x10sv retinopathy,OP Fee Schedule,Per Unit,"$1,018.36 ",OP,488.28,"1,018.36",,,,,,,,,,,,,
Corvel,CPT,67229,Tr retinal les preterm inf,OP Fee Schedule,Straight Discount,53.20%,OP,488.28,488.28,,,,,,,,,,,,,
Corvel,CPT,67250,Reinforce eye wall,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67255,Reinforce/graft eye wall,OP Fee Schedule,Per Unit,"$5,528.66 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Corvel,CPT,67299,Eye surgery procedure,OP Fee Schedule,Per Unit,$787.83 ,OP,787.83,"2,014.88",,,,,,,,,,,,,
Corvel,CPT,67311,Revise eye muscle,OP Fee Schedule,Per Unit,"$4,262.40 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Corvel,CPT,67312,Revise two eye muscles,OP Fee Schedule,Per Unit,"$4,262.40 ",OP,"3,203.25","4,262.40",,,,,,,,,,,,,
Corvel,CPT,67314,Revise eye muscle,OP Fee Schedule,Per Unit,"$4,262.40 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Corvel,CPT,67316,Revise two eye muscles,OP Fee Schedule,Per Unit,"$4,262.40 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Corvel,CPT,67318,Revise eye muscle(s),OP Fee Schedule,Per Unit,"$4,262.40 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Corvel,CPT,67343,Release eye tissue,OP Fee Schedule,Per Unit,"$4,262.40 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Corvel,CPT,67345,Destroy nerve of eye muscle,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67346,Biopsy eye muscle,OP Fee Schedule,Per Unit,"$2,881.19 ",OP,"2,881.19","3,203.25",,,,,,,,,,,,,
Corvel,CPT,67399,Unlisted px extraocular musc,OP Fee Schedule,Per Unit,"$4,262.40 ",OP,253.2,"4,262.40",,,,,,,,,,,,,
Corvel,CPT,67400,Explore/biopsy eye socket,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67405,Explore/drain eye socket,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67412,Explore/treat eye socket,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67413,Explore/treat eye socket,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67414,Explr/decompress eye socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67415,Aspiration orbital contents,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67420,Explore/treat eye socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67430,Explore/treat eye socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67440,Explore/drain eye socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67445,Explr/decompress eye socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67450,Explore/biopsy eye socket,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67500,Inject/treat eye socket,OP Fee Schedule,Per Unit,$429.68 ,OP,253.2,429.68,,,,,,,,,,,,,
Corvel,CPT,67505,Inject/treat eye socket,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67515,Inject/treat eye socket,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67550,Insert eye socket implant,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67560,Revise eye socket implant,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67570,Decompress optic nerve,OP Fee Schedule,Per Unit,"$7,056.40 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Corvel,CPT,67599,Orbit surgery procedure,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67700,Drainage of eyelid abscess,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67710,Incision of eyelid,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,784.51,"1,458.56",,,,,,,,,,,,,
Corvel,CPT,67715,Incision of eyelid fold,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67800,Remove eyelid lesion,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67801,Remove eyelid lesions,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,784.51,"1,458.56",,,,,,,,,,,,,
Corvel,CPT,67805,Remove eyelid lesions,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67808,Remove eyelid lesion(s),OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67810,Biopsy eyelid & lid margin,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67825,Revise eyelashes,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,67830,Revise eyelashes,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,784.51,"1,458.56",,,,,,,,,,,,,
Corvel,CPT,67835,Revise eyelashes,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67840,Remove eyelid lesion,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,784.51,"1,458.56",,,,,,,,,,,,,
Corvel,CPT,67850,Treat eyelid lesion,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,784.51,"1,458.56",,,,,,,,,,,,,
Corvel,CPT,67875,Closure of eyelid by suture,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,784.51,"1,458.56",,,,,,,,,,,,,
Corvel,CPT,67880,Revision of eyelid,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,67882,Revision of eyelid,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67900,Repair brow defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67901,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67902,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"3,203.25","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67903,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67904,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67906,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"3,203.25","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67908,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67909,Revise eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67911,Revise eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67912,Correction eyelid w/implant,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67914,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67915,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67916,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67917,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67921,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67922,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67923,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67924,Repair eyelid defect,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67930,Repair eyelid wound,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67935,Repair eyelid wound,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67938,Remove eyelid foreign body,OP Fee Schedule,Per Unit,$232.50 ,OP,232.5,253.2,,,,,,,,,,,,,
Corvel,CPT,67950,Revision of eyelid,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67961,Revision of eyelid,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67966,Revision of eyelid,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67971,Reconstruction of eyelid,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67973,Reconstruction of eyelid,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67974,Reconstruction of eyelid,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,67975,Reconstruction of eyelid,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,67999,Revision of eyelid,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,68020,Incise/drain eyelid lining,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,784.51,"3,430.01",,,,,,,,,,,,,
Corvel,CPT,68040,Treatment of eyelid lesions,OP Fee Schedule,Per Unit,$232.50 ,OP,232.5,253.2,,,,,,,,,,,,,
Corvel,CPT,68100,Biopsy of eyelid lining,OP Fee Schedule,Per Unit,"$1,215.27 ",OP,"1,215.27","1,940.45",,,,,,,,,,,,,
Corvel,CPT,68110,Remove eyelid lining lesion,OP Fee Schedule,Per Unit,"$2,881.19 ",OP,"1,940.45","2,881.19",,,,,,,,,,,,,
Corvel,CPT,68115,Remove eyelid lining lesion,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68130,Remove eyelid lining lesion,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,68135,Remove eyelid lining lesion,OP Fee Schedule,Per Unit,"$1,458.56 ",OP,"1,458.56","1,940.45",,,,,,,,,,,,,
Corvel,CPT,68320,Revise/graft eyelid lining,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68325,Revise/graft eyelid lining,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68326,Revise/graft eyelid lining,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68328,Revise/graft eyelid lining,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68330,Revise eyelid lining,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Corvel,CPT,68335,Revise/graft eyelid lining,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68340,Separate eyelid adhesions,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68360,Revise eyelid lining,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"3,203.25","4,606.28",,,,,,,,,,,,,
Corvel,CPT,68362,Revise eyelid lining,OP Fee Schedule,Per Unit,"$4,606.28 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Corvel,CPT,68371,Harvest eye tissue alograft,OP Fee Schedule,Per Unit,"$3,049.73 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Corvel,CPT,68399,Eyelid lining surgery,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,68400,Incise/drain tear gland,OP Fee Schedule,Per Unit,$579.95 ,OP,579.95,784.51,,,,,,,,,,,,,
Corvel,CPT,68420,Incise/drain tear sac,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68440,Incise tear duct opening,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,68500,Removal of tear gland,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68505,Partial removal tear gland,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68510,Biopsy of tear gland,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68520,Removal of tear sac,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68525,Biopsy of tear sac,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68530,Clearance of tear duct,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,253.2,"3,430.01",,,,,,,,,,,,,
Corvel,CPT,68540,Remove tear gland lesion,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68550,Remove tear gland lesion,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68700,Repair tear ducts,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68705,Revise tear duct opening,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,68720,Create tear sac drain,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68745,Create tear duct drain,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68750,Create tear duct drain,OP Fee Schedule,Per Unit,"$5,058.57 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Corvel,CPT,68760,Close tear duct opening,OP Fee Schedule,Per Unit,$429.68 ,OP,253.2,429.68,,,,,,,,,,,,,
Corvel,CPT,68761,Close tear duct opening,OP Fee Schedule,Per Unit,$429.68 ,OP,253.2,429.68,,,,,,,,,,,,,
Corvel,CPT,68770,Close tear system fistula,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68810,Probe nasolacrimal duct,OP Fee Schedule,Per Unit,$429.68 ,OP,253.2,429.68,,,,,,,,,,,,,
Corvel,CPT,68811,Probe nasolacrimal duct,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68815,Probe nasolacrimal duct,OP Fee Schedule,Per Unit,"$3,430.01 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Corvel,CPT,68816,Probe nl duct w/balloon,OP Fee Schedule,Straight Discount,53.20%,OP,"1,940.45","1,940.45",,,,,,,,,,,,,
Corvel,CPT,68840,Explore/irrigate tear ducts,OP Fee Schedule,Per Unit,$232.50 ,OP,232.5,253.2,,,,,,,,,,,,,
Corvel,CPT,68899,Tear duct system surgery,OP Fee Schedule,Per Unit,$579.95 ,OP,253.2,579.95,,,,,,,,,,,,,
Corvel,CPT,69000,Drain external ear lesion,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,602.74,,,,,,,,,,,,,
Corvel,CPT,69005,Drain external ear lesion,OP Fee Schedule,Per Unit,"$3,506.97 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Corvel,CPT,69020,Drain outer ear canal lesion,OP Fee Schedule,Per Unit,$288.27 ,OP,288.27,602.74,,,,,,,,,,,,,
Corvel,CPT,69100,Biopsy of external ear,OP Fee Schedule,Per Unit,$819.60 ,OP,205.06,819.6,,,,,,,,,,,,,
Corvel,CPT,69105,Biopsy of external ear canal,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,69110,Remove external ear partial,OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,69120,Removal of external ear,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,69140,Remove ear canal lesion(s),OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,69145,Remove ear canal lesion(s),OP Fee Schedule,Per Unit,"$3,025.00 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Corvel,CPT,69150,Extensive ear canal surgery,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
Corvel,CPT,69205,Clear outer ear canal,OP Fee Schedule,Per Unit,"$4,019.12 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Corvel,CPT,69222,Clean out mastoid cavity,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,69300,Revise external ear,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,69310,Rebuild outer ear canal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69320,Rebuild outer ear canal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69399,Outer ear surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,69420,Incision of eardrum,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,69421,Incision of eardrum,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Corvel,CPT,69433,Create eardrum opening,OP Fee Schedule,Per Unit,"$1,512.50 ",OP,438.38,"1,512.50",,,,,,,,,,,,,
Corvel,CPT,69436,Create eardrum opening,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,69440,Exploration of middle ear,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,69450,Eardrum revision,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69501,Mastoidectomy,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69502,Mastoidectomy,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Corvel,CPT,69505,Remove mastoid structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69511,Extensive mastoid surgery,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69530,Extensive mastoid surgery,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69540,Remove ear lesion,OP Fee Schedule,Per Unit,"$3,290.24 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Corvel,CPT,69550,Remove ear lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69552,Remove ear lesion,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69601,Mastoid surgery revision,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69602,Mastoid surgery revision,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69603,Mastoid surgery revision,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69604,Mastoid surgery revision,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69610,Repair of eardrum,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Corvel,CPT,69620,Repair of eardrum,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,69631,Repair eardrum structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69632,Rebuild eardrum structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69633,Rebuild eardrum structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69635,Repair eardrum structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69636,Rebuild eardrum structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69637,Rebuild eardrum structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69641,Revise middle ear & mastoid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69642,Revise middle ear & mastoid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69643,Revise middle ear & mastoid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69644,Revise middle ear & mastoid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69645,Revise middle ear & mastoid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69646,Revise middle ear & mastoid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69650,Release middle ear bone,OP Fee Schedule,Per Unit,"$4,672.97 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Corvel,CPT,69660,Revise middle ear bone,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69661,Revise middle ear bone,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69662,Revise middle ear bone,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69666,Repair middle ear structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69667,Repair middle ear structures,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69670,Remove mastoid air cells,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69676,Remove middle ear nerve,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69700,Close mastoid fistula,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69705,Nps surg dilat eust tube uni,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,69706,Nps surg dilat eust tube bi,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,69711,Remove/repair hearing aid,OP Fee Schedule,Straight Discount,53.20%,OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Corvel,CPT,69714,Implant temple bone w/stimul,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"7,651.26","11,934.03",,,,,,,,,,,,,
Corvel,CPT,69715,Temple bne implnt w/stimulat,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"7,651.26","15,377.54",,,,,,,,,,,,,
Corvel,CPT,69717,Temple bone implant revision,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"6,071.26","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69718,Revise temple bone implant,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"7,651.26","11,934.03",,,,,,,,,,,,,
Corvel,CPT,69720,Release facial nerve,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69725,Release facial nerve,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69740,Repair facial nerve,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69745,Repair facial nerve,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69799,Middle ear surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,69801,Incise inner ear,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69805,Explore inner ear,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69806,Explore inner ear,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69905,Remove inner ear,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69910,Remove inner ear & mastoid,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69915,Incise inner ear nerve,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69930,Implant cochlear device,OP Fee Schedule,Per Unit,"$83,093.33 ",OP,"33,363.18","83,093.33",,,,,,,,,,,,,
Corvel,CPT,69949,Inner ear surgery procedure,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,69955,Release facial nerve,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69960,Release inner ear canal,OP Fee Schedule,Per Unit,"$7,651.26 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Corvel,CPT,69970,Remove inner ear lesion,OP Fee Schedule,Straight Discount,53.20%,OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Corvel,CPT,69979,Temporal bone surgery,OP Fee Schedule,Per Unit,$491.14 ,OP,205.06,491.14,,,,,,,,,,,,,
Corvel,CPT,70010,Contrast x-ray of brain,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,70015,Contrast x-ray of brain,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,70030,X-ray eye for foreign body,OP Fee Schedule,Per Unit,$133.38 ,OP,78.4,133.38,,,,,,,,,,,,,
Corvel,CPT,70100,X-ray exam of jaw <4views,OP Fee Schedule,Per Unit,$195.80 ,OP,78.4,195.8,,,,,,,,,,,,,
Corvel,CPT,70110,X-ray exam of jaw 4/> views,OP Fee Schedule,Per Unit,$494.34 ,OP,105.6,494.34,,,,,,,,,,,,,
Corvel,CPT,70120,X-ray exam of mastoids,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,70130,X-ray exam of mastoids,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,70134,X-ray exam of middle ear,OP Fee Schedule,Straight Discount,53.20%,OP,467.96,467.96,,,,,,,,,,,,,
Corvel,CPT,70140,X-ray exam of facial bones,OP Fee Schedule,Per Unit,$219.35 ,OP,78.4,219.35,,,,,,,,,,,,,
Corvel,CPT,70150,X-ray exam of facial bones,OP Fee Schedule,Per Unit,$393.83 ,OP,105.6,393.83,,,,,,,,,,,,,
Corvel,CPT,70160,X-ray exam of nasal bones,OP Fee Schedule,Per Unit,$160.01 ,OP,78.4,160.01,,,,,,,,,,,,,
Corvel,CPT,70170,X-ray exam of tear duct,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70190,X-ray exam of eye sockets,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,70200,X-ray exam of eye sockets,OP Fee Schedule,Per Unit,$252.64 ,OP,105.6,252.64,,,,,,,,,,,,,
Corvel,CPT,70210,X-ray exam of sinuses,OP Fee Schedule,Per Unit,$178.48 ,OP,78.4,178.48,,,,,,,,,,,,,
Corvel,CPT,70220,X-ray exam of sinuses,OP Fee Schedule,Per Unit,$208.32 ,OP,78.4,208.32,,,,,,,,,,,,,
Corvel,CPT,70240,X-ray exam pituitary saddle,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,70250,X-ray exam of skull,OP Fee Schedule,Per Unit,$219.35 ,OP,105.6,219.35,,,,,,,,,,,,,
Corvel,CPT,70260,X-ray exam of skull,OP Fee Schedule,Per Unit,$303.86 ,OP,105.6,303.86,,,,,,,,,,,,,
Corvel,CPT,70300,X-ray exam of teeth,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,70310,X-ray exam of teeth,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70320,Full mouth x-ray of teeth,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70328,X-ray exam of jaw joint,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,70330,X-ray exam of jaw joints,OP Fee Schedule,Per Unit,$249.76 ,OP,78.4,249.76,,,,,,,,,,,,,
Corvel,CPT,70332,X-ray exam of jaw joint,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70336,Magnetic image jaw joint,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70350,X-ray head for orthodontia,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,70355,Panoramic x-ray of jaws,OP Fee Schedule,Per Unit,$170.17 ,OP,78.4,170.17,,,,,,,,,,,,,
Corvel,CPT,70360,X-ray exam of neck,OP Fee Schedule,Per Unit,$154.49 ,OP,78.4,154.49,,,,,,,,,,,,,
Corvel,CPT,70370,Throat x-ray & fluoroscopy,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,70371,Speech evaluation complex,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70380,X-ray exam of salivary gland,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,70390,X-ray exam of salivary duct,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70450,Ct head/brain w/o dye,OP Fee Schedule,Per Unit,$829.64 ,OP,105.6,829.64,,,,,,,,,,,,,
Corvel,CPT,70460,Ct head/brain w/dye,OP Fee Schedule,Per Unit,"$1,760.80 ",OP,173.03,"1,760.80",,,,,,,,,,,,,
Corvel,CPT,70470,Ct head/brain w/o & w/dye,OP Fee Schedule,Per Unit,"$1,016.65 ",OP,173.03,"1,016.65",,,,,,,,,,,,,
Corvel,CPT,70480,Ct orbit/ear/fossa w/o dye,OP Fee Schedule,Per Unit,"$1,180.07 ",OP,105.6,"1,180.07",,,,,,,,,,,,,
Corvel,CPT,70481,Ct orbit/ear/fossa w/dye,OP Fee Schedule,Per Unit,"$2,744.16 ",OP,173.03,"2,744.16",,,,,,,,,,,,,
Corvel,CPT,70482,Ct orbit/ear/fossa w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,70486,Ct maxillofacial w/o dye,OP Fee Schedule,Per Unit,$722.16 ,OP,105.6,722.16,,,,,,,,,,,,,
Corvel,CPT,70487,Ct maxillofacial w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,70488,Ct maxillofacial w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,70490,Ct soft tissue neck w/o dye,OP Fee Schedule,Per Unit,"$1,070.58 ",OP,105.6,"1,070.58",,,,,,,,,,,,,
Corvel,CPT,70491,Ct soft tissue neck w/dye,OP Fee Schedule,Per Unit,"$1,062.50 ",OP,173.03,"1,062.50",,,,,,,,,,,,,
Corvel,CPT,70492,Ct sft tsue nck w/o & w/dye,OP Fee Schedule,Per Unit,"$2,286.75 ",OP,173.03,"2,286.75",,,,,,,,,,,,,
Corvel,CPT,70496,Ct angiography head,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,70498,Ct angiography neck,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,70540,Mri orbit/face/neck w/o dye,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70542,Mri orbit/face/neck w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,70543,Mri orbt/fac/nck w/o &w/dye,OP Fee Schedule,Per Unit,"$2,347.49 ",OP,356.73,"2,347.49",,,,,,,,,,,,,
Corvel,CPT,70544,Mr angiography head w/o dye,OP Fee Schedule,Per Unit,"$1,445.16 ",OP,223.01,"1,445.16",,,,,,,,,,,,,
Corvel,CPT,70545,Mr angiography head w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,70546,Mr angiograph head w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,70547,Mr angiography neck w/o dye,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70548,Mr angiography neck w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,70549,Mr angiograph neck w/o&w/dye,OP Fee Schedule,Per Unit,"$2,998.60 ",OP,356.73,"2,998.60",,,,,,,,,,,,,
Corvel,CPT,70551,Mri brain stem w/o dye,OP Fee Schedule,Per Unit,"$1,477.82 ",OP,223.01,"1,477.82",,,,,,,,,,,,,
Corvel,CPT,70552,Mri brain stem w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,70553,Mri brain stem w/o & w/dye,OP Fee Schedule,Per Unit,"$2,053.11 ",OP,356.73,"2,053.11",,,,,,,,,,,,,
Corvel,CPT,70554,Fmri brain by tech,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70555,Fmri brain by phys/psych,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,70557,Mri brain w/o dye,OP Fee Schedule,Straight Discount,53.20%,OP,467.96,467.96,,,,,,,,,,,,,
Corvel,CPT,70558,Mri brain w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,70559,Mri brain w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,71045,X-ray exam chest 1 view,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,71046,X-ray exam chest 2 views,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,71047,X-ray exam chest 3 views,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,71048,X-ray exam chest 4+ views,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,71100,X-ray exam ribs uni 2 views,OP Fee Schedule,Per Unit,$473.31 ,OP,78.4,473.31,,,,,,,,,,,,,
Corvel,CPT,71101,X-ray exam unilat ribs/chest,OP Fee Schedule,Per Unit,$234.65 ,OP,105.6,234.65,,,,,,,,,,,,,
Corvel,CPT,71110,X-ray exam ribs bil 3 views,OP Fee Schedule,Per Unit,$250.85 ,OP,105.6,250.85,,,,,,,,,,,,,
Corvel,CPT,71111,X-ray exam ribs/chest4/> vws,OP Fee Schedule,Per Unit,$295.27 ,OP,105.6,295.27,,,,,,,,,,,,,
Corvel,CPT,71120,X-ray exam breastbone 2/>vws,OP Fee Schedule,Per Unit,$198.07 ,OP,78.4,198.07,,,,,,,,,,,,,
Corvel,CPT,71130,X-ray strenoclavic jt 3/>vws,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,71250,Ct thorax dx c-,OP Fee Schedule,Per Unit,$957.00 ,OP,105.6,957,,,,,,,,,,,,,
Corvel,CPT,71260,Ct thorax dx c+,OP Fee Schedule,Per Unit,"$1,120.94 ",OP,173.03,"1,120.94",,,,,,,,,,,,,
Corvel,CPT,71270,Ct thorax dx c-/c+,OP Fee Schedule,Per Unit,"$1,131.96 ",OP,173.03,"1,131.96",,,,,,,,,,,,,
Corvel,CPT,71271,Ct thorax lung cancer scr c-,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,71275,Ct angiography chest,OP Fee Schedule,Per Unit,"$2,406.25 ",OP,173.03,"2,406.25",,,,,,,,,,,,,
Corvel,CPT,71550,Mri chest w/o dye,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,71551,Mri chest w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,71552,Mri chest w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,71555,Mri angio chest w or w/o dye,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,72020,X-ray exam of spine 1 view,OP Fee Schedule,Per Unit,$141.31 ,OP,78.4,141.31,,,,,,,,,,,,,
Corvel,CPT,72040,X-ray exam neck spine 2-3 vw,OP Fee Schedule,Per Unit,$186.52 ,OP,78.4,186.52,,,,,,,,,,,,,
Corvel,CPT,72050,X-ray exam neck spine 4/5vws,OP Fee Schedule,Per Unit,$234.90 ,OP,105.6,234.9,,,,,,,,,,,,,
Corvel,CPT,72052,X-ray exam neck spine 6/>vws,OP Fee Schedule,Per Unit,$417.60 ,OP,105.6,417.6,,,,,,,,,,,,,
Corvel,CPT,72070,X-ray exam thorac spine 2vws,OP Fee Schedule,Per Unit,$476.40 ,OP,105.6,476.4,,,,,,,,,,,,,
Corvel,CPT,72072,X-ray exam thorac spine 3vws,OP Fee Schedule,Per Unit,$228.37 ,OP,105.6,228.37,,,,,,,,,,,,,
Corvel,CPT,72074,X-ray exam thorac spine4/>vw,OP Fee Schedule,Per Unit,$692.07 ,OP,105.6,692.07,,,,,,,,,,,,,
Corvel,CPT,72080,X-ray exam thoracolmb 2/> vw,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,72081,X-ray exam entire spi 1 vw,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,72082,X-ray exam entire spi 2/3 vw,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,72083,X-ray exam entire spi 4/5 vw,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,72084,X-ray exam entire spi 6/> vw,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,72100,X-ray exam l-s spine 2/3 vws,OP Fee Schedule,Per Unit,$177.33 ,OP,105.6,177.33,,,,,,,,,,,,,
Corvel,CPT,72110,X-ray exam l-2 spine 4/>vws,OP Fee Schedule,Per Unit,$236.41 ,OP,105.6,236.41,,,,,,,,,,,,,
Corvel,CPT,72114,X-ray exam l-s spine bending,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,72120,X-ray bend only l-s spine,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,72125,Ct neck spine w/o dye,OP Fee Schedule,Per Unit,"$1,064.24 ",OP,105.6,"1,064.24",,,,,,,,,,,,,
Corvel,CPT,72126,Ct neck spine w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,72127,Ct neck spine w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,72128,Ct chest spine w/o dye,OP Fee Schedule,Per Unit,"$2,151.68 ",OP,105.6,"2,151.68",,,,,,,,,,,,,
Corvel,CPT,72129,Ct chest spine w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,72130,Ct chest spine w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,72131,Ct lumbar spine w/o dye,OP Fee Schedule,Per Unit,"$1,137.50 ",OP,105.6,"1,137.50",,,,,,,,,,,,,
Corvel,CPT,72132,Ct lumbar spine w/dye,OP Fee Schedule,Per Unit,"$1,967.27 ",OP,356.73,"1,967.27",,,,,,,,,,,,,
Corvel,CPT,72133,Ct lumbar spine w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,72141,Mri neck spine w/o dye,OP Fee Schedule,Per Unit,"$1,451.99 ",OP,223.01,"1,451.99",,,,,,,,,,,,,
Corvel,CPT,72142,Mri neck spine w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,72146,Mri chest spine w/o dye,OP Fee Schedule,Per Unit,"$1,566.80 ",OP,223.01,"1,566.80",,,,,,,,,,,,,
Corvel,CPT,72147,Mri chest spine w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,72148,Mri lumbar spine w/o dye,OP Fee Schedule,Per Unit,"$1,418.12 ",OP,223.01,"1,418.12",,,,,,,,,,,,,
Corvel,CPT,72149,Mri lumbar spine w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,72156,Mri neck spine w/o & w/dye,OP Fee Schedule,Per Unit,"$2,270.11 ",OP,356.73,"2,270.11",,,,,,,,,,,,,
Corvel,CPT,72157,Mri chest spine w/o & w/dye,OP Fee Schedule,Per Unit,"$1,927.03 ",OP,356.73,"1,927.03",,,,,,,,,,,,,
Corvel,CPT,72158,Mri lumbar spine w/o & w/dye,OP Fee Schedule,Per Unit,"$2,303.09 ",OP,356.73,"2,303.09",,,,,,,,,,,,,
Corvel,CPT,72159,Mr angio spine w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,72170,X-ray exam of pelvis,OP Fee Schedule,Per Unit,$115.25 ,OP,105.6,115.25,,,,,,,,,,,,,
Corvel,CPT,72190,X-ray exam of pelvis,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,72191,Ct angiograph pelv w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,72192,Ct pelvis w/o dye,OP Fee Schedule,Per Unit,$859.42 ,OP,105.6,859.42,,,,,,,,,,,,,
Corvel,CPT,72193,Ct pelvis w/dye,OP Fee Schedule,Per Unit,$989.41 ,OP,173.03,989.41,,,,,,,,,,,,,
Corvel,CPT,72194,Ct pelvis w/o & w/dye,OP Fee Schedule,Per Unit,"$1,102.96 ",OP,173.03,"1,102.96",,,,,,,,,,,,,
Corvel,CPT,72195,Mri pelvis w/o dye,OP Fee Schedule,Per Unit,"$1,378.20 ",OP,223.01,"1,378.20",,,,,,,,,,,,,
Corvel,CPT,72196,Mri pelvis w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,72197,Mri pelvis w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,72198,Mr angio pelvis w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,72200,X-ray exam si joints,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,72202,X-ray exam si joints 3/> vws,OP Fee Schedule,Per Unit,$189.15 ,OP,105.6,189.15,,,,,,,,,,,,,
Corvel,CPT,72220,X-ray exam sacrum tailbone,OP Fee Schedule,Per Unit,$306.39 ,OP,78.4,306.39,,,,,,,,,,,,,
Corvel,CPT,72240,Myelography neck spine,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,72255,Myelography thoracic spine,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,72265,Myelography l-s spine,OP Fee Schedule,Per Unit,"$1,935.13 ",OP,693.07,"1,935.13",,,,,,,,,,,,,
Corvel,CPT,72270,Myelogphy 2/> spine regions,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,72275,Epidurography,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,72285,Discography cerv/thor spine,OP Fee Schedule,Straight Discount,53.20%,OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Corvel,CPT,72295,X-ray of lower spine disk,OP Fee Schedule,Straight Discount,53.20%,OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Corvel,CPT,73000,X-ray exam of collar bone,OP Fee Schedule,Per Unit,$162.67 ,OP,78.4,162.67,,,,,,,,,,,,,
Corvel,CPT,73010,X-ray exam of shoulder blade,OP Fee Schedule,Per Unit,$167.01 ,OP,105.6,167.01,,,,,,,,,,,,,
Corvel,CPT,73020,X-ray exam of shoulder,OP Fee Schedule,Per Unit,$168.42 ,OP,78.4,168.42,,,,,,,,,,,,,
Corvel,CPT,73030,X-ray exam of shoulder,OP Fee Schedule,Per Unit,$176.10 ,OP,78.4,176.1,,,,,,,,,,,,,
Corvel,CPT,73040,Contrast x-ray of shoulder,OP Fee Schedule,Per Unit,$771.30 ,OP,356.73,771.3,,,,,,,,,,,,,
Corvel,CPT,73050,X-ray exam of shoulders,OP Fee Schedule,Per Unit,$333.13 ,OP,78.4,333.13,,,,,,,,,,,,,
Corvel,CPT,73060,X-ray exam of humerus,OP Fee Schedule,Per Unit,$152.12 ,OP,78.4,152.12,,,,,,,,,,,,,
Corvel,CPT,73070,X-ray exam of elbow,OP Fee Schedule,Per Unit,$193.84 ,OP,78.4,193.84,,,,,,,,,,,,,
Corvel,CPT,73080,X-ray exam of elbow,OP Fee Schedule,Per Unit,$139.79 ,OP,78.4,139.79,,,,,,,,,,,,,
Corvel,CPT,73085,Contrast x-ray of elbow,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73090,X-ray exam of forearm,OP Fee Schedule,Per Unit,$133.31 ,OP,78.4,133.31,,,,,,,,,,,,,
Corvel,CPT,73092,X-ray exam of arm infant,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,73100,X-ray exam of wrist,OP Fee Schedule,Per Unit,$143.83 ,OP,78.4,143.83,,,,,,,,,,,,,
Corvel,CPT,73110,X-ray exam of wrist,OP Fee Schedule,Per Unit,$129.10 ,OP,78.4,129.1,,,,,,,,,,,,,
Corvel,CPT,73115,Contrast x-ray of wrist,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73120,X-ray exam of hand,OP Fee Schedule,Per Unit,$234.06 ,OP,105.6,234.06,,,,,,,,,,,,,
Corvel,CPT,73130,X-ray exam of hand,OP Fee Schedule,Per Unit,$150.13 ,OP,78.4,150.13,,,,,,,,,,,,,
Corvel,CPT,73140,X-ray exam of finger(s),OP Fee Schedule,Per Unit,$102.15 ,OP,78.4,102.15,,,,,,,,,,,,,
Corvel,CPT,73200,Ct upper extremity w/o dye,OP Fee Schedule,Per Unit,"$1,246.65 ",OP,105.6,"1,246.65",,,,,,,,,,,,,
Corvel,CPT,73201,Ct upper extremity w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73202,Ct uppr extremity w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,73206,Ct angio upr extrm w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,73218,Mri upper extremity w/o dye,OP Fee Schedule,Per Unit,"$2,922.27 ",OP,223.01,"2,922.27",,,,,,,,,,,,,
Corvel,CPT,73219,Mri upper extremity w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73220,Mri uppr extremity w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73221,Mri joint upr extrem w/o dye,OP Fee Schedule,Per Unit,"$1,534.05 ",OP,223.01,"1,534.05",,,,,,,,,,,,,
Corvel,CPT,73222,Mri joint upr extrem w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,73223,Mri joint upr extr w/o&w/dye,OP Fee Schedule,Per Unit,"$1,768.47 ",OP,356.73,"1,768.47",,,,,,,,,,,,,
Corvel,CPT,73225,Mr angio upr extr w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,73501,X-ray exam hip uni 1 view,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,73502,X-ray exam hip uni 2-3 views,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,73503,X-ray exam hip uni 4/> views,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,73521,X-ray exam hips bi 2 views,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,73522,X-ray exam hips bi 3-4 views,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,73523,X-ray exam hips bi 5/> views,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,73525,Contrast x-ray of hip,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73551,X-ray exam of femur 1,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,73552,X-ray exam of femur 2/>,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,73560,X-ray exam of knee 1 or 2,OP Fee Schedule,Per Unit,$131.57 ,OP,78.4,131.57,,,,,,,,,,,,,
Corvel,CPT,73562,X-ray exam of knee 3,OP Fee Schedule,Per Unit,$140.75 ,OP,78.4,140.75,,,,,,,,,,,,,
Corvel,CPT,73564,X-ray exam knee 4 or more,OP Fee Schedule,Per Unit,$195.38 ,OP,105.6,195.38,,,,,,,,,,,,,
Corvel,CPT,73565,X-ray exam of knees,OP Fee Schedule,Per Unit,$116.72 ,OP,78.4,116.72,,,,,,,,,,,,,
Corvel,CPT,73580,Contrast x-ray of knee joint,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73590,X-ray exam of lower leg,OP Fee Schedule,Per Unit,$142.09 ,OP,78.4,142.09,,,,,,,,,,,,,
Corvel,CPT,73592,X-ray exam of leg infant,OP Fee Schedule,Per Unit,$280.40 ,OP,78.4,280.4,,,,,,,,,,,,,
Corvel,CPT,73600,X-ray exam of ankle,OP Fee Schedule,Per Unit,$253.62 ,OP,78.4,253.62,,,,,,,,,,,,,
Corvel,CPT,73610,X-ray exam of ankle,OP Fee Schedule,Per Unit,$159.66 ,OP,78.4,159.66,,,,,,,,,,,,,
Corvel,CPT,73615,Contrast x-ray of ankle,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73620,X-ray exam of foot,OP Fee Schedule,Per Unit,$200.73 ,OP,78.4,200.73,,,,,,,,,,,,,
Corvel,CPT,73630,X-ray exam of foot,OP Fee Schedule,Per Unit,$140.11 ,OP,78.4,140.11,,,,,,,,,,,,,
Corvel,CPT,73650,X-ray exam of heel,OP Fee Schedule,Per Unit,$144.20 ,OP,78.4,144.2,,,,,,,,,,,,,
Corvel,CPT,73660,X-ray exam of toe(s),OP Fee Schedule,Per Unit,$118.08 ,OP,78.4,118.08,,,,,,,,,,,,,
Corvel,CPT,73700,Ct lower extremity w/o dye,OP Fee Schedule,Per Unit,"$1,787.80 ",OP,105.6,"1,787.80",,,,,,,,,,,,,
Corvel,CPT,73701,Ct lower extremity w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,73702,Ct lwr extremity w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,73706,Ct angio lwr extr w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,73718,Mri lower extremity w/o dye,OP Fee Schedule,Per Unit,"$1,563.26 ",OP,223.01,"1,563.26",,,,,,,,,,,,,
Corvel,CPT,73719,Mri lower extremity w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73720,Mri lwr extremity w/o&w/dye,OP Fee Schedule,Per Unit,"$1,492.72 ",OP,356.73,"1,492.72",,,,,,,,,,,,,
Corvel,CPT,73721,Mri jnt of lwr extre w/o dye,OP Fee Schedule,Per Unit,"$1,518.71 ",OP,223.01,"1,518.71",,,,,,,,,,,,,
Corvel,CPT,73722,Mri joint of lwr extr w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,73723,Mri joint lwr extr w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,73725,Mr ang lwr ext w or w/o dye,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74018,X-ray exam abdomen 1 view,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,74019,X-ray exam abdomen 2 views,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,74021,X-ray exam abdomen 3+ views,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,74022,X-ray exam complete abdomen,OP Fee Schedule,Per Unit,$252.00 ,OP,105.6,252,,,,,,,,,,,,,
Corvel,CPT,74150,Ct abdomen w/o dye,OP Fee Schedule,Per Unit,$924.98 ,OP,105.6,924.98,,,,,,,,,,,,,
Corvel,CPT,74160,Ct abdomen w/dye,OP Fee Schedule,Per Unit,"$1,231.32 ",OP,173.03,"1,231.32",,,,,,,,,,,,,
Corvel,CPT,74170,Ct abdomen w/o & w/dye,OP Fee Schedule,Per Unit,"$1,221.42 ",OP,173.03,"1,221.42",,,,,,,,,,,,,
Corvel,CPT,74174,Ct angio abd&pelv w/o&w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,74175,Ct angio abdom w/o & w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74176,Ct abd & pelvis w/o contrast,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,74177,Ct abd & pelv w/contrast,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,74178,Ct abd & pelv 1/> regns,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,74181,Mri abdomen w/o dye,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,74182,Mri abdomen w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,74183,Mri abdomen w/o & w/dye,OP Fee Schedule,Per Unit,"$2,284.59 ",OP,356.73,"2,284.59",,,,,,,,,,,,,
Corvel,CPT,74185,Mri angio abdom w orw/o dye,OP Fee Schedule,Per Unit,"$1,490.93 ",OP,"1,490.93","1,490.93",,,,,,,,,,,,,
Corvel,CPT,74190,X-ray exam of peritoneum,OP Fee Schedule,Straight Discount,53.20%,OP,467.96,467.96,,,,,,,,,,,,,
Corvel,CPT,74210,X-ray xm phrnx&/crv esoph c+,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74220,X-ray xm esophagus 1cntrst,OP Fee Schedule,Per Unit,$295.50 ,OP,173.03,295.5,,,,,,,,,,,,,
Corvel,CPT,74221,X-ray xm esophagus 2cntrst,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74230,X-ray xm swlng funcj c+,OP Fee Schedule,Per Unit,$568.65 ,OP,173.03,568.65,,,,,,,,,,,,,
Corvel,CPT,74235,Remove esophagus obstruction,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74240,X-ray xm upr gi trc 1cntrst,OP Fee Schedule,Per Unit,$431.98 ,OP,173.03,431.98,,,,,,,,,,,,,
Corvel,CPT,74246,X-ray xm upr gi trc 2cntrst,OP Fee Schedule,Per Unit,$474.77 ,OP,173.03,474.77,,,,,,,,,,,,,
Corvel,CPT,74248,X-ray sm int f-thru std,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74250,X-ray xm sm int 1cntrst std,OP Fee Schedule,Per Unit,$316.42 ,OP,173.03,316.42,,,,,,,,,,,,,
Corvel,CPT,74251,X-ray xm sm int 2cntrst std,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74261,Ct colonography dx,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,74262,Ct colonography dx w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74263,Ct colonography screening,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74270,X-ray xm colon 1cntrst std,OP Fee Schedule,Per Unit,$675.83 ,OP,173.03,675.83,,,,,,,,,,,,,
Corvel,CPT,74280,X-ray xm colon 2cntrst std,OP Fee Schedule,Per Unit,$500.45 ,OP,173.03,500.45,,,,,,,,,,,,,
Corvel,CPT,74283,Ther nma rdctj intus/obstrcj,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74290,Contrast x-ray gallbladder,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74300,X-ray bile ducts/pancreas,OP Fee Schedule,Per Unit,$416.47 ,OP,416.47,416.47,,,,,,,,,,,,,
Corvel,CPT,74301,X-rays at surgery add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74328,X-ray bile duct endoscopy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74329,X-ray for pancreas endoscopy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74330,X-ray bile/panc endoscopy,OP Fee Schedule,Per Unit,"$1,053.48 ",OP,"1,053.48","1,053.48",,,,,,,,,,,,,
Corvel,CPT,74340,X-ray guide for gi tube,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74355,X-ray guide intestinal tube,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74360,X-ray guide gi dilation,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74363,X-ray bile duct dilation,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74400,Urography iv +-kub tomog,OP Fee Schedule,Per Unit,$411.86 ,OP,173.03,411.86,,,,,,,,,,,,,
Corvel,CPT,74410,Urography nfs drip&/bolus,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,74415,Urography nfs drip&/bls w/nf,OP Fee Schedule,Per Unit,$639.90 ,OP,173.03,639.9,,,,,,,,,,,,,
Corvel,CPT,74420,Urography rtrgr +-kub,OP Fee Schedule,Per Unit,$397.58 ,OP,356.73,397.58,,,,,,,,,,,,,
Corvel,CPT,74425,Urography antegrade rs&i,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,74430,Contrast x-ray bladder,OP Fee Schedule,Per Unit,$334.58 ,OP,334.58,356.73,,,,,,,,,,,,,
Corvel,CPT,74440,X-ray male genital tract,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,74445,X-ray exam of penis,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,74450,X-ray urethra/bladder,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,74455,X-ray urethra/bladder,OP Fee Schedule,Per Unit,$299.84 ,OP,223.01,299.84,,,,,,,,,,,,,
Corvel,CPT,74470,X-ray exam of kidney lesion,OP Fee Schedule,Straight Discount,53.20%,OP,467.96,467.96,,,,,,,,,,,,,
Corvel,CPT,74485,Dilation urtr/urt rs&i,OP Fee Schedule,Straight Discount,53.20%,OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Corvel,CPT,74710,X-ray measurement of pelvis,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,74712,Mri fetal sngl/1st gestation,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,74713,Mri fetal ea addl gestation,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74740,X-ray female genital tract,OP Fee Schedule,Per Unit,"$1,538.97 ",OP,223.01,"1,538.97",,,,,,,,,,,,,
Corvel,CPT,74742,X-ray fallopian tube,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,74775,X-ray exam of perineum,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,75557,Cardiac mri for morph,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,75559,Cardiac mri w/stress img,OP Fee Schedule,Straight Discount,53.20%,OP,467.96,467.96,,,,,,,,,,,,,
Corvel,CPT,75561,Cardiac mri for morph w/dye,OP Fee Schedule,Straight Discount,53.20%,OP,356.73,356.73,,,,,,,,,,,,,
Corvel,CPT,75563,Card mri w/stress img & dye,OP Fee Schedule,Straight Discount,53.20%,OP,693.07,693.07,,,,,,,,,,,,,
Corvel,CPT,75565,Card mri veloc flow mapping,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,75571,Ct hrt w/o dye w/ca test,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,75572,Ct hrt w/3d image,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,75573,Ct hrt w/3d image congen,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,75574,Ct angio hrt w/3d image,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,75600,Contrast exam thoracic aorta,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75605,Contrast exam thoracic aorta,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,75625,Contrast exam abdominl aorta,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75630,X-ray aorta leg arteries,OP Fee Schedule,Per Unit,"$2,687.18 ",OP,"2,687.18","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75635,Ct angio abdominal arteries,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,75705,Artery x-rays spine,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,75710,Artery x-rays arm/leg,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75716,Artery x-rays arms/legs,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75726,Artery x-rays abdomen,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,75731,Artery x-rays adrenal gland,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75733,Artery x-rays adrenals,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75736,Artery x-rays pelvis,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,75741,Artery x-rays lung,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75743,Artery x-rays lungs,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75746,Artery x-rays lung,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75756,Artery x-rays chest,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75774,Artery x-ray each vessel,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,75801,Lymph vessel x-ray arm/leg,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,75803,Lymph vessel x-ray arms/legs,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,75805,Lymph vessel x-ray trunk,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75807,Lymph vessel x-ray trunk,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75809,Nonvascular shunt x-ray,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,75810,Vein x-ray spleen/liver,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75820,Vein x-ray arm/leg,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,75822,Vein x-ray arms/legs,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,75825,Vein x-ray trunk,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75827,Vein x-ray chest,OP Fee Schedule,Straight Discount,53.20%,OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Corvel,CPT,75831,Vein x-ray kidney,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75833,Vein x-ray kidneys,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75840,Vein x-ray adrenal gland,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75842,Vein x-ray adrenal glands,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,75860,Vein x-ray neck,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75870,Vein x-ray skull,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75872,Vein x-ray skull epidural,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,75880,Vein x-ray eye socket,OP Fee Schedule,Straight Discount,53.20%,OP,524.87,524.87,,,,,,,,,,,,,
Corvel,CPT,75885,Vein x-ray liver w/hemodynam,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75887,Vein x-ray liver w/o hemodyn,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75889,Vein x-ray liver w/hemodynam,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75891,Vein x-ray liver,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75893,Venous sampling by catheter,OP Fee Schedule,Straight Discount,53.20%,OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Corvel,CPT,75894,X-rays transcath therapy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,75898,Follow-up angiography,OP Fee Schedule,Straight Discount,53.20%,OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Corvel,CPT,75901,Remove cva device obstruct,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,75902,Remove cva lumen obstruct,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,75956,Xray endovasc thor ao repr,OP Fee Schedule,Straight Discount,53.20%,OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Corvel,CPT,75957,Xray endovasc thor ao repr,OP Fee Schedule,Straight Discount,53.20%,OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Corvel,CPT,75958,Xray place prox ext thor ao,OP Fee Schedule,Straight Discount,53.20%,OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Corvel,CPT,75959,Xray place dist ext thor ao,OP Fee Schedule,Straight Discount,53.20%,OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Corvel,CPT,75970,Vascular biopsy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,75984,Xray control catheter change,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,75989,Abscess drainage under x-ray,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76000,Fluoroscopy <1 hr phys/qhp,OP Fee Schedule,Per Unit,$232.44 ,OP,223.01,232.44,,,,,,,,,,,,,
Corvel,CPT,76010,X-ray nose to rectum,OP Fee Schedule,Per Unit,$126.81 ,OP,78.4,126.81,,,,,,,,,,,,,
Corvel,CPT,76080,X-ray exam of fistula,OP Fee Schedule,Straight Discount,53.20%,OP,467.96,467.96,,,,,,,,,,,,,
Corvel,CPT,76098,X-ray exam surgical specimen,OP Fee Schedule,Per Unit,$59.28 ,OP,59.28,467.96,,,,,,,,,,,,,
Corvel,CPT,76100,X-ray exam of body section,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76101,Complex body section x-ray,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76102,Complex body section x-rays,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76120,Cine/video x-rays,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76125,Cine/video x-rays add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76140,X-ray consultation,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76145,Med physic dos eval rad exps,OP Fee Schedule,Straight Discount,53.20%,OP,122.95,122.95,,,,,,,,,,,,,
Corvel,CPT,76376,3d render w/intrp postproces,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76377,3d render w/intrp postproces,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76380,Cat scan follow-up study,OP Fee Schedule,Per Unit,$643.34 ,OP,78.4,643.34,,,,,,,,,,,,,
Corvel,CPT,76390,Mr spectroscopy,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76391,Mr elastography,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,76496,Fluoroscopic procedure,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76497,Ct procedure,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76498,Mri procedure,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76499,Radiographic procedure,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76506,Echo exam of head,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76510,Oph us dx b-scan&quan a-scan,OP Fee Schedule,Straight Discount,53.20%,OP,108.49,108.49,,,,,,,,,,,,,
Corvel,CPT,76511,Oph us dx quan a-scan only,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76512,Oph us dx b-scan,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76513,Oph us dx ant sgm us uni/bi,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76514,Echo exam of eye thickness,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,76516,Echo exam of eye,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76519,Echo exam of eye,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76529,Echo exam of eye,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76536,Us exam of head and neck,OP Fee Schedule,Per Unit,$294.14 ,OP,105.6,294.14,,,,,,,,,,,,,
Corvel,CPT,76604,Us exam chest,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76641,Ultrasound breast complete,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76642,Ultrasound breast limited,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76700,Us exam abdom complete,OP Fee Schedule,Per Unit,$397.09 ,OP,105.6,397.09,,,,,,,,,,,,,
Corvel,CPT,76705,Echo exam of abdomen,OP Fee Schedule,Per Unit,$534.04 ,OP,105.6,534.04,,,,,,,,,,,,,
Corvel,CPT,76706,Us abdl aorta screen aaa,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76770,Us exam abdo back wall comp,OP Fee Schedule,Per Unit,$287.97 ,OP,105.6,287.97,,,,,,,,,,,,,
Corvel,CPT,76775,Us exam abdo back wall lim,OP Fee Schedule,Per Unit,$558.82 ,OP,105.6,558.82,,,,,,,,,,,,,
Corvel,CPT,76776,Us exam k transpl w/doppler,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76800,Us exam spinal canal,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76801,Ob us < 14 wks single fetus,OP Fee Schedule,Per Unit,$400.29 ,OP,105.6,400.29,,,,,,,,,,,,,
Corvel,CPT,76802,Ob us < 14 wks addl fetus,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76805,Ob us >= 14 wks sngl fetus,OP Fee Schedule,Per Unit,$302.54 ,OP,105.6,302.54,,,,,,,,,,,,,
Corvel,CPT,76810,Ob us >= 14 wks addl fetus,OP Fee Schedule,Per Unit,$811.89 ,OP,811.89,811.89,,,,,,,,,,,,,
Corvel,CPT,76811,Ob us detailed sngl fetus,OP Fee Schedule,Per Unit,$533.00 ,OP,223.01,533,,,,,,,,,,,,,
Corvel,CPT,76812,Ob us detailed addl fetus,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76813,Ob us nuchal meas 1 gest,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76814,Ob us nuchal meas add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76815,Ob us limited fetus(s),OP Fee Schedule,Per Unit,$262.58 ,OP,105.6,262.58,,,,,,,,,,,,,
Corvel,CPT,76816,Ob us follow-up per fetus,OP Fee Schedule,Per Unit,$374.21 ,OP,105.6,374.21,,,,,,,,,,,,,
Corvel,CPT,76817,Transvaginal us obstetric,OP Fee Schedule,Per Unit,$305.60 ,OP,105.6,305.6,,,,,,,,,,,,,
Corvel,CPT,76818,Fetal biophys profile w/nst,OP Fee Schedule,Per Unit,$343.48 ,OP,105.6,343.48,,,,,,,,,,,,,
Corvel,CPT,76819,Fetal biophys profil w/o nst,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76820,Umbilical artery echo,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76821,Middle cerebral artery echo,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76825,Echo exam of fetal heart,OP Fee Schedule,Straight Discount,53.20%,OP,467.96,467.96,,,,,,,,,,,,,
Corvel,CPT,76826,Echo exam of fetal heart,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,76827,Echo exam of fetal heart,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76828,Echo exam of fetal heart,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76830,Transvaginal us non-ob,OP Fee Schedule,Per Unit,$247.50 ,OP,105.6,247.5,,,,,,,,,,,,,
Corvel,CPT,76831,Echo exam uterus,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,76856,Us exam pelvic complete,OP Fee Schedule,Per Unit,$321.85 ,OP,105.6,321.85,,,,,,,,,,,,,
Corvel,CPT,76857,Us exam pelvic limited,OP Fee Schedule,Per Unit,$265.09 ,OP,105.6,265.09,,,,,,,,,,,,,
Corvel,CPT,76870,Us exam scrotum,OP Fee Schedule,Per Unit,$263.65 ,OP,105.6,263.65,,,,,,,,,,,,,
Corvel,CPT,76872,Us transrectal,OP Fee Schedule,Per Unit,$891.67 ,OP,105.6,891.67,,,,,,,,,,,,,
Corvel,CPT,76873,Echograp trans r pros study,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76881,Us compl joint r-t w/img,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76882,Us lmtd jt/nonvasc xtr strux,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76885,Us exam infant hips dynamic,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76886,Us exam infant hips static,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,76932,Echo guide for heart biopsy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76936,Echo guide for artery repair,OP Fee Schedule,Straight Discount,53.20%,OP,256.27,256.27,,,,,,,,,,,,,
Corvel,CPT,76937,Us guide vascular access,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76940,Us guide tissue ablation,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76941,Echo guide for transfusion,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76942,Echo guide for biopsy,OP Fee Schedule,Per Unit,$755.17 ,OP,755.17,755.17,,,,,,,,,,,,,
Corvel,CPT,76945,Echo guide villus sampling,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76946,Echo guide for amniocentesis,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76948,Echo guide ova aspiration,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76965,Echo guidance radiotherapy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76975,Gi endoscopic ultrasound,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,76977,Us bone density measure,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76978,Us trgt dyn mbubb 1st les,OP Fee Schedule,Straight Discount,53.20%,OP,173.03,173.03,,,,,,,,,,,,,
Corvel,CPT,76979,Us trgt dyn mbubb ea addl,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76981,Use parenchyma,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76982,Use 1st target lesion,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,76983,Use ea addl target lesion,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76998,Us guide intraop,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,76999,Echo examination procedure,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,77001,Fluoroguide for vein device,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77002,Needle localization by xray,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77003,Fluoroguide for spine inject,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77011,Ct scan for localization,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77012,Ct scan for needle biopsy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77013,Ct guide for tissue ablation,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77014,Ct scan for therapy guide,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77021,Mri guidance ndl plmt rs&i,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77022,Mri gdn parnchyma tiss abltj,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77046,Mri breast c- unilateral,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,77047,Mri breast c- bilateral,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,77048,Mri breast c-+ w/cad uni,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77049,Mri breast c-+ w/cad bi,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77053,X-ray of mammary duct,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,77054,X-ray of mammary ducts,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,77061,Breast tomosynthesis uni,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77062,Breast tomosynthesis bi,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77063,Breast tomosynthesis bi,OP Fee Schedule,Straight Discount,53.20%,OP,23.23,23.23,,,,,,,,,,,,,
Corvel,CPT,77065,Dx mammo incl cad uni,OP Fee Schedule,Straight Discount,53.20%,OP,83.47,83.47,,,,,,,,,,,,,
Corvel,CPT,77066,Dx mammo incl cad bi,OP Fee Schedule,Straight Discount,53.20%,OP,106.7,106.7,,,,,,,,,,,,,
Corvel,CPT,77067,Scr mammo bi incl cad,OP Fee Schedule,Straight Discount,53.20%,OP,88.24,88.24,,,,,,,,,,,,,
Corvel,CPT,77071,X-ray stress view,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,77072,X-rays for bone age,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77073,X-rays bone length studies,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77074,X-rays bone survey limited,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77075,X-rays bone survey complete,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77076,X-rays bone survey infant,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77077,Joint survey single view,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77078,Ct bone density axial,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,77080,Dxa bone density axial,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77081,Dxa bone density/peripheral,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,77084,Magnetic image bone marrow,OP Fee Schedule,Straight Discount,53.20%,OP,223.01,223.01,,,,,,,,,,,,,
Corvel,CPT,77085,Dxa bone density study,OP Fee Schedule,Straight Discount,53.20%,OP,105.6,105.6,,,,,,,,,,,,,
Corvel,CPT,77086,Fracture assessment via dxa,OP Fee Schedule,Straight Discount,53.20%,OP,78.4,78.4,,,,,,,,,,,,,
Corvel,CPT,77261,Radiation therapy planning,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77262,Radiation therapy planning,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77263,Radiation therapy planning,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77280,Set radiation therapy field,OP Fee Schedule,Per Unit,"$1,135.25 ",OP,122.95,"1,135.25",,,,,,,,,,,,,
Corvel,CPT,77285,Set radiation therapy field,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77290,Set radiation therapy field,OP Fee Schedule,Per Unit,"$2,127.37 ",OP,328.21,"2,127.37",,,,,,,,,,,,,
Corvel,CPT,77293,Respirator motion mgmt simul,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77295,3-d radiotherapy plan,OP Fee Schedule,Per Unit,"$2,465.87 ",OP,"1,223.16","2,465.87",,,,,,,,,,,,,
Corvel,CPT,77299,Radiation therapy planning,OP Fee Schedule,Straight Discount,53.20%,OP,122.95,122.95,,,,,,,,,,,,,
Corvel,CPT,77300,Radiation therapy dose plan,OP Fee Schedule,Per Unit,$186.12 ,OP,122.95,186.12,,,,,,,,,,,,,
Corvel,CPT,77301,Radiotherapy dose plan imrt,OP Fee Schedule,Straight Discount,53.20%,OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Corvel,CPT,77306,Telethx isodose plan simple,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77307,Telethx isodose plan cplx,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77316,Brachytx isodose plan simple,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77317,Brachytx isodose intermed,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77318,Brachytx isodose complex,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77321,Special teletx port plan,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77331,Special radiation dosimetry,OP Fee Schedule,Per Unit,$102.17 ,OP,102.17,122.95,,,,,,,,,,,,,
Corvel,CPT,77332,Radiation treatment aid(s),OP Fee Schedule,Straight Discount,53.20%,OP,122.95,122.95,,,,,,,,,,,,,
Corvel,CPT,77333,Radiation treatment aid(s),OP Fee Schedule,Per Unit,$659.06 ,OP,122.95,659.06,,,,,,,,,,,,,
Corvel,CPT,77334,Radiation treatment aid(s),OP Fee Schedule,Per Unit,$464.16 ,OP,328.21,464.16,,,,,,,,,,,,,
Corvel,CPT,77336,Radiation physics consult,OP Fee Schedule,Per Unit,$218.53 ,OP,122.95,218.53,,,,,,,,,,,,,
Corvel,CPT,77338,Design mlc device for imrt,OP Fee Schedule,Straight Discount,53.20%,OP,328.21,328.21,,,,,,,,,,,,,
Corvel,CPT,77370,Radiation physics consult,OP Fee Schedule,Straight Discount,53.20%,OP,122.95,122.95,,,,,,,,,,,,,
Corvel,CPT,77371,Srs multisource,OP Fee Schedule,Straight Discount,53.20%,OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Corvel,CPT,77372,Srs linear based,OP Fee Schedule,Straight Discount,53.20%,OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Corvel,CPT,77373,Sbrt delivery,OP Fee Schedule,Straight Discount,53.20%,OP,"1,680.14","1,680.14",,,,,,,,,,,,,
Corvel,CPT,77385,Ntsty modul rad tx dlvr smpl,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77386,Ntsty modul rad tx dlvr cplx,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77387,Guidance for radj tx dlvr,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77399,External radiation dosimetry,OP Fee Schedule,Straight Discount,53.20%,OP,122.95,122.95,,,,,,,,,,,,,
Corvel,CPT,77401,Radiation treatment delivery,OP Fee Schedule,Straight Discount,53.20%,OP,116.82,116.82,,,,,,,,,,,,,
Corvel,CPT,77402,Radiation treatment delivery,OP Fee Schedule,Straight Discount,53.20%,OP,116.82,116.82,,,,,,,,,,,,,
Corvel,CPT,77407,Radiation treatment delivery,OP Fee Schedule,Straight Discount,53.20%,OP,234.21,234.21,,,,,,,,,,,,,
Corvel,CPT,77412,Radiation treatment delivery,OP Fee Schedule,Per Unit,$490.74 ,OP,234.21,490.74,,,,,,,,,,,,,
Corvel,CPT,77417,Radiology port images(s),OP Fee Schedule,Per Unit,$84.44 ,OP,84.44,84.44,,,,,,,,,,,,,
Corvel,CPT,77423,Neutron beam tx complex,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77424,Io rad tx delivery by x-ray,OP Fee Schedule,Straight Discount,53.20%,OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Corvel,CPT,77425,Io rad tx deliver by elctrns,OP Fee Schedule,Straight Discount,53.20%,OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Corvel,CPT,77427,Radiation tx management x5,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77431,Radiation therapy management,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77432,Stereotactic radiation trmt,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77435,Sbrt management,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77469,Io radiation tx management,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77470,Special radiation treatment,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77499,Radiation therapy management,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77520,Proton trmt simple w/o comp,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77522,Proton trmt simple w/comp,OP Fee Schedule,Straight Discount,53.20%,OP,"1,257.79","1,257.79",,,,,,,,,,,,,
Corvel,CPT,77523,Proton trmt intermediate,OP Fee Schedule,Straight Discount,53.20%,OP,"1,257.79","1,257.79",,,,,,,,,,,,,
Corvel,CPT,77525,Proton treatment complex,OP Fee Schedule,Straight Discount,53.20%,OP,"1,257.79","1,257.79",,,,,,,,,,,,,
Corvel,CPT,77600,Hyperthermia treatment,OP Fee Schedule,Straight Discount,53.20%,OP,234.21,234.21,,,,,,,,,,,,,
Corvel,CPT,77605,Hyperthermia treatment,OP Fee Schedule,Straight Discount,53.20%,OP,686.56,686.56,,,,,,,,,,,,,
Corvel,CPT,77610,Hyperthermia treatment,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77615,Hyperthermia treatment,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77620,Hyperthermia treatment,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77750,Infuse radioactive materials,OP Fee Schedule,Straight Discount,53.20%,OP,234.21,234.21,,,,,,,,,,,,,
Corvel,CPT,77761,Apply intrcav radiat simple,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77762,Apply intrcav radiat interm,OP Fee Schedule,Straight Discount,53.20%,OP,525.78,525.78,,,,,,,,,,,,,
Corvel,CPT,77763,Apply intrcav radiat compl,OP Fee Schedule,Straight Discount,53.20%,OP,686.56,686.56,,,,,,,,,,,,,
Corvel,CPT,77767,Hdr rdncl skn surf brachytx,OP Fee Schedule,Straight Discount,53.20%,OP,234.21,234.21,,,,,,,,,,,,,
Corvel,CPT,77768,Hdr rdncl skn surf brachytx,OP Fee Schedule,Straight Discount,53.20%,OP,234.21,234.21,,,,,,,,,,,,,
Corvel,CPT,77770,Hdr rdncl ntrstl/icav brchtx,OP Fee Schedule,Straight Discount,53.20%,OP,686.56,686.56,,,,,,,,,,,,,
Corvel,CPT,77771,Hdr rdncl ntrstl/icav brchtx,OP Fee Schedule,Straight Discount,53.20%,OP,686.56,686.56,,,,,,,,,,,,,
Corvel,CPT,77772,Hdr rdncl ntrstl/icav brchtx,OP Fee Schedule,Straight Discount,53.20%,OP,686.56,686.56,,,,,,,,,,,,,
Corvel,CPT,77778,Apply interstit radiat compl,OP Fee Schedule,Straight Discount,53.20%,OP,686.56,686.56,,,,,,,,,,,,,
Corvel,CPT,77789,Apply surf ldr radionuclide,OP Fee Schedule,Straight Discount,53.20%,OP,116.82,116.82,,,,,,,,,,,,,
Corvel,CPT,77790,Radiation handling,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,77799,Radium/radioisotope therapy,OP Fee Schedule,Straight Discount,53.20%,OP,116.82,116.82,,,,,,,,,,,,,
Corvel,CPT,78012,Thyroid uptake measurement,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78013,Thyroid imaging w/blood flow,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78014,Thyroid imaging w/blood flow,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78015,Thyroid met imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78016,Thyroid met imaging/studies,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78018,Thyroid met imaging body,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78020,Thyroid met uptake,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78070,Parathyroid planar imaging,OP Fee Schedule,Per Unit,$609.95 ,OP,365.46,609.95,,,,,,,,,,,,,
Corvel,CPT,78071,Parathyrd planar w/wo subtrj,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78072,Parathyrd planar w/spect&ct,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78075,Adrenal cortex & medulla img,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78099,Endocrine nuclear procedure,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78102,Bone marrow imaging ltd,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78103,Bone marrow imaging mult,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78104,Bone marrow imaging body,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78110,Plasma volume single,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78111,Plasma volume multiple,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78120,Red cell mass single,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78121,Red cell mass multiple,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78122,Blood volume,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78130,Red cell survival study,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78140,Red cell sequestration,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78185,Spleen imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78191,Platelet survival,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78195,Lymph system imaging,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78199,Blood/lymph nuclear exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78201,Liver imaging,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78202,Liver imaging with flow,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78215,Liver and spleen imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78216,Liver & spleen image/flow,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78226,Hepatobiliary system imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78227,Hepatobil syst image w/drug,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78230,Salivary gland imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78231,Serial salivary imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78232,Salivary gland function exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78258,Esophageal motility study,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78261,Gastric mucosa imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78262,Gastroesophageal reflux exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78264,Gastric emptying imag study,OP Fee Schedule,Per Unit,"$1,902.35 ",OP,365.46,"1,902.35",,,,,,,,,,,,,
Corvel,CPT,78265,Gastric emptying imag study,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78266,Gastric emptying imag study,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78267,Breath tst attain/anal c-14,OP Fee Schedule,Straight Discount,53.20%,OP,11.06,11.06,,,,,,,,,,,,,
Corvel,CPT,78268,Breath test analysis c-14,OP Fee Schedule,Straight Discount,53.20%,OP,94.41,94.41,,,,,,,,,,,,,
Corvel,CPT,78278,Acute gi blood loss imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78282,Gi protein loss exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78290,Meckels divert exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78291,Leveen/shunt patency exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78299,Gi nuclear procedure,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78300,Bone imaging limited area,OP Fee Schedule,Per Unit,"$1,101.26 ",OP,365.46,"1,101.26",,,,,,,,,,,,,
Corvel,CPT,78305,Bone imaging multiple areas,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78306,Bone imaging whole body,OP Fee Schedule,Per Unit,$737.91 ,OP,365.46,737.91,,,,,,,,,,,,,
Corvel,CPT,78315,Bone imaging 3 phase,OP Fee Schedule,Per Unit,$717.59 ,OP,365.46,717.59,,,,,,,,,,,,,
Corvel,CPT,78350,Bone mineral single photon,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78351,Bone mineral dual photon,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78399,Musculoskeletal nuclear exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78414,Non-imaging heart function,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78428,Cardiac shunt imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78429,Myocrd img pet 1 std w/ct,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78430,Myocrd img pet rst/strs w/ct,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78431,Myocrd img pet rst&strs ct,OP Fee Schedule,Straight Discount,53.20%,OP,"2,180.92","2,180.92",,,,,,,,,,,,,
Corvel,CPT,78432,Myocrd img pet 2rtracer,OP Fee Schedule,Straight Discount,53.20%,OP,"2,665.46","2,665.46",,,,,,,,,,,,,
Corvel,CPT,78433,Myocrd img pet 2rtracer ct,OP Fee Schedule,Straight Discount,53.20%,OP,"2,665.46","2,665.46",,,,,,,,,,,,,
Corvel,CPT,78434,Aqmbf pet rest & rx stress,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78445,Vascular flow imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78451,Ht muscle image spect sing,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78452,Ht muscle image spect mult,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78453,Ht muscle image planar sing,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78454,Ht musc image planar mult,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78456,Acute venous thrombus image,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78457,Venous thrombosis imaging,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78458,Ven thrombosis images bilat,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78459,Myocrd img pet single study,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78466,Heart infarct image,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78468,Heart infarct image (ef),OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78469,Heart infarct image (3d),OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78472,Gated heart planar single,OP Fee Schedule,Per Unit,"$1,150.55 ",OP,365.46,"1,150.55",,,,,,,,,,,,,
Corvel,CPT,78473,Gated heart multiple,OP Fee Schedule,Per Unit,"$1,535.54 ",OP,365.46,"1,535.54",,,,,,,,,,,,,
Corvel,CPT,78481,Heart first pass single,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78483,Heart first pass multiple,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78491,Myocrd img pet 1std rst/strs,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78492,Myocrd img pet mlt rst&strs,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78494,Heart image spect,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78496,Heart first pass add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78499,Cardiovascular nuclear exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78579,Lung ventilation imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78580,Lung perfusion imaging,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78582,Lung ventilat&perfus imaging,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78597,Lung perfusion differential,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78598,Lung perf&ventilat diferentl,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78599,Respiratory nuclear exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78600,Brain image < 4 views,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78601,Brain image w/flow < 4 views,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78605,Brain image 4+ views,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78606,Brain image w/flow 4 + views,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78608,Brain imaging (pet),OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78609,Brain imaging (pet),OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78610,Brain flow imaging only,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78630,Cerebrospinal fluid scan,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78635,Csf ventriculography,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78645,Csf shunt evaluation,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78650,Csf leakage imaging,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78660,Nuclear exam of tear flow,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78699,Nervous system nuclear exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78700,Kidney imaging morphol,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78701,Kidney imaging with flow,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78707,K flow/funct image w/o drug,OP Fee Schedule,Per Unit,"$1,550.43 ",OP,474.27,"1,550.43",,,,,,,,,,,,,
Corvel,CPT,78708,K flow/funct image w/drug,OP Fee Schedule,Per Unit,"$2,347.35 ",OP,474.27,"2,347.35",,,,,,,,,,,,,
Corvel,CPT,78709,K flow/funct image multiple,OP Fee Schedule,Straight Discount,53.20%,OP,474.27,474.27,,,,,,,,,,,,,
Corvel,CPT,78725,Kidney function study,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78730,Urinary bladder retention,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78740,Ureteral reflux study,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78761,Testicular imaging w/flow,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78799,Genitourinary nuclear exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78800,Rp loclzj tum 1 area 1 d img,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78801,Rp loclzj tum 2+area 1+d img,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78802,Rp loclzj tum whbdy 1 d img,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78803,Rp loclzj tum spect 1 area,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78804,Rp loclzj tum whbdy 2+d img,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78808,Iv inj ra drug dx study,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,78811,Pet image ltd area,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78812,Pet image skull-thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78813,Pet image full body,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78814,Pet image w/ct lmtd,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78815,Pet image w/ct skull-thigh,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78816,Pet image w/ct full body,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78830,Rp loclzj tum spect w/ct 1,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78831,Rp loclzj tum spect 2 areas,OP Fee Schedule,Straight Discount,53.20%,OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Corvel,CPT,78832,Rp loclzj tum spect w/ct 2,OP Fee Schedule,Straight Discount,53.20%,OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Corvel,CPT,78835,Rp quan meas single area,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,78999,Nuclear diagnostic exam,OP Fee Schedule,Straight Discount,53.20%,OP,365.46,365.46,,,,,,,,,,,,,
Corvel,CPT,79005,Nuclear rx oral admin,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,79101,Nuclear rx iv admin,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,79200,Nuclear rx intracav admin,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,79300,Nuclr rx interstit colloid,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,79403,Hematopoietic nuclear tx,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,79440,Nuclear rx intra-articular,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,79445,Nuclear rx intra-arterial,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,79999,Nuclear medicine therapy,OP Fee Schedule,Straight Discount,53.20%,OP,241.91,241.91,,,,,,,,,,,,,
Corvel,CPT,80047,Metabolic panel ionized ca,OP Fee Schedule,Straight Discount,53.20%,OP,13.73,13.73,,,,,,,,,,,,,
Corvel,CPT,80048,Metabolic panel total ca,OP Fee Schedule,Per Unit,$75.98 ,OP,8.46,75.98,,,,,,,,,,,,,
Corvel,CPT,80050,General health panel,OP Fee Schedule,Per Unit,$82.41 ,OP,82.41,82.41,,,,,,,,,,,,,
Corvel,CPT,80051,Electrolyte panel,OP Fee Schedule,Per Unit,$122.72 ,OP,7.01,122.72,,,,,,,,,,,,,
Corvel,CPT,80053,Comprehen metabolic panel,OP Fee Schedule,Per Unit,$110.59 ,OP,10.56,110.59,,,,,,,,,,,,,
Corvel,CPT,80055,Obstetric panel,OP Fee Schedule,Per Unit,$198.12 ,OP,47.81,198.12,,,,,,,,,,,,,
Corvel,CPT,80061,Lipid panel,OP Fee Schedule,Per Unit,$115.89 ,OP,13.39,115.89,,,,,,,,,,,,,
Corvel,CPT,80069,Renal function panel,OP Fee Schedule,Per Unit,$126.53 ,OP,8.68,126.53,,,,,,,,,,,,,
Corvel,CPT,80074,Acute hepatitis panel,OP Fee Schedule,Per Unit,$293.02 ,OP,47.63,293.02,,,,,,,,,,,,,
Corvel,CPT,80076,Hepatic function panel,OP Fee Schedule,Per Unit,$126.45 ,OP,8.17,126.45,,,,,,,,,,,,,
Corvel,CPT,80081,Obstetric panel,OP Fee Schedule,Straight Discount,53.20%,OP,74.86,74.86,,,,,,,,,,,,,
Corvel,CPT,80143,Drug assay acetaminophen,OP Fee Schedule,Straight Discount,53.20%,OP,18.64,18.64,,,,,,,,,,,,,
Corvel,CPT,80145,Drug assay adalimumab,OP Fee Schedule,Straight Discount,53.20%,OP,38.57,38.57,,,,,,,,,,,,,
Corvel,CPT,80150,Assay of amikacin,OP Fee Schedule,Straight Discount,53.20%,OP,15.08,15.08,,,,,,,,,,,,,
Corvel,CPT,80151,Drug assay amiodarone,OP Fee Schedule,Straight Discount,53.20%,OP,18.64,18.64,,,,,,,,,,,,,
Corvel,CPT,80155,Drug assay caffeine,OP Fee Schedule,Straight Discount,53.20%,OP,38.57,38.57,,,,,,,,,,,,,
Corvel,CPT,80156,Assay carbamazepine total,OP Fee Schedule,Per Unit,$89.27 ,OP,14.57,89.27,,,,,,,,,,,,,
Corvel,CPT,80157,Assay carbamazepine free,OP Fee Schedule,Straight Discount,53.20%,OP,13.25,13.25,,,,,,,,,,,,,
Corvel,CPT,80158,Drug assay cyclosporine,OP Fee Schedule,Per Unit,$191.48 ,OP,18.05,191.48,,,,,,,,,,,,,
Corvel,CPT,80159,Drug assay clozapine,OP Fee Schedule,Straight Discount,53.20%,OP,20.15,20.15,,,,,,,,,,,,,
Corvel,CPT,80161,Asy carbamazepin 10-11-epxid,OP Fee Schedule,Straight Discount,53.20%,OP,18.64,18.64,,,,,,,,,,,,,
Corvel,CPT,80162,Assay of digoxin total,OP Fee Schedule,Per Unit,$85.77 ,OP,13.28,85.77,,,,,,,,,,,,,
Corvel,CPT,80163,Assay of digoxin free,OP Fee Schedule,Straight Discount,53.20%,OP,13.28,13.28,,,,,,,,,,,,,
Corvel,CPT,80164,Assay dipropylacetic acd tot,OP Fee Schedule,Per Unit,$79.89 ,OP,13.54,79.89,,,,,,,,,,,,,
Corvel,CPT,80165,Dipropylacetic acid free,OP Fee Schedule,Straight Discount,53.20%,OP,13.54,13.54,,,,,,,,,,,,,
Corvel,CPT,80167,Drug assay felbamate,OP Fee Schedule,Straight Discount,53.20%,OP,18.64,18.64,,,,,,,,,,,,,
Corvel,CPT,80168,Assay of ethosuximide,OP Fee Schedule,Straight Discount,53.20%,OP,16.34,16.34,,,,,,,,,,,,,
Corvel,CPT,80169,Drug assay everolimus,OP Fee Schedule,Straight Discount,53.20%,OP,13.73,13.73,,,,,,,,,,,,,
Corvel,CPT,80170,Assay of gentamicin,OP Fee Schedule,Per Unit,$111.00 ,OP,16.38,111,,,,,,,,,,,,,
Corvel,CPT,80171,Drug screen quant gabapentin,OP Fee Schedule,Straight Discount,53.20%,OP,21.67,21.67,,,,,,,,,,,,,
Corvel,CPT,80173,Assay of haloperidol,OP Fee Schedule,Straight Discount,53.20%,OP,15.78,15.78,,,,,,,,,,,,,
Corvel,CPT,80175,Drug screen quan lamotrigine,OP Fee Schedule,Straight Discount,53.20%,OP,13.25,13.25,,,,,,,,,,,,,
Corvel,CPT,80176,Assay of lidocaine,OP Fee Schedule,Straight Discount,53.20%,OP,14.69,14.69,,,,,,,,,,,,,
Corvel,CPT,80177,Drug scrn quan levetiracetam,OP Fee Schedule,Straight Discount,53.20%,OP,13.25,13.25,,,,,,,,,,,,,
Corvel,CPT,80178,Assay of lithium,OP Fee Schedule,Per Unit,$57.37 ,OP,6.61,57.37,,,,,,,,,,,,,
Corvel,CPT,80179,Drug assay salicylate,OP Fee Schedule,Straight Discount,53.20%,OP,18.64,18.64,,,,,,,,,,,,,
Corvel,CPT,80180,Drug scrn quan mycophenolate,OP Fee Schedule,Straight Discount,53.20%,OP,18.05,18.05,,,,,,,,,,,,,
Corvel,CPT,80181,Drug assay flecainide,OP Fee Schedule,Straight Discount,53.20%,OP,18.64,18.64,,,,,,,,,,,,,
Corvel,CPT,80183,Drug scrn quant oxcarbazepin,OP Fee Schedule,Straight Discount,53.20%,OP,13.25,13.25,,,,,,,,,,,,,
Corvel,CPT,80184,Assay of phenobarbital,OP Fee Schedule,Per Unit,$113.59 ,OP,15.3,113.59,,,,,,,,,,,,,
Corvel,CPT,80185,Assay of phenytoin total,OP Fee Schedule,Per Unit,$88.48 ,OP,13.25,88.48,,,,,,,,,,,,,
Corvel,CPT,80186,Assay of phenytoin free,OP Fee Schedule,Straight Discount,53.20%,OP,13.76,13.76,,,,,,,,,,,,,
Corvel,CPT,80187,Drug assay posaconazole,OP Fee Schedule,Straight Discount,53.20%,OP,27.11,27.11,,,,,,,,,,,,,
Corvel,CPT,80188,Assay of primidone,OP Fee Schedule,Straight Discount,53.20%,OP,16.59,16.59,,,,,,,,,,,,,
Corvel,CPT,80189,Drug assay itraconzaole,OP Fee Schedule,Straight Discount,53.20%,OP,27.11,27.11,,,,,,,,,,,,,
Corvel,CPT,80190,Assay of procainamide,OP Fee Schedule,Straight Discount,53.20%,OP,60,60,,,,,,,,,,,,,
Corvel,CPT,80192,Assay of procainamide,OP Fee Schedule,Straight Discount,53.20%,OP,16.75,16.75,,,,,,,,,,,,,
Corvel,CPT,80193,Drug assay leflunomide,OP Fee Schedule,Straight Discount,53.20%,OP,38.57,38.57,,,,,,,,,,,,,
Corvel,CPT,80194,Assay of quinidine,OP Fee Schedule,Straight Discount,53.20%,OP,14.6,14.6,,,,,,,,,,,,,
Corvel,CPT,80195,Assay of sirolimus,OP Fee Schedule,Straight Discount,53.20%,OP,13.73,13.73,,,,,,,,,,,,,
Corvel,CPT,80197,Assay of tacrolimus,OP Fee Schedule,Straight Discount,53.20%,OP,13.73,13.73,,,,,,,,,,,,,
Corvel,CPT,80198,Assay of theophylline,OP Fee Schedule,Per Unit,$121.98 ,OP,14.14,121.98,,,,,,,,,,,,,
Corvel,CPT,80199,Drug screen quant tiagabine,OP Fee Schedule,Straight Discount,53.20%,OP,27.11,27.11,,,,,,,,,,,,,
Corvel,CPT,80200,Assay of tobramycin,OP Fee Schedule,Straight Discount,53.20%,OP,16.13,16.13,,,,,,,,,,,,,
Corvel,CPT,80201,Assay of topiramate,OP Fee Schedule,Straight Discount,53.20%,OP,11.92,11.92,,,,,,,,,,,,,
Corvel,CPT,80202,Assay of vancomycin,OP Fee Schedule,Per Unit,$88.68 ,OP,13.54,88.68,,,,,,,,,,,,,
Corvel,CPT,80203,Drug screen quant zonisamide,OP Fee Schedule,Straight Discount,53.20%,OP,13.25,13.25,,,,,,,,,,,,,
Corvel,CPT,80204,Drug assay methotrexate,OP Fee Schedule,Straight Discount,53.20%,OP,38.57,38.57,,,,,,,,,,,,,
Corvel,CPT,80210,Drug assay rufinamide,OP Fee Schedule,Straight Discount,53.20%,OP,27.11,27.11,,,,,,,,,,,,,
Corvel,CPT,80230,Drug assay infliximab,OP Fee Schedule,Straight Discount,53.20%,OP,38.57,38.57,,,,,,,,,,,,,
Corvel,CPT,80235,Drug assay lacosamide,OP Fee Schedule,Straight Discount,53.20%,OP,27.11,27.11,,,,,,,,,,,,,
Corvel,CPT,80280,Drug assay vedolizumab,OP Fee Schedule,Straight Discount,53.20%,OP,38.57,38.57,,,,,,,,,,,,,
Corvel,CPT,80285,Drug assay voriconazole,OP Fee Schedule,Straight Discount,53.20%,OP,27.11,27.11,,,,,,,,,,,,,
Corvel,CPT,80299,Quantitative assay drug,OP Fee Schedule,Straight Discount,53.20%,OP,18.64,18.64,,,,,,,,,,,,,
Corvel,CPT,80305,Drug test prsmv dir opt obs,OP Fee Schedule,Straight Discount,53.20%,OP,12.6,12.6,,,,,,,,,,,,,
Corvel,CPT,80306,Drug test prsmv instrmnt,OP Fee Schedule,Straight Discount,53.20%,OP,17.14,17.14,,,,,,,,,,,,,
Corvel,CPT,80307,Drug test prsmv chem anlyzr,OP Fee Schedule,Straight Discount,53.20%,OP,62.14,62.14,,,,,,,,,,,,,
Corvel,CPT,80320,Drug screen quantalcohols,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80321,Alcohols biomarkers 1or 2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80322,Alcohols biomarkers 3/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80323,Alkaloids nos,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80324,Drug screen amphetamines 1/2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80325,Amphetamines 3or 4,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80326,Amphetamines 5 or more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80327,Anabolic steroid 1 or 2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80328,Anabolic steroid 3 or more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80329,Analgesics non-opioid 1 or 2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80330,Analgesics non-opioid 3-5,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80331,Analgesics non-opioid 6/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80332,Antidepressants class 1 or 2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80333,Antidepressants class 3-5,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80334,Antidepressants class 6/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80335,Antidepressant tricyclic 1/2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80336,Antidepressant tricyclic 3-5,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80337,Tricyclic & cyclicals 6/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80338,Antidepressant not specified,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80339,Antiepileptics nos 1-3,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80340,Antiepileptics nos 4-6,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80341,Antiepileptics nos 7/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80342,Antipsychotics nos 1-3,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80343,Antipsychotics nos 4-6,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80344,Antipsychotics nos 7/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80345,Drug screening barbiturates,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80346,Benzodiazepines1-12,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80347,Benzodiazepines 13 or more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80348,Drug screening buprenorphine,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80349,Cannabinoids natural,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80350,Cannabinoids synthetic 1-3,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80351,Cannabinoids synthetic 4-6,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80352,Cannabinoid synthetic 7/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80353,Drug screening cocaine,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80354,Drug screening fentanyl,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80355,Gabapentin non-blood,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80356,Heroin metabolite,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80357,Ketamine and norketamine,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80358,Drug screening methadone,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80359,Methylenedioxyamphetamines,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80360,Methylphenidate,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80361,Opiates 1 or more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80362,Opioids & opiate analogs 1/2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80363,Opioids & opiate analogs 3/4,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80364,Opioid &opiate analog 5/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80365,Drug screening oxycodone,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80366,Drug screening pregabalin,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80367,Drug screening propoxyphene,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80368,Sedative hypnotics,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80369,Skeletal muscle relaxant 1/2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80370,Skel musc relaxant 3 or more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80371,Stimulants synthetic,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80372,Drug screening tapentadol,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80373,Drug screening tramadol,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80374,Stereoisomer analysis,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80375,Drug/substance nos 1-3,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80376,Drug/substance nos 4-6,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80377,Drug/substance nos 7/more,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,80400,Acth stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,32.62,32.62,,,,,,,,,,,,,
Corvel,CPT,80402,Acth stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,86.96,86.96,,,,,,,,,,,,,
Corvel,CPT,80406,Acth stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,78.26,78.26,,,,,,,,,,,,,
Corvel,CPT,80408,Aldosterone suppression eval,OP Fee Schedule,Straight Discount,53.20%,OP,125.5,125.5,,,,,,,,,,,,,
Corvel,CPT,80410,Calcitonin stimul panel,OP Fee Schedule,Straight Discount,53.20%,OP,80.37,80.37,,,,,,,,,,,,,
Corvel,CPT,80412,Crh stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,801.62,801.62,,,,,,,,,,,,,
Corvel,CPT,80414,Testosterone response panel,OP Fee Schedule,Straight Discount,53.20%,OP,51.64,51.64,,,,,,,,,,,,,
Corvel,CPT,80415,Tot estradiol response panel,OP Fee Schedule,Straight Discount,53.20%,OP,55.89,55.89,,,,,,,,,,,,,
Corvel,CPT,80416,Renin stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,209.32,209.32,,,,,,,,,,,,,
Corvel,CPT,80417,Renin stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,43.99,43.99,,,,,,,,,,,,,
Corvel,CPT,80418,Pituitary evaluation panel,OP Fee Schedule,Straight Discount,53.20%,OP,579.48,579.48,,,,,,,,,,,,,
Corvel,CPT,80420,Dexamethasone panel,OP Fee Schedule,Straight Discount,53.20%,OP,161.88,161.88,,,,,,,,,,,,,
Corvel,CPT,80422,Glucagon tolerance panel,OP Fee Schedule,Straight Discount,53.20%,OP,46.07,46.07,,,,,,,,,,,,,
Corvel,CPT,80424,Glucagon tolerance panel,OP Fee Schedule,Straight Discount,53.20%,OP,50.5,50.5,,,,,,,,,,,,,
Corvel,CPT,80426,Gonadotropin hormone panel,OP Fee Schedule,Straight Discount,53.20%,OP,148.41,148.41,,,,,,,,,,,,,
Corvel,CPT,80428,Growth hormone panel,OP Fee Schedule,Straight Discount,53.20%,OP,66.7,66.7,,,,,,,,,,,,,
Corvel,CPT,80430,Growth hormone panel,OP Fee Schedule,Straight Discount,53.20%,OP,129.33,129.33,,,,,,,,,,,,,
Corvel,CPT,80432,Insulin suppression panel,OP Fee Schedule,Straight Discount,53.20%,OP,165.61,165.61,,,,,,,,,,,,,
Corvel,CPT,80434,Insulin tolerance panel,OP Fee Schedule,Straight Discount,53.20%,OP,285.03,285.03,,,,,,,,,,,,,
Corvel,CPT,80435,Insulin tolerance panel,OP Fee Schedule,Straight Discount,53.20%,OP,103,103,,,,,,,,,,,,,
Corvel,CPT,80436,Metyrapone panel,OP Fee Schedule,Straight Discount,53.20%,OP,91.16,91.16,,,,,,,,,,,,,
Corvel,CPT,80438,Trh stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,50.41,50.41,,,,,,,,,,,,,
Corvel,CPT,80439,Trh stimulation panel,OP Fee Schedule,Straight Discount,53.20%,OP,67.21,67.21,,,,,,,,,,,,,
Corvel,CPT,80500,Lab pathology consultation,OP Fee Schedule,Per Unit,$15.72 ,OP,15.72,48.22,,,,,,,,,,,,,
Corvel,CPT,80502,Lab pathology consultation,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,81000,Urinalysis nonauto w/scope,OP Fee Schedule,Per Unit,$33.22 ,OP,4.02,33.22,,,,,,,,,,,,,
Corvel,CPT,81001,Urinalysis auto w/scope,OP Fee Schedule,Per Unit,$33.60 ,OP,3.17,33.6,,,,,,,,,,,,,
Corvel,CPT,81002,Urinalysis nonauto w/o scope,OP Fee Schedule,Per Unit,$22.20 ,OP,3.48,22.2,,,,,,,,,,,,,
Corvel,CPT,81003,Urinalysis auto w/o scope,OP Fee Schedule,Per Unit,$25.45 ,OP,2.25,25.45,,,,,,,,,,,,,
Corvel,CPT,81005,Urinalysis,OP Fee Schedule,Straight Discount,53.20%,OP,2.17,2.17,,,,,,,,,,,,,
Corvel,CPT,81007,Urine screen for bacteria,OP Fee Schedule,Straight Discount,53.20%,OP,29.98,29.98,,,,,,,,,,,,,
Corvel,CPT,81015,Microscopic exam of urine,OP Fee Schedule,Per Unit,$33.06 ,OP,3.05,33.06,,,,,,,,,,,,,
Corvel,CPT,81020,Urinalysis glass test,OP Fee Schedule,Straight Discount,53.20%,OP,4.7,4.7,,,,,,,,,,,,,
Corvel,CPT,81025,Urine pregnancy test,OP Fee Schedule,Per Unit,$62.62 ,OP,8.61,62.62,,,,,,,,,,,,,
Corvel,CPT,81050,Urinalysis volume measure,OP Fee Schedule,Per Unit,$12.48 ,OP,3.64,12.48,,,,,,,,,,,,,
Corvel,CPT,81099,Urinalysis test procedure,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,81105,Hpa-1 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81106,Hpa-2 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81107,Hpa-3 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81108,Hpa-4 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81109,Hpa-5 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81110,Hpa-6 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81111,Hpa-9 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81112,Hpa-15 genotyping,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81120,Idh1 common variants,OP Fee Schedule,Straight Discount,53.20%,OP,193.25,193.25,,,,,,,,,,,,,
Corvel,CPT,81121,Idh2 common variants,OP Fee Schedule,Straight Discount,53.20%,OP,295.79,295.79,,,,,,,,,,,,,
Corvel,CPT,81161,Dmd dup/delet analysis,OP Fee Schedule,Straight Discount,53.20%,OP,279,279,,,,,,,,,,,,,
Corvel,CPT,81162,Brca1&2 gen full seq dup/del,OP Fee Schedule,Straight Discount,53.20%,OP,"1,824.88","1,824.88",,,,,,,,,,,,,
Corvel,CPT,81163,Brca1&2 gene full seq alys,OP Fee Schedule,Straight Discount,53.20%,OP,468,468,,,,,,,,,,,,,
Corvel,CPT,81164,Brca1&2 gen ful dup/del alys,OP Fee Schedule,Straight Discount,53.20%,OP,584.23,584.23,,,,,,,,,,,,,
Corvel,CPT,81165,Brca1 gene full seq alys,OP Fee Schedule,Straight Discount,53.20%,OP,282.88,282.88,,,,,,,,,,,,,
Corvel,CPT,81166,Brca1 gene full dup/del alys,OP Fee Schedule,Straight Discount,53.20%,OP,301.35,301.35,,,,,,,,,,,,,
Corvel,CPT,81167,Brca2 gene full dup/del alys,OP Fee Schedule,Straight Discount,53.20%,OP,282.88,282.88,,,,,,,,,,,,,
Corvel,CPT,81168,Ccnd1/igh translocation alys,OP Fee Schedule,Straight Discount,53.20%,OP,207.31,207.31,,,,,,,,,,,,,
Corvel,CPT,81170,Abl1 gene,OP Fee Schedule,Straight Discount,53.20%,OP,300,300,,,,,,,,,,,,,
Corvel,CPT,81171,Aff2 gene detc abnor alleles,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81172,Aff2 gene charac alleles,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81173,Ar gene full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,301.35,301.35,,,,,,,,,,,,,
Corvel,CPT,81174,Ar gene known famil variant,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81175,Asxl1 full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,676.5,676.5,,,,,,,,,,,,,
Corvel,CPT,81176,Asxl1 gene target seq alys,OP Fee Schedule,Straight Discount,53.20%,OP,241.9,241.9,,,,,,,,,,,,,
Corvel,CPT,81177,Atn1 gene detc abnor alleles,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81178,Atxn1 gene detc abnor allele,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81179,Atxn2 gene detc abnor allele,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81180,Atxn3 gene detc abnor allele,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81181,Atxn7 gene detc abnor allele,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81182,Atxn8os gen detc abnor allel,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81183,Atxn10 gene detc abnor allel,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81184,Cacna1a gen detc abnor allel,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81185,Cacna1a gene full gene seq,OP Fee Schedule,Straight Discount,53.20%,OP,846.27,846.27,,,,,,,,,,,,,
Corvel,CPT,81186,Cacna1a gen known famil vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81187,Cnbp gene detc abnor allele,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81188,Cstb gene detc abnor allele,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81189,Cstb gene full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81190,Cstb gene known famil vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81191,Ntrk1 translocation analysis,OP Fee Schedule,Straight Discount,53.20%,OP,207.31,207.31,,,,,,,,,,,,,
Corvel,CPT,81192,Ntrk2 translocation analysis,OP Fee Schedule,Straight Discount,53.20%,OP,207.31,207.31,,,,,,,,,,,,,
Corvel,CPT,81193,Ntrk3 translocation analysis,OP Fee Schedule,Straight Discount,53.20%,OP,207.31,207.31,,,,,,,,,,,,,
Corvel,CPT,81194,Ntrk translocation analysis,OP Fee Schedule,Straight Discount,53.20%,OP,518.28,518.28,,,,,,,,,,,,,
Corvel,CPT,81200,Aspa gene,OP Fee Schedule,Straight Discount,53.20%,OP,47.25,47.25,,,,,,,,,,,,,
Corvel,CPT,81201,Apc gene full sequence,OP Fee Schedule,Straight Discount,53.20%,OP,780,780,,,,,,,,,,,,,
Corvel,CPT,81202,Apc gene known fam variants,OP Fee Schedule,Straight Discount,53.20%,OP,280,280,,,,,,,,,,,,,
Corvel,CPT,81203,Apc gene dup/delet variants,OP Fee Schedule,Straight Discount,53.20%,OP,200,200,,,,,,,,,,,,,
Corvel,CPT,81204,Ar gene charac alleles,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81205,Bckdhb gene,OP Fee Schedule,Straight Discount,53.20%,OP,94.99,94.99,,,,,,,,,,,,,
Corvel,CPT,81206,Bcr/abl1 gene major bp,OP Fee Schedule,Straight Discount,53.20%,OP,163.96,163.96,,,,,,,,,,,,,
Corvel,CPT,81207,Bcr/abl1 gene minor bp,OP Fee Schedule,Straight Discount,53.20%,OP,144.84,144.84,,,,,,,,,,,,,
Corvel,CPT,81208,Bcr/abl1 gene other bp,OP Fee Schedule,Straight Discount,53.20%,OP,214.62,214.62,,,,,,,,,,,,,
Corvel,CPT,81209,Blm gene,OP Fee Schedule,Straight Discount,53.20%,OP,39.31,39.31,,,,,,,,,,,,,
Corvel,CPT,81210,Braf gene,OP Fee Schedule,Straight Discount,53.20%,OP,175.4,175.4,,,,,,,,,,,,,
Corvel,CPT,81212,Brca1&2 185&5385&6174 vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,440,440,,,,,,,,,,,,,
Corvel,CPT,81215,Brca1 gene known famil vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,375.25,375.25,,,,,,,,,,,,,
Corvel,CPT,81216,Brca2 gene full seq alys,OP Fee Schedule,Straight Discount,53.20%,OP,185.12,185.12,,,,,,,,,,,,,
Corvel,CPT,81217,Brca2 gene known famil vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,375.25,375.25,,,,,,,,,,,,,
Corvel,CPT,81218,Cebpa gene full sequence,OP Fee Schedule,Straight Discount,53.20%,OP,241.9,241.9,,,,,,,,,,,,,
Corvel,CPT,81219,Calr gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,121.63,121.63,,,,,,,,,,,,,
Corvel,CPT,81220,Cftr gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,556.6,556.6,,,,,,,,,,,,,
Corvel,CPT,81221,Cftr gene known fam variants,OP Fee Schedule,Straight Discount,53.20%,OP,97.22,97.22,,,,,,,,,,,,,
Corvel,CPT,81222,Cftr gene dup/delet variants,OP Fee Schedule,Straight Discount,53.20%,OP,435.07,435.07,,,,,,,,,,,,,
Corvel,CPT,81223,Cftr gene full sequence,OP Fee Schedule,Straight Discount,53.20%,OP,499,499,,,,,,,,,,,,,
Corvel,CPT,81224,Cftr gene intron poly t,OP Fee Schedule,Straight Discount,53.20%,OP,168.75,168.75,,,,,,,,,,,,,
Corvel,CPT,81225,Cyp2c19 gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,291.36,291.36,,,,,,,,,,,,,
Corvel,CPT,81226,Cyp2d6 gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,450.91,450.91,,,,,,,,,,,,,
Corvel,CPT,81227,Cyp2c9 gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81228,Cytogen micrarray copy nmbr,OP Fee Schedule,Straight Discount,53.20%,OP,900,900,,,,,,,,,,,,,
Corvel,CPT,81229,Cytogen m array copy no&snp,OP Fee Schedule,Straight Discount,53.20%,OP,"1,160.00","1,160.00",,,,,,,,,,,,,
Corvel,CPT,81230,Cyp3a4 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81231,Cyp3a5 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81232,Dpyd gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81233,Btk gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,175.4,175.4,,,,,,,,,,,,,
Corvel,CPT,81234,Dmpk gene detc abnor allele,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81235,Egfr gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,324.58,324.58,,,,,,,,,,,,,
Corvel,CPT,81236,Ezh2 gene full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,282.88,282.88,,,,,,,,,,,,,
Corvel,CPT,81237,Ezh2 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,175.4,175.4,,,,,,,,,,,,,
Corvel,CPT,81238,F9 full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,600,600,,,,,,,,,,,,,
Corvel,CPT,81239,Dmpk gene charac alleles,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81240,F2 gene,OP Fee Schedule,Straight Discount,53.20%,OP,65.69,65.69,,,,,,,,,,,,,
Corvel,CPT,81241,F5 gene,OP Fee Schedule,Straight Discount,53.20%,OP,73.37,73.37,,,,,,,,,,,,,
Corvel,CPT,81242,Fancc gene,OP Fee Schedule,Straight Discount,53.20%,OP,36.62,36.62,,,,,,,,,,,,,
Corvel,CPT,81243,Fmr1 gene detection,OP Fee Schedule,Straight Discount,53.20%,OP,57.04,57.04,,,,,,,,,,,,,
Corvel,CPT,81244,Fmr1 gene charac alleles,OP Fee Schedule,Straight Discount,53.20%,OP,44.89,44.89,,,,,,,,,,,,,
Corvel,CPT,81245,Flt3 gene,OP Fee Schedule,Straight Discount,53.20%,OP,165.51,165.51,,,,,,,,,,,,,
Corvel,CPT,81246,Flt3 gene analysis,OP Fee Schedule,Straight Discount,53.20%,OP,83,83,,,,,,,,,,,,,
Corvel,CPT,81247,G6pd gene alys cmn variant,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81248,G6pd known familial variant,OP Fee Schedule,Straight Discount,53.20%,OP,375.25,375.25,,,,,,,,,,,,,
Corvel,CPT,81249,G6pd full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,600,600,,,,,,,,,,,,,
Corvel,CPT,81250,G6pc gene,OP Fee Schedule,Straight Discount,53.20%,OP,58.49,58.49,,,,,,,,,,,,,
Corvel,CPT,81251,Gba gene,OP Fee Schedule,Straight Discount,53.20%,OP,47.25,47.25,,,,,,,,,,,,,
Corvel,CPT,81252,Gjb2 gene full sequence,OP Fee Schedule,Straight Discount,53.20%,OP,101.12,101.12,,,,,,,,,,,,,
Corvel,CPT,81253,Gjb2 gene known fam variants,OP Fee Schedule,Straight Discount,53.20%,OP,61.52,61.52,,,,,,,,,,,,,
Corvel,CPT,81254,Gjb6 gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,35,35,,,,,,,,,,,,,
Corvel,CPT,81255,Hexa gene,OP Fee Schedule,Straight Discount,53.20%,OP,51.45,51.45,,,,,,,,,,,,,
Corvel,CPT,81256,Hfe gene,OP Fee Schedule,Straight Discount,53.20%,OP,65.36,65.36,,,,,,,,,,,,,
Corvel,CPT,81257,Hba1/hba2 gene,OP Fee Schedule,Straight Discount,53.20%,OP,102.26,102.26,,,,,,,,,,,,,
Corvel,CPT,81258,Hba1/hba2 gene fam vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,375.25,375.25,,,,,,,,,,,,,
Corvel,CPT,81259,Hba1/hba2 full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,600,600,,,,,,,,,,,,,
Corvel,CPT,81260,Ikbkap gene,OP Fee Schedule,Straight Discount,53.20%,OP,39.31,39.31,,,,,,,,,,,,,
Corvel,CPT,81261,Igh gene rearrange amp meth,OP Fee Schedule,Straight Discount,53.20%,OP,197.99,197.99,,,,,,,,,,,,,
Corvel,CPT,81262,Igh gene rearrang dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,68.55,68.55,,,,,,,,,,,,,
Corvel,CPT,81263,Igh vari regional mutation,OP Fee Schedule,Straight Discount,53.20%,OP,294.52,294.52,,,,,,,,,,,,,
Corvel,CPT,81264,Igk rearrangeabn clonal pop,OP Fee Schedule,Straight Discount,53.20%,OP,172.73,172.73,,,,,,,,,,,,,
Corvel,CPT,81265,Str markers specimen anal,OP Fee Schedule,Straight Discount,53.20%,OP,233.07,233.07,,,,,,,,,,,,,
Corvel,CPT,81266,Str markers spec anal addl,OP Fee Schedule,Straight Discount,53.20%,OP,304.81,304.81,,,,,,,,,,,,,
Corvel,CPT,81267,Chimerism anal no cell selec,OP Fee Schedule,Straight Discount,53.20%,OP,207.46,207.46,,,,,,,,,,,,,
Corvel,CPT,81268,Chimerism anal w/cell select,OP Fee Schedule,Straight Discount,53.20%,OP,260.79,260.79,,,,,,,,,,,,,
Corvel,CPT,81269,Hba1/hba2 gene dup/del vrnts,OP Fee Schedule,Straight Discount,53.20%,OP,202.4,202.4,,,,,,,,,,,,,
Corvel,CPT,81270,Jak2 gene,OP Fee Schedule,Straight Discount,53.20%,OP,91.66,91.66,,,,,,,,,,,,,
Corvel,CPT,81271,Htt gene detc abnor alleles,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81272,Kit gene targeted seq analys,OP Fee Schedule,Straight Discount,53.20%,OP,329.51,329.51,,,,,,,,,,,,,
Corvel,CPT,81273,Kit gene analys d816 variant,OP Fee Schedule,Straight Discount,53.20%,OP,124.87,124.87,,,,,,,,,,,,,
Corvel,CPT,81274,Htt gene charac alleles,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81275,Kras gene variants exon 2,OP Fee Schedule,Straight Discount,53.20%,OP,193.25,193.25,,,,,,,,,,,,,
Corvel,CPT,81276,Kras gene addl variants,OP Fee Schedule,Straight Discount,53.20%,OP,193.25,193.25,,,,,,,,,,,,,
Corvel,CPT,81277,Cytogenomic neo microra alys,OP Fee Schedule,Straight Discount,53.20%,OP,"1,160.00","1,160.00",,,,,,,,,,,,,
Corvel,CPT,81278,Igh@/bcl2 translocation alys,OP Fee Schedule,Straight Discount,53.20%,OP,207.31,207.31,,,,,,,,,,,,,
Corvel,CPT,81279,Jak2 gene trgt sequence alys,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81283,Ifnl3 gene,OP Fee Schedule,Straight Discount,53.20%,OP,73.37,73.37,,,,,,,,,,,,,
Corvel,CPT,81284,Fxn gene detc abnor alleles,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81285,Fxn gene charac alleles,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81286,Fxn gene full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81287,Mgmt gene prmtr mthyltn alys,OP Fee Schedule,Straight Discount,53.20%,OP,124.64,124.64,,,,,,,,,,,,,
Corvel,CPT,81288,Mlh1 gene,OP Fee Schedule,Straight Discount,53.20%,OP,192.32,192.32,,,,,,,,,,,,,
Corvel,CPT,81289,Fxn gene known famil variant,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81290,Mcoln1 gene,OP Fee Schedule,Straight Discount,53.20%,OP,39.31,39.31,,,,,,,,,,,,,
Corvel,CPT,81291,Mthfr gene,OP Fee Schedule,Straight Discount,53.20%,OP,65.34,65.34,,,,,,,,,,,,,
Corvel,CPT,81292,Mlh1 gene full seq,OP Fee Schedule,Straight Discount,53.20%,OP,675.4,675.4,,,,,,,,,,,,,
Corvel,CPT,81293,Mlh1 gene known variants,OP Fee Schedule,Straight Discount,53.20%,OP,331,331,,,,,,,,,,,,,
Corvel,CPT,81294,Mlh1 gene dup/delete variant,OP Fee Schedule,Straight Discount,53.20%,OP,202.4,202.4,,,,,,,,,,,,,
Corvel,CPT,81295,Msh2 gene full seq,OP Fee Schedule,Straight Discount,53.20%,OP,381.7,381.7,,,,,,,,,,,,,
Corvel,CPT,81296,Msh2 gene known variants,OP Fee Schedule,Straight Discount,53.20%,OP,337.73,337.73,,,,,,,,,,,,,
Corvel,CPT,81297,Msh2 gene dup/delete variant,OP Fee Schedule,Straight Discount,53.20%,OP,213.3,213.3,,,,,,,,,,,,,
Corvel,CPT,81298,Msh6 gene full seq,OP Fee Schedule,Straight Discount,53.20%,OP,641.85,641.85,,,,,,,,,,,,,
Corvel,CPT,81299,Msh6 gene known variants,OP Fee Schedule,Straight Discount,53.20%,OP,308,308,,,,,,,,,,,,,
Corvel,CPT,81300,Msh6 gene dup/delete variant,OP Fee Schedule,Straight Discount,53.20%,OP,238,238,,,,,,,,,,,,,
Corvel,CPT,81301,Microsatellite instability,OP Fee Schedule,Straight Discount,53.20%,OP,348.56,348.56,,,,,,,,,,,,,
Corvel,CPT,81302,Mecp2 gene full seq,OP Fee Schedule,Straight Discount,53.20%,OP,527.87,527.87,,,,,,,,,,,,,
Corvel,CPT,81303,Mecp2 gene known variant,OP Fee Schedule,Straight Discount,53.20%,OP,120,120,,,,,,,,,,,,,
Corvel,CPT,81304,Mecp2 gene dup/delet variant,OP Fee Schedule,Straight Discount,53.20%,OP,150,150,,,,,,,,,,,,,
Corvel,CPT,81305,Myd88 gene p.leu265pro vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,175.4,175.4,,,,,,,,,,,,,
Corvel,CPT,81306,Nudt15 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,291.36,291.36,,,,,,,,,,,,,
Corvel,CPT,81307,Palb2 gene full gene seq,OP Fee Schedule,Straight Discount,53.20%,OP,676.5,676.5,,,,,,,,,,,,,
Corvel,CPT,81308,Palb2 gene known famil vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,301.35,301.35,,,,,,,,,,,,,
Corvel,CPT,81309,Pik3ca gene trgt seq alys,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81310,Npm1 gene,OP Fee Schedule,Straight Discount,53.20%,OP,246.52,246.52,,,,,,,,,,,,,
Corvel,CPT,81311,Nras gene variants exon 2&3,OP Fee Schedule,Straight Discount,53.20%,OP,295.79,295.79,,,,,,,,,,,,,
Corvel,CPT,81312,Pabpn1 gene detc abnor allel,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81313,Pca3/klk3 antigen,OP Fee Schedule,Straight Discount,53.20%,OP,255.05,255.05,,,,,,,,,,,,,
Corvel,CPT,81314,Pdgfra gene,OP Fee Schedule,Straight Discount,53.20%,OP,329.51,329.51,,,,,,,,,,,,,
Corvel,CPT,81315,Pml/raralpha com breakpoints,OP Fee Schedule,Straight Discount,53.20%,OP,207.31,207.31,,,,,,,,,,,,,
Corvel,CPT,81316,Pml/raralpha 1 breakpoint,OP Fee Schedule,Straight Discount,53.20%,OP,207.31,207.31,,,,,,,,,,,,,
Corvel,CPT,81317,Pms2 gene full seq analysis,OP Fee Schedule,Straight Discount,53.20%,OP,676.5,676.5,,,,,,,,,,,,,
Corvel,CPT,81318,Pms2 known familial variants,OP Fee Schedule,Straight Discount,53.20%,OP,331,331,,,,,,,,,,,,,
Corvel,CPT,81319,Pms2 gene dup/delet variants,OP Fee Schedule,Straight Discount,53.20%,OP,203.5,203.5,,,,,,,,,,,,,
Corvel,CPT,81320,Plcg2 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,291.36,291.36,,,,,,,,,,,,,
Corvel,CPT,81321,Pten gene full sequence,OP Fee Schedule,Straight Discount,53.20%,OP,600,600,,,,,,,,,,,,,
Corvel,CPT,81322,Pten gene known fam variant,OP Fee Schedule,Straight Discount,53.20%,OP,46.6,46.6,,,,,,,,,,,,,
Corvel,CPT,81323,Pten gene dup/delet variant,OP Fee Schedule,Straight Discount,53.20%,OP,300,300,,,,,,,,,,,,,
Corvel,CPT,81324,Pmp22 gene dup/delet,OP Fee Schedule,Straight Discount,53.20%,OP,758.36,758.36,,,,,,,,,,,,,
Corvel,CPT,81325,Pmp22 gene full sequence,OP Fee Schedule,Straight Discount,53.20%,OP,769.58,769.58,,,,,,,,,,,,,
Corvel,CPT,81326,Pmp22 gene known fam variant,OP Fee Schedule,Straight Discount,53.20%,OP,46.6,46.6,,,,,,,,,,,,,
Corvel,CPT,81327,Sept9 gen prmtr mthyltn alys,OP Fee Schedule,Straight Discount,53.20%,OP,192,192,,,,,,,,,,,,,
Corvel,CPT,81328,Slco1b1 gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81329,Smn1 gene dos/deletion alys,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81330,Smpd1 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,47,47,,,,,,,,,,,,,
Corvel,CPT,81331,Snrpn/ube3a gene,OP Fee Schedule,Straight Discount,53.20%,OP,51.07,51.07,,,,,,,,,,,,,
Corvel,CPT,81332,Serpina1 gene,OP Fee Schedule,Straight Discount,53.20%,OP,43.65,43.65,,,,,,,,,,,,,
Corvel,CPT,81333,Tgfbi gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81334,Runx1 gene targeted seq alys,OP Fee Schedule,Straight Discount,53.20%,OP,329.51,329.51,,,,,,,,,,,,,
Corvel,CPT,81335,Tpmt gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81336,Smn1 gene full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,301.35,301.35,,,,,,,,,,,,,
Corvel,CPT,81337,Smn1 gen nown famil seq vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81338,Mpl gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,150.33,150.33,,,,,,,,,,,,,
Corvel,CPT,81339,Mpl gene seq alys exon 10,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81340,Trb@ gene rearrange amplify,OP Fee Schedule,Straight Discount,53.20%,OP,208.92,208.92,,,,,,,,,,,,,
Corvel,CPT,81341,Trb@ gene rearrange dirprobe,OP Fee Schedule,Straight Discount,53.20%,OP,49.59,49.59,,,,,,,,,,,,,
Corvel,CPT,81342,Trg gene rearrangement anal,OP Fee Schedule,Straight Discount,53.20%,OP,201.5,201.5,,,,,,,,,,,,,
Corvel,CPT,81343,Ppp2r2b gen detc abnor allel,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81344,Tbp gene detc abnor alleles,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81345,Tert gene targeted seq alys,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81346,Tyms gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81347,Sf3b1 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,193.25,193.25,,,,,,,,,,,,,
Corvel,CPT,81348,Srsf2 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,175.4,175.4,,,,,,,,,,,,,
Corvel,CPT,81350,Ugt1a1 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,234,234,,,,,,,,,,,,,
Corvel,CPT,81351,Tp53 gene full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,641.85,641.85,,,,,,,,,,,,,
Corvel,CPT,81352,Tp53 gene trgt sequence alys,OP Fee Schedule,Straight Discount,53.20%,OP,329.51,329.51,,,,,,,,,,,,,
Corvel,CPT,81353,Tp53 gene known famil vrnt,OP Fee Schedule,Straight Discount,53.20%,OP,308,308,,,,,,,,,,,,,
Corvel,CPT,81355,Vkorc1 gene,OP Fee Schedule,Straight Discount,53.20%,OP,88.2,88.2,,,,,,,,,,,,,
Corvel,CPT,81357,U2af1 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,193.25,193.25,,,,,,,,,,,,,
Corvel,CPT,81360,Zrsr2 gene common variants,OP Fee Schedule,Straight Discount,53.20%,OP,193.25,193.25,,,,,,,,,,,,,
Corvel,CPT,81361,Hbb gene com variants,OP Fee Schedule,Straight Discount,53.20%,OP,174.81,174.81,,,,,,,,,,,,,
Corvel,CPT,81362,Hbb gene known fam variant,OP Fee Schedule,Straight Discount,53.20%,OP,375.25,375.25,,,,,,,,,,,,,
Corvel,CPT,81363,Hbb gene dup/del variants,OP Fee Schedule,Straight Discount,53.20%,OP,202.4,202.4,,,,,,,,,,,,,
Corvel,CPT,81364,Hbb full gene sequence,OP Fee Schedule,Straight Discount,53.20%,OP,324.58,324.58,,,,,,,,,,,,,
Corvel,CPT,81370,Hla i & ii typing lr,OP Fee Schedule,Straight Discount,53.20%,OP,402.12,402.12,,,,,,,,,,,,,
Corvel,CPT,81371,Hla i & ii type verify lr,OP Fee Schedule,Straight Discount,53.20%,OP,404.52,404.52,,,,,,,,,,,,,
Corvel,CPT,81372,Hla i typing complete lr,OP Fee Schedule,Straight Discount,53.20%,OP,403.59,403.59,,,,,,,,,,,,,
Corvel,CPT,81373,Hla i typing 1 locus lr,OP Fee Schedule,Straight Discount,53.20%,OP,127.43,127.43,,,,,,,,,,,,,
Corvel,CPT,81374,Hla i typing 1 antigen lr,OP Fee Schedule,Straight Discount,53.20%,OP,74.33,74.33,,,,,,,,,,,,,
Corvel,CPT,81375,Hla ii typing ag equiv lr,OP Fee Schedule,Straight Discount,53.20%,OP,220.74,220.74,,,,,,,,,,,,,
Corvel,CPT,81376,Hla ii typing 1 locus lr,OP Fee Schedule,Straight Discount,53.20%,OP,122.22,122.22,,,,,,,,,,,,,
Corvel,CPT,81377,Hla ii type 1 ag equiv lr,OP Fee Schedule,Straight Discount,53.20%,OP,94.74,94.74,,,,,,,,,,,,,
Corvel,CPT,81378,Hla i & ii typing hr,OP Fee Schedule,Straight Discount,53.20%,OP,345.57,345.57,,,,,,,,,,,,,
Corvel,CPT,81379,Hla i typing complete hr,OP Fee Schedule,Straight Discount,53.20%,OP,335.38,335.38,,,,,,,,,,,,,
Corvel,CPT,81380,Hla i typing 1 locus hr,OP Fee Schedule,Straight Discount,53.20%,OP,177.25,177.25,,,,,,,,,,,,,
Corvel,CPT,81381,Hla i typing 1 allele hr,OP Fee Schedule,Straight Discount,53.20%,OP,169.9,169.9,,,,,,,,,,,,,
Corvel,CPT,81382,Hla ii typing 1 loc hr,OP Fee Schedule,Straight Discount,53.20%,OP,123.68,123.68,,,,,,,,,,,,,
Corvel,CPT,81383,Hla ii typing 1 allele hr,OP Fee Schedule,Straight Discount,53.20%,OP,109.13,109.13,,,,,,,,,,,,,
Corvel,CPT,81400,Mopath procedure level 1,OP Fee Schedule,Straight Discount,53.20%,OP,63.96,63.96,,,,,,,,,,,,,
Corvel,CPT,81401,Mopath procedure level 2,OP Fee Schedule,Straight Discount,53.20%,OP,137,137,,,,,,,,,,,,,
Corvel,CPT,81402,Mopath procedure level 3,OP Fee Schedule,Straight Discount,53.20%,OP,150.33,150.33,,,,,,,,,,,,,
Corvel,CPT,81403,Mopath procedure level 4,OP Fee Schedule,Straight Discount,53.20%,OP,185.2,185.2,,,,,,,,,,,,,
Corvel,CPT,81404,Mopath procedure level 5,OP Fee Schedule,Straight Discount,53.20%,OP,274.83,274.83,,,,,,,,,,,,,
Corvel,CPT,81405,Mopath procedure level 6,OP Fee Schedule,Straight Discount,53.20%,OP,301.35,301.35,,,,,,,,,,,,,
Corvel,CPT,81406,Mopath procedure level 7,OP Fee Schedule,Straight Discount,53.20%,OP,282.88,282.88,,,,,,,,,,,,,
Corvel,CPT,81407,Mopath procedure level 8,OP Fee Schedule,Straight Discount,53.20%,OP,846.27,846.27,,,,,,,,,,,,,
Corvel,CPT,81408,Mopath procedure level 9,OP Fee Schedule,Straight Discount,53.20%,OP,"2,000.00","2,000.00",,,,,,,,,,,,,
Corvel,CPT,81410,Aortic dysfunction/dilation,OP Fee Schedule,Straight Discount,53.20%,OP,504,504,,,,,,,,,,,,,
Corvel,CPT,81411,Aortic dysfunction/dilation,OP Fee Schedule,Straight Discount,53.20%,OP,"1,350.19","1,350.19",,,,,,,,,,,,,
Corvel,CPT,81412,Ashkenazi jewish assoc dis,OP Fee Schedule,Straight Discount,53.20%,OP,"2,448.56","2,448.56",,,,,,,,,,,,,
Corvel,CPT,81413,Car ion chnnlpath inc 10 gns,OP Fee Schedule,Straight Discount,53.20%,OP,584.9,584.9,,,,,,,,,,,,,
Corvel,CPT,81414,Car ion chnnlpath inc 2 gns,OP Fee Schedule,Straight Discount,53.20%,OP,584.9,584.9,,,,,,,,,,,,,
Corvel,CPT,81415,Exome sequence analysis,OP Fee Schedule,Straight Discount,53.20%,OP,"4,780.00","4,780.00",,,,,,,,,,,,,
Corvel,CPT,81416,Exome sequence analysis,OP Fee Schedule,Straight Discount,53.20%,OP,"12,000.00","12,000.00",,,,,,,,,,,,,
Corvel,CPT,81417,Exome re-evaluation,OP Fee Schedule,Straight Discount,53.20%,OP,320,320,,,,,,,,,,,,,
Corvel,CPT,81419,Epilepsy gen seq alys panel,OP Fee Schedule,Straight Discount,53.20%,OP,"2,448.56","2,448.56",,,,,,,,,,,,,
Corvel,CPT,81420,Fetal chrmoml aneuploidy,OP Fee Schedule,Straight Discount,53.20%,OP,759.05,759.05,,,,,,,,,,,,,
Corvel,CPT,81422,Fetal chrmoml microdeltj,OP Fee Schedule,Straight Discount,53.20%,OP,759.05,759.05,,,,,,,,,,,,,
Corvel,CPT,81425,Genome sequence analysis,OP Fee Schedule,Straight Discount,53.20%,OP,"5,031.20","5,031.20",,,,,,,,,,,,,
Corvel,CPT,81426,Genome sequence analysis,OP Fee Schedule,Straight Discount,53.20%,OP,"2,709.95","2,709.95",,,,,,,,,,,,,
Corvel,CPT,81427,Genome re-evaluation,OP Fee Schedule,Straight Discount,53.20%,OP,"2,337.65","2,337.65",,,,,,,,,,,,,
Corvel,CPT,81430,Hearing loss sequence analys,OP Fee Schedule,Straight Discount,53.20%,OP,"1,625.00","1,625.00",,,,,,,,,,,,,
Corvel,CPT,81431,Hearing loss dup/del analys,OP Fee Schedule,Straight Discount,53.20%,OP,679.57,679.57,,,,,,,,,,,,,
Corvel,CPT,81432,Hrdtry brst ca-rlatd dsordrs,OP Fee Schedule,Straight Discount,53.20%,OP,679.05,679.05,,,,,,,,,,,,,
Corvel,CPT,81433,Hrdtry brst ca-rlatd dsordrs,OP Fee Schedule,Straight Discount,53.20%,OP,438.93,438.93,,,,,,,,,,,,,
Corvel,CPT,81434,Hereditary retinal disorders,OP Fee Schedule,Straight Discount,53.20%,OP,597.91,597.91,,,,,,,,,,,,,
Corvel,CPT,81435,Hereditary colon ca dsordrs,OP Fee Schedule,Straight Discount,53.20%,OP,584.9,584.9,,,,,,,,,,,,,
Corvel,CPT,81436,Hereditary colon ca dsordrs,OP Fee Schedule,Straight Discount,53.20%,OP,584.9,584.9,,,,,,,,,,,,,
Corvel,CPT,81437,Heredtry nurondcrn tum dsrdr,OP Fee Schedule,Straight Discount,53.20%,OP,438.93,438.93,,,,,,,,,,,,,
Corvel,CPT,81438,Heredtry nurondcrn tum dsrdr,OP Fee Schedule,Straight Discount,53.20%,OP,438.93,438.93,,,,,,,,,,,,,
Corvel,CPT,81439,Hrdtry cardmypy gene panel,OP Fee Schedule,Straight Discount,53.20%,OP,584.9,584.9,,,,,,,,,,,,,
Corvel,CPT,81440,Mitochondrial gene,OP Fee Schedule,Straight Discount,53.20%,OP,"3,324.00","3,324.00",,,,,,,,,,,,,
Corvel,CPT,81442,Noonan spectrum disorders,OP Fee Schedule,Straight Discount,53.20%,OP,"2,143.60","2,143.60",,,,,,,,,,,,,
Corvel,CPT,81443,Genetic tstg severe inh cond,OP Fee Schedule,Straight Discount,53.20%,OP,"2,448.56","2,448.56",,,,,,,,,,,,,
Corvel,CPT,81445,Targeted genomic seq analys,OP Fee Schedule,Straight Discount,53.20%,OP,597.91,597.91,,,,,,,,,,,,,
Corvel,CPT,81448,Hrdtry perph neurphy panel,OP Fee Schedule,Straight Discount,53.20%,OP,584.9,584.9,,,,,,,,,,,,,
Corvel,CPT,81450,Targeted genomic seq analys,OP Fee Schedule,Straight Discount,53.20%,OP,759.53,759.53,,,,,,,,,,,,,
Corvel,CPT,81455,Targeted genomic seq analys,OP Fee Schedule,Straight Discount,53.20%,OP,"2,919.60","2,919.60",,,,,,,,,,,,,
Corvel,CPT,81460,Whole mitochondrial genome,OP Fee Schedule,Straight Discount,53.20%,OP,"1,287.00","1,287.00",,,,,,,,,,,,,
Corvel,CPT,81465,Whole mitochondrial genome,OP Fee Schedule,Straight Discount,53.20%,OP,936,936,,,,,,,,,,,,,
Corvel,CPT,81470,X-linked intellectual dblt,OP Fee Schedule,Straight Discount,53.20%,OP,914,914,,,,,,,,,,,,,
Corvel,CPT,81471,X-linked intellectual dblt,OP Fee Schedule,Straight Discount,53.20%,OP,914,914,,,,,,,,,,,,,
Corvel,CPT,81479,Unlisted molecular pathology,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,81490,Autoimmune rheumatoid arthr,OP Fee Schedule,Straight Discount,53.20%,OP,840.65,840.65,,,,,,,,,,,,,
Corvel,CPT,81493,Cor artery disease mrna,OP Fee Schedule,Straight Discount,53.20%,OP,"1,050.00","1,050.00",,,,,,,,,,,,,
Corvel,CPT,81500,Onco (ovar) two proteins,OP Fee Schedule,Straight Discount,53.20%,OP,260.5,260.5,,,,,,,,,,,,,
Corvel,CPT,81503,Onco (ovar) five proteins,OP Fee Schedule,Straight Discount,53.20%,OP,897,897,,,,,,,,,,,,,
Corvel,CPT,81504,Oncology tissue of origin,OP Fee Schedule,Straight Discount,53.20%,OP,520,520,,,,,,,,,,,,,
Corvel,CPT,81506,Endo assay seven anal,OP Fee Schedule,Straight Discount,53.20%,OP,68.92,68.92,,,,,,,,,,,,,
Corvel,CPT,81507,Fetal aneuploidy trisom risk,OP Fee Schedule,Straight Discount,53.20%,OP,795,795,,,,,,,,,,,,,
Corvel,CPT,81508,Ftl cgen abnor two proteins,OP Fee Schedule,Straight Discount,53.20%,OP,54.3,54.3,,,,,,,,,,,,,
Corvel,CPT,81509,Ftl cgen abnor 3 proteins,OP Fee Schedule,Straight Discount,53.20%,OP,"1,487.37","1,487.37",,,,,,,,,,,,,
Corvel,CPT,81510,Ftl cgen abnor three anal,OP Fee Schedule,Straight Discount,53.20%,OP,55.54,55.54,,,,,,,,,,,,,
Corvel,CPT,81511,Ftl cgen abnor four anal,OP Fee Schedule,Straight Discount,53.20%,OP,153.5,153.5,,,,,,,,,,,,,
Corvel,CPT,81512,Ftl cgen abnor five anal,OP Fee Schedule,Straight Discount,53.20%,OP,69.52,69.52,,,,,,,,,,,,,
Corvel,CPT,81513,Nfct ds bv rna vag flu alg,OP Fee Schedule,Straight Discount,53.20%,OP,142.63,142.63,,,,,,,,,,,,,
Corvel,CPT,81514,Nfct ds bv&vaginitis dna alg,OP Fee Schedule,Straight Discount,53.20%,OP,262.99,262.99,,,,,,,,,,,,,
Corvel,CPT,81518,Onc brst mrna 11 genes,OP Fee Schedule,Straight Discount,53.20%,OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Corvel,CPT,81519,Oncology breast mrna,OP Fee Schedule,Straight Discount,53.20%,OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Corvel,CPT,81520,Onc breast mrna 58 genes,OP Fee Schedule,Straight Discount,53.20%,OP,"2,510.21","2,510.21",,,,,,,,,,,,,
Corvel,CPT,81521,Onc breast mrna 70 genes,OP Fee Schedule,Straight Discount,53.20%,OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Corvel,CPT,81522,Onc breast mrna 12 genes,OP Fee Schedule,Straight Discount,53.20%,OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Corvel,CPT,81525,Oncology colon mrna,OP Fee Schedule,Straight Discount,53.20%,OP,"3,116.00","3,116.00",,,,,,,,,,,,,
Corvel,CPT,81528,Oncology colorectal scr,OP Fee Schedule,Straight Discount,53.20%,OP,508.87,508.87,,,,,,,,,,,,,
Corvel,CPT,81529,Onc cutan mlnma mrna 31 gene,OP Fee Schedule,Straight Discount,53.20%,OP,"7,193.00","7,193.00",,,,,,,,,,,,,
Corvel,CPT,81535,Oncology gynecologic,OP Fee Schedule,Straight Discount,53.20%,OP,579.46,579.46,,,,,,,,,,,,,
Corvel,CPT,81536,Oncology gynecologic,OP Fee Schedule,Straight Discount,53.20%,OP,177.56,177.56,,,,,,,,,,,,,
Corvel,CPT,81538,Oncology lung,OP Fee Schedule,Straight Discount,53.20%,OP,"2,871.00","2,871.00",,,,,,,,,,,,,
Corvel,CPT,81539,Oncology prostate prob score,OP Fee Schedule,Straight Discount,53.20%,OP,760,760,,,,,,,,,,,,,
Corvel,CPT,81540,Oncology tum unknown origin,OP Fee Schedule,Straight Discount,53.20%,OP,"3,750.00","3,750.00",,,,,,,,,,,,,
Corvel,CPT,81541,Onc prostate mrna 46 genes,OP Fee Schedule,Straight Discount,53.20%,OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Corvel,CPT,81542,Onc prostate mrna 22 cnt gen,OP Fee Schedule,Straight Discount,53.20%,OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Corvel,CPT,81546,Onc thyr mrna 10-196 gen alg,OP Fee Schedule,Straight Discount,53.20%,OP,"3,600.00","3,600.00",,,,,,,,,,,,,
Corvel,CPT,81551,Onc prostate 3 genes,OP Fee Schedule,Straight Discount,53.20%,OP,"2,030.00","2,030.00",,,,,,,,,,,,,
Corvel,CPT,81552,Onc uveal mlnma mrna 15 gene,OP Fee Schedule,Straight Discount,53.20%,OP,"7,776.00","7,776.00",,,,,,,,,,,,,
Corvel,CPT,81554,Pulm ds ipf mrna 190 gen alg,OP Fee Schedule,Straight Discount,53.20%,OP,"5,500.00","5,500.00",,,,,,,,,,,,,
Corvel,CPT,81595,Cardiology hrt trnspl mrna,OP Fee Schedule,Straight Discount,53.20%,OP,"3,240.00","3,240.00",,,,,,,,,,,,,
Corvel,CPT,81596,Nfct ds chrnc hcv 6 assays,OP Fee Schedule,Straight Discount,53.20%,OP,72.19,72.19,,,,,,,,,,,,,
Corvel,CPT,81599,Unlisted maaa,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,82009,Test for acetone/ketones,OP Fee Schedule,Per Unit,$39.06 ,OP,4.52,39.06,,,,,,,,,,,,,
Corvel,CPT,82010,Acetone assay,OP Fee Schedule,Straight Discount,53.20%,OP,8.17,8.17,,,,,,,,,,,,,
Corvel,CPT,82013,Acetylcholinesterase assay,OP Fee Schedule,Straight Discount,53.20%,OP,12.29,12.29,,,,,,,,,,,,,
Corvel,CPT,82016,Acylcarnitines qual,OP Fee Schedule,Straight Discount,53.20%,OP,16.49,16.49,,,,,,,,,,,,,
Corvel,CPT,82017,Acylcarnitines quant,OP Fee Schedule,Straight Discount,53.20%,OP,16.87,16.87,,,,,,,,,,,,,
Corvel,CPT,82024,Assay of acth,OP Fee Schedule,Straight Discount,53.20%,OP,38.62,38.62,,,,,,,,,,,,,
Corvel,CPT,82030,Assay of adp & amp,OP Fee Schedule,Straight Discount,53.20%,OP,25.8,25.8,,,,,,,,,,,,,
Corvel,CPT,82040,Assay of serum albumin,OP Fee Schedule,Per Unit,$47.59 ,OP,4.95,47.59,,,,,,,,,,,,,
Corvel,CPT,82042,Other source albumin quan ea,OP Fee Schedule,Per Unit,$37.76 ,OP,7.78,37.76,,,,,,,,,,,,,
Corvel,CPT,82043,Ur albumin quantitative,OP Fee Schedule,Per Unit,$56.29 ,OP,5.78,56.29,,,,,,,,,,,,,
Corvel,CPT,82044,Ur albumin semiquantitative,OP Fee Schedule,Straight Discount,53.20%,OP,6.23,6.23,,,,,,,,,,,,,
Corvel,CPT,82045,Albumin ischemia modified,OP Fee Schedule,Straight Discount,53.20%,OP,33.94,33.94,,,,,,,,,,,,,
Corvel,CPT,82075,Assay of breath ethanol,OP Fee Schedule,Per Unit,$59.76 ,OP,30,59.76,,,,,,,,,,,,,
Corvel,CPT,82077,Assay spec xcp ur&breath ia,OP Fee Schedule,Straight Discount,53.20%,OP,17.27,17.27,,,,,,,,,,,,,
Corvel,CPT,82085,Assay of aldolase,OP Fee Schedule,Per Unit,$127.64 ,OP,9.71,127.64,,,,,,,,,,,,,
Corvel,CPT,82088,Assay of aldosterone,OP Fee Schedule,Straight Discount,53.20%,OP,40.75,40.75,,,,,,,,,,,,,
Corvel,CPT,82103,Alpha-1-antitrypsin total,OP Fee Schedule,Per Unit,$76.97 ,OP,13.44,76.97,,,,,,,,,,,,,
Corvel,CPT,82104,Alpha-1-antitrypsin pheno,OP Fee Schedule,Straight Discount,53.20%,OP,14.46,14.46,,,,,,,,,,,,,
Corvel,CPT,82105,Alpha-fetoprotein serum,OP Fee Schedule,Per Unit,$96.80 ,OP,16.77,96.8,,,,,,,,,,,,,
Corvel,CPT,82106,Alpha-fetoprotein amniotic,OP Fee Schedule,Straight Discount,53.20%,OP,17,17,,,,,,,,,,,,,
Corvel,CPT,82107,Alpha-fetoprotein l3,OP Fee Schedule,Straight Discount,53.20%,OP,64.41,64.41,,,,,,,,,,,,,
Corvel,CPT,82108,Assay of aluminum,OP Fee Schedule,Straight Discount,53.20%,OP,25.48,25.48,,,,,,,,,,,,,
Corvel,CPT,82120,Amines vaginal fluid qual,OP Fee Schedule,Straight Discount,53.20%,OP,5.99,5.99,,,,,,,,,,,,,
Corvel,CPT,82127,Amino acid single qual,OP Fee Schedule,Straight Discount,53.20%,OP,14.18,14.18,,,,,,,,,,,,,
Corvel,CPT,82128,Amino acids mult qual,OP Fee Schedule,Straight Discount,53.20%,OP,13.87,13.87,,,,,,,,,,,,,
Corvel,CPT,82131,Amino acids single quant,OP Fee Schedule,Per Unit,$213.56 ,OP,22.98,213.56,,,,,,,,,,,,,
Corvel,CPT,82135,Assay aminolevulinic acid,OP Fee Schedule,Straight Discount,53.20%,OP,16.45,16.45,,,,,,,,,,,,,
Corvel,CPT,82136,Amino acids quant 2-5,OP Fee Schedule,Straight Discount,53.20%,OP,19.61,19.61,,,,,,,,,,,,,
Corvel,CPT,82139,Amino acids quan 6 or more,OP Fee Schedule,Straight Discount,53.20%,OP,16.87,16.87,,,,,,,,,,,,,
Corvel,CPT,82140,Assay of ammonia,OP Fee Schedule,Per Unit,$149.25 ,OP,14.57,149.25,,,,,,,,,,,,,
Corvel,CPT,82143,Amniotic fluid scan,OP Fee Schedule,Straight Discount,53.20%,OP,9.35,9.35,,,,,,,,,,,,,
Corvel,CPT,82150,Assay of amylase,OP Fee Schedule,Per Unit,$69.36 ,OP,6.48,69.36,,,,,,,,,,,,,
Corvel,CPT,82154,Androstanediol glucuronide,OP Fee Schedule,Straight Discount,53.20%,OP,28.83,28.83,,,,,,,,,,,,,
Corvel,CPT,82157,Assay of androstenedione,OP Fee Schedule,Straight Discount,53.20%,OP,29.28,29.28,,,,,,,,,,,,,
Corvel,CPT,82160,Assay of androsterone,OP Fee Schedule,Straight Discount,53.20%,OP,25.55,25.55,,,,,,,,,,,,,
Corvel,CPT,82163,Assay of angiotensin ii,OP Fee Schedule,Straight Discount,53.20%,OP,20.52,20.52,,,,,,,,,,,,,
Corvel,CPT,82164,Angiotensin i enzyme test,OP Fee Schedule,Straight Discount,53.20%,OP,14.6,14.6,,,,,,,,,,,,,
Corvel,CPT,82172,Assay of apolipoprotein,OP Fee Schedule,Per Unit,$65.93 ,OP,21.09,65.93,,,,,,,,,,,,,
Corvel,CPT,82175,Assay of arsenic,OP Fee Schedule,Straight Discount,53.20%,OP,18.97,18.97,,,,,,,,,,,,,
Corvel,CPT,82180,Assay of ascorbic acid,OP Fee Schedule,Straight Discount,53.20%,OP,9.89,9.89,,,,,,,,,,,,,
Corvel,CPT,82190,Atomic absorption,OP Fee Schedule,Straight Discount,53.20%,OP,15.9,15.9,,,,,,,,,,,,,
Corvel,CPT,82232,Assay of beta-2 protein,OP Fee Schedule,Straight Discount,53.20%,OP,16.18,16.18,,,,,,,,,,,,,
Corvel,CPT,82239,Bile acids total,OP Fee Schedule,Straight Discount,53.20%,OP,17.12,17.12,,,,,,,,,,,,,
Corvel,CPT,82240,Bile acids cholylglycine,OP Fee Schedule,Straight Discount,53.20%,OP,26.58,26.58,,,,,,,,,,,,,
Corvel,CPT,82247,Bilirubin total,OP Fee Schedule,Per Unit,$42.69 ,OP,5.02,42.69,,,,,,,,,,,,,
Corvel,CPT,82248,Bilirubin direct,OP Fee Schedule,Per Unit,$29.14 ,OP,5.02,29.14,,,,,,,,,,,,,
Corvel,CPT,82252,Fecal bilirubin test,OP Fee Schedule,Straight Discount,53.20%,OP,4.56,4.56,,,,,,,,,,,,,
Corvel,CPT,82261,Assay of biotinidase,OP Fee Schedule,Straight Discount,53.20%,OP,16.87,16.87,,,,,,,,,,,,,
Corvel,CPT,82270,Occult blood feces,OP Fee Schedule,Per Unit,$26.72 ,OP,4.38,26.72,,,,,,,,,,,,,
Corvel,CPT,82271,Occult blood other sources,OP Fee Schedule,Straight Discount,53.20%,OP,5.32,5.32,,,,,,,,,,,,,
Corvel,CPT,82272,Occult bld feces 1-3 tests,OP Fee Schedule,Straight Discount,53.20%,OP,4.23,4.23,,,,,,,,,,,,,
Corvel,CPT,82274,Assay test for blood fecal,OP Fee Schedule,Straight Discount,53.20%,OP,15.92,15.92,,,,,,,,,,,,,
Corvel,CPT,82286,Assay of bradykinin,OP Fee Schedule,Straight Discount,53.20%,OP,5.16,5.16,,,,,,,,,,,,,
Corvel,CPT,82300,Assay of cadmium,OP Fee Schedule,Straight Discount,53.20%,OP,23.64,23.64,,,,,,,,,,,,,
Corvel,CPT,82306,Vitamin d 25 hydroxy,OP Fee Schedule,Straight Discount,53.20%,OP,29.6,29.6,,,,,,,,,,,,,
Corvel,CPT,82308,Assay of calcitonin,OP Fee Schedule,Straight Discount,53.20%,OP,26.79,26.79,,,,,,,,,,,,,
Corvel,CPT,82310,Assay of calcium,OP Fee Schedule,Per Unit,$46.90 ,OP,5.16,46.9,,,,,,,,,,,,,
Corvel,CPT,82330,Assay of calcium,OP Fee Schedule,Per Unit,$145.45 ,OP,13.68,145.45,,,,,,,,,,,,,
Corvel,CPT,82331,Calcium infusion test,OP Fee Schedule,Straight Discount,53.20%,OP,13.34,13.34,,,,,,,,,,,,,
Corvel,CPT,82340,Assay of calcium in urine,OP Fee Schedule,Per Unit,$61.99 ,OP,6.03,61.99,,,,,,,,,,,,,
Corvel,CPT,82355,Calculus analysis qual,OP Fee Schedule,Per Unit,$137.91 ,OP,11.58,137.91,,,,,,,,,,,,,
Corvel,CPT,82360,Calculus assay quant,OP Fee Schedule,Per Unit,$96.43 ,OP,12.87,96.43,,,,,,,,,,,,,
Corvel,CPT,82365,Calculus spectroscopy,OP Fee Schedule,Per Unit,$67.73 ,OP,12.9,67.73,,,,,,,,,,,,,
Corvel,CPT,82370,X-ray assay calculus,OP Fee Schedule,Straight Discount,53.20%,OP,12.52,12.52,,,,,,,,,,,,,
Corvel,CPT,82373,Assay c-d transfer measure,OP Fee Schedule,Straight Discount,53.20%,OP,18.06,18.06,,,,,,,,,,,,,
Corvel,CPT,82374,Assay blood carbon dioxide,OP Fee Schedule,Straight Discount,53.20%,OP,4.88,4.88,,,,,,,,,,,,,
Corvel,CPT,82375,Assay carboxyhb quant,OP Fee Schedule,Per Unit,$55.37 ,OP,12.32,55.37,,,,,,,,,,,,,
Corvel,CPT,82376,Assay carboxyhb qual,OP Fee Schedule,Straight Discount,53.20%,OP,14.07,14.07,,,,,,,,,,,,,
Corvel,CPT,82378,Carcinoembryonic antigen,OP Fee Schedule,Per Unit,$146.00 ,OP,18.96,146,,,,,,,,,,,,,
Corvel,CPT,82379,Assay of carnitine,OP Fee Schedule,Straight Discount,53.20%,OP,16.87,16.87,,,,,,,,,,,,,
Corvel,CPT,82380,Assay of carotene,OP Fee Schedule,Straight Discount,53.20%,OP,9.22,9.22,,,,,,,,,,,,,
Corvel,CPT,82382,Assay urine catecholamines,OP Fee Schedule,Straight Discount,53.20%,OP,27.3,27.3,,,,,,,,,,,,,
Corvel,CPT,82383,Assay blood catecholamines,OP Fee Schedule,Straight Discount,53.20%,OP,29.08,29.08,,,,,,,,,,,,,
Corvel,CPT,82384,Assay three catecholamines,OP Fee Schedule,Per Unit,$115.86 ,OP,25.25,115.86,,,,,,,,,,,,,
Corvel,CPT,82387,Assay of cathepsin-d,OP Fee Schedule,Straight Discount,53.20%,OP,18.06,18.06,,,,,,,,,,,,,
Corvel,CPT,82390,Assay of ceruloplasmin,OP Fee Schedule,Per Unit,$63.06 ,OP,10.74,63.06,,,,,,,,,,,,,
Corvel,CPT,82397,Chemiluminescent assay,OP Fee Schedule,Straight Discount,53.20%,OP,14.12,14.12,,,,,,,,,,,,,
Corvel,CPT,82415,Assay of chloramphenicol,OP Fee Schedule,Straight Discount,53.20%,OP,12.67,12.67,,,,,,,,,,,,,
Corvel,CPT,82435,Assay of blood chloride,OP Fee Schedule,Per Unit,$11.06 ,OP,4.6,11.06,,,,,,,,,,,,,
Corvel,CPT,82436,Assay of urine chloride,OP Fee Schedule,Straight Discount,53.20%,OP,5.75,5.75,,,,,,,,,,,,,
Corvel,CPT,82438,Assay other fluid chlorides,OP Fee Schedule,Straight Discount,53.20%,OP,5,5,,,,,,,,,,,,,
Corvel,CPT,82441,Test for chlorohydrocarbons,OP Fee Schedule,Straight Discount,53.20%,OP,6.01,6.01,,,,,,,,,,,,,
Corvel,CPT,82465,Assay bld/serum cholesterol,OP Fee Schedule,Per Unit,$40.97 ,OP,4.35,40.97,,,,,,,,,,,,,
Corvel,CPT,82480,Assay serum cholinesterase,OP Fee Schedule,Per Unit,$85.68 ,OP,7.87,85.68,,,,,,,,,,,,,
Corvel,CPT,82482,Assay rbc cholinesterase,OP Fee Schedule,Straight Discount,53.20%,OP,9.81,9.81,,,,,,,,,,,,,
Corvel,CPT,82485,Assay chondroitin sulfate,OP Fee Schedule,Straight Discount,53.20%,OP,20.65,20.65,,,,,,,,,,,,,
Corvel,CPT,82495,Assay of chromium,OP Fee Schedule,Straight Discount,53.20%,OP,20.28,20.28,,,,,,,,,,,,,
Corvel,CPT,82507,Assay of citrate,OP Fee Schedule,Straight Discount,53.20%,OP,27.8,27.8,,,,,,,,,,,,,
Corvel,CPT,82523,Collagen crosslinks,OP Fee Schedule,Straight Discount,53.20%,OP,18.68,18.68,,,,,,,,,,,,,
Corvel,CPT,82525,Assay of copper,OP Fee Schedule,Straight Discount,53.20%,OP,12.41,12.41,,,,,,,,,,,,,
Corvel,CPT,82528,Assay of corticosterone,OP Fee Schedule,Straight Discount,53.20%,OP,22.52,22.52,,,,,,,,,,,,,
Corvel,CPT,82530,Cortisol free,OP Fee Schedule,Straight Discount,53.20%,OP,16.71,16.71,,,,,,,,,,,,,
Corvel,CPT,82533,Total cortisol,OP Fee Schedule,Per Unit,$154.34 ,OP,16.3,154.34,,,,,,,,,,,,,
Corvel,CPT,82540,Assay of creatine,OP Fee Schedule,Straight Discount,53.20%,OP,4.64,4.64,,,,,,,,,,,,,
Corvel,CPT,82542,Col chromotography qual/quan,OP Fee Schedule,Straight Discount,53.20%,OP,24.09,24.09,,,,,,,,,,,,,
Corvel,CPT,82550,Assay of ck (cpk),OP Fee Schedule,Per Unit,$50.25 ,OP,6.51,50.25,,,,,,,,,,,,,
Corvel,CPT,82552,Assay of cpk in blood,OP Fee Schedule,Per Unit,$79.97 ,OP,13.39,79.97,,,,,,,,,,,,,
Corvel,CPT,82553,Creatine mb fraction,OP Fee Schedule,Per Unit,$77.94 ,OP,11.55,77.94,,,,,,,,,,,,,
Corvel,CPT,82554,Creatine isoforms,OP Fee Schedule,Straight Discount,53.20%,OP,11.87,11.87,,,,,,,,,,,,,
Corvel,CPT,82565,Assay of creatinine,OP Fee Schedule,Per Unit,$39.40 ,OP,5.12,39.4,,,,,,,,,,,,,
Corvel,CPT,82570,Assay of urine creatinine,OP Fee Schedule,Per Unit,$31.47 ,OP,5.18,31.47,,,,,,,,,,,,,
Corvel,CPT,82575,Creatinine clearance test,OP Fee Schedule,Per Unit,$104.78 ,OP,9.46,104.78,,,,,,,,,,,,,
Corvel,CPT,82585,Assay of cryofibrinogen,OP Fee Schedule,Straight Discount,53.20%,OP,14.14,14.14,,,,,,,,,,,,,
Corvel,CPT,82595,Assay of cryoglobulin,OP Fee Schedule,Straight Discount,53.20%,OP,6.47,6.47,,,,,,,,,,,,,
Corvel,CPT,82600,Assay of cyanide,OP Fee Schedule,Straight Discount,53.20%,OP,19.4,19.4,,,,,,,,,,,,,
Corvel,CPT,82607,Vitamin b-12,OP Fee Schedule,Per Unit,$93.21 ,OP,15.08,93.21,,,,,,,,,,,,,
Corvel,CPT,82608,B-12 binding capacity,OP Fee Schedule,Straight Discount,53.20%,OP,14.32,14.32,,,,,,,,,,,,,
Corvel,CPT,82610,Cystatin c,OP Fee Schedule,Straight Discount,53.20%,OP,18.52,18.52,,,,,,,,,,,,,
Corvel,CPT,82615,Test for urine cystines,OP Fee Schedule,Straight Discount,53.20%,OP,9.55,9.55,,,,,,,,,,,,,
Corvel,CPT,82626,Dehydroepiandrosterone,OP Fee Schedule,Straight Discount,53.20%,OP,25.27,25.27,,,,,,,,,,,,,
Corvel,CPT,82627,Dehydroepiandrosterone,OP Fee Schedule,Per Unit,$150.96 ,OP,22.23,150.96,,,,,,,,,,,,,
Corvel,CPT,82633,Desoxycorticosterone,OP Fee Schedule,Straight Discount,53.20%,OP,30.98,30.98,,,,,,,,,,,,,
Corvel,CPT,82634,Deoxycortisol,OP Fee Schedule,Straight Discount,53.20%,OP,29.28,29.28,,,,,,,,,,,,,
Corvel,CPT,82638,Assay of dibucaine number,OP Fee Schedule,Straight Discount,53.20%,OP,12.25,12.25,,,,,,,,,,,,,
Corvel,CPT,82642,Dihydrotestosterone,OP Fee Schedule,Straight Discount,53.20%,OP,29.28,29.28,,,,,,,,,,,,,
Corvel,CPT,82652,Vit d 1 25-dihydroxy,OP Fee Schedule,Per Unit,$314.51 ,OP,38.5,314.51,,,,,,,,,,,,,
Corvel,CPT,82656,Pancreatic elastase fecal,OP Fee Schedule,Straight Discount,53.20%,OP,11.53,11.53,,,,,,,,,,,,,
Corvel,CPT,82657,Enzyme cell activity,OP Fee Schedule,Straight Discount,53.20%,OP,22.17,22.17,,,,,,,,,,,,,
Corvel,CPT,82658,Enzyme cell activity ra,OP Fee Schedule,Straight Discount,53.20%,OP,44.03,44.03,,,,,,,,,,,,,
Corvel,CPT,82664,Electrophoretic test,OP Fee Schedule,Straight Discount,53.20%,OP,61.5,61.5,,,,,,,,,,,,,
Corvel,CPT,82668,Assay of erythropoietin,OP Fee Schedule,Straight Discount,53.20%,OP,18.79,18.79,,,,,,,,,,,,,
Corvel,CPT,82670,Assay of total estradiol,OP Fee Schedule,Per Unit,$182.45 ,OP,27.94,182.45,,,,,,,,,,,,,
Corvel,CPT,82671,Assay of estrogens,OP Fee Schedule,Straight Discount,53.20%,OP,32.3,32.3,,,,,,,,,,,,,
Corvel,CPT,82672,Assay of estrogen,OP Fee Schedule,Per Unit,$122.09 ,OP,21.7,122.09,,,,,,,,,,,,,
Corvel,CPT,82677,Assay of estriol,OP Fee Schedule,Per Unit,$89.99 ,OP,24.18,89.99,,,,,,,,,,,,,
Corvel,CPT,82679,Assay of estrone,OP Fee Schedule,Straight Discount,53.20%,OP,24.95,24.95,,,,,,,,,,,,,
Corvel,CPT,82681,Assay dir meas fr estradiol,OP Fee Schedule,Straight Discount,53.20%,OP,27.94,27.94,,,,,,,,,,,,,
Corvel,CPT,82693,Assay of ethylene glycol,OP Fee Schedule,Straight Discount,53.20%,OP,14.9,14.9,,,,,,,,,,,,,
Corvel,CPT,82696,Assay of etiocholanolone,OP Fee Schedule,Straight Discount,53.20%,OP,26.24,26.24,,,,,,,,,,,,,
Corvel,CPT,82705,Fats/lipids feces qual,OP Fee Schedule,Straight Discount,53.20%,OP,5.1,5.1,,,,,,,,,,,,,
Corvel,CPT,82710,Fats/lipids feces quant,OP Fee Schedule,Straight Discount,53.20%,OP,16.8,16.8,,,,,,,,,,,,,
Corvel,CPT,82715,Assay of fecal fat,OP Fee Schedule,Straight Discount,53.20%,OP,22.97,22.97,,,,,,,,,,,,,
Corvel,CPT,82725,Assay of blood fatty acids,OP Fee Schedule,Straight Discount,53.20%,OP,18.77,18.77,,,,,,,,,,,,,
Corvel,CPT,82726,Long chain fatty acids,OP Fee Schedule,Straight Discount,53.20%,OP,19.75,19.75,,,,,,,,,,,,,
Corvel,CPT,82728,Assay of ferritin,OP Fee Schedule,Per Unit,$97.87 ,OP,13.63,97.87,,,,,,,,,,,,,
Corvel,CPT,82731,Assay of fetal fibronectin,OP Fee Schedule,Straight Discount,53.20%,OP,64.41,64.41,,,,,,,,,,,,,
Corvel,CPT,82735,Assay of fluoride,OP Fee Schedule,Straight Discount,53.20%,OP,18.54,18.54,,,,,,,,,,,,,
Corvel,CPT,82746,Assay of folic acid serum,OP Fee Schedule,Per Unit,$76.42 ,OP,14.7,76.42,,,,,,,,,,,,,
Corvel,CPT,82747,Assay of folic acid rbc,OP Fee Schedule,Per Unit,$188.10 ,OP,17.65,188.1,,,,,,,,,,,,,
Corvel,CPT,82757,Assay of semen fructose,OP Fee Schedule,Straight Discount,53.20%,OP,17.34,17.34,,,,,,,,,,,,,
Corvel,CPT,82759,Assay of rbc galactokinase,OP Fee Schedule,Straight Discount,53.20%,OP,21.48,21.48,,,,,,,,,,,,,
Corvel,CPT,82760,Assay of galactose,OP Fee Schedule,Straight Discount,53.20%,OP,11.2,11.2,,,,,,,,,,,,,
Corvel,CPT,82775,Assay galactose transferase,OP Fee Schedule,Straight Discount,53.20%,OP,21.07,21.07,,,,,,,,,,,,,
Corvel,CPT,82776,Galactose transferase test,OP Fee Schedule,Straight Discount,53.20%,OP,11.74,11.74,,,,,,,,,,,,,
Corvel,CPT,82777,Galectin-3,OP Fee Schedule,Straight Discount,53.20%,OP,44.25,44.25,,,,,,,,,,,,,
Corvel,CPT,82784,Assay iga/igd/igg/igm each,OP Fee Schedule,Per Unit,$81.34 ,OP,9.3,81.34,,,,,,,,,,,,,
Corvel,CPT,82785,Assay of ige,OP Fee Schedule,Per Unit,$94.25 ,OP,16.46,94.25,,,,,,,,,,,,,
Corvel,CPT,82787,Igg 1 2 3 or 4 each,OP Fee Schedule,Straight Discount,53.20%,OP,8.02,8.02,,,,,,,,,,,,,
Corvel,CPT,82800,Blood ph,OP Fee Schedule,Straight Discount,53.20%,OP,11,11,,,,,,,,,,,,,
Corvel,CPT,82803,Blood gases any combination,OP Fee Schedule,Per Unit,$109.97 ,OP,26.07,109.97,,,,,,,,,,,,,
Corvel,CPT,82805,Blood gases w/o2 saturation,OP Fee Schedule,Per Unit,$177.91 ,OP,78.77,177.91,,,,,,,,,,,,,
Corvel,CPT,82810,Blood gases o2 sat only,OP Fee Schedule,Per Unit,$14.47 ,OP,9.77,14.47,,,,,,,,,,,,,
Corvel,CPT,82820,Hemoglobin-oxygen affinity,OP Fee Schedule,Straight Discount,53.20%,OP,13.34,13.34,,,,,,,,,,,,,
Corvel,CPT,82930,Gastric analy w/ph ea spec,OP Fee Schedule,Straight Discount,53.20%,OP,6.71,6.71,,,,,,,,,,,,,
Corvel,CPT,82938,Gastrin test,OP Fee Schedule,Straight Discount,53.20%,OP,17.69,17.69,,,,,,,,,,,,,
Corvel,CPT,82941,Assay of gastrin,OP Fee Schedule,Straight Discount,53.20%,OP,17.63,17.63,,,,,,,,,,,,,
Corvel,CPT,82943,Assay of glucagon,OP Fee Schedule,Straight Discount,53.20%,OP,14.29,14.29,,,,,,,,,,,,,
Corvel,CPT,82945,Glucose other fluid,OP Fee Schedule,Per Unit,$66.42 ,OP,3.93,66.42,,,,,,,,,,,,,
Corvel,CPT,82946,Glucagon tolerance test,OP Fee Schedule,Straight Discount,53.20%,OP,17.77,17.77,,,,,,,,,,,,,
Corvel,CPT,82947,Assay glucose blood quant,OP Fee Schedule,Per Unit,$34.49 ,OP,3.93,34.49,,,,,,,,,,,,,
Corvel,CPT,82948,Reagent strip/blood glucose,OP Fee Schedule,Per Unit,$18.76 ,OP,5.04,18.76,,,,,,,,,,,,,
Corvel,CPT,82950,Glucose test,OP Fee Schedule,Per Unit,$49.30 ,OP,4.75,49.3,,,,,,,,,,,,,
Corvel,CPT,82951,Glucose tolerance test (gtt),OP Fee Schedule,Per Unit,$102.53 ,OP,12.87,102.53,,,,,,,,,,,,,
Corvel,CPT,82952,Gtt-added samples,OP Fee Schedule,Per Unit,$46.17 ,OP,3.92,46.17,,,,,,,,,,,,,
Corvel,CPT,82955,Assay of g6pd enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,9.7,9.7,,,,,,,,,,,,,
Corvel,CPT,82960,Test for g6pd enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,6.05,6.05,,,,,,,,,,,,,
Corvel,CPT,82962,Glucose blood test,OP Fee Schedule,Per Unit,$15.52 ,OP,3.28,15.52,,,,,,,,,,,,,
Corvel,CPT,82963,Assay of glucosidase,OP Fee Schedule,Straight Discount,53.20%,OP,21.48,21.48,,,,,,,,,,,,,
Corvel,CPT,82965,Assay of gdh enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,13.15,13.15,,,,,,,,,,,,,
Corvel,CPT,82977,Assay of ggt,OP Fee Schedule,Per Unit,$64.70 ,OP,7.2,64.7,,,,,,,,,,,,,
Corvel,CPT,82978,Assay of glutathione,OP Fee Schedule,Straight Discount,53.20%,OP,15.45,15.45,,,,,,,,,,,,,
Corvel,CPT,82979,Assay rbc glutathione,OP Fee Schedule,Straight Discount,53.20%,OP,9.44,9.44,,,,,,,,,,,,,
Corvel,CPT,82985,Assay of glycated protein,OP Fee Schedule,Straight Discount,53.20%,OP,16.76,16.76,,,,,,,,,,,,,
Corvel,CPT,83001,Assay of gonadotropin (fsh),OP Fee Schedule,Per Unit,$108.61 ,OP,18.58,108.61,,,,,,,,,,,,,
Corvel,CPT,83002,Assay of gonadotropin (lh),OP Fee Schedule,Per Unit,$108.49 ,OP,18.52,108.49,,,,,,,,,,,,,
Corvel,CPT,83003,Assay growth hormone (hgh),OP Fee Schedule,Straight Discount,53.20%,OP,16.67,16.67,,,,,,,,,,,,,
Corvel,CPT,83006,Growth stimulation gene 2,OP Fee Schedule,Straight Discount,53.20%,OP,75.6,75.6,,,,,,,,,,,,,
Corvel,CPT,83009,H pylori (c-13) blood,OP Fee Schedule,Straight Discount,53.20%,OP,67.36,67.36,,,,,,,,,,,,,
Corvel,CPT,83010,Assay of haptoglobin quant,OP Fee Schedule,Straight Discount,53.20%,OP,12.58,12.58,,,,,,,,,,,,,
Corvel,CPT,83012,Assay of haptoglobins,OP Fee Schedule,Straight Discount,53.20%,OP,26.89,26.89,,,,,,,,,,,,,
Corvel,CPT,83013,H pylori (c-13) breath,OP Fee Schedule,Straight Discount,53.20%,OP,67.36,67.36,,,,,,,,,,,,,
Corvel,CPT,83014,H pylori drug admin,OP Fee Schedule,Straight Discount,53.20%,OP,7.86,7.86,,,,,,,,,,,,,
Corvel,CPT,83015,Heavy metal qual any anal,OP Fee Schedule,Straight Discount,53.20%,OP,20.94,20.94,,,,,,,,,,,,,
Corvel,CPT,83018,Heavy metal quant each nes,OP Fee Schedule,Straight Discount,53.20%,OP,21.96,21.96,,,,,,,,,,,,,
Corvel,CPT,83020,Hemoglobin electrophoresis,OP Fee Schedule,Straight Discount,53.20%,OP,12.87,12.87,,,,,,,,,,,,,
Corvel,CPT,83021,Hemoglobin chromotography,OP Fee Schedule,Straight Discount,53.20%,OP,18.06,18.06,,,,,,,,,,,,,
Corvel,CPT,83026,Hemoglobin copper sulfate,OP Fee Schedule,Straight Discount,53.20%,OP,4.01,4.01,,,,,,,,,,,,,
Corvel,CPT,83030,Fetal hemoglobin chemical,OP Fee Schedule,Straight Discount,53.20%,OP,10.74,10.74,,,,,,,,,,,,,
Corvel,CPT,83033,Fetal hemoglobin assay qual,OP Fee Schedule,Straight Discount,53.20%,OP,8,8,,,,,,,,,,,,,
Corvel,CPT,83036,Glycosylated hemoglobin test,OP Fee Schedule,Per Unit,$66.83 ,OP,9.71,66.83,,,,,,,,,,,,,
Corvel,CPT,83037,Glycosylated hb home device,OP Fee Schedule,Straight Discount,53.20%,OP,9.71,9.71,,,,,,,,,,,,,
Corvel,CPT,83045,Blood methemoglobin test,OP Fee Schedule,Straight Discount,53.20%,OP,6.49,6.49,,,,,,,,,,,,,
Corvel,CPT,83050,Blood methemoglobin assay,OP Fee Schedule,Per Unit,$30.64 ,OP,8.2,30.64,,,,,,,,,,,,,
Corvel,CPT,83051,Assay of plasma hemoglobin,OP Fee Schedule,Straight Discount,53.20%,OP,7.31,7.31,,,,,,,,,,,,,
Corvel,CPT,83060,Blood sulfhemoglobin assay,OP Fee Schedule,Straight Discount,53.20%,OP,8.8,8.8,,,,,,,,,,,,,
Corvel,CPT,83065,Assay of hemoglobin heat,OP Fee Schedule,Straight Discount,53.20%,OP,9,9,,,,,,,,,,,,,
Corvel,CPT,83068,Hemoglobin stability screen,OP Fee Schedule,Straight Discount,53.20%,OP,9.47,9.47,,,,,,,,,,,,,
Corvel,CPT,83069,Assay of urine hemoglobin,OP Fee Schedule,Straight Discount,53.20%,OP,3.95,3.95,,,,,,,,,,,,,
Corvel,CPT,83070,Assay of hemosiderin qual,OP Fee Schedule,Straight Discount,53.20%,OP,4.75,4.75,,,,,,,,,,,,,
Corvel,CPT,83080,Assay of b hexosaminidase,OP Fee Schedule,Straight Discount,53.20%,OP,16.87,16.87,,,,,,,,,,,,,
Corvel,CPT,83088,Assay of histamine,OP Fee Schedule,Straight Discount,53.20%,OP,29.53,29.53,,,,,,,,,,,,,
Corvel,CPT,83090,Assay of homocystine,OP Fee Schedule,Per Unit,$139.22 ,OP,17.92,139.22,,,,,,,,,,,,,
Corvel,CPT,83150,Assay of homovanillic acid,OP Fee Schedule,Straight Discount,53.20%,OP,22.41,22.41,,,,,,,,,,,,,
Corvel,CPT,83491,Assay of corticosteroids 17,OP Fee Schedule,Straight Discount,53.20%,OP,17.9,17.9,,,,,,,,,,,,,
Corvel,CPT,83497,Assay of 5-hiaa,OP Fee Schedule,Straight Discount,53.20%,OP,12.9,12.9,,,,,,,,,,,,,
Corvel,CPT,83498,Assay of progesterone 17-d,OP Fee Schedule,Straight Discount,53.20%,OP,27.17,27.17,,,,,,,,,,,,,
Corvel,CPT,83500,Assay free hydroxyproline,OP Fee Schedule,Straight Discount,53.20%,OP,22.65,22.65,,,,,,,,,,,,,
Corvel,CPT,83505,Assay total hydroxyproline,OP Fee Schedule,Straight Discount,53.20%,OP,24.3,24.3,,,,,,,,,,,,,
Corvel,CPT,83516,Immunoassay nonantibody,OP Fee Schedule,Per Unit,$130.82 ,OP,11.53,130.82,,,,,,,,,,,,,
Corvel,CPT,83518,Immunoassay dipstick,OP Fee Schedule,Straight Discount,53.20%,OP,9.64,9.64,,,,,,,,,,,,,
Corvel,CPT,83519,Ria nonantibody,OP Fee Schedule,Straight Discount,53.20%,OP,18.4,18.4,,,,,,,,,,,,,
Corvel,CPT,83520,Immunoassay quant nos nonab,OP Fee Schedule,Per Unit,$118.31 ,OP,17.27,118.31,,,,,,,,,,,,,
Corvel,CPT,83525,Assay of insulin,OP Fee Schedule,Per Unit,$67.22 ,OP,11.43,67.22,,,,,,,,,,,,,
Corvel,CPT,83527,Assay of insulin,OP Fee Schedule,Straight Discount,53.20%,OP,12.95,12.95,,,,,,,,,,,,,
Corvel,CPT,83528,Assay of intrinsic factor,OP Fee Schedule,Straight Discount,53.20%,OP,19.82,19.82,,,,,,,,,,,,,
Corvel,CPT,83540,Assay of iron,OP Fee Schedule,Per Unit,$52.51 ,OP,6.47,52.51,,,,,,,,,,,,,
Corvel,CPT,83550,Iron binding test,OP Fee Schedule,Per Unit,$63.67 ,OP,8.74,63.67,,,,,,,,,,,,,
Corvel,CPT,83570,Assay of idh enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,8.85,8.85,,,,,,,,,,,,,
Corvel,CPT,83582,Assay of ketogenic steroids,OP Fee Schedule,Straight Discount,53.20%,OP,15.47,15.47,,,,,,,,,,,,,
Corvel,CPT,83586,Assay 17- ketosteroids,OP Fee Schedule,Straight Discount,53.20%,OP,12.8,12.8,,,,,,,,,,,,,
Corvel,CPT,83593,Fractionation ketosteroids,OP Fee Schedule,Straight Discount,53.20%,OP,28.5,28.5,,,,,,,,,,,,,
Corvel,CPT,83605,Assay of lactic acid,OP Fee Schedule,Straight Discount,53.20%,OP,11.57,11.57,,,,,,,,,,,,,
Corvel,CPT,83615,Lactate (ld) (ldh) enzyme,OP Fee Schedule,Per Unit,$38.41 ,OP,6.04,38.41,,,,,,,,,,,,,
Corvel,CPT,83625,Assay of ldh enzymes,OP Fee Schedule,Straight Discount,53.20%,OP,12.79,12.79,,,,,,,,,,,,,
Corvel,CPT,83630,Lactoferrin fecal (qual),OP Fee Schedule,Straight Discount,53.20%,OP,19.7,19.7,,,,,,,,,,,,,
Corvel,CPT,83631,Lactoferrin fecal (quant),OP Fee Schedule,Straight Discount,53.20%,OP,19.63,19.63,,,,,,,,,,,,,
Corvel,CPT,83632,Placental lactogen,OP Fee Schedule,Straight Discount,53.20%,OP,20.22,20.22,,,,,,,,,,,,,
Corvel,CPT,83633,Test urine for lactose,OP Fee Schedule,Straight Discount,53.20%,OP,11.25,11.25,,,,,,,,,,,,,
Corvel,CPT,83655,Assay of lead,OP Fee Schedule,Per Unit,$51.41 ,OP,12.11,51.41,,,,,,,,,,,,,
Corvel,CPT,83661,L/s ratio fetal lung,OP Fee Schedule,Straight Discount,53.20%,OP,21.99,21.99,,,,,,,,,,,,,
Corvel,CPT,83662,Foam stability fetal lung,OP Fee Schedule,Straight Discount,53.20%,OP,18.91,18.91,,,,,,,,,,,,,
Corvel,CPT,83663,Fluoro polarize fetal lung,OP Fee Schedule,Straight Discount,53.20%,OP,18.91,18.91,,,,,,,,,,,,,
Corvel,CPT,83664,Lamellar bdy fetal lung,OP Fee Schedule,Straight Discount,53.20%,OP,19.32,19.32,,,,,,,,,,,,,
Corvel,CPT,83670,Assay of lap enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,9.81,9.81,,,,,,,,,,,,,
Corvel,CPT,83690,Assay of lipase,OP Fee Schedule,Per Unit,$62.85 ,OP,6.89,62.85,,,,,,,,,,,,,
Corvel,CPT,83695,Assay of lipoprotein(a),OP Fee Schedule,Straight Discount,53.20%,OP,14.32,14.32,,,,,,,,,,,,,
Corvel,CPT,83698,Assay lipoprotein pla2,OP Fee Schedule,Straight Discount,53.20%,OP,46.31,46.31,,,,,,,,,,,,,
Corvel,CPT,83700,Lipopro bld electrophoretic,OP Fee Schedule,Straight Discount,53.20%,OP,11.26,11.26,,,,,,,,,,,,,
Corvel,CPT,83701,Lipoprotein bld hr fraction,OP Fee Schedule,Straight Discount,53.20%,OP,33.86,33.86,,,,,,,,,,,,,
Corvel,CPT,83704,Lipoprotein bld quan part,OP Fee Schedule,Straight Discount,53.20%,OP,34.19,34.19,,,,,,,,,,,,,
Corvel,CPT,83718,Assay of lipoprotein,OP Fee Schedule,Straight Discount,53.20%,OP,8.19,8.19,,,,,,,,,,,,,
Corvel,CPT,83719,Assay of blood lipoprotein,OP Fee Schedule,Straight Discount,53.20%,OP,12.75,12.75,,,,,,,,,,,,,
Corvel,CPT,83721,Assay of blood lipoprotein,OP Fee Schedule,Per Unit,$31.54 ,OP,10.5,31.54,,,,,,,,,,,,,
Corvel,CPT,83722,Lipoprtn dir meas sd ldl chl,OP Fee Schedule,Straight Discount,53.20%,OP,34.19,34.19,,,,,,,,,,,,,
Corvel,CPT,83727,Assay of lrh hormone,OP Fee Schedule,Straight Discount,53.20%,OP,17.19,17.19,,,,,,,,,,,,,
Corvel,CPT,83735,Assay of magnesium,OP Fee Schedule,Per Unit,$49.93 ,OP,6.7,49.93,,,,,,,,,,,,,
Corvel,CPT,83775,Assay malate dehydrogenase,OP Fee Schedule,Straight Discount,53.20%,OP,7.37,7.37,,,,,,,,,,,,,
Corvel,CPT,83785,Assay of manganese,OP Fee Schedule,Straight Discount,53.20%,OP,26.65,26.65,,,,,,,,,,,,,
Corvel,CPT,83789,Mass spectrometry qual/quan,OP Fee Schedule,Straight Discount,53.20%,OP,24.11,24.11,,,,,,,,,,,,,
Corvel,CPT,83825,Assay of mercury,OP Fee Schedule,Straight Discount,53.20%,OP,16.26,16.26,,,,,,,,,,,,,
Corvel,CPT,83835,Assay of metanephrines,OP Fee Schedule,Straight Discount,53.20%,OP,16.94,16.94,,,,,,,,,,,,,
Corvel,CPT,83857,Assay of methemalbumin,OP Fee Schedule,Straight Discount,53.20%,OP,10.74,10.74,,,,,,,,,,,,,
Corvel,CPT,83861,Microfluid analy tears,OP Fee Schedule,Straight Discount,53.20%,OP,22.48,22.48,,,,,,,,,,,,,
Corvel,CPT,83864,Mucopolysaccharides,OP Fee Schedule,Straight Discount,53.20%,OP,28.5,28.5,,,,,,,,,,,,,
Corvel,CPT,83872,Assay synovial fluid mucin,OP Fee Schedule,Straight Discount,53.20%,OP,5.86,5.86,,,,,,,,,,,,,
Corvel,CPT,83873,Assay of csf protein,OP Fee Schedule,Straight Discount,53.20%,OP,17.2,17.2,,,,,,,,,,,,,
Corvel,CPT,83874,Assay of myoglobin,OP Fee Schedule,Per Unit,$88.13 ,OP,12.92,88.13,,,,,,,,,,,,,
Corvel,CPT,83876,Assay myeloperoxidase,OP Fee Schedule,Straight Discount,53.20%,OP,50.86,50.86,,,,,,,,,,,,,
Corvel,CPT,83880,Assay of natriuretic peptide,OP Fee Schedule,Per Unit,$117.54 ,OP,39.26,117.54,,,,,,,,,,,,,
Corvel,CPT,83883,Assay nephelometry not spec,OP Fee Schedule,Straight Discount,53.20%,OP,13.6,13.6,,,,,,,,,,,,,
Corvel,CPT,83885,Assay of nickel,OP Fee Schedule,Straight Discount,53.20%,OP,24.51,24.51,,,,,,,,,,,,,
Corvel,CPT,83915,Assay of nucleotidase,OP Fee Schedule,Straight Discount,53.20%,OP,11.15,11.15,,,,,,,,,,,,,
Corvel,CPT,83916,Oligoclonal bands,OP Fee Schedule,Straight Discount,53.20%,OP,27.39,27.39,,,,,,,,,,,,,
Corvel,CPT,83918,Organic acids total quant,OP Fee Schedule,Straight Discount,53.20%,OP,23.6,23.6,,,,,,,,,,,,,
Corvel,CPT,83919,Organic acids qual each,OP Fee Schedule,Straight Discount,53.20%,OP,16.45,16.45,,,,,,,,,,,,,
Corvel,CPT,83921,Organic acid single quant,OP Fee Schedule,Per Unit,$145.24 ,OP,21.21,145.24,,,,,,,,,,,,,
Corvel,CPT,83930,Assay of blood osmolality,OP Fee Schedule,Straight Discount,53.20%,OP,6.61,6.61,,,,,,,,,,,,,
Corvel,CPT,83935,Assay of urine osmolality,OP Fee Schedule,Straight Discount,53.20%,OP,6.82,6.82,,,,,,,,,,,,,
Corvel,CPT,83937,Assay of osteocalcin,OP Fee Schedule,Straight Discount,53.20%,OP,29.85,29.85,,,,,,,,,,,,,
Corvel,CPT,83945,Assay of oxalate,OP Fee Schedule,Straight Discount,53.20%,OP,14.45,14.45,,,,,,,,,,,,,
Corvel,CPT,83950,Oncoprotein her-2/neu,OP Fee Schedule,Straight Discount,53.20%,OP,64.41,64.41,,,,,,,,,,,,,
Corvel,CPT,83951,Oncoprotein dcp,OP Fee Schedule,Straight Discount,53.20%,OP,64.41,64.41,,,,,,,,,,,,,
Corvel,CPT,83970,Assay of parathormone,OP Fee Schedule,Per Unit,$150.72 ,OP,41.28,150.72,,,,,,,,,,,,,
Corvel,CPT,83986,Assay ph body fluid nos,OP Fee Schedule,Per Unit,$42.85 ,OP,3.58,42.85,,,,,,,,,,,,,
Corvel,CPT,83987,Exhaled breath condensate,OP Fee Schedule,Straight Discount,53.20%,OP,3.58,3.58,,,,,,,,,,,,,
Corvel,CPT,83992,Assay for phencyclidine,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,83993,Assay for calprotectin fecal,OP Fee Schedule,Straight Discount,53.20%,OP,19.63,19.63,,,,,,,,,,,,,
Corvel,CPT,84030,Assay of blood pku,OP Fee Schedule,Straight Discount,53.20%,OP,5.5,5.5,,,,,,,,,,,,,
Corvel,CPT,84035,Assay of phenylketones,OP Fee Schedule,Straight Discount,53.20%,OP,3.98,3.98,,,,,,,,,,,,,
Corvel,CPT,84060,Assay acid phosphatase,OP Fee Schedule,Straight Discount,53.20%,OP,7.64,7.64,,,,,,,,,,,,,
Corvel,CPT,84066,Assay prostate phosphatase,OP Fee Schedule,Per Unit,$52.50 ,OP,9.66,52.5,,,,,,,,,,,,,
Corvel,CPT,84075,Assay alkaline phosphatase,OP Fee Schedule,Per Unit,$49.45 ,OP,5.18,49.45,,,,,,,,,,,,,
Corvel,CPT,84078,Assay alkaline phosphatase,OP Fee Schedule,Straight Discount,53.20%,OP,8.26,8.26,,,,,,,,,,,,,
Corvel,CPT,84080,Assay alkaline phosphatases,OP Fee Schedule,Straight Discount,53.20%,OP,14.78,14.78,,,,,,,,,,,,,
Corvel,CPT,84081,Assay phosphatidylglycerol,OP Fee Schedule,Straight Discount,53.20%,OP,16.52,16.52,,,,,,,,,,,,,
Corvel,CPT,84085,Assay of rbc pg6d enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,9.44,9.44,,,,,,,,,,,,,
Corvel,CPT,84087,Assay phosphohexose enzymes,OP Fee Schedule,Straight Discount,53.20%,OP,10.73,10.73,,,,,,,,,,,,,
Corvel,CPT,84100,Assay of phosphorus,OP Fee Schedule,Per Unit,$30.03 ,OP,4.74,30.03,,,,,,,,,,,,,
Corvel,CPT,84105,Assay of urine phosphorus,OP Fee Schedule,Straight Discount,53.20%,OP,5.78,5.78,,,,,,,,,,,,,
Corvel,CPT,84106,Test for porphobilinogen,OP Fee Schedule,Straight Discount,53.20%,OP,5.82,5.82,,,,,,,,,,,,,
Corvel,CPT,84110,Assay of porphobilinogen,OP Fee Schedule,Straight Discount,53.20%,OP,8.44,8.44,,,,,,,,,,,,,
Corvel,CPT,84112,Eval amniotic fluid protein,OP Fee Schedule,Straight Discount,53.20%,OP,98.11,98.11,,,,,,,,,,,,,
Corvel,CPT,84119,Test urine for porphyrins,OP Fee Schedule,Straight Discount,53.20%,OP,13.36,13.36,,,,,,,,,,,,,
Corvel,CPT,84120,Assay of urine porphyrins,OP Fee Schedule,Straight Discount,53.20%,OP,14.71,14.71,,,,,,,,,,,,,
Corvel,CPT,84126,Assay of feces porphyrins,OP Fee Schedule,Straight Discount,53.20%,OP,39.11,39.11,,,,,,,,,,,,,
Corvel,CPT,84132,Assay of serum potassium,OP Fee Schedule,Per Unit,$26.28 ,OP,4.76,26.28,,,,,,,,,,,,,
Corvel,CPT,84133,Assay of urine potassium,OP Fee Schedule,Straight Discount,53.20%,OP,4.73,4.73,,,,,,,,,,,,,
Corvel,CPT,84134,Assay of prealbumin,OP Fee Schedule,Per Unit,$134.58 ,OP,14.59,134.58,,,,,,,,,,,,,
Corvel,CPT,84135,Assay of pregnanediol,OP Fee Schedule,Straight Discount,53.20%,OP,21.27,21.27,,,,,,,,,,,,,
Corvel,CPT,84138,Assay of pregnanetriol,OP Fee Schedule,Straight Discount,53.20%,OP,21.05,21.05,,,,,,,,,,,,,
Corvel,CPT,84140,Assay of pregnenolone,OP Fee Schedule,Straight Discount,53.20%,OP,20.67,20.67,,,,,,,,,,,,,
Corvel,CPT,84143,Assay of 17-hydroxypregneno,OP Fee Schedule,Straight Discount,53.20%,OP,22.81,22.81,,,,,,,,,,,,,
Corvel,CPT,84144,Assay of progesterone,OP Fee Schedule,Per Unit,$106.83 ,OP,20.86,106.83,,,,,,,,,,,,,
Corvel,CPT,84145,Procalcitonin (pct),OP Fee Schedule,Straight Discount,53.20%,OP,27.22,27.22,,,,,,,,,,,,,
Corvel,CPT,84146,Assay of prolactin,OP Fee Schedule,Per Unit,$102.92 ,OP,19.38,102.92,,,,,,,,,,,,,
Corvel,CPT,84150,Assay of prostaglandin,OP Fee Schedule,Straight Discount,53.20%,OP,41.77,41.77,,,,,,,,,,,,,
Corvel,CPT,84152,Assay of psa complexed,OP Fee Schedule,Straight Discount,53.20%,OP,18.39,18.39,,,,,,,,,,,,,
Corvel,CPT,84153,Assay of psa total,OP Fee Schedule,Per Unit,$85.77 ,OP,18.39,85.77,,,,,,,,,,,,,
Corvel,CPT,84154,Assay of psa free,OP Fee Schedule,Per Unit,$137.20 ,OP,18.39,137.2,,,,,,,,,,,,,
Corvel,CPT,84155,Assay of protein serum,OP Fee Schedule,Per Unit,$57.96 ,OP,3.67,57.96,,,,,,,,,,,,,
Corvel,CPT,84156,Assay of protein urine,OP Fee Schedule,Per Unit,$61.98 ,OP,3.67,61.98,,,,,,,,,,,,,
Corvel,CPT,84157,Assay of protein other,OP Fee Schedule,Per Unit,$58.82 ,OP,4,58.82,,,,,,,,,,,,,
Corvel,CPT,84160,Assay of protein any source,OP Fee Schedule,Straight Discount,53.20%,OP,5.61,5.61,,,,,,,,,,,,,
Corvel,CPT,84163,Pappa serum,OP Fee Schedule,Straight Discount,53.20%,OP,15.05,15.05,,,,,,,,,,,,,
Corvel,CPT,84165,Protein e-phoresis serum,OP Fee Schedule,Per Unit,$98.71 ,OP,10.74,98.71,,,,,,,,,,,,,
Corvel,CPT,84166,Protein e-phoresis/urine/csf,OP Fee Schedule,Straight Discount,53.20%,OP,17.83,17.83,,,,,,,,,,,,,
Corvel,CPT,84181,Western blot test,OP Fee Schedule,Straight Discount,53.20%,OP,17.03,17.03,,,,,,,,,,,,,
Corvel,CPT,84182,Protein western blot test,OP Fee Schedule,Straight Discount,53.20%,OP,29.21,29.21,,,,,,,,,,,,,
Corvel,CPT,84202,Assay rbc protoporphyrin,OP Fee Schedule,Straight Discount,53.20%,OP,14.35,14.35,,,,,,,,,,,,,
Corvel,CPT,84203,Test rbc protoporphyrin,OP Fee Schedule,Straight Discount,53.20%,OP,9.74,9.74,,,,,,,,,,,,,
Corvel,CPT,84206,Assay of proinsulin,OP Fee Schedule,Straight Discount,53.20%,OP,26.69,26.69,,,,,,,,,,,,,
Corvel,CPT,84207,Assay of vitamin b-6,OP Fee Schedule,Straight Discount,53.20%,OP,28.1,28.1,,,,,,,,,,,,,
Corvel,CPT,84210,Assay of pyruvate,OP Fee Schedule,Straight Discount,53.20%,OP,14.48,14.48,,,,,,,,,,,,,
Corvel,CPT,84220,Assay of pyruvate kinase,OP Fee Schedule,Straight Discount,53.20%,OP,9.44,9.44,,,,,,,,,,,,,
Corvel,CPT,84228,Assay of quinine,OP Fee Schedule,Straight Discount,53.20%,OP,11.63,11.63,,,,,,,,,,,,,
Corvel,CPT,84233,Assay of estrogen,OP Fee Schedule,Straight Discount,53.20%,OP,87.88,87.88,,,,,,,,,,,,,
Corvel,CPT,84234,Assay of progesterone,OP Fee Schedule,Straight Discount,53.20%,OP,64.88,64.88,,,,,,,,,,,,,
Corvel,CPT,84235,Assay of endocrine hormone,OP Fee Schedule,Straight Discount,53.20%,OP,71.23,71.23,,,,,,,,,,,,,
Corvel,CPT,84238,Assay nonendocrine receptor,OP Fee Schedule,Straight Discount,53.20%,OP,36.57,36.57,,,,,,,,,,,,,
Corvel,CPT,84244,Assay of renin,OP Fee Schedule,Straight Discount,53.20%,OP,21.99,21.99,,,,,,,,,,,,,
Corvel,CPT,84252,Assay of vitamin b-2,OP Fee Schedule,Straight Discount,53.20%,OP,20.24,20.24,,,,,,,,,,,,,
Corvel,CPT,84255,Assay of selenium,OP Fee Schedule,Straight Discount,53.20%,OP,25.53,25.53,,,,,,,,,,,,,
Corvel,CPT,84260,Assay of serotonin,OP Fee Schedule,Straight Discount,53.20%,OP,30.98,30.98,,,,,,,,,,,,,
Corvel,CPT,84270,Assay of sex hormone globul,OP Fee Schedule,Straight Discount,53.20%,OP,21.73,21.73,,,,,,,,,,,,,
Corvel,CPT,84275,Assay of sialic acid,OP Fee Schedule,Straight Discount,53.20%,OP,13.44,13.44,,,,,,,,,,,,,
Corvel,CPT,84285,Assay of silica,OP Fee Schedule,Straight Discount,53.20%,OP,25.21,25.21,,,,,,,,,,,,,
Corvel,CPT,84295,Assay of serum sodium,OP Fee Schedule,Per Unit,$27.05 ,OP,4.81,27.05,,,,,,,,,,,,,
Corvel,CPT,84300,Assay of urine sodium,OP Fee Schedule,Straight Discount,53.20%,OP,5.06,5.06,,,,,,,,,,,,,
Corvel,CPT,84302,Assay of sweat sodium,OP Fee Schedule,Straight Discount,53.20%,OP,4.86,4.86,,,,,,,,,,,,,
Corvel,CPT,84305,Assay of somatomedin,OP Fee Schedule,Straight Discount,53.20%,OP,21.26,21.26,,,,,,,,,,,,,
Corvel,CPT,84307,Assay of somatostatin,OP Fee Schedule,Straight Discount,53.20%,OP,18.28,18.28,,,,,,,,,,,,,
Corvel,CPT,84311,Spectrophotometry,OP Fee Schedule,Straight Discount,53.20%,OP,8.1,8.1,,,,,,,,,,,,,
Corvel,CPT,84315,Body fluid specific gravity,OP Fee Schedule,Straight Discount,53.20%,OP,3.28,3.28,,,,,,,,,,,,,
Corvel,CPT,84375,Chromatogram assay sugars,OP Fee Schedule,Straight Discount,53.20%,OP,39,39,,,,,,,,,,,,,
Corvel,CPT,84376,Sugars single qual,OP Fee Schedule,Straight Discount,53.20%,OP,5.5,5.5,,,,,,,,,,,,,
Corvel,CPT,84377,Sugars multiple qual,OP Fee Schedule,Straight Discount,53.20%,OP,5.5,5.5,,,,,,,,,,,,,
Corvel,CPT,84378,Sugars single quant,OP Fee Schedule,Straight Discount,53.20%,OP,11.53,11.53,,,,,,,,,,,,,
Corvel,CPT,84379,Sugars multiple quant,OP Fee Schedule,Straight Discount,53.20%,OP,11.53,11.53,,,,,,,,,,,,,
Corvel,CPT,84392,Assay of urine sulfate,OP Fee Schedule,Straight Discount,53.20%,OP,5.49,5.49,,,,,,,,,,,,,
Corvel,CPT,84402,Assay of free testosterone,OP Fee Schedule,Per Unit,$124.14 ,OP,25.47,124.14,,,,,,,,,,,,,
Corvel,CPT,84403,Assay of total testosterone,OP Fee Schedule,Per Unit,$89.47 ,OP,25.81,89.47,,,,,,,,,,,,,
Corvel,CPT,84410,Testosterone bioavailable,OP Fee Schedule,Straight Discount,53.20%,OP,51.28,51.28,,,,,,,,,,,,,
Corvel,CPT,84425,Assay of vitamin b-1,OP Fee Schedule,Per Unit,$100.21 ,OP,21.23,100.21,,,,,,,,,,,,,
Corvel,CPT,84430,Assay of thiocyanate,OP Fee Schedule,Straight Discount,53.20%,OP,11.63,11.63,,,,,,,,,,,,,
Corvel,CPT,84431,Thromboxane urine,OP Fee Schedule,Straight Discount,53.20%,OP,35.11,35.11,,,,,,,,,,,,,
Corvel,CPT,84432,Assay of thyroglobulin,OP Fee Schedule,Straight Discount,53.20%,OP,16.06,16.06,,,,,,,,,,,,,
Corvel,CPT,84436,Assay of total thyroxine,OP Fee Schedule,Per Unit,$68.93 ,OP,6.87,68.93,,,,,,,,,,,,,
Corvel,CPT,84437,Assay of neonatal thyroxine,OP Fee Schedule,Straight Discount,53.20%,OP,6.47,6.47,,,,,,,,,,,,,
Corvel,CPT,84439,Assay of free thyroxine,OP Fee Schedule,Per Unit,$89.58 ,OP,9.02,89.58,,,,,,,,,,,,,
Corvel,CPT,84442,Assay of thyroid activity,OP Fee Schedule,Straight Discount,53.20%,OP,14.78,14.78,,,,,,,,,,,,,
Corvel,CPT,84443,Assay thyroid stim hormone,OP Fee Schedule,Per Unit,$88.05 ,OP,16.8,88.05,,,,,,,,,,,,,
Corvel,CPT,84445,Assay of tsi globulin,OP Fee Schedule,Straight Discount,53.20%,OP,50.86,50.86,,,,,,,,,,,,,
Corvel,CPT,84446,Assay of vitamin e,OP Fee Schedule,Straight Discount,53.20%,OP,14.18,14.18,,,,,,,,,,,,,
Corvel,CPT,84449,Assay of transcortin,OP Fee Schedule,Straight Discount,53.20%,OP,18,18,,,,,,,,,,,,,
Corvel,CPT,84450,Transferase (ast) (sgot),OP Fee Schedule,Per Unit,$43.18 ,OP,5.18,43.18,,,,,,,,,,,,,
Corvel,CPT,84460,Alanine amino (alt) (sgpt),OP Fee Schedule,Per Unit,$53.21 ,OP,5.3,53.21,,,,,,,,,,,,,
Corvel,CPT,84466,Assay of transferrin,OP Fee Schedule,Per Unit,$137.91 ,OP,12.76,137.91,,,,,,,,,,,,,
Corvel,CPT,84478,Assay of triglycerides,OP Fee Schedule,Per Unit,$47.98 ,OP,5.74,47.98,,,,,,,,,,,,,
Corvel,CPT,84479,Assay of thyroid (t3 or t4),OP Fee Schedule,Per Unit,$51.35 ,OP,6.47,51.35,,,,,,,,,,,,,
Corvel,CPT,84480,Assay triiodothyronine (t3),OP Fee Schedule,Per Unit,$70.19 ,OP,14.18,70.19,,,,,,,,,,,,,
Corvel,CPT,84481,Free assay (ft-3),OP Fee Schedule,Per Unit,$203.60 ,OP,16.94,203.6,,,,,,,,,,,,,
Corvel,CPT,84482,T3 reverse,OP Fee Schedule,Straight Discount,53.20%,OP,15.76,15.76,,,,,,,,,,,,,
Corvel,CPT,84484,Assay of troponin quant,OP Fee Schedule,Per Unit,$101.15 ,OP,12.47,101.15,,,,,,,,,,,,,
Corvel,CPT,84485,Assay duodenal fluid trypsin,OP Fee Schedule,Straight Discount,53.20%,OP,7.2,7.2,,,,,,,,,,,,,
Corvel,CPT,84488,Test feces for trypsin,OP Fee Schedule,Straight Discount,53.20%,OP,7.3,7.3,,,,,,,,,,,,,
Corvel,CPT,84490,Assay of feces for trypsin,OP Fee Schedule,Straight Discount,53.20%,OP,9.93,9.93,,,,,,,,,,,,,
Corvel,CPT,84510,Assay of tyrosine,OP Fee Schedule,Straight Discount,53.20%,OP,10.63,10.63,,,,,,,,,,,,,
Corvel,CPT,84512,Assay of troponin qual,OP Fee Schedule,Per Unit,$18.49 ,OP,10.09,18.49,,,,,,,,,,,,,
Corvel,CPT,84520,Assay of urea nitrogen,OP Fee Schedule,Per Unit,$35.34 ,OP,3.95,35.34,,,,,,,,,,,,,
Corvel,CPT,84525,Urea nitrogen semi-quant,OP Fee Schedule,Straight Discount,53.20%,OP,5.13,5.13,,,,,,,,,,,,,
Corvel,CPT,84540,Assay of urine/urea-n,OP Fee Schedule,Straight Discount,53.20%,OP,5.56,5.56,,,,,,,,,,,,,
Corvel,CPT,84545,Urea-n clearance test,OP Fee Schedule,Straight Discount,53.20%,OP,7.2,7.2,,,,,,,,,,,,,
Corvel,CPT,84550,Assay of blood/uric acid,OP Fee Schedule,Per Unit,$40.06 ,OP,4.52,40.06,,,,,,,,,,,,,
Corvel,CPT,84560,Assay of urine/uric acid,OP Fee Schedule,Straight Discount,53.20%,OP,5.08,5.08,,,,,,,,,,,,,
Corvel,CPT,84577,Assay of feces/urobilinogen,OP Fee Schedule,Straight Discount,53.20%,OP,16.8,16.8,,,,,,,,,,,,,
Corvel,CPT,84578,Test urine urobilinogen,OP Fee Schedule,Straight Discount,53.20%,OP,4.47,4.47,,,,,,,,,,,,,
Corvel,CPT,84580,Assay of urine urobilinogen,OP Fee Schedule,Straight Discount,53.20%,OP,9.55,9.55,,,,,,,,,,,,,
Corvel,CPT,84583,Assay of urine urobilinogen,OP Fee Schedule,Straight Discount,53.20%,OP,6.05,6.05,,,,,,,,,,,,,
Corvel,CPT,84585,Assay of urine vma,OP Fee Schedule,Straight Discount,53.20%,OP,15.5,15.5,,,,,,,,,,,,,
Corvel,CPT,84586,Assay of vip,OP Fee Schedule,Straight Discount,53.20%,OP,35.33,35.33,,,,,,,,,,,,,
Corvel,CPT,84588,Assay of vasopressin,OP Fee Schedule,Straight Discount,53.20%,OP,33.94,33.94,,,,,,,,,,,,,
Corvel,CPT,84590,Assay of vitamin a,OP Fee Schedule,Straight Discount,53.20%,OP,11.61,11.61,,,,,,,,,,,,,
Corvel,CPT,84591,Assay of nos vitamin,OP Fee Schedule,Straight Discount,53.20%,OP,17.06,17.06,,,,,,,,,,,,,
Corvel,CPT,84597,Assay of vitamin k,OP Fee Schedule,Straight Discount,53.20%,OP,13.72,13.72,,,,,,,,,,,,,
Corvel,CPT,84600,Assay of volatiles,OP Fee Schedule,Straight Discount,53.20%,OP,17.11,17.11,,,,,,,,,,,,,
Corvel,CPT,84620,Xylose tolerance test,OP Fee Schedule,Straight Discount,53.20%,OP,12.91,12.91,,,,,,,,,,,,,
Corvel,CPT,84630,Assay of zinc,OP Fee Schedule,Straight Discount,53.20%,OP,11.39,11.39,,,,,,,,,,,,,
Corvel,CPT,84681,Assay of c-peptide,OP Fee Schedule,Straight Discount,53.20%,OP,20.81,20.81,,,,,,,,,,,,,
Corvel,CPT,84702,Chorionic gonadotropin test,OP Fee Schedule,Per Unit,$119.76 ,OP,15.05,119.76,,,,,,,,,,,,,
Corvel,CPT,84703,Chorionic gonadotropin assay,OP Fee Schedule,Per Unit,$74.14 ,OP,7.52,74.14,,,,,,,,,,,,,
Corvel,CPT,84704,Hcg free betachain test,OP Fee Schedule,Straight Discount,53.20%,OP,15.29,15.29,,,,,,,,,,,,,
Corvel,CPT,84830,Ovulation tests,OP Fee Schedule,Straight Discount,53.20%,OP,12.7,12.7,,,,,,,,,,,,,
Corvel,CPT,84999,Clinical chemistry test,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,85002,Bleeding time test,OP Fee Schedule,Per Unit,$57.42 ,OP,4.82,57.42,,,,,,,,,,,,,
Corvel,CPT,85004,Automated diff wbc count,OP Fee Schedule,Per Unit,$23.58 ,OP,6.47,23.58,,,,,,,,,,,,,
Corvel,CPT,85007,Bl smear w/diff wbc count,OP Fee Schedule,Per Unit,$25.99 ,OP,3.8,25.99,,,,,,,,,,,,,
Corvel,CPT,85008,Bl smear w/o diff wbc count,OP Fee Schedule,Per Unit,$7.88 ,OP,3.43,7.88,,,,,,,,,,,,,
Corvel,CPT,85009,Manual diff wbc count b-coat,OP Fee Schedule,Straight Discount,53.20%,OP,5.07,5.07,,,,,,,,,,,,,
Corvel,CPT,85013,Spun microhematocrit,OP Fee Schedule,Straight Discount,53.20%,OP,7,7,,,,,,,,,,,,,
Corvel,CPT,85014,Hematocrit,OP Fee Schedule,Per Unit,$24.01 ,OP,2.37,24.01,,,,,,,,,,,,,
Corvel,CPT,85018,Hemoglobin,OP Fee Schedule,Per Unit,$24.58 ,OP,2.37,24.58,,,,,,,,,,,,,
Corvel,CPT,85025,Complete cbc w/auto diff wbc,OP Fee Schedule,Per Unit,$56.94 ,OP,7.77,56.94,,,,,,,,,,,,,
Corvel,CPT,85027,Complete cbc automated,OP Fee Schedule,Per Unit,$51.06 ,OP,6.47,51.06,,,,,,,,,,,,,
Corvel,CPT,85032,Manual cell count each,OP Fee Schedule,Straight Discount,53.20%,OP,4.31,4.31,,,,,,,,,,,,,
Corvel,CPT,85041,Automated rbc count,OP Fee Schedule,Straight Discount,53.20%,OP,3.02,3.02,,,,,,,,,,,,,
Corvel,CPT,85044,Manual reticulocyte count,OP Fee Schedule,Per Unit,$52.26 ,OP,4.31,52.26,,,,,,,,,,,,,
Corvel,CPT,85045,Automated reticulocyte count,OP Fee Schedule,Per Unit,$44.56 ,OP,3.99,44.56,,,,,,,,,,,,,
Corvel,CPT,85046,Reticyte/hgb concentrate,OP Fee Schedule,Straight Discount,53.20%,OP,5.57,5.57,,,,,,,,,,,,,
Corvel,CPT,85048,Automated leukocyte count,OP Fee Schedule,Per Unit,$41.39 ,OP,2.54,41.39,,,,,,,,,,,,,
Corvel,CPT,85049,Automated platelet count,OP Fee Schedule,Per Unit,$35.71 ,OP,4.48,35.71,,,,,,,,,,,,,
Corvel,CPT,85055,Reticulated platelet assay,OP Fee Schedule,Straight Discount,53.20%,OP,35.74,35.74,,,,,,,,,,,,,
Corvel,CPT,85060,Blood smear interpretation,OP Fee Schedule,Per Unit,$56.42 ,OP,56.42,56.42,,,,,,,,,,,,,
Corvel,CPT,85097,Bone marrow interpretation,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,85130,Chromogenic substrate assay,OP Fee Schedule,Straight Discount,53.20%,OP,11.89,11.89,,,,,,,,,,,,,
Corvel,CPT,85170,Blood clot retraction,OP Fee Schedule,Straight Discount,53.20%,OP,16.3,16.3,,,,,,,,,,,,,
Corvel,CPT,85175,Blood clot lysis time,OP Fee Schedule,Straight Discount,53.20%,OP,20.37,20.37,,,,,,,,,,,,,
Corvel,CPT,85210,Clot factor ii prothrom spec,OP Fee Schedule,Straight Discount,53.20%,OP,12.98,12.98,,,,,,,,,,,,,
Corvel,CPT,85220,Blooc clot factor v test,OP Fee Schedule,Straight Discount,53.20%,OP,17.65,17.65,,,,,,,,,,,,,
Corvel,CPT,85230,Clot factor vii proconvertin,OP Fee Schedule,Straight Discount,53.20%,OP,17.9,17.9,,,,,,,,,,,,,
Corvel,CPT,85240,Clot factor viii ahg 1 stage,OP Fee Schedule,Straight Discount,53.20%,OP,17.9,17.9,,,,,,,,,,,,,
Corvel,CPT,85244,Clot factor viii reltd antgn,OP Fee Schedule,Straight Discount,53.20%,OP,20.42,20.42,,,,,,,,,,,,,
Corvel,CPT,85245,Clot factor viii vw ristoctn,OP Fee Schedule,Straight Discount,53.20%,OP,22.94,22.94,,,,,,,,,,,,,
Corvel,CPT,85246,Clot factor viii vw antigen,OP Fee Schedule,Straight Discount,53.20%,OP,22.94,22.94,,,,,,,,,,,,,
Corvel,CPT,85247,Clot factor viii multimetric,OP Fee Schedule,Straight Discount,53.20%,OP,22.94,22.94,,,,,,,,,,,,,
Corvel,CPT,85250,Clot factor ix ptc/chrstmas,OP Fee Schedule,Straight Discount,53.20%,OP,19.04,19.04,,,,,,,,,,,,,
Corvel,CPT,85260,Clot factor x stuart-power,OP Fee Schedule,Straight Discount,53.20%,OP,17.9,17.9,,,,,,,,,,,,,
Corvel,CPT,85270,Clot factor xi pta,OP Fee Schedule,Straight Discount,53.20%,OP,17.9,17.9,,,,,,,,,,,,,
Corvel,CPT,85280,Clot factor xii hageman,OP Fee Schedule,Straight Discount,53.20%,OP,19.35,19.35,,,,,,,,,,,,,
Corvel,CPT,85290,Clot factor xiii fibrin stab,OP Fee Schedule,Straight Discount,53.20%,OP,16.34,16.34,,,,,,,,,,,,,
Corvel,CPT,85291,Clot factor xiii fibrin scrn,OP Fee Schedule,Straight Discount,53.20%,OP,9.11,9.11,,,,,,,,,,,,,
Corvel,CPT,85292,Clot factor fletcher fact,OP Fee Schedule,Straight Discount,53.20%,OP,18.93,18.93,,,,,,,,,,,,,
Corvel,CPT,85293,Clot factor wght kininogen,OP Fee Schedule,Straight Discount,53.20%,OP,18.93,18.93,,,,,,,,,,,,,
Corvel,CPT,85300,Antithrombin iii activity,OP Fee Schedule,Straight Discount,53.20%,OP,11.85,11.85,,,,,,,,,,,,,
Corvel,CPT,85301,Antithrombin iii antigen,OP Fee Schedule,Straight Discount,53.20%,OP,10.81,10.81,,,,,,,,,,,,,
Corvel,CPT,85302,Clot inhibit prot c antigen,OP Fee Schedule,Straight Discount,53.20%,OP,12.01,12.01,,,,,,,,,,,,,
Corvel,CPT,85303,Clot inhibit prot c activity,OP Fee Schedule,Straight Discount,53.20%,OP,13.84,13.84,,,,,,,,,,,,,
Corvel,CPT,85305,Clot inhibit prot s total,OP Fee Schedule,Straight Discount,53.20%,OP,11.61,11.61,,,,,,,,,,,,,
Corvel,CPT,85306,Clot inhibit prot s free,OP Fee Schedule,Straight Discount,53.20%,OP,15.32,15.32,,,,,,,,,,,,,
Corvel,CPT,85307,Assay activated protein c,OP Fee Schedule,Straight Discount,53.20%,OP,15.32,15.32,,,,,,,,,,,,,
Corvel,CPT,85335,Factor inhibitor test,OP Fee Schedule,Straight Discount,53.20%,OP,12.87,12.87,,,,,,,,,,,,,
Corvel,CPT,85337,Thrombomodulin,OP Fee Schedule,Straight Discount,53.20%,OP,17.27,17.27,,,,,,,,,,,,,
Corvel,CPT,85345,Coagulation time lee & white,OP Fee Schedule,Straight Discount,53.20%,OP,4.69,4.69,,,,,,,,,,,,,
Corvel,CPT,85347,Coagulation time activated,OP Fee Schedule,Straight Discount,53.20%,OP,4.28,4.28,,,,,,,,,,,,,
Corvel,CPT,85348,Coagulation time otr method,OP Fee Schedule,Straight Discount,53.20%,OP,4.49,4.49,,,,,,,,,,,,,
Corvel,CPT,85360,Euglobulin lysis,OP Fee Schedule,Straight Discount,53.20%,OP,8.41,8.41,,,,,,,,,,,,,
Corvel,CPT,85362,Fibrin degradation products,OP Fee Schedule,Straight Discount,53.20%,OP,6.89,6.89,,,,,,,,,,,,,
Corvel,CPT,85366,Fibrinogen test,OP Fee Schedule,Straight Discount,53.20%,OP,80.46,80.46,,,,,,,,,,,,,
Corvel,CPT,85370,Fibrinogen test,OP Fee Schedule,Per Unit,$108.05 ,OP,12.43,108.05,,,,,,,,,,,,,
Corvel,CPT,85378,Fibrin degrade semiquant,OP Fee Schedule,Per Unit,$231.57 ,OP,9.72,231.57,,,,,,,,,,,,,
Corvel,CPT,85379,Fibrin degradation quant,OP Fee Schedule,Per Unit,$89.03 ,OP,10.18,89.03,,,,,,,,,,,,,
Corvel,CPT,85380,Fibrin degradj d-dimer,OP Fee Schedule,Per Unit,$91.84 ,OP,10.18,91.84,,,,,,,,,,,,,
Corvel,CPT,85384,Fibrinogen activity,OP Fee Schedule,Per Unit,$93.84 ,OP,9.72,93.84,,,,,,,,,,,,,
Corvel,CPT,85385,Fibrinogen antigen,OP Fee Schedule,Straight Discount,53.20%,OP,14.46,14.46,,,,,,,,,,,,,
Corvel,CPT,85390,Fibrinolysins screen i&r,OP Fee Schedule,Straight Discount,53.20%,OP,15.48,15.48,,,,,,,,,,,,,
Corvel,CPT,85396,Clotting assay whole blood,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,85397,Clotting funct activity,OP Fee Schedule,Straight Discount,53.20%,OP,30.86,30.86,,,,,,,,,,,,,
Corvel,CPT,85400,Fibrinolytic plasmin,OP Fee Schedule,Straight Discount,53.20%,OP,7.71,7.71,,,,,,,,,,,,,
Corvel,CPT,85410,Fibrinolytic antiplasmin,OP Fee Schedule,Straight Discount,53.20%,OP,7.71,7.71,,,,,,,,,,,,,
Corvel,CPT,85415,Fibrinolytic plasminogen,OP Fee Schedule,Straight Discount,53.20%,OP,17.19,17.19,,,,,,,,,,,,,
Corvel,CPT,85420,Fibrinolytic plasminogen,OP Fee Schedule,Straight Discount,53.20%,OP,6.53,6.53,,,,,,,,,,,,,
Corvel,CPT,85421,Fibrinolytic plasminogen,OP Fee Schedule,Straight Discount,53.20%,OP,10.18,10.18,,,,,,,,,,,,,
Corvel,CPT,85441,Heinz bodies direct,OP Fee Schedule,Straight Discount,53.20%,OP,4.2,4.2,,,,,,,,,,,,,
Corvel,CPT,85445,Heinz bodies induced,OP Fee Schedule,Straight Discount,53.20%,OP,6.82,6.82,,,,,,,,,,,,,
Corvel,CPT,85460,Hemoglobin fetal,OP Fee Schedule,Per Unit,$192.31 ,OP,7.73,192.31,,,,,,,,,,,,,
Corvel,CPT,85461,Hemoglobin fetal,OP Fee Schedule,Per Unit,$47.96 ,OP,9.36,47.96,,,,,,,,,,,,,
Corvel,CPT,85475,Hemolysin acid,OP Fee Schedule,Straight Discount,53.20%,OP,8.87,8.87,,,,,,,,,,,,,
Corvel,CPT,85520,Heparin assay,OP Fee Schedule,Straight Discount,53.20%,OP,13.09,13.09,,,,,,,,,,,,,
Corvel,CPT,85525,Heparin neutralization,OP Fee Schedule,Straight Discount,53.20%,OP,11.84,11.84,,,,,,,,,,,,,
Corvel,CPT,85530,Heparin-protamine tolerance,OP Fee Schedule,Straight Discount,53.20%,OP,13.09,13.09,,,,,,,,,,,,,
Corvel,CPT,85536,Iron stain peripheral blood,OP Fee Schedule,Straight Discount,53.20%,OP,6.88,6.88,,,,,,,,,,,,,
Corvel,CPT,85540,Wbc alkaline phosphatase,OP Fee Schedule,Straight Discount,53.20%,OP,8.6,8.6,,,,,,,,,,,,,
Corvel,CPT,85547,Rbc mechanical fragility,OP Fee Schedule,Straight Discount,53.20%,OP,8.6,8.6,,,,,,,,,,,,,
Corvel,CPT,85549,Muramidase,OP Fee Schedule,Straight Discount,53.20%,OP,18.75,18.75,,,,,,,,,,,,,
Corvel,CPT,85555,Rbc osmotic fragility,OP Fee Schedule,Straight Discount,53.20%,OP,7.47,7.47,,,,,,,,,,,,,
Corvel,CPT,85557,Rbc osmotic fragility,OP Fee Schedule,Straight Discount,53.20%,OP,13.36,13.36,,,,,,,,,,,,,
Corvel,CPT,85576,Blood platelet aggregation,OP Fee Schedule,Per Unit,$48.46 ,OP,24.91,48.46,,,,,,,,,,,,,
Corvel,CPT,85597,Phospholipid pltlt neutraliz,OP Fee Schedule,Straight Discount,53.20%,OP,17.98,17.98,,,,,,,,,,,,,
Corvel,CPT,85598,Hexagnal phosph pltlt neutrl,OP Fee Schedule,Straight Discount,53.20%,OP,17.98,17.98,,,,,,,,,,,,,
Corvel,CPT,85610,Prothrombin time,OP Fee Schedule,Per Unit,$39.92 ,OP,4.29,39.92,,,,,,,,,,,,,
Corvel,CPT,85611,Prothrombin test,OP Fee Schedule,Straight Discount,53.20%,OP,3.94,3.94,,,,,,,,,,,,,
Corvel,CPT,85612,Viper venom prothrombin time,OP Fee Schedule,Straight Discount,53.20%,OP,17.49,17.49,,,,,,,,,,,,,
Corvel,CPT,85613,Russell viper venom diluted,OP Fee Schedule,Per Unit,$75.09 ,OP,9.58,75.09,,,,,,,,,,,,,
Corvel,CPT,85635,Reptilase test,OP Fee Schedule,Straight Discount,53.20%,OP,9.85,9.85,,,,,,,,,,,,,
Corvel,CPT,85651,Rbc sed rate nonautomated,OP Fee Schedule,Per Unit,$31.01 ,OP,4.27,31.01,,,,,,,,,,,,,
Corvel,CPT,85652,Rbc sed rate automated,OP Fee Schedule,Per Unit,$32.55 ,OP,2.7,32.55,,,,,,,,,,,,,
Corvel,CPT,85660,Rbc sickle cell test,OP Fee Schedule,Per Unit,$59.97 ,OP,5.51,59.97,,,,,,,,,,,,,
Corvel,CPT,85670,Thrombin time plasma,OP Fee Schedule,Straight Discount,53.20%,OP,5.77,5.77,,,,,,,,,,,,,
Corvel,CPT,85675,Thrombin time titer,OP Fee Schedule,Straight Discount,53.20%,OP,6.85,6.85,,,,,,,,,,,,,
Corvel,CPT,85705,Thromboplastin inhibition,OP Fee Schedule,Straight Discount,53.20%,OP,9.63,9.63,,,,,,,,,,,,,
Corvel,CPT,85730,Thromboplastin time partial,OP Fee Schedule,Per Unit,$38.20 ,OP,6.01,38.2,,,,,,,,,,,,,
Corvel,CPT,85732,Thromboplastin time partial,OP Fee Schedule,Straight Discount,53.20%,OP,6.47,6.47,,,,,,,,,,,,,
Corvel,CPT,85810,Blood viscosity examination,OP Fee Schedule,Straight Discount,53.20%,OP,11.67,11.67,,,,,,,,,,,,,
Corvel,CPT,85999,Hematology procedure,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,86000,Agglutinins febrile antigen,OP Fee Schedule,Straight Discount,53.20%,OP,6.98,6.98,,,,,,,,,,,,,
Corvel,CPT,86001,Allergen specific igg,OP Fee Schedule,Per Unit,$45.23 ,OP,7.82,45.23,,,,,,,,,,,,,
Corvel,CPT,86003,Allg spec ige crude xtrc ea,OP Fee Schedule,Per Unit,$26.11 ,OP,5.22,26.11,,,,,,,,,,,,,
Corvel,CPT,86005,Allg spec ige multiallg scr,OP Fee Schedule,Straight Discount,53.20%,OP,7.97,7.97,,,,,,,,,,,,,
Corvel,CPT,86008,Allg spec ige recomb ea,OP Fee Schedule,Straight Discount,53.20%,OP,17.93,17.93,,,,,,,,,,,,,
Corvel,CPT,86021,Wbc antibody identification,OP Fee Schedule,Straight Discount,53.20%,OP,15.05,15.05,,,,,,,,,,,,,
Corvel,CPT,86022,Platelet antibodies,OP Fee Schedule,Straight Discount,53.20%,OP,18.37,18.37,,,,,,,,,,,,,
Corvel,CPT,86023,Immunoglobulin assay,OP Fee Schedule,Straight Discount,53.20%,OP,12.46,12.46,,,,,,,,,,,,,
Corvel,CPT,86038,Antinuclear antibodies,OP Fee Schedule,Per Unit,$79.61 ,OP,12.09,79.61,,,,,,,,,,,,,
Corvel,CPT,86039,Antinuclear antibodies (ana),OP Fee Schedule,Per Unit,$104.77 ,OP,11.16,104.77,,,,,,,,,,,,,
Corvel,CPT,86060,Antistreptolysin o titer,OP Fee Schedule,Per Unit,$80.34 ,OP,7.3,80.34,,,,,,,,,,,,,
Corvel,CPT,86063,Antistreptolysin o screen,OP Fee Schedule,Straight Discount,53.20%,OP,5.77,5.77,,,,,,,,,,,,,
Corvel,CPT,86077,Phys blood bank serv xmatch,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,86078,Phys blood bank serv reactj,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86079,Phys blood bank serv authrj,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,86140,C-reactive protein,OP Fee Schedule,Per Unit,$39.28 ,OP,5.18,39.28,,,,,,,,,,,,,
Corvel,CPT,86141,C-reactive protein hs,OP Fee Schedule,Per Unit,$68.68 ,OP,12.95,68.68,,,,,,,,,,,,,
Corvel,CPT,86146,Beta-2 glycoprotein antibody,OP Fee Schedule,Straight Discount,53.20%,OP,25.45,25.45,,,,,,,,,,,,,
Corvel,CPT,86147,Cardiolipin antibody ea ig,OP Fee Schedule,Per Unit,$53.09 ,OP,25.45,53.09,,,,,,,,,,,,,
Corvel,CPT,86148,Anti-phospholipid antibody,OP Fee Schedule,Straight Discount,53.20%,OP,16.07,16.07,,,,,,,,,,,,,
Corvel,CPT,86152,Cell enumeration & id,OP Fee Schedule,Straight Discount,53.20%,OP,250.78,250.78,,,,,,,,,,,,,
Corvel,CPT,86153,Cell enumeration phys interp,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,86155,Chemotaxis assay,OP Fee Schedule,Straight Discount,53.20%,OP,15.99,15.99,,,,,,,,,,,,,
Corvel,CPT,86156,Cold agglutinin screen,OP Fee Schedule,Straight Discount,53.20%,OP,8.07,8.07,,,,,,,,,,,,,
Corvel,CPT,86157,Cold agglutinin titer,OP Fee Schedule,Per Unit,$67.86 ,OP,8.06,67.86,,,,,,,,,,,,,
Corvel,CPT,86160,Complement antigen,OP Fee Schedule,Per Unit,$88.44 ,OP,12,88.44,,,,,,,,,,,,,
Corvel,CPT,86161,Complement/function activity,OP Fee Schedule,Straight Discount,53.20%,OP,12,12,,,,,,,,,,,,,
Corvel,CPT,86162,Complement total (ch50),OP Fee Schedule,Per Unit,$63.10 ,OP,20.32,63.1,,,,,,,,,,,,,
Corvel,CPT,86171,Complement fixation each,OP Fee Schedule,Straight Discount,53.20%,OP,10.01,10.01,,,,,,,,,,,,,
Corvel,CPT,86200,Ccp antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.95,12.95,,,,,,,,,,,,,
Corvel,CPT,86215,Deoxyribonuclease antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.25,13.25,,,,,,,,,,,,,
Corvel,CPT,86225,Dna antibody native,OP Fee Schedule,Per Unit,$174.09 ,OP,13.74,174.09,,,,,,,,,,,,,
Corvel,CPT,86226,Dna antibody single strand,OP Fee Schedule,Straight Discount,53.20%,OP,12.11,12.11,,,,,,,,,,,,,
Corvel,CPT,86235,Nuclear antigen antibody,OP Fee Schedule,Per Unit,$103.22 ,OP,17.93,103.22,,,,,,,,,,,,,
Corvel,CPT,86255,Fluorescent antibody screen,OP Fee Schedule,Per Unit,$75.15 ,OP,12.05,75.15,,,,,,,,,,,,,
Corvel,CPT,86256,Fluorescent antibody titer,OP Fee Schedule,Per Unit,$88.26 ,OP,12.05,88.26,,,,,,,,,,,,,
Corvel,CPT,86277,Growth hormone antibody,OP Fee Schedule,Straight Discount,53.20%,OP,15.74,15.74,,,,,,,,,,,,,
Corvel,CPT,86280,Hemagglutination inhibition,OP Fee Schedule,Straight Discount,53.20%,OP,8.19,8.19,,,,,,,,,,,,,
Corvel,CPT,86294,Immunoassay tumor qual,OP Fee Schedule,Straight Discount,53.20%,OP,25.57,25.57,,,,,,,,,,,,,
Corvel,CPT,86300,Immunoassay tumor ca 15-3,OP Fee Schedule,Per Unit,$144.29 ,OP,20.81,144.29,,,,,,,,,,,,,
Corvel,CPT,86301,Immunoassay tumor ca 19-9,OP Fee Schedule,Per Unit,$130.83 ,OP,20.81,130.83,,,,,,,,,,,,,
Corvel,CPT,86304,Immunoassay tumor ca 125,OP Fee Schedule,Per Unit,$147.05 ,OP,20.81,147.05,,,,,,,,,,,,,
Corvel,CPT,86305,Human epididymis protein 4,OP Fee Schedule,Straight Discount,53.20%,OP,20.81,20.81,,,,,,,,,,,,,
Corvel,CPT,86308,Heterophile antibody screen,OP Fee Schedule,Per Unit,$45.13 ,OP,5.18,45.13,,,,,,,,,,,,,
Corvel,CPT,86309,Heterophile antibody titer,OP Fee Schedule,Straight Discount,53.20%,OP,6.47,6.47,,,,,,,,,,,,,
Corvel,CPT,86310,Heterophile antibody absrbj,OP Fee Schedule,Straight Discount,53.20%,OP,7.37,7.37,,,,,,,,,,,,,
Corvel,CPT,86316,Immunoassay tumor other,OP Fee Schedule,Per Unit,$151.27 ,OP,20.81,151.27,,,,,,,,,,,,,
Corvel,CPT,86317,Immunoassay infectious agent,OP Fee Schedule,Per Unit,$47.31 ,OP,14.99,47.31,,,,,,,,,,,,,
Corvel,CPT,86318,Ia infectious agent antibody,OP Fee Schedule,Per Unit,$57.94 ,OP,18.09,57.94,,,,,,,,,,,,,
Corvel,CPT,86320,Serum immunoelectrophoresis,OP Fee Schedule,Straight Discount,53.20%,OP,29.92,29.92,,,,,,,,,,,,,
Corvel,CPT,86325,Other immunoelectrophoresis,OP Fee Schedule,Straight Discount,53.20%,OP,23.13,23.13,,,,,,,,,,,,,
Corvel,CPT,86327,Immunoelectrophoresis assay,OP Fee Schedule,Straight Discount,53.20%,OP,29.92,29.92,,,,,,,,,,,,,
Corvel,CPT,86328,Ia nfct ab sarscov2 covid19,OP Fee Schedule,Straight Discount,53.20%,OP,45.23,45.23,,,,,,,,,,,,,
Corvel,CPT,86329,Immunodiffusion nes,OP Fee Schedule,Straight Discount,53.20%,OP,14.05,14.05,,,,,,,,,,,,,
Corvel,CPT,86331,Immunodiffusion ouchterlony,OP Fee Schedule,Per Unit,$49.10 ,OP,11.98,49.1,,,,,,,,,,,,,
Corvel,CPT,86332,Immune complex assay,OP Fee Schedule,Straight Discount,53.20%,OP,24.37,24.37,,,,,,,,,,,,,
Corvel,CPT,86334,Immunofix e-phoresis serum,OP Fee Schedule,Per Unit,$242.15 ,OP,22.34,242.15,,,,,,,,,,,,,
Corvel,CPT,86335,Immunfix e-phorsis/urine/csf,OP Fee Schedule,Straight Discount,53.20%,OP,29.35,29.35,,,,,,,,,,,,,
Corvel,CPT,86336,Inhibin a,OP Fee Schedule,Straight Discount,53.20%,OP,15.59,15.59,,,,,,,,,,,,,
Corvel,CPT,86337,Insulin antibodies,OP Fee Schedule,Straight Discount,53.20%,OP,21.41,21.41,,,,,,,,,,,,,
Corvel,CPT,86340,Intrinsic factor antibody,OP Fee Schedule,Straight Discount,53.20%,OP,15.08,15.08,,,,,,,,,,,,,
Corvel,CPT,86341,Islet cell antibody,OP Fee Schedule,Straight Discount,53.20%,OP,23.57,23.57,,,,,,,,,,,,,
Corvel,CPT,86343,Leukocyte histamine release,OP Fee Schedule,Straight Discount,53.20%,OP,12.46,12.46,,,,,,,,,,,,,
Corvel,CPT,86344,Leukocyte phagocytosis,OP Fee Schedule,Straight Discount,53.20%,OP,10.39,10.39,,,,,,,,,,,,,
Corvel,CPT,86352,Cell function assay w/stim,OP Fee Schedule,Straight Discount,53.20%,OP,135.86,135.86,,,,,,,,,,,,,
Corvel,CPT,86353,Lymphocyte transformation,OP Fee Schedule,Straight Discount,53.20%,OP,49.03,49.03,,,,,,,,,,,,,
Corvel,CPT,86355,B cells total count,OP Fee Schedule,Straight Discount,53.20%,OP,37.73,37.73,,,,,,,,,,,,,
Corvel,CPT,86356,Mononuclear cell antigen,OP Fee Schedule,Straight Discount,53.20%,OP,26.78,26.78,,,,,,,,,,,,,
Corvel,CPT,86357,Nk cells total count,OP Fee Schedule,Straight Discount,53.20%,OP,37.73,37.73,,,,,,,,,,,,,
Corvel,CPT,86359,T cells total count,OP Fee Schedule,Straight Discount,53.20%,OP,37.73,37.73,,,,,,,,,,,,,
Corvel,CPT,86360,T cell absolute count/ratio,OP Fee Schedule,Straight Discount,53.20%,OP,46.98,46.98,,,,,,,,,,,,,
Corvel,CPT,86361,T cell absolute count,OP Fee Schedule,Straight Discount,53.20%,OP,26.78,26.78,,,,,,,,,,,,,
Corvel,CPT,86367,Stem cells total count,OP Fee Schedule,Straight Discount,53.20%,OP,77.78,77.78,,,,,,,,,,,,,
Corvel,CPT,86376,Microsomal antibody each,OP Fee Schedule,Per Unit,$93.26 ,OP,14.55,93.26,,,,,,,,,,,,,
Corvel,CPT,86382,Neutralization test viral,OP Fee Schedule,Straight Discount,53.20%,OP,16.91,16.91,,,,,,,,,,,,,
Corvel,CPT,86384,Nitroblue tetrazolium dye,OP Fee Schedule,Straight Discount,53.20%,OP,13.61,13.61,,,,,,,,,,,,,
Corvel,CPT,86386,Nuclear matrix protein 22,OP Fee Schedule,Straight Discount,53.20%,OP,21.78,21.78,,,,,,,,,,,,,
Corvel,CPT,86403,Particle agglut antbdy scrn,OP Fee Schedule,Per Unit,$103.86 ,OP,11.54,103.86,,,,,,,,,,,,,
Corvel,CPT,86406,Particle agglut antbdy titr,OP Fee Schedule,Straight Discount,53.20%,OP,10.64,10.64,,,,,,,,,,,,,
Corvel,CPT,86408,Neutrlzg antb sarscov2 scr,OP Fee Schedule,Straight Discount,53.20%,OP,42.13,42.13,,,,,,,,,,,,,
Corvel,CPT,86409,Neutrlzg antb sarscov2 titer,OP Fee Schedule,Straight Discount,53.20%,OP,79.61,79.61,,,,,,,,,,,,,
Corvel,CPT,86413,Sars-cov-2 antb quantitative,OP Fee Schedule,Straight Discount,53.20%,OP,51.43,51.43,,,,,,,,,,,,,
Corvel,CPT,86430,Rheumatoid factor test qual,OP Fee Schedule,Per Unit,$40.64 ,OP,6.14,40.64,,,,,,,,,,,,,
Corvel,CPT,86431,Rheumatoid factor quant,OP Fee Schedule,Per Unit,$72.66 ,OP,5.67,72.66,,,,,,,,,,,,,
Corvel,CPT,86480,Tb test cell immun measure,OP Fee Schedule,Straight Discount,53.20%,OP,61.98,61.98,,,,,,,,,,,,,
Corvel,CPT,86481,Tb ag response t-cell susp,OP Fee Schedule,Straight Discount,53.20%,OP,100,100,,,,,,,,,,,,,
Corvel,CPT,86485,Skin test candida,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,86486,Skin test nos antigen,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,86490,Coccidioidomycosis skin test,OP Fee Schedule,Straight Discount,53.20%,OP,53.94,53.94,,,,,,,,,,,,,
Corvel,CPT,86510,Histoplasmosis skin test,OP Fee Schedule,Straight Discount,53.20%,OP,53.94,53.94,,,,,,,,,,,,,
Corvel,CPT,86580,Tb intradermal test,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,86590,Streptokinase antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.66,12.66,,,,,,,,,,,,,
Corvel,CPT,86592,Syphilis test non-trep qual,OP Fee Schedule,Per Unit,$29.58 ,OP,4.27,29.58,,,,,,,,,,,,,
Corvel,CPT,86593,Syphilis test non-trep quant,OP Fee Schedule,Straight Discount,53.20%,OP,4.4,4.4,,,,,,,,,,,,,
Corvel,CPT,86602,Antinomyces antibody,OP Fee Schedule,Straight Discount,53.20%,OP,10.18,10.18,,,,,,,,,,,,,
Corvel,CPT,86603,Adenovirus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.87,12.87,,,,,,,,,,,,,
Corvel,CPT,86606,Aspergillus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,15.05,15.05,,,,,,,,,,,,,
Corvel,CPT,86609,Bacterium antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.88,12.88,,,,,,,,,,,,,
Corvel,CPT,86611,Bartonella antibody,OP Fee Schedule,Straight Discount,53.20%,OP,10.18,10.18,,,,,,,,,,,,,
Corvel,CPT,86612,Blastomyces antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.9,12.9,,,,,,,,,,,,,
Corvel,CPT,86615,Bordetella antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86617,Lyme disease antibody,OP Fee Schedule,Per Unit,$87.27 ,OP,15.49,87.27,,,,,,,,,,,,,
Corvel,CPT,86618,Lyme disease antibody,OP Fee Schedule,Per Unit,$146.78 ,OP,17.03,146.78,,,,,,,,,,,,,
Corvel,CPT,86619,Borrelia antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.38,13.38,,,,,,,,,,,,,
Corvel,CPT,86622,Brucella antibody,OP Fee Schedule,Straight Discount,53.20%,OP,8.93,8.93,,,,,,,,,,,,,
Corvel,CPT,86625,Campylobacter antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.12,13.12,,,,,,,,,,,,,
Corvel,CPT,86628,Candida antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.01,12.01,,,,,,,,,,,,,
Corvel,CPT,86631,Chlamydia antibody,OP Fee Schedule,Straight Discount,53.20%,OP,11.82,11.82,,,,,,,,,,,,,
Corvel,CPT,86632,Chlamydia igm antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.68,12.68,,,,,,,,,,,,,
Corvel,CPT,86635,Coccidioides antibody,OP Fee Schedule,Straight Discount,53.20%,OP,11.47,11.47,,,,,,,,,,,,,
Corvel,CPT,86638,Q fever antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.12,12.12,,,,,,,,,,,,,
Corvel,CPT,86641,Cryptococcus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,14.41,14.41,,,,,,,,,,,,,
Corvel,CPT,86644,Cmv antibody,OP Fee Schedule,Per Unit,$74.47 ,OP,14.39,74.47,,,,,,,,,,,,,
Corvel,CPT,86645,Cmv antibody igm,OP Fee Schedule,Per Unit,$74.08 ,OP,16.85,74.08,,,,,,,,,,,,,
Corvel,CPT,86648,Diphtheria antibody,OP Fee Schedule,Straight Discount,53.20%,OP,15.21,15.21,,,,,,,,,,,,,
Corvel,CPT,86651,Encephalitis californ antbdy,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86652,Encephaltis east eqne anbdy,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86653,Encephaltis st louis antbody,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86654,Encephaltis west eqne antbdy,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86658,Enterovirus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.03,13.03,,,,,,,,,,,,,
Corvel,CPT,86663,Epstein-barr antibody,OP Fee Schedule,Per Unit,$57.25 ,OP,13.12,57.25,,,,,,,,,,,,,
Corvel,CPT,86664,Epstein-barr nuclear antigen,OP Fee Schedule,Per Unit,$93.06 ,OP,15.29,93.06,,,,,,,,,,,,,
Corvel,CPT,86665,Epstein-barr capsid vca,OP Fee Schedule,Per Unit,$60.64 ,OP,18.14,60.64,,,,,,,,,,,,,
Corvel,CPT,86666,Ehrlichia antibody,OP Fee Schedule,Straight Discount,53.20%,OP,10.18,10.18,,,,,,,,,,,,,
Corvel,CPT,86668,Francisella tularensis,OP Fee Schedule,Straight Discount,53.20%,OP,14.16,14.16,,,,,,,,,,,,,
Corvel,CPT,86671,Fungus nes antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.25,12.25,,,,,,,,,,,,,
Corvel,CPT,86674,Giardia lamblia antibody,OP Fee Schedule,Straight Discount,53.20%,OP,14.72,14.72,,,,,,,,,,,,,
Corvel,CPT,86677,Helicobacter pylori antibody,OP Fee Schedule,Per Unit,$103.56 ,OP,16.85,103.56,,,,,,,,,,,,,
Corvel,CPT,86682,Helminth antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.01,13.01,,,,,,,,,,,,,
Corvel,CPT,86684,Hemophilus influenza antibdy,OP Fee Schedule,Straight Discount,53.20%,OP,15.84,15.84,,,,,,,,,,,,,
Corvel,CPT,86687,Htlv-i antibody,OP Fee Schedule,Straight Discount,53.20%,OP,9.09,9.09,,,,,,,,,,,,,
Corvel,CPT,86688,Htlv-ii antibody,OP Fee Schedule,Straight Discount,53.20%,OP,14,14,,,,,,,,,,,,,
Corvel,CPT,86689,Htlv/hiv confirmj antibody,OP Fee Schedule,Straight Discount,53.20%,OP,19.35,19.35,,,,,,,,,,,,,
Corvel,CPT,86692,Hepatitis delta agent antbdy,OP Fee Schedule,Straight Discount,53.20%,OP,17.16,17.16,,,,,,,,,,,,,
Corvel,CPT,86694,Herpes simplex nes antbdy,OP Fee Schedule,Straight Discount,53.20%,OP,14.39,14.39,,,,,,,,,,,,,
Corvel,CPT,86695,Herpes simplex type 1 test,OP Fee Schedule,Per Unit,$73.26 ,OP,13.19,73.26,,,,,,,,,,,,,
Corvel,CPT,86696,Herpes simplex type 2 test,OP Fee Schedule,Per Unit,$53.71 ,OP,19.35,53.71,,,,,,,,,,,,,
Corvel,CPT,86698,Histoplasma antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.79,13.79,,,,,,,,,,,,,
Corvel,CPT,86701,Hiv-1antibody,OP Fee Schedule,Per Unit,$52.14 ,OP,8.89,52.14,,,,,,,,,,,,,
Corvel,CPT,86702,Hiv-2 antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.52,13.52,,,,,,,,,,,,,
Corvel,CPT,86703,Hiv-1/hiv-2 1 result antbdy,OP Fee Schedule,Per Unit,$96.85 ,OP,13.71,96.85,,,,,,,,,,,,,
Corvel,CPT,86704,Hep b core antibody total,OP Fee Schedule,Per Unit,$152.26 ,OP,12.05,152.26,,,,,,,,,,,,,
Corvel,CPT,86705,Hep b core antibody igm,OP Fee Schedule,Straight Discount,53.20%,OP,11.77,11.77,,,,,,,,,,,,,
Corvel,CPT,86706,Hep b surface antibody,OP Fee Schedule,Per Unit,$88.89 ,OP,10.74,88.89,,,,,,,,,,,,,
Corvel,CPT,86707,Hepatitis be antibody,OP Fee Schedule,Straight Discount,53.20%,OP,11.57,11.57,,,,,,,,,,,,,
Corvel,CPT,86708,Hepatitis a antibody,OP Fee Schedule,Per Unit,$115.32 ,OP,12.39,115.32,,,,,,,,,,,,,
Corvel,CPT,86709,Hepatitis a igm antibody,OP Fee Schedule,Per Unit,$153.78 ,OP,11.26,153.78,,,,,,,,,,,,,
Corvel,CPT,86710,Influenza virus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.55,13.55,,,,,,,,,,,,,
Corvel,CPT,86711,John cunningham antibody,OP Fee Schedule,Straight Discount,53.20%,OP,16.89,16.89,,,,,,,,,,,,,
Corvel,CPT,86713,Legionella antibody,OP Fee Schedule,Straight Discount,53.20%,OP,15.3,15.3,,,,,,,,,,,,,
Corvel,CPT,86717,Leishmania antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.25,12.25,,,,,,,,,,,,,
Corvel,CPT,86720,Leptospira antibody,OP Fee Schedule,Straight Discount,53.20%,OP,16.2,16.2,,,,,,,,,,,,,
Corvel,CPT,86723,Listeria monocytogenes,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86727,Lymph choriomeningitis ab,OP Fee Schedule,Straight Discount,53.20%,OP,12.87,12.87,,,,,,,,,,,,,
Corvel,CPT,86732,Mucormycosis antibody,OP Fee Schedule,Straight Discount,53.20%,OP,15,15,,,,,,,,,,,,,
Corvel,CPT,86735,Mumps antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.05,13.05,,,,,,,,,,,,,
Corvel,CPT,86738,Mycoplasma antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.24,13.24,,,,,,,,,,,,,
Corvel,CPT,86741,Neisseria meningitidis,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86744,Nocardia antibody,OP Fee Schedule,Straight Discount,53.20%,OP,15.99,15.99,,,,,,,,,,,,,
Corvel,CPT,86747,Parvovirus antibody,OP Fee Schedule,Per Unit,$76.33 ,OP,15.03,76.33,,,,,,,,,,,,,
Corvel,CPT,86750,Malaria antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86753,Protozoa antibody nos,OP Fee Schedule,Straight Discount,53.20%,OP,12.39,12.39,,,,,,,,,,,,,
Corvel,CPT,86756,Respiratory virus antibody,OP Fee Schedule,Per Unit,$253.07 ,OP,15.89,253.07,,,,,,,,,,,,,
Corvel,CPT,86757,Rickettsia antibody,OP Fee Schedule,Straight Discount,53.20%,OP,19.35,19.35,,,,,,,,,,,,,
Corvel,CPT,86759,Rotavirus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,18.23,18.23,,,,,,,,,,,,,
Corvel,CPT,86762,Rubella antibody,OP Fee Schedule,Per Unit,$82.75 ,OP,14.39,82.75,,,,,,,,,,,,,
Corvel,CPT,86765,Rubeola antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.88,12.88,,,,,,,,,,,,,
Corvel,CPT,86768,Salmonella antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86769,Sars-cov-2 covid-19 antibody,OP Fee Schedule,Straight Discount,53.20%,OP,42.13,42.13,,,,,,,,,,,,,
Corvel,CPT,86771,Shigella antibody,OP Fee Schedule,Straight Discount,53.20%,OP,24.48,24.48,,,,,,,,,,,,,
Corvel,CPT,86774,Tetanus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,14.8,14.8,,,,,,,,,,,,,
Corvel,CPT,86777,Toxoplasma antibody,OP Fee Schedule,Per Unit,$27.10 ,OP,14.39,27.1,,,,,,,,,,,,,
Corvel,CPT,86778,Toxoplasma antibody igm,OP Fee Schedule,Straight Discount,53.20%,OP,14.41,14.41,,,,,,,,,,,,,
Corvel,CPT,86780,Treponema pallidum,OP Fee Schedule,Straight Discount,53.20%,OP,13.24,13.24,,,,,,,,,,,,,
Corvel,CPT,86784,Trichinella antibody,OP Fee Schedule,Straight Discount,53.20%,OP,12.56,12.56,,,,,,,,,,,,,
Corvel,CPT,86787,Varicella-zoster antibody,OP Fee Schedule,Per Unit,$162.40 ,OP,12.88,162.4,,,,,,,,,,,,,
Corvel,CPT,86788,West nile virus ab igm,OP Fee Schedule,Straight Discount,53.20%,OP,16.85,16.85,,,,,,,,,,,,,
Corvel,CPT,86789,West nile virus antibody,OP Fee Schedule,Straight Discount,53.20%,OP,14.39,14.39,,,,,,,,,,,,,
Corvel,CPT,86790,Virus antibody nos,OP Fee Schedule,Straight Discount,53.20%,OP,12.88,12.88,,,,,,,,,,,,,
Corvel,CPT,86793,Yersinia antibody,OP Fee Schedule,Straight Discount,53.20%,OP,13.19,13.19,,,,,,,,,,,,,
Corvel,CPT,86794,Zika virus igm antibody,OP Fee Schedule,Straight Discount,53.20%,OP,16.85,16.85,,,,,,,,,,,,,
Corvel,CPT,86800,Thyroglobulin antibody,OP Fee Schedule,Per Unit,$65.77 ,OP,15.91,65.77,,,,,,,,,,,,,
Corvel,CPT,86803,Hepatitis c ab test,OP Fee Schedule,Per Unit,$83.08 ,OP,14.27,83.08,,,,,,,,,,,,,
Corvel,CPT,86804,Hep c ab test confirm,OP Fee Schedule,Straight Discount,53.20%,OP,15.49,15.49,,,,,,,,,,,,,
Corvel,CPT,86805,Lymphocytotoxicity assay,OP Fee Schedule,Straight Discount,53.20%,OP,189.51,189.51,,,,,,,,,,,,,
Corvel,CPT,86806,Lymphocytotoxicity assay,OP Fee Schedule,Straight Discount,53.20%,OP,47.59,47.59,,,,,,,,,,,,,
Corvel,CPT,86807,Cytotoxic antibody screening,OP Fee Schedule,Straight Discount,53.20%,OP,78.65,78.65,,,,,,,,,,,,,
Corvel,CPT,86808,Cytotoxic antibody screening,OP Fee Schedule,Straight Discount,53.20%,OP,29.68,29.68,,,,,,,,,,,,,
Corvel,CPT,86812,Hla typing a b or c,OP Fee Schedule,Per Unit,$70.37 ,OP,25.81,70.37,,,,,,,,,,,,,
Corvel,CPT,86813,Hla typing a b or c,OP Fee Schedule,Straight Discount,53.20%,OP,58,58,,,,,,,,,,,,,
Corvel,CPT,86816,Hla typing dr/dq,OP Fee Schedule,Straight Discount,53.20%,OP,30.17,30.17,,,,,,,,,,,,,
Corvel,CPT,86817,Hla typing dr/dq,OP Fee Schedule,Straight Discount,53.20%,OP,106.14,106.14,,,,,,,,,,,,,
Corvel,CPT,86821,Lymphocyte culture mixed,OP Fee Schedule,Straight Discount,53.20%,OP,36.56,36.56,,,,,,,,,,,,,
Corvel,CPT,86825,Hla x-math non-cytotoxic,OP Fee Schedule,Straight Discount,53.20%,OP,109.49,109.49,,,,,,,,,,,,,
Corvel,CPT,86826,Hla x-match noncytotoxc addl,OP Fee Schedule,Straight Discount,53.20%,OP,36.53,36.53,,,,,,,,,,,,,
Corvel,CPT,86828,Hla class i&ii antibody qual,OP Fee Schedule,Straight Discount,53.20%,OP,64.19,64.19,,,,,,,,,,,,,
Corvel,CPT,86829,Hla class i/ii antibody qual,OP Fee Schedule,Straight Discount,53.20%,OP,64.19,64.19,,,,,,,,,,,,,
Corvel,CPT,86830,Hla class i phenotype qual,OP Fee Schedule,Straight Discount,53.20%,OP,95.52,95.52,,,,,,,,,,,,,
Corvel,CPT,86831,Hla class ii phenotype qual,OP Fee Schedule,Straight Discount,53.20%,OP,81.88,81.88,,,,,,,,,,,,,
Corvel,CPT,86832,Hla class i high defin qual,OP Fee Schedule,Straight Discount,53.20%,OP,323.75,323.75,,,,,,,,,,,,,
Corvel,CPT,86833,Hla class ii high defin qual,OP Fee Schedule,Straight Discount,53.20%,OP,325.8,325.8,,,,,,,,,,,,,
Corvel,CPT,86834,Hla class i semiquant panel,OP Fee Schedule,Straight Discount,53.20%,OP,357.56,357.56,,,,,,,,,,,,,
Corvel,CPT,86835,Hla class ii semiquant panel,OP Fee Schedule,Straight Discount,53.20%,OP,322.96,322.96,,,,,,,,,,,,,
Corvel,CPT,86849,Immunology procedure,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,86850,Rbc antibody screen,OP Fee Schedule,Per Unit,$56.34 ,OP,48.22,56.34,,,,,,,,,,,,,
Corvel,CPT,86860,Rbc antibody elution,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86870,Rbc antibody identification,OP Fee Schedule,Per Unit,$297.21 ,OP,282.25,297.21,,,,,,,,,,,,,
Corvel,CPT,86880,Coombs test direct,OP Fee Schedule,Straight Discount,53.20%,OP,53.94,53.94,,,,,,,,,,,,,
Corvel,CPT,86885,Coombs test indirect qual,OP Fee Schedule,Per Unit,$90.00 ,OP,90,144.55,,,,,,,,,,,,,
Corvel,CPT,86886,Coombs test indirect titer,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86890,Autologous blood process,OP Fee Schedule,Per Unit,$254.56 ,OP,144.55,254.56,,,,,,,,,,,,,
Corvel,CPT,86891,Autologous blood op salvage,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,86900,Blood typing serologic abo,OP Fee Schedule,Per Unit,$23.28 ,OP,23.28,108.49,,,,,,,,,,,,,
Corvel,CPT,86901,Blood typing serologic rh(d),OP Fee Schedule,Per Unit,$25.24 ,OP,25.24,32.79,,,,,,,,,,,,,
Corvel,CPT,86902,Blood type antigen donor ea,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,86904,Blood typing patient serum,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,86905,Blood typing rbc antigens,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,86906,Bld typing serologic rh phnt,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,86910,Blood typing paternity test,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,86911,Blood typing antigen system,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,86920,Compatibility test spin,OP Fee Schedule,Per Unit,$44.61 ,OP,44.61,144.55,,,,,,,,,,,,,
Corvel,CPT,86921,Compatibility test incubate,OP Fee Schedule,Per Unit,$40.26 ,OP,40.26,144.55,,,,,,,,,,,,,
Corvel,CPT,86922,Compatibility test antiglob,OP Fee Schedule,Per Unit,$55.93 ,OP,55.93,144.55,,,,,,,,,,,,,
Corvel,CPT,86923,Compatibility test electric,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86927,Plasma fresh frozen,OP Fee Schedule,Per Unit,$50.47 ,OP,50.47,144.55,,,,,,,,,,,,,
Corvel,CPT,86930,Frozen blood prep,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,86931,Frozen blood thaw,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,86932,Frozen blood freeze/thaw,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,86940,Hemolysins/agglutinins auto,OP Fee Schedule,Straight Discount,53.20%,OP,8.77,8.77,,,,,,,,,,,,,
Corvel,CPT,86941,Hemolysins/agglutinins,OP Fee Schedule,Per Unit,$45.99 ,OP,12.11,45.99,,,,,,,,,,,,,
Corvel,CPT,86945,Blood product/irradiation,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,86950,Leukacyte transfusion,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86960,Vol reduction of blood/prod,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86965,Pooling blood platelets,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86970,Rbc pretx incubatj w/chemicl,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,86971,Rbc pretx incubatj w/enzymes,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,86972,Rbc pretx incubatj w/density,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86975,Rbc serum pretx incubj drugs,OP Fee Schedule,Straight Discount,53.20%,OP,261.87,261.87,,,,,,,,,,,,,
Corvel,CPT,86976,Rbc serum pretx id dilution,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,86977,Rbc serum pretx incubj/inhib,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86978,Rbc pretreatment serum,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,86985,Split blood or products,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,86999,Transfusion procedure,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,87003,Small animal inoculation,OP Fee Schedule,Straight Discount,53.20%,OP,16.84,16.84,,,,,,,,,,,,,
Corvel,CPT,87015,Specimen infect agnt concntj,OP Fee Schedule,Straight Discount,53.20%,OP,6.68,6.68,,,,,,,,,,,,,
Corvel,CPT,87040,Blood culture for bacteria,OP Fee Schedule,Per Unit,$75.09 ,OP,10.32,75.09,,,,,,,,,,,,,
Corvel,CPT,87045,Feces culture aerobic bact,OP Fee Schedule,Per Unit,$78.51 ,OP,9.44,78.51,,,,,,,,,,,,,
Corvel,CPT,87046,Stool cultr aerobic bact ea,OP Fee Schedule,Per Unit,$30.04 ,OP,9.44,30.04,,,,,,,,,,,,,
Corvel,CPT,87070,Culture othr specimn aerobic,OP Fee Schedule,Per Unit,$74.12 ,OP,8.62,74.12,,,,,,,,,,,,,
Corvel,CPT,87071,Culture aerobic quant other,OP Fee Schedule,Per Unit,$84.72 ,OP,9.89,84.72,,,,,,,,,,,,,
Corvel,CPT,87073,Culture bacteria anaerobic,OP Fee Schedule,Straight Discount,53.20%,OP,9.66,9.66,,,,,,,,,,,,,
Corvel,CPT,87075,Cultr bacteria except blood,OP Fee Schedule,Per Unit,$109.32 ,OP,9.47,109.32,,,,,,,,,,,,,
Corvel,CPT,87076,Culture anaerobe ident each,OP Fee Schedule,Per Unit,$34.10 ,OP,8.08,34.1,,,,,,,,,,,,,
Corvel,CPT,87077,Culture aerobic identify,OP Fee Schedule,Per Unit,$60.94 ,OP,8.08,60.94,,,,,,,,,,,,,
Corvel,CPT,87081,Culture screen only,OP Fee Schedule,Per Unit,$79.30 ,OP,6.63,79.3,,,,,,,,,,,,,
Corvel,CPT,87084,Culture of specimen by kit,OP Fee Schedule,Straight Discount,53.20%,OP,27.07,27.07,,,,,,,,,,,,,
Corvel,CPT,87086,Urine culture/colony count,OP Fee Schedule,Per Unit,$64.07 ,OP,8.07,64.07,,,,,,,,,,,,,
Corvel,CPT,87088,Urine bacteria culture,OP Fee Schedule,Per Unit,$52.49 ,OP,8.09,52.49,,,,,,,,,,,,,
Corvel,CPT,87101,Skin fungi culture,OP Fee Schedule,Straight Discount,53.20%,OP,7.71,7.71,,,,,,,,,,,,,
Corvel,CPT,87102,Fungus isolation culture,OP Fee Schedule,Per Unit,$127.47 ,OP,8.41,127.47,,,,,,,,,,,,,
Corvel,CPT,87103,Blood fungus culture,OP Fee Schedule,Straight Discount,53.20%,OP,20.46,20.46,,,,,,,,,,,,,
Corvel,CPT,87106,Fungi identification yeast,OP Fee Schedule,Straight Discount,53.20%,OP,10.32,10.32,,,,,,,,,,,,,
Corvel,CPT,87107,Fungi identification mold,OP Fee Schedule,Straight Discount,53.20%,OP,10.32,10.32,,,,,,,,,,,,,
Corvel,CPT,87109,Mycoplasma,OP Fee Schedule,Straight Discount,53.20%,OP,15.39,15.39,,,,,,,,,,,,,
Corvel,CPT,87110,Chlamydia culture,OP Fee Schedule,Per Unit,$66.22 ,OP,19.6,66.22,,,,,,,,,,,,,
Corvel,CPT,87116,Mycobacteria culture,OP Fee Schedule,Per Unit,$168.11 ,OP,10.8,168.11,,,,,,,,,,,,,
Corvel,CPT,87118,Mycobacteric identification,OP Fee Schedule,Straight Discount,53.20%,OP,14.61,14.61,,,,,,,,,,,,,
Corvel,CPT,87140,Culture type immunofluoresc,OP Fee Schedule,Straight Discount,53.20%,OP,5.57,5.57,,,,,,,,,,,,,
Corvel,CPT,87143,Culture typing glc/hplc,OP Fee Schedule,Straight Discount,53.20%,OP,12.52,12.52,,,,,,,,,,,,,
Corvel,CPT,87147,Culture type immunologic,OP Fee Schedule,Per Unit,$55.93 ,OP,5.18,55.93,,,,,,,,,,,,,
Corvel,CPT,87149,Dna/rna direct probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87150,Dna/rna amplified probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87152,Culture type pulse field gel,OP Fee Schedule,Straight Discount,53.20%,OP,7.74,7.74,,,,,,,,,,,,,
Corvel,CPT,87153,Dna/rna sequencing,OP Fee Schedule,Straight Discount,53.20%,OP,115.36,115.36,,,,,,,,,,,,,
Corvel,CPT,87158,Culture typing added method,OP Fee Schedule,Straight Discount,53.20%,OP,7.74,7.74,,,,,,,,,,,,,
Corvel,CPT,87164,Dark field examination,OP Fee Schedule,Straight Discount,53.20%,OP,10.74,10.74,,,,,,,,,,,,,
Corvel,CPT,87166,Dark field examination,OP Fee Schedule,Straight Discount,53.20%,OP,11.3,11.3,,,,,,,,,,,,,
Corvel,CPT,87168,Macroscopic exam arthropod,OP Fee Schedule,Straight Discount,53.20%,OP,4.27,4.27,,,,,,,,,,,,,
Corvel,CPT,87169,Macroscopic exam parasite,OP Fee Schedule,Straight Discount,53.20%,OP,4.31,4.31,,,,,,,,,,,,,
Corvel,CPT,87172,Pinworm exam,OP Fee Schedule,Straight Discount,53.20%,OP,4.27,4.27,,,,,,,,,,,,,
Corvel,CPT,87176,Tissue homogenization cultr,OP Fee Schedule,Straight Discount,53.20%,OP,5.88,5.88,,,,,,,,,,,,,
Corvel,CPT,87177,Ova and parasites smears,OP Fee Schedule,Per Unit,$68.24 ,OP,8.9,68.24,,,,,,,,,,,,,
Corvel,CPT,87181,Microbe susceptible diffuse,OP Fee Schedule,Per Unit,$15.72 ,OP,4.75,15.72,,,,,,,,,,,,,
Corvel,CPT,87184,Microbe susceptible disk,OP Fee Schedule,Per Unit,$43.40 ,OP,7.48,43.4,,,,,,,,,,,,,
Corvel,CPT,87185,Microbe susceptible enzyme,OP Fee Schedule,Straight Discount,53.20%,OP,4.75,4.75,,,,,,,,,,,,,
Corvel,CPT,87186,Microbe susceptible mic,OP Fee Schedule,Per Unit,$46.20 ,OP,8.65,46.2,,,,,,,,,,,,,
Corvel,CPT,87187,Microbe susceptible mlc,OP Fee Schedule,Straight Discount,53.20%,OP,40.17,40.17,,,,,,,,,,,,,
Corvel,CPT,87188,Microbe suscept macrobroth,OP Fee Schedule,Straight Discount,53.20%,OP,6.64,6.64,,,,,,,,,,,,,
Corvel,CPT,87190,Microbe suscept mycobacteri,OP Fee Schedule,Straight Discount,53.20%,OP,7.31,7.31,,,,,,,,,,,,,
Corvel,CPT,87197,Bactericidal level serum,OP Fee Schedule,Straight Discount,53.20%,OP,15.02,15.02,,,,,,,,,,,,,
Corvel,CPT,87205,Smear gram stain,OP Fee Schedule,Per Unit,$26.32 ,OP,4.27,26.32,,,,,,,,,,,,,
Corvel,CPT,87206,Smear fluorescent/acid stai,OP Fee Schedule,Per Unit,$72.56 ,OP,5.39,72.56,,,,,,,,,,,,,
Corvel,CPT,87207,Smear special stain,OP Fee Schedule,Straight Discount,53.20%,OP,5.99,5.99,,,,,,,,,,,,,
Corvel,CPT,87209,Smear complex stain,OP Fee Schedule,Straight Discount,53.20%,OP,17.98,17.98,,,,,,,,,,,,,
Corvel,CPT,87210,Smear wet mount saline/ink,OP Fee Schedule,Per Unit,$45.19 ,OP,5.82,45.19,,,,,,,,,,,,,
Corvel,CPT,87220,Tissue exam for fungi,OP Fee Schedule,Per Unit,$93.53 ,OP,4.27,93.53,,,,,,,,,,,,,
Corvel,CPT,87230,Assay toxin or antitoxin,OP Fee Schedule,Per Unit,$185.21 ,OP,19.74,185.21,,,,,,,,,,,,,
Corvel,CPT,87250,Virus inoculate eggs/animal,OP Fee Schedule,Straight Discount,53.20%,OP,19.56,19.56,,,,,,,,,,,,,
Corvel,CPT,87252,Virus inoculation tissue,OP Fee Schedule,Per Unit,$157.27 ,OP,26.07,157.27,,,,,,,,,,,,,
Corvel,CPT,87253,Virus inoculate tissue addl,OP Fee Schedule,Straight Discount,53.20%,OP,20.2,20.2,,,,,,,,,,,,,
Corvel,CPT,87254,Virus inoculation shell via,OP Fee Schedule,Straight Discount,53.20%,OP,19.56,19.56,,,,,,,,,,,,,
Corvel,CPT,87255,Genet virus isolate hsv,OP Fee Schedule,Straight Discount,53.20%,OP,33.86,33.86,,,,,,,,,,,,,
Corvel,CPT,87260,Adenovirus ag if,OP Fee Schedule,Straight Discount,53.20%,OP,14.43,14.43,,,,,,,,,,,,,
Corvel,CPT,87265,Pertussis ag if,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87267,Enterovirus antibody dfa,OP Fee Schedule,Straight Discount,53.20%,OP,13.42,13.42,,,,,,,,,,,,,
Corvel,CPT,87269,Giardia ag if,OP Fee Schedule,Straight Discount,53.20%,OP,13.61,13.61,,,,,,,,,,,,,
Corvel,CPT,87270,Chlamydia trachomatis ag if,OP Fee Schedule,Per Unit,$49.20 ,OP,11.98,49.2,,,,,,,,,,,,,
Corvel,CPT,87271,Cytomegalovirus dfa,OP Fee Schedule,Straight Discount,53.20%,OP,13.42,13.42,,,,,,,,,,,,,
Corvel,CPT,87272,Cryptosporidium ag if,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87273,Herpes simplex 2 ag if,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87274,Herpes simplex 1 ag if,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87275,Influenza b ag if,OP Fee Schedule,Straight Discount,53.20%,OP,12.25,12.25,,,,,,,,,,,,,
Corvel,CPT,87276,Influenza a ag if,OP Fee Schedule,Per Unit,$36.26 ,OP,16.07,36.26,,,,,,,,,,,,,
Corvel,CPT,87278,Legion pneumophilia ag if,OP Fee Schedule,Straight Discount,53.20%,OP,15.6,15.6,,,,,,,,,,,,,
Corvel,CPT,87279,Parainfluenza ag if,OP Fee Schedule,Straight Discount,53.20%,OP,16.43,16.43,,,,,,,,,,,,,
Corvel,CPT,87280,Respiratory syncytial ag if,OP Fee Schedule,Straight Discount,53.20%,OP,13.42,13.42,,,,,,,,,,,,,
Corvel,CPT,87281,Pneumocystis carinii ag if,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87283,Rubeola ag if,OP Fee Schedule,Straight Discount,53.20%,OP,60.8,60.8,,,,,,,,,,,,,
Corvel,CPT,87285,Treponema pallidum ag if,OP Fee Schedule,Straight Discount,53.20%,OP,12.18,12.18,,,,,,,,,,,,,
Corvel,CPT,87290,Varicella zoster ag if,OP Fee Schedule,Straight Discount,53.20%,OP,13.42,13.42,,,,,,,,,,,,,
Corvel,CPT,87299,Antibody detection nos if,OP Fee Schedule,Straight Discount,53.20%,OP,16.1,16.1,,,,,,,,,,,,,
Corvel,CPT,87300,Ag detection polyval if,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87301,Adenovirus ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87305,Aspergillus ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87320,Chylmd trach ag ia,OP Fee Schedule,Per Unit,$40.07 ,OP,15,40.07,,,,,,,,,,,,,
Corvel,CPT,87324,Clostridium ag ia,OP Fee Schedule,Per Unit,$104.93 ,OP,11.98,104.93,,,,,,,,,,,,,
Corvel,CPT,87327,Cryptococcus neoform ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,13.42,13.42,,,,,,,,,,,,,
Corvel,CPT,87328,Cryptosporidium ag ia,OP Fee Schedule,Per Unit,$51.28 ,OP,13.82,51.28,,,,,,,,,,,,,
Corvel,CPT,87329,Giardia ag ia,OP Fee Schedule,Per Unit,$32.82 ,OP,11.98,32.82,,,,,,,,,,,,,
Corvel,CPT,87332,Cytomegalovirus ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,11.98,11.98,,,,,,,,,,,,,
Corvel,CPT,87335,E coli 0157 ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,12.66,12.66,,,,,,,,,,,,,
Corvel,CPT,87336,Entamoeb hist dispr ag ia,OP Fee Schedule,Per Unit,$38.46 ,OP,16,38.46,,,,,,,,,,,,,
Corvel,CPT,87337,Entamoeb hist group ag ia,OP Fee Schedule,Per Unit,$37.43 ,OP,11.98,37.43,,,,,,,,,,,,,
Corvel,CPT,87338,Hpylori stool ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,14.38,14.38,,,,,,,,,,,,,
Corvel,CPT,87339,H pylori ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,16,16,,,,,,,,,,,,,
Corvel,CPT,87340,Hepatitis b surface ag ia,OP Fee Schedule,Per Unit,$74.99 ,OP,10.33,74.99,,,,,,,,,,,,,
Corvel,CPT,87341,Hepatitis b surface ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,10.33,10.33,,,,,,,,,,,,,
Corvel,CPT,87350,Hepatitis be ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,11.53,11.53,,,,,,,,,,,,,
Corvel,CPT,87380,Hepatitis delta agent ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,18.36,18.36,,,,,,,,,,,,,
Corvel,CPT,87385,Histoplasma capsul ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,13.25,13.25,,,,,,,,,,,,,
Corvel,CPT,87389,Hiv-1 ag w/hiv-1&2 ab ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,24.08,24.08,,,,,,,,,,,,,
Corvel,CPT,87390,Hiv-1 ag ia,OP Fee Schedule,Per Unit,$58.69 ,OP,24.06,58.69,,,,,,,,,,,,,
Corvel,CPT,87391,Hiv-2 ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,21.9,21.9,,,,,,,,,,,,,
Corvel,CPT,87400,Influenza a/b each ag ia,OP Fee Schedule,Per Unit,$68.87 ,OP,14.13,68.87,,,,,,,,,,,,,
Corvel,CPT,87420,Resp syncytial virus ag ia,OP Fee Schedule,Per Unit,$109.39 ,OP,13.91,109.39,,,,,,,,,,,,,
Corvel,CPT,87425,Rotavirus ag ia,OP Fee Schedule,Per Unit,$132.28 ,OP,11.98,132.28,,,,,,,,,,,,,
Corvel,CPT,87426,Sarscov coronavirus ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,35.33,35.33,,,,,,,,,,,,,
Corvel,CPT,87427,Shiga-like toxin ag ia,OP Fee Schedule,Per Unit,$111.91 ,OP,11.98,111.91,,,,,,,,,,,,,
Corvel,CPT,87428,Sarscov & inf vir a&b ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,63.59,63.59,,,,,,,,,,,,,
Corvel,CPT,87430,Strep a ag ia,OP Fee Schedule,Per Unit,$39.98 ,OP,16.81,39.98,,,,,,,,,,,,,
Corvel,CPT,87449,Nos each organism ag ia,OP Fee Schedule,Per Unit,$41.31 ,OP,11.98,41.31,,,,,,,,,,,,,
Corvel,CPT,87451,Polyvalent mult org ea ag ia,OP Fee Schedule,Straight Discount,53.20%,OP,10.51,10.51,,,,,,,,,,,,,
Corvel,CPT,87471,Bartonella dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87472,Bartonella dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87475,Lyme dis dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87476,Lyme dis dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87480,Candida dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87481,Candida dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87482,Candida dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,55.74,55.74,,,,,,,,,,,,,
Corvel,CPT,87483,Cns dna amp probe type 12-25,OP Fee Schedule,Straight Discount,53.20%,OP,416.78,416.78,,,,,,,,,,,,,
Corvel,CPT,87485,Chylmd pneum dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87486,Chylmd pneum dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87487,Chylmd pneum dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87490,Chylmd trach dna dir probe,OP Fee Schedule,Per Unit,$105.11 ,OP,22.75,105.11,,,,,,,,,,,,,
Corvel,CPT,87491,Chylmd trach dna amp probe,OP Fee Schedule,Per Unit,$56.70 ,OP,35.09,56.7,,,,,,,,,,,,,
Corvel,CPT,87492,Chylmd trach dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,53.47,53.47,,,,,,,,,,,,,
Corvel,CPT,87493,C diff amplified probe,OP Fee Schedule,Straight Discount,53.20%,OP,37.27,37.27,,,,,,,,,,,,,
Corvel,CPT,87495,Cytomeg dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,30.03,30.03,,,,,,,,,,,,,
Corvel,CPT,87496,Cytomeg dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87497,Cytomeg dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87498,Enterovirus probe&revrs trns,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87500,Vanomycin dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87501,Influenza dna amp prob 1+,OP Fee Schedule,Straight Discount,53.20%,OP,51.31,51.31,,,,,,,,,,,,,
Corvel,CPT,87502,Influenza dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,95.8,95.8,,,,,,,,,,,,,
Corvel,CPT,87503,Influenza dna amp prob addl,OP Fee Schedule,Straight Discount,53.20%,OP,29.22,29.22,,,,,,,,,,,,,
Corvel,CPT,87505,Nfct agent detection gi,OP Fee Schedule,Straight Discount,53.20%,OP,128.29,128.29,,,,,,,,,,,,,
Corvel,CPT,87506,Iadna-dna/rna probe tq 6-11,OP Fee Schedule,Straight Discount,53.20%,OP,262.99,262.99,,,,,,,,,,,,,
Corvel,CPT,87507,Iadna-dna/rna probe tq 12-25,OP Fee Schedule,Straight Discount,53.20%,OP,416.78,416.78,,,,,,,,,,,,,
Corvel,CPT,87510,Gardner vag dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87511,Gardner vag dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87512,Gardner vag dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,41.76,41.76,,,,,,,,,,,,,
Corvel,CPT,87516,Hepatitis b dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87517,Hepatitis b dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87520,Hepatitis c rna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,31.22,31.22,,,,,,,,,,,,,
Corvel,CPT,87521,Hepatitis c probe&rvrs trnsc,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87522,Hepatitis c revrs trnscrpj,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87525,Hepatitis g dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,29.8,29.8,,,,,,,,,,,,,
Corvel,CPT,87526,Hepatitis g dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,39.26,39.26,,,,,,,,,,,,,
Corvel,CPT,87527,Hepatitis g dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,41.76,41.76,,,,,,,,,,,,,
Corvel,CPT,87528,Hsv dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87529,Hsv dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87530,Hsv dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87531,Hhv-6 dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,58,58,,,,,,,,,,,,,
Corvel,CPT,87532,Hhv-6 dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87533,Hhv-6 dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,41.76,41.76,,,,,,,,,,,,,
Corvel,CPT,87534,Hiv-1 dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,21.92,21.92,,,,,,,,,,,,,
Corvel,CPT,87535,Hiv-1 probe&reverse trnscrpj,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87536,Hiv-1 quant&revrse trnscrpj,OP Fee Schedule,Straight Discount,53.20%,OP,85.1,85.1,,,,,,,,,,,,,
Corvel,CPT,87537,Hiv-2 dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,21.92,21.92,,,,,,,,,,,,,
Corvel,CPT,87538,Hiv-2 probe&revrse trnscripj,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87539,Hiv-2 quant&revrse trnscripj,OP Fee Schedule,Straight Discount,53.20%,OP,58.62,58.62,,,,,,,,,,,,,
Corvel,CPT,87540,Legion pneumo dna dir prob,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87541,Legion pneumo dna amp prob,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87542,Legion pneumo dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,41.76,41.76,,,,,,,,,,,,,
Corvel,CPT,87550,Mycobacteria dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87551,Mycobacteria dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,48.24,48.24,,,,,,,,,,,,,
Corvel,CPT,87552,Mycobacteria dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87555,M.tuberculo dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,26.88,26.88,,,,,,,,,,,,,
Corvel,CPT,87556,M.tuberculo dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,41.68,41.68,,,,,,,,,,,,,
Corvel,CPT,87557,M.tuberculo dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87560,M.avium-intra dna dir prob,OP Fee Schedule,Straight Discount,53.20%,OP,27.29,27.29,,,,,,,,,,,,,
Corvel,CPT,87561,M.avium-intra dna amp prob,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87562,M.avium-intra dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87563,M. genitalium amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87580,M.pneumon dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87581,M.pneumon dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87582,M.pneumon dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,302.62,302.62,,,,,,,,,,,,,
Corvel,CPT,87590,N.gonorrhoeae dna dir prob,OP Fee Schedule,Per Unit,$105.11 ,OP,26.88,105.11,,,,,,,,,,,,,
Corvel,CPT,87591,N.gonorrhoeae dna amp prob,OP Fee Schedule,Per Unit,$56.70 ,OP,35.09,56.7,,,,,,,,,,,,,
Corvel,CPT,87592,N.gonorrhoeae dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87623,Hpv low-risk types,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87624,Hpv high-risk types,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87625,Hpv types 16 & 18 only,OP Fee Schedule,Straight Discount,53.20%,OP,40.55,40.55,,,,,,,,,,,,,
Corvel,CPT,87631,Resp virus 3-5 targets,OP Fee Schedule,Straight Discount,53.20%,OP,142.63,142.63,,,,,,,,,,,,,
Corvel,CPT,87632,Resp virus 6-11 targets,OP Fee Schedule,Straight Discount,53.20%,OP,218.06,218.06,,,,,,,,,,,,,
Corvel,CPT,87633,Resp virus 12-25 targets,OP Fee Schedule,Straight Discount,53.20%,OP,416.78,416.78,,,,,,,,,,,,,
Corvel,CPT,87634,Rsv dna/rna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,70.2,70.2,,,,,,,,,,,,,
Corvel,CPT,87635,Sars-cov-2 covid-19 amp prb,OP Fee Schedule,Straight Discount,53.20%,OP,51.31,51.31,,,,,,,,,,,,,
Corvel,CPT,87636,Sarscov2 & inf a&b amp prb,OP Fee Schedule,Straight Discount,53.20%,OP,142.63,142.63,,,,,,,,,,,,,
Corvel,CPT,87637,Sarscov2&inf a&b&rsv amp prb,OP Fee Schedule,Straight Discount,53.20%,OP,142.63,142.63,,,,,,,,,,,,,
Corvel,CPT,87640,Staph a dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87641,Mr-staph dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87650,Strep a dna dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87651,Strep a dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87652,Strep a dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,41.76,41.76,,,,,,,,,,,,,
Corvel,CPT,87653,Strep b dna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87660,Trichomonas vagin dir probe,OP Fee Schedule,Straight Discount,53.20%,OP,20.05,20.05,,,,,,,,,,,,,
Corvel,CPT,87661,Trichomonas vaginalis amplif,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87662,Zika virus dna/rna amp probe,OP Fee Schedule,Straight Discount,53.20%,OP,51.31,51.31,,,,,,,,,,,,,
Corvel,CPT,87797,Detect agent nos dna dir,OP Fee Schedule,Straight Discount,53.20%,OP,30.03,30.03,,,,,,,,,,,,,
Corvel,CPT,87798,Detect agent nos dna amp,OP Fee Schedule,Straight Discount,53.20%,OP,35.09,35.09,,,,,,,,,,,,,
Corvel,CPT,87799,Detect agent nos dna quant,OP Fee Schedule,Straight Discount,53.20%,OP,42.84,42.84,,,,,,,,,,,,,
Corvel,CPT,87800,Detect agnt mult dna direc,OP Fee Schedule,Straight Discount,53.20%,OP,43.67,43.67,,,,,,,,,,,,,
Corvel,CPT,87801,Detect agnt mult dna ampli,OP Fee Schedule,Straight Discount,53.20%,OP,70.2,70.2,,,,,,,,,,,,,
Corvel,CPT,87802,Strep b assay w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,12.73,12.73,,,,,,,,,,,,,
Corvel,CPT,87803,Clostridium toxin a w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,16,16,,,,,,,,,,,,,
Corvel,CPT,87804,Influenza assay w/optic,OP Fee Schedule,Per Unit,$63.89 ,OP,16.55,63.89,,,,,,,,,,,,,
Corvel,CPT,87806,Hiv w/hiv1&2 antb w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,32.77,32.77,,,,,,,,,,,,,
Corvel,CPT,87807,Rsv assay w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,13.1,13.1,,,,,,,,,,,,,
Corvel,CPT,87808,Trichomonas assay w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,15.29,15.29,,,,,,,,,,,,,
Corvel,CPT,87809,Adenovirus assay w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,21.76,21.76,,,,,,,,,,,,,
Corvel,CPT,87810,Chylmd trach assay w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,35.29,35.29,,,,,,,,,,,,,
Corvel,CPT,87811,Sars-cov-2 covid19 w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,41.38,41.38,,,,,,,,,,,,,
Corvel,CPT,87850,N. gonorrhoeae assay w/optic,OP Fee Schedule,Straight Discount,53.20%,OP,24.56,24.56,,,,,,,,,,,,,
Corvel,CPT,87880,Strep a assay w/optic,OP Fee Schedule,Per Unit,$45.77 ,OP,16.53,45.77,,,,,,,,,,,,,
Corvel,CPT,87899,Agent nos assay w/optic,OP Fee Schedule,Per Unit,$27.53 ,OP,16.07,27.53,,,,,,,,,,,,,
Corvel,CPT,87900,Phenotype infect agent drug,OP Fee Schedule,Straight Discount,53.20%,OP,130.35,130.35,,,,,,,,,,,,,
Corvel,CPT,87901,Genotype dna hiv reverse t,OP Fee Schedule,Straight Discount,53.20%,OP,257.45,257.45,,,,,,,,,,,,,
Corvel,CPT,87902,Genotype dna/rna hep c,OP Fee Schedule,Straight Discount,53.20%,OP,257.45,257.45,,,,,,,,,,,,,
Corvel,CPT,87903,Phenotype dna hiv w/culture,OP Fee Schedule,Straight Discount,53.20%,OP,488.66,488.66,,,,,,,,,,,,,
Corvel,CPT,87904,Phenotype dna hiv w/clt add,OP Fee Schedule,Straight Discount,53.20%,OP,26.07,26.07,,,,,,,,,,,,,
Corvel,CPT,87905,Sialidase enzyme assay,OP Fee Schedule,Straight Discount,53.20%,OP,12.22,12.22,,,,,,,,,,,,,
Corvel,CPT,87906,Genotype dna/rna hiv,OP Fee Schedule,Straight Discount,53.20%,OP,128.73,128.73,,,,,,,,,,,,,
Corvel,CPT,87910,Genotype cytomegalovirus,OP Fee Schedule,Straight Discount,53.20%,OP,257.45,257.45,,,,,,,,,,,,,
Corvel,CPT,87912,Genotype dna hepatitis b,OP Fee Schedule,Straight Discount,53.20%,OP,257.45,257.45,,,,,,,,,,,,,
Corvel,CPT,87999,Microbiology procedure,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88000,Autopsy (necropsy) gross,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88005,Autopsy (necropsy) gross,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88007,Autopsy (necropsy) gross,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88012,Autopsy (necropsy) gross,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88014,Autopsy (necropsy) gross,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88016,Autopsy (necropsy) gross,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88020,Autopsy (necropsy) complete,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88025,Autopsy (necropsy) complete,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88027,Autopsy (necropsy) complete,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88028,Autopsy (necropsy) complete,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88029,Autopsy (necropsy) complete,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88036,Limited autopsy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88037,Limited autopsy,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88040,Forensic autopsy (necropsy),OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88045,Coroners autopsy (necropsy),OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88099,Necropsy (autopsy) procedure,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88104,Cytopath fl nongyn smears,OP Fee Schedule,Per Unit,$74.90 ,OP,32.79,74.9,,,,,,,,,,,,,
Corvel,CPT,88106,Cytopath fl nongyn filter,OP Fee Schedule,Per Unit,$62.00 ,OP,23.91,62,,,,,,,,,,,,,
Corvel,CPT,88108,Cytopath concentrate tech,OP Fee Schedule,Per Unit,$32.39 ,OP,32.39,32.79,,,,,,,,,,,,,
Corvel,CPT,88112,Cytopath cell enhance tech,OP Fee Schedule,Per Unit,$52.41 ,OP,48.22,52.41,,,,,,,,,,,,,
Corvel,CPT,88120,Cytp urne 3-5 probes ea spec,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,88121,Cytp urine 3-5 probes cmptr,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88125,Forensic cytopathology,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88130,Sex chromatin identification,OP Fee Schedule,Straight Discount,53.20%,OP,17.98,17.98,,,,,,,,,,,,,
Corvel,CPT,88140,Sex chromatin identification,OP Fee Schedule,Straight Discount,53.20%,OP,7.99,7.99,,,,,,,,,,,,,
Corvel,CPT,88141,Cytopath c/v interpret,OP Fee Schedule,Per Unit,$9.25 ,OP,9.25,9.25,,,,,,,,,,,,,
Corvel,CPT,88142,Cytopath c/v thin layer,OP Fee Schedule,Per Unit,$53.51 ,OP,20.26,53.51,,,,,,,,,,,,,
Corvel,CPT,88143,Cytopath c/v thin layer redo,OP Fee Schedule,Straight Discount,53.20%,OP,23.04,23.04,,,,,,,,,,,,,
Corvel,CPT,88147,Cytopath c/v automated,OP Fee Schedule,Straight Discount,53.20%,OP,50.56,50.56,,,,,,,,,,,,,
Corvel,CPT,88148,Cytopath c/v auto rescreen,OP Fee Schedule,Straight Discount,53.20%,OP,16,16,,,,,,,,,,,,,
Corvel,CPT,88150,Cytopath c/v manual,OP Fee Schedule,Per Unit,$29.39 ,OP,15.15,29.39,,,,,,,,,,,,,
Corvel,CPT,88152,Cytopath c/v auto redo,OP Fee Schedule,Straight Discount,53.20%,OP,27.64,27.64,,,,,,,,,,,,,
Corvel,CPT,88153,Cytopath c/v redo,OP Fee Schedule,Straight Discount,53.20%,OP,24.03,24.03,,,,,,,,,,,,,
Corvel,CPT,88155,Cytopath c/v index add-on,OP Fee Schedule,Straight Discount,53.20%,OP,14.65,14.65,,,,,,,,,,,,,
Corvel,CPT,88160,Cytopath smear other source,OP Fee Schedule,Per Unit,$44.56 ,OP,23.91,44.56,,,,,,,,,,,,,
Corvel,CPT,88161,Cytopath smear other source,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,88162,Cytopath smear other source,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88164,Cytopath tbs c/v manual,OP Fee Schedule,Per Unit,$37.86 ,OP,15.15,37.86,,,,,,,,,,,,,
Corvel,CPT,88165,Cytopath tbs c/v redo,OP Fee Schedule,Straight Discount,53.20%,OP,42.22,42.22,,,,,,,,,,,,,
Corvel,CPT,88166,Cytopath tbs c/v auto redo,OP Fee Schedule,Straight Discount,53.20%,OP,15.15,15.15,,,,,,,,,,,,,
Corvel,CPT,88167,Cytopath tbs c/v select,OP Fee Schedule,Straight Discount,53.20%,OP,15.15,15.15,,,,,,,,,,,,,
Corvel,CPT,88172,Cytp dx eval fna 1st ea site,OP Fee Schedule,Per Unit,$185.92 ,OP,144.55,185.92,,,,,,,,,,,,,
Corvel,CPT,88173,Cytopath eval fna report,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88174,Cytopath c/v auto in fluid,OP Fee Schedule,Straight Discount,53.20%,OP,25.37,25.37,,,,,,,,,,,,,
Corvel,CPT,88175,Cytopath c/v auto fluid redo,OP Fee Schedule,Per Unit,$67.47 ,OP,26.61,67.47,,,,,,,,,,,,,
Corvel,CPT,88177,Cytp fna eval ea addl,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88182,Cell marker study,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88184,Flowcytometry/ tc 1 marker,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88185,Flowcytometry/tc add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88187,Flowcytometry/read 2-8,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88188,Flowcytometry/read 9-15,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88189,Flowcytometry/read 16 & >,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88199,Cytopathology procedure,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88230,Tissue culture lymphocyte,OP Fee Schedule,Straight Discount,53.20%,OP,116.49,116.49,,,,,,,,,,,,,
Corvel,CPT,88233,Tissue culture skin/biopsy,OP Fee Schedule,Straight Discount,53.20%,OP,140.73,140.73,,,,,,,,,,,,,
Corvel,CPT,88235,Tissue culture placenta,OP Fee Schedule,Straight Discount,53.20%,OP,150.3,150.3,,,,,,,,,,,,,
Corvel,CPT,88237,Tissue culture bone marrow,OP Fee Schedule,Straight Discount,53.20%,OP,143.75,143.75,,,,,,,,,,,,,
Corvel,CPT,88239,Tissue culture tumor,OP Fee Schedule,Straight Discount,53.20%,OP,147.52,147.52,,,,,,,,,,,,,
Corvel,CPT,88240,Cell cryopreserve/storage,OP Fee Schedule,Straight Discount,53.20%,OP,13.07,13.07,,,,,,,,,,,,,
Corvel,CPT,88241,Frozen cell preparation,OP Fee Schedule,Straight Discount,53.20%,OP,12.09,12.09,,,,,,,,,,,,,
Corvel,CPT,88245,Chromosome analysis 20-25,OP Fee Schedule,Straight Discount,53.20%,OP,173.17,173.17,,,,,,,,,,,,,
Corvel,CPT,88248,Chromosome analysis 50-100,OP Fee Schedule,Straight Discount,53.20%,OP,173.17,173.17,,,,,,,,,,,,,
Corvel,CPT,88249,Chromosome analysis 100,OP Fee Schedule,Straight Discount,53.20%,OP,173.17,173.17,,,,,,,,,,,,,
Corvel,CPT,88261,Chromosome analysis 5,OP Fee Schedule,Straight Discount,53.20%,OP,264.34,264.34,,,,,,,,,,,,,
Corvel,CPT,88262,Chromosome analysis 15-20,OP Fee Schedule,Straight Discount,53.20%,OP,125.49,125.49,,,,,,,,,,,,,
Corvel,CPT,88263,Chromosome analysis 45,OP Fee Schedule,Straight Discount,53.20%,OP,150.29,150.29,,,,,,,,,,,,,
Corvel,CPT,88264,Chromosome analysis 20-25,OP Fee Schedule,Straight Discount,53.20%,OP,144.61,144.61,,,,,,,,,,,,,
Corvel,CPT,88267,Chromosome analys placenta,OP Fee Schedule,Straight Discount,53.20%,OP,188.57,188.57,,,,,,,,,,,,,
Corvel,CPT,88269,Chromosome analys amniotic,OP Fee Schedule,Straight Discount,53.20%,OP,173.66,173.66,,,,,,,,,,,,,
Corvel,CPT,88271,Cytogenetics dna probe,OP Fee Schedule,Straight Discount,53.20%,OP,21.42,21.42,,,,,,,,,,,,,
Corvel,CPT,88272,Cytogenetics 3-5,OP Fee Schedule,Straight Discount,53.20%,OP,40.7,40.7,,,,,,,,,,,,,
Corvel,CPT,88273,Cytogenetics 10-30,OP Fee Schedule,Straight Discount,53.20%,OP,34.81,34.81,,,,,,,,,,,,,
Corvel,CPT,88274,Cytogenetics 25-99,OP Fee Schedule,Straight Discount,53.20%,OP,42.38,42.38,,,,,,,,,,,,,
Corvel,CPT,88275,Cytogenetics 100-300,OP Fee Schedule,Straight Discount,53.20%,OP,51.19,51.19,,,,,,,,,,,,,
Corvel,CPT,88280,Chromosome karyotype study,OP Fee Schedule,Straight Discount,53.20%,OP,33.47,33.47,,,,,,,,,,,,,
Corvel,CPT,88283,Chromosome banding study,OP Fee Schedule,Straight Discount,53.20%,OP,68.6,68.6,,,,,,,,,,,,,
Corvel,CPT,88285,Chromosome count additional,OP Fee Schedule,Straight Discount,53.20%,OP,26.91,26.91,,,,,,,,,,,,,
Corvel,CPT,88289,Chromosome study additional,OP Fee Schedule,Straight Discount,53.20%,OP,34.43,34.43,,,,,,,,,,,,,
Corvel,CPT,88291,Cyto/molecular report,OP Fee Schedule,Per Unit,$51.79 ,OP,51.79,51.79,,,,,,,,,,,,,
Corvel,CPT,88299,Cytogenetic study,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88300,Surgical path gross,OP Fee Schedule,Per Unit,$45.47 ,OP,23.91,45.47,,,,,,,,,,,,,
Corvel,CPT,88302,Tissue exam by pathologist,OP Fee Schedule,Per Unit,$73.48 ,OP,23.91,73.48,,,,,,,,,,,,,
Corvel,CPT,88304,Tissue exam by pathologist,OP Fee Schedule,Per Unit,$91.86 ,OP,48.22,91.86,,,,,,,,,,,,,
Corvel,CPT,88305,Tissue exam by pathologist,OP Fee Schedule,Per Unit,$109.05 ,OP,48.22,109.05,,,,,,,,,,,,,
Corvel,CPT,88307,Tissue exam by pathologist,OP Fee Schedule,Per Unit,$75.98 ,OP,75.98,282.25,,,,,,,,,,,,,
Corvel,CPT,88309,Tissue exam by pathologist,OP Fee Schedule,Per Unit,$528.45 ,OP,528.45,635.86,,,,,,,,,,,,,
Corvel,CPT,88311,Decalcify tissue,OP Fee Schedule,Per Unit,$66.57 ,OP,66.57,66.57,,,,,,,,,,,,,
Corvel,CPT,88312,Special stains group 1,OP Fee Schedule,Per Unit,$82.69 ,OP,48.22,82.69,,,,,,,,,,,,,
Corvel,CPT,88313,Special stains group 2,OP Fee Schedule,Per Unit,$55.33 ,OP,32.79,55.33,,,,,,,,,,,,,
Corvel,CPT,88314,Histochemical stains add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88319,Enzyme histochemistry,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,88321,Microslide consultation,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,88323,Microslide consultation,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88325,Comprehensive review of data,OP Fee Schedule,Per Unit,$141.52 ,OP,141.52,144.55,,,,,,,,,,,,,
Corvel,CPT,88329,Path consult introp,OP Fee Schedule,Straight Discount,53.20%,OP,32.79,32.79,,,,,,,,,,,,,
Corvel,CPT,88331,Path consult intraop 1 bloc,OP Fee Schedule,Per Unit,$152.02 ,OP,144.55,152.02,,,,,,,,,,,,,
Corvel,CPT,88332,Path consult intraop addl,OP Fee Schedule,Per Unit,$171.52 ,OP,171.52,171.52,,,,,,,,,,,,,
Corvel,CPT,88333,Intraop cyto path consult 1,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,88334,Intraop cyto path consult 2,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88341,Immunohisto antb addl slide,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88342,Immunohisto antb 1st stain,OP Fee Schedule,Per Unit,$156.44 ,OP,144.55,156.44,,,,,,,,,,,,,
Corvel,CPT,88344,Immunohisto antibody slide,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88346,Immunofluor antb 1st stain,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88348,Electron microscopy,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,88350,Immunofluor antb addl stain,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88355,Analysis skeletal muscle,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,88356,Analysis nerve,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88358,Analysis tumor,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,88360,Tumor immunohistochem/manual,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,88361,Tumor immunohistochem/comput,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88362,Nerve teasing preparations,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,88363,Xm archive tissue molec anal,OP Fee Schedule,Straight Discount,53.20%,OP,23.91,23.91,,,,,,,,,,,,,
Corvel,CPT,88364,Insitu hybridization (fish),OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88365,Insitu hybridization (fish),OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,88366,Insitu hybridization (fish),OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88367,Insitu hybridization auto,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88368,Insitu hybridization manual,OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,88369,M/phmtrc alysishquant/semiq,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88371,Protein western blot tissue,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88372,Protein analysis w/probe,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88373,M/phmtrc alys ishquant/semiq,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88374,M/phmtrc alys ishquant/semiq,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,88375,Optical endomicroscpy interp,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88377,M/phmtrc alys ishquant/semiq,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,88380,Microdissection laser,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88381,Microdissection manual,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88387,Tiss exam molecular study,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88388,Tiss ex molecul study add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,88399,Surgical pathology procedure,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,88720,Bilirubin total transcut,OP Fee Schedule,Straight Discount,53.20%,OP,5.02,5.02,,,,,,,,,,,,,
Corvel,CPT,88738,Hgb quant transcutaneous,OP Fee Schedule,Straight Discount,53.20%,OP,5.02,5.02,,,,,,,,,,,,,
Corvel,CPT,88740,Transcutaneous carboxyhb,OP Fee Schedule,Straight Discount,53.20%,OP,9.37,9.37,,,,,,,,,,,,,
Corvel,CPT,88741,Transcutaneous methb,OP Fee Schedule,Straight Discount,53.20%,OP,9.37,9.37,,,,,,,,,,,,,
Corvel,CPT,88749,In vivo lab service,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,89049,Chct for mal hyperthermia,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89050,Body fluid cell count,OP Fee Schedule,Per Unit,$80.35 ,OP,4.72,80.35,,,,,,,,,,,,,
Corvel,CPT,89051,Body fluid cell count,OP Fee Schedule,Per Unit,$81.44 ,OP,5.6,81.44,,,,,,,,,,,,,
Corvel,CPT,89055,Leukocyte assessment fecal,OP Fee Schedule,Per Unit,$48.75 ,OP,4.27,48.75,,,,,,,,,,,,,
Corvel,CPT,89060,Exam synovial fluid crystals,OP Fee Schedule,Per Unit,$73.63 ,OP,7.33,73.63,,,,,,,,,,,,,
Corvel,CPT,89125,Specimen fat stain,OP Fee Schedule,Straight Discount,53.20%,OP,5.88,5.88,,,,,,,,,,,,,
Corvel,CPT,89160,Exam feces for meat fibers,OP Fee Schedule,Per Unit,$36.31 ,OP,4.85,36.31,,,,,,,,,,,,,
Corvel,CPT,89190,Nasal smear for eosinophils,OP Fee Schedule,Straight Discount,53.20%,OP,5.79,5.79,,,,,,,,,,,,,
Corvel,CPT,89220,Sputum specimen collection,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89230,Collect sweat for test,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89240,Pathology lab procedure,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89250,Cultr oocyte/embryo <4 days,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89251,Cultr oocyte/embryo <4 days,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89253,Embryo hatching,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89254,Oocyte identification,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89255,Prepare embryo for transfer,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89257,Sperm identification,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89258,Cryopreservation embryo(s),OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,89259,Cryopreservation sperm,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89260,Sperm isolation simple,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89261,Sperm isolation complex,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89264,Identify sperm tissue,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89268,Insemination of oocytes,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89272,Extended culture of oocytes,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,89280,Assist oocyte fertilization,OP Fee Schedule,Straight Discount,53.20%,OP,635.86,635.86,,,,,,,,,,,,,
Corvel,CPT,89281,Assist oocyte fertilization,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89290,Biopsy oocyte polar body,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89291,Biopsy oocyte polar body,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89300,Semen analysis w/huhner,OP Fee Schedule,Straight Discount,53.20%,OP,9.84,9.84,,,,,,,,,,,,,
Corvel,CPT,89310,Semen analysis w/count,OP Fee Schedule,Straight Discount,53.20%,OP,8.61,8.61,,,,,,,,,,,,,
Corvel,CPT,89320,Semen anal vol/count/mot,OP Fee Schedule,Per Unit,$207.84 ,OP,12.31,207.84,,,,,,,,,,,,,
Corvel,CPT,89321,Semen anal sperm detection,OP Fee Schedule,Per Unit,$35.80 ,OP,12.05,35.8,,,,,,,,,,,,,
Corvel,CPT,89322,Semen anal strict criteria,OP Fee Schedule,Straight Discount,53.20%,OP,15.5,15.5,,,,,,,,,,,,,
Corvel,CPT,89325,Sperm antibody test,OP Fee Schedule,Straight Discount,53.20%,OP,10.67,10.67,,,,,,,,,,,,,
Corvel,CPT,89329,Sperm evaluation test,OP Fee Schedule,Straight Discount,53.20%,OP,19.59,19.59,,,,,,,,,,,,,
Corvel,CPT,89330,Evaluation cervical mucus,OP Fee Schedule,Straight Discount,53.20%,OP,10.38,10.38,,,,,,,,,,,,,
Corvel,CPT,89331,Retrograde ejaculation anal,OP Fee Schedule,Straight Discount,53.20%,OP,19.59,19.59,,,,,,,,,,,,,
Corvel,CPT,89335,Cryopreserve testicular tiss,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89337,Cryopreservation oocyte(s),OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89342,Storage/year embryo(s),OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89343,Storage/year sperm/semen,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89344,Storage/year reprod tissue,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89346,Storage/year oocyte(s),OP Fee Schedule,Straight Discount,53.20%,OP,282.25,282.25,,,,,,,,,,,,,
Corvel,CPT,89352,Thawing cryopresrved embryo,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89353,Thawing cryopresrved sperm,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,89354,Thaw cryoprsvrd reprod tiss,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89356,Thawing cryopresrved oocyte,OP Fee Schedule,Straight Discount,53.20%,OP,144.55,144.55,,,,,,,,,,,,,
Corvel,CPT,89398,Unlisted reprod med lab proc,OP Fee Schedule,Straight Discount,53.20%,OP,48.22,48.22,,,,,,,,,,,,,
Corvel,CPT,97010,Hot or cold packs therapy,OP Fee Schedule,Per Unit,$27.53 ,OP,27.53,27.53,,,,,,,,,,,,,
Corvel,CPT,97012,Mechanical traction therapy,OP Fee Schedule,Per Unit,$41.06 ,OP,14.55,41.06,,,,,,,,,,,,,
Corvel,CPT,97014,Electric stimulation therapy,OP Fee Schedule,Per Unit,$38.45 ,OP,38.45,38.45,,,,,,,,,,,,,
Corvel,CPT,97016,Vasopneumatic device therapy,OP Fee Schedule,Per Unit,$22.11 ,OP,11.78,22.11,,,,,,,,,,,,,
Corvel,CPT,97018,Paraffin bath therapy,OP Fee Schedule,Per Unit,$52.91 ,OP,5.69,52.91,,,,,,,,,,,,,
Corvel,CPT,97022,Whirlpool therapy,OP Fee Schedule,Per Unit,$40.29 ,OP,17.16,40.29,,,,,,,,,,,,,
Corvel,CPT,97024,Diathermy eg microwave,OP Fee Schedule,Straight Discount,53.20%,OP,6.96,6.96,,,,,,,,,,,,,
Corvel,CPT,97026,Infrared therapy,OP Fee Schedule,Per Unit,$65.39 ,OP,6.32,65.39,,,,,,,,,,,,,
Corvel,CPT,97028,Ultraviolet therapy,OP Fee Schedule,Straight Discount,53.20%,OP,7.98,7.98,,,,,,,,,,,,,
Corvel,CPT,97032,Electrical stimulation,OP Fee Schedule,Per Unit,$54.07 ,OP,14.55,54.07,,,,,,,,,,,,,
Corvel,CPT,97033,Electric current therapy,OP Fee Schedule,Per Unit,$53.14 ,OP,19.67,53.14,,,,,,,,,,,,,
Corvel,CPT,97034,Contrast bath therapy,OP Fee Schedule,Straight Discount,53.20%,OP,14.42,14.42,,,,,,,,,,,,,
Corvel,CPT,97035,Ultrasound therapy,OP Fee Schedule,Per Unit,$47.97 ,OP,14.1,47.97,,,,,,,,,,,,,
Corvel,CPT,97036,Hydrotherapy,OP Fee Schedule,Straight Discount,53.20%,OP,33.09,33.09,,,,,,,,,,,,,
Corvel,CPT,97039,Physical therapy treatment,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97110,Therapeutic exercises,OP Fee Schedule,Per Unit,$61.13 ,OP,29.26,61.13,,,,,,,,,,,,,
Corvel,CPT,97112,Neuromuscular reeducation,OP Fee Schedule,Per Unit,$40.78 ,OP,33.86,40.78,,,,,,,,,,,,,
Corvel,CPT,97113,Aquatic therapy/exercises,OP Fee Schedule,Per Unit,$84.21 ,OP,36.67,84.21,,,,,,,,,,,,,
Corvel,CPT,97116,Gait training therapy,OP Fee Schedule,Per Unit,$41.74 ,OP,29.26,41.74,,,,,,,,,,,,,
Corvel,CPT,97124,Massage therapy,OP Fee Schedule,Per Unit,$79.36 ,OP,28.22,79.36,,,,,,,,,,,,,
Corvel,CPT,97129,Ther ivntj 1st 15 min,OP Fee Schedule,Straight Discount,53.20%,OP,23.04,23.04,,,,,,,,,,,,,
Corvel,CPT,97130,Ther ivntj ea addl 15 min,OP Fee Schedule,Straight Discount,53.20%,OP,22.35,22.35,,,,,,,,,,,,,
Corvel,CPT,97139,Physical medicine procedure,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97140,Manual therapy 1/> regions,OP Fee Schedule,Per Unit,$56.54 ,OP,26.97,56.54,,,,,,,,,,,,,
Corvel,CPT,97150,Group therapeutic procedures,OP Fee Schedule,Per Unit,$49.83 ,OP,17.53,49.83,,,,,,,,,,,,,
Corvel,CPT,97151,Bhv id assmt by phys/qhp,OP Fee Schedule,Straight Discount,53.20%,OP,72.56,72.56,,,,,,,,,,,,,
Corvel,CPT,97152,Bhv id suprt assmt by 1 tech,OP Fee Schedule,Straight Discount,53.20%,OP,72.56,72.56,,,,,,,,,,,,,
Corvel,CPT,97153,Adaptive behavior tx by tech,OP Fee Schedule,Straight Discount,53.20%,OP,72.56,72.56,,,,,,,,,,,,,
Corvel,CPT,97154,Grp adapt bhv tx by tech,OP Fee Schedule,Straight Discount,53.20%,OP,25.42,25.42,,,,,,,,,,,,,
Corvel,CPT,97155,Adapt behavior tx phys/qhp,OP Fee Schedule,Straight Discount,53.20%,OP,72.56,72.56,,,,,,,,,,,,,
Corvel,CPT,97156,Fam adapt bhv tx gdn phy/qhp,OP Fee Schedule,Straight Discount,53.20%,OP,25.42,25.42,,,,,,,,,,,,,
Corvel,CPT,97157,Mult fam adapt bhv tx gdn,OP Fee Schedule,Straight Discount,53.20%,OP,25.42,25.42,,,,,,,,,,,,,
Corvel,CPT,97158,Grp adapt bhv tx by phy/qhp,OP Fee Schedule,Straight Discount,53.20%,OP,25.42,25.42,,,,,,,,,,,,,
Corvel,CPT,97161,Pt eval low complex 20 min,OP Fee Schedule,Straight Discount,53.20%,OP,98.12,98.12,,,,,,,,,,,,,
Corvel,CPT,97162,Pt eval mod complex 30 min,OP Fee Schedule,Straight Discount,53.20%,OP,98.12,98.12,,,,,,,,,,,,,
Corvel,CPT,97163,Pt eval high complex 45 min,OP Fee Schedule,Straight Discount,53.20%,OP,98.12,98.12,,,,,,,,,,,,,
Corvel,CPT,97164,Pt re-eval est plan care,OP Fee Schedule,Straight Discount,53.20%,OP,66.97,66.97,,,,,,,,,,,,,
Corvel,CPT,97165,Ot eval low complex 30 min,OP Fee Schedule,Straight Discount,53.20%,OP,95.26,95.26,,,,,,,,,,,,,
Corvel,CPT,97166,Ot eval mod complex 45 min,OP Fee Schedule,Straight Discount,53.20%,OP,95.26,95.26,,,,,,,,,,,,,
Corvel,CPT,97167,Ot eval high complex 60 min,OP Fee Schedule,Straight Discount,53.20%,OP,95.26,95.26,,,,,,,,,,,,,
Corvel,CPT,97168,Ot re-eval est plan care,OP Fee Schedule,Straight Discount,53.20%,OP,64.11,64.11,,,,,,,,,,,,,
Corvel,CPT,97169,Athletic trn eval low cmplx,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97170,Athletic trn eval mod cmplx,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97171,Athletic trn eval high cmplx,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97172,Athletic trn re-eval plan cr,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97530,Therapeutic activities,OP Fee Schedule,Per Unit,$56.52 ,OP,37.5,56.52,,,,,,,,,,,,,
Corvel,CPT,97533,Sensory integration,OP Fee Schedule,Per Unit,$178.52 ,OP,57.03,178.52,,,,,,,,,,,,,
Corvel,CPT,97535,Self care mngment training,OP Fee Schedule,Per Unit,$43.32 ,OP,32.44,43.32,,,,,,,,,,,,,
Corvel,CPT,97537,Community/work reintegration,OP Fee Schedule,Straight Discount,53.20%,OP,31.26,31.26,,,,,,,,,,,,,
Corvel,CPT,97542,Wheelchair mngment training,OP Fee Schedule,Per Unit,$46.28 ,OP,31.58,46.28,,,,,,,,,,,,,
Corvel,CPT,97545,Work hardening,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97546,Work hardening add-on,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97597,Rmvl devital tis 20 cm/<,OP Fee Schedule,Straight Discount,53.20%,OP,173.99,173.99,,,,,,,,,,,,,
Corvel,CPT,97598,Rmvl devital tis addl 20cm/<,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Corvel,CPT,97602,Wound(s) care non-selective,OP Fee Schedule,Per Unit,$68.84 ,OP,68.84,173.99,,,,,,,,,,,,,
Corvel,CPT,97605,Neg press wound tx <=50 cm,OP Fee Schedule,Straight Discount,53.20%,OP,173.99,173.99,,,,,,,,,,,,,
Corvel,CPT,97606,Neg press wound tx >50 cm,OP Fee Schedule,Straight Discount,53.20%,OP,335.15,335.15,,,,,,,,,,,,,
Corvel,CPT,97607,Neg press wnd tx <=50 sq cm,OP Fee Schedule,Straight Discount,53.20%,OP,335.15,335.15,,,,,,,,,,,,,
Corvel,CPT,97608,Neg press wound tx >50 cm,OP Fee Schedule,Straight Discount,53.20%,OP,335.15,335.15,,,,,,,,,,,,,
Corvel,CPT,97610,Low frequency non-thermal us,OP Fee Schedule,Straight Discount,53.20%,OP,173.99,173.99,,,,,,,,,,,,,
Corvel,CPT,97750,Physical performance test,OP Fee Schedule,Per Unit,$79.74 ,OP,33.07,79.74,,,,,,,,,,,,,
Corvel,CPT,97755,Assistive technology assess,OP Fee Schedule,Straight Discount,53.20%,OP,37.42,37.42,,,,,,,,,,,,,
Corvel,CPT,97760,Orthotic mgmt&traing 1st enc,OP Fee Schedule,Straight Discount,53.20%,OP,47.55,47.55,,,,,,,,,,,,,
Corvel,CPT,97761,Prosthetic traing 1st enc,OP Fee Schedule,Straight Discount,53.20%,OP,40.55,40.55,,,,,,,,,,,,,
Corvel,CPT,97763,Orthc/prostc mgmt sbsq enc,OP Fee Schedule,Straight Discount,53.20%,OP,51.94,51.94,,,,,,,,,,,,,
Corvel,CPT,97799,Physical medicine procedure,OP Fee Schedule,Straight Discount,53.20%,OP,,,,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"281,947.26",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"155,072.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"284,088.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"224,999.56",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Surgical,Per Diem,$930.00 ,IP,930,"99,513.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"45,669.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-007,LUNG TRANSPLANT,Surgical,Per Diem,$930.00 ,IP,930,"112,664.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Surgical,Per Diem,$930.00 ,IP,930,"52,824.47",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-010,PANCREAS TRANSPLANT,Surgical,Per Diem,$930.00 ,IP,930,"35,214.69",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"48,829.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"74,654.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"29,317.87",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Surgical,Per Diem,$930.00 ,IP,930,"124,388.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"65,472.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"47,017.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,Medical,Per Diem,$880.00 ,IP,880,"363,360.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Surgical,Per Diem,$930.00 ,IP,930,"64,846.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"100,455.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"73,312.59",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"47,303.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Surgical,Per Diem,$930.00 ,IP,930,"73,951.33",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"39,702.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"100,858.36",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"47,469.26",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"29,826.86",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"56,651.88",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Surgical,Per Diem,$930.00 ,IP,930,"39,621.18",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"29,340.89",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"42,499.62",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"24,825.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,749.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"38,688.76",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,749.33",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,019.58",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"33,522.99",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,772.44",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,297.42",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"74,748.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Surgical,Per Diem,$930.00 ,IP,930,"22,882.69",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,244.51",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"17,960.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"11,058.80",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"26,640.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"16,029.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"21,291.18",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"12,305.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,905.04",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,554.38",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,686.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"28,113.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical,Per Diem,$880.00 ,IP,880,"19,343.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"16,644.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"29,588.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical,Per Diem,$880.00 ,IP,880,"15,543.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"12,253.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,867.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"12,660.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical,Per Diem,$880.00 ,IP,880,"9,563.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,318.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"9,839.13",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,341.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,444.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"9,913.11",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"15,827.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,548.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,911.51",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical,Per Diem,$880.00 ,IP,880,"9,237.57",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,074.67",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"20,363.53",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"10,010.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"21,980.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical,Per Diem,$880.00 ,IP,880,"16,494.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,801.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"45,763.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical,Per Diem,$880.00 ,IP,880,"17,459.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,138.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-088,CONCUSSION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,204.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-089,CONCUSSION WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,793.62",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"10,126.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,050.39",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical,Per Diem,$880.00 ,IP,880,"12,405.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"10,377.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"50,515.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical,Per Diem,$880.00 ,IP,880,"33,641.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"22,694.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"36,527.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"38,577.09",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"13,601.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-100,SEIZURES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"21,842.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-101,SEIZURES WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,634.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-102,HEADACHES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"11,210.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-103,HEADACHES WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,918.22",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"21,334.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,070.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Surgical,Per Diem,$930.00 ,IP,930,"14,146.42",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,272.66",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"10,112.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"11,570.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"6,709.38",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical,Per Diem,$880.00 ,IP,880,"8,500.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,615.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,131.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,836.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,221.04",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,295.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,787.56",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-139,SALIVARY GLAND PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"11,941.67",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"38,747.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"21,487.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,660.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"28,849.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"17,039.37",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,812.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"19,790.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical,Per Diem,$880.00 ,IP,880,"12,664.91",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,653.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-149,DYSEQUILIBRIUM,Medical,Per Diem,$880.00 ,IP,880,"7,392.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-150,EPISTAXIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"12,894.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,173.96",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"10,482.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"6,916.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,014.70",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"8,892.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,456.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,305.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"9,313.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"6,737.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"101,978.91",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"39,411.86",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,578.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"46,767.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"30,246.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"22,687.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical,Per Diem,$880.00 ,IP,880,"18,304.55",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"15,051.96",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"28,695.97",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"23,962.45",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"12,328.33",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"24,073.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"16,177.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,666.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,222.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical,Per Diem,$880.00 ,IP,880,"15,216.38",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,201.76",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"40,210.79",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical,Per Diem,$880.00 ,IP,880,"12,210.89",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,884.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical,Per Diem,$880.00 ,IP,880,"16,929.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,531.37",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,266.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,118.38",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"19,397.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,652.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,432.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,102.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical,Per Diem,$880.00 ,IP,880,"17,659.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,378.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"19,033.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical,Per Diem,$880.00 ,IP,880,"15,173.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,175.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,399.15",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"6,867.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical,Per Diem,$880.00 ,IP,880,"8,328.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"34,334.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,606.80",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical,Per Diem,$880.00 ,IP,880,"76,148.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical,Per Diem,$880.00 ,IP,880,"31,656.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Surgical,Per Diem,$930.00 ,IP,930,"108,611.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"126,394.99",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"74,069.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"50,063.91",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"95,509.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"60,249.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"57,682.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"81,970.99",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"60,468.58",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"71,663.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"54,771.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"64,359.26",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"51,121.99",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"60,499.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"57,167.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"82,643.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"57,414.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"137,557.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"52,820.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"94,461.59",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"49,122.62",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"84,834.80",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"54,863.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"19,430.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"41,106.15",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"32,586.89",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,107.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-245,AICD GENERATOR PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"52,699.88",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Per Diem,$930.00 ,IP,930,"30,425.56",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"19,353.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Per Diem,$930.00 ,IP,930,"30,894.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"32,084.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"24,556.94",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"24,457.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"61,448.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"37,067.89",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"21,026.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"24,753.56",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"19,755.71",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,301.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"31,161.45",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,638.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"34,888.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"19,383.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,626.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-263,VEIN LIGATION AND STRIPPING,Surgical,Per Diem,$930.00 ,IP,930,"22,439.79",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"31,614.09",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-265,AICD LEAD PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"32,732.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"69,084.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"54,519.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"67,696.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"41,998.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"50,437.69",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"34,697.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"26,172.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"37,351.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"31,980.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"29,690.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical,Per Diem,$880.00 ,IP,880,"23,082.57",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"20,276.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"38,792.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical,Per Diem,$880.00 ,IP,880,"25,216.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"4,831.96",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"31,281.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"20,170.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"47,943.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"15,989.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,963.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"24,955.04",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,086.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,312.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"12,745.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,551.97",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,523.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical,Per Diem,$880.00 ,IP,880,"6,858.58",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"4,752.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,496.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"10,144.77",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,251.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,024.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"13,191.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-304,HYPERTENSION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"10,664.57",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,013.43",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,637.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,453.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,068.11",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"10,737.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,351.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-311,ANGINA PECTORIS,Medical,Per Diem,$880.00 ,IP,880,"6,784.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical,Per Diem,$880.00 ,IP,880,"8,308.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-313,CHEST PAIN,Medical,Per Diem,$880.00 ,IP,880,"7,016.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"21,590.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"14,251.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"10,062.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"42,010.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"23,786.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"72,806.55",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"36,840.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"21,222.70",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"58,786.79",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"32,076.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"22,739.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-332,RECTAL RESECTION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"40,490.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-333,RECTAL RESECTION WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"23,168.53",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"22,161.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"40,376.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"30,773.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"19,745.42",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"42,970.69",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"29,459.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,383.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"22,545.89",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"16,376.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,823.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"27,263.96",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"24,196.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,121.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"23,961.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"14,526.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"9,532.51",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"23,871.66",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"14,886.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"10,736.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"42,132.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,629.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,128.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"41,772.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"21,937.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,746.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,906.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"14,533.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,008.96",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"20,975.37",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"14,263.75",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,237.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"20,879.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical,Per Diem,$880.00 ,IP,880,"16,469.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,713.88",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,510.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,201.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,353.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,330.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical,Per Diem,$880.00 ,IP,880,"16,393.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,875.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"12,760.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,686.62",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,760.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical,Per Diem,$880.00 ,IP,880,"12,619.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"11,388.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,414.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical,Per Diem,$880.00 ,IP,880,"9,770.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,374.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,398.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,984.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,096.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"10,892.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,654.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"112,898.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"41,825.91",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"27,794.09",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"39,095.75",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"20,580.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,240.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"36,525.86",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,151.66",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"24,838.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"47,586.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"25,671.18",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,836.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"23,590.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"19,926.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,420.41",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"34,206.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"18,581.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,127.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"40,678.39",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,209.09",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,022.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"19,308.42",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,980.70",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,045.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,484.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,731.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,707.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"25,887.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical,Per Diem,$880.00 ,IP,880,"14,357.76",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,273.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"20,401.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"14,680.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,700.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,244.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,433.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,848.68",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"89,490.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"59,358.91",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"46,635.59",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"83,693.91",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"63,290.47",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"48,839.37",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"65,527.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"38,280.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"59,145.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"30,605.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"103,000.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"33,683.44",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,945.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"52,028.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"34,810.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"27,294.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Surgical,Per Diem,$930.00 ,IP,930,"31,852.97",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,493.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"48,833.53",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"29,719.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"24,726.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"39,644.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"25,444.94",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,391.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"32,676.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"41,472.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,611.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"33,955.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"27,785.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,467.71",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Surgical,Per Diem,$930.00 ,IP,930,"23,228.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"33,169.58",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"37,924.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,429.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"19,220.76",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"13,956.09",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"33,759.46",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,633.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,026.39",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"35,375.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"19,327.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,198.99",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"25,155.58",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,668.15",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"30,700.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"18,582.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,954.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-503,FOOT PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"25,587.77",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-504,FOOT PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"17,267.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,267.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"22,732.26",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"19,685.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"13,763.88",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-509,ARTHROSCOPY,Surgical,Per Diem,$930.00 ,IP,930,"16,292.77",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"26,580.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"19,161.38",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,148.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,495.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"9,677.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"30,535.56",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"20,939.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,164.18",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Surgical,Per Diem,$930.00 ,IP,930,"34,889.58",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"19,056.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"13,796.97",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"29,819.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"21,308.70",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,750.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"9,003.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"12,009.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"10,296.75",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,083.77",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"11,438.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,895.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"16,619.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"11,354.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"42,249.68",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical,Per Diem,$880.00 ,IP,880,"21,655.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"12,656.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"28,263.70",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"17,348.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"10,953.43",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"19,756.13",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"12,137.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,709.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"20,193.22",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"9,169.43",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"12,345.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,693.75",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,265.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,848.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,568.22",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,354.69",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,182.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,188.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,700.57",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,525.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"9,252.79",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,735.33",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"17,516.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,315.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"27,608.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"15,893.68",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"10,732.71",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"53,900.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"31,618.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,146.44",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"49,165.46",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"40,864.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,873.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"28,499.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"15,577.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,187.94",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,922.88",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,969.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,757.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,904.06",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-592,SKIN ULCERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,418.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-593,SKIN ULCERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,065.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,969.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"19,585.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"9,628.87",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,931.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"10,816.42",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"6,533.46",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,692.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,644.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-602,CELLULITIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,311.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,223.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,516.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"10,528.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,708.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,036.39",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"23,233.11",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"30,961.86",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"38,826.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"24,974.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,683.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"46,417.37",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"29,276.15",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"21,824.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"35,167.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"20,650.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"10,651.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"27,656.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"16,454.94",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,627.38",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"35,997.31",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"42,844.13",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"62,529.13",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-637,DIABETES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,384.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-638,DIABETES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,497.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"6,523.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,032.71",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,705.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical,Per Diem,$880.00 ,IP,880,"12,532.53",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,190.56",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"9,912.13",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,473.77",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"43,930.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"35,953.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-652,KIDNEY TRANSPLANT,Surgical,Per Diem,$930.00 ,IP,930,"30,972.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"53,042.51",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"34,877.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,247.69",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"31,944.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"24,776.42",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,687.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"25,939.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,402.18",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,610.09",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"28,518.67",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"15,524.76",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,527.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-665,PROSTATECTOMY WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"29,559.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-666,PROSTATECTOMY WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"16,881.68",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"9,684.36",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"34,290.18",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"14,911.51",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"9,916.13",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,294.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,202.86",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"72,221.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"24,957.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,920.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-682,RENAL FAILURE WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"28,276.40",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-683,RENAL FAILURE WITH CC,Medical,Per Diem,$880.00 ,IP,880,"15,981.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"11,604.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,233.73",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"15,308.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"6,670.71",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,266.88",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,711.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-693,URINARY STONES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,038.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,989.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"11,060.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"10,088.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-697,URETHRAL STRICTURE,Medical,Per Diem,$880.00 ,IP,880,"9,704.80",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,964.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,322.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,322.67",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"19,671.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,904.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"22,504.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,135.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,736.34",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"10,293.71",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,519.23",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"9,038.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"19,651.97",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,425.45",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,506.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,033.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,635.41",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical,Per Diem,$880.00 ,IP,880,"10,601.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"12,900.09",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"12,478.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,235.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"13,803.79",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,821.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,780.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"5,506.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"21,636.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"13,759.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"41,449.32",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"24,678.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,233.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"37,200.43",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"17,521.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,454.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,713.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,021.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"17,462.80",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,393.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,985.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"10,529.41",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"13,124.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"26,353.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,269.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,725.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,542.79",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,899.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"14,816.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Per Diem,$880.00 ,IP,880,"9,412.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,933.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"12,819.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,742.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Vaginal Delivery,Per Diem,"$2,125.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Surgical,Per Diem,$930.00 ,IP,930,"16,800.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Surgical,Per Diem,$930.00 ,IP,930,"8,928.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical,Per Diem,$880.00 ,IP,880,"7,483.50",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-779,ABORTION WITHOUT D&C,Medical,Per Diem,$880.00 ,IP,880,"10,127.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,C-Section,Per Diem,"$2,975.00 ",IP,"2,975.00","17,026.59",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,C-Section,Per Diem,"$2,975.00 ",IP,"2,975.00","9,954.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$2,975.00 ",IP,"2,975.00","8,321.91",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,C-Section,Per Diem,"$2,975.00 ",IP,"2,975.00","14,466.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,C-Section,Per Diem,"$2,975.00 ",IP,"2,975.00","9,662.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$2,975.00 ",IP,"2,975.00","8,065.51",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-795,NORMAL NEWBORN,Normal Newborn,Per Diem,$280.00 ,IP,280,"1,732.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Vaginal Delivery,Per Diem,"$2,125.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Vaginal Delivery,Per Diem,"$2,125.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Diem,"$2,125.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-799,SPLENECTOMY WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"50,070.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-800,SPLENECTOMY WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"28,728.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"23,774.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"36,100.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"18,346.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"13,279.12",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Vaginal Delivery,Per Diem,"$2,125.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Vaginal Delivery,Per Diem,"$2,125.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Diem,"$2,125.00 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"21,199.68",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,075.41",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"10,300.53",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,949.69",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,563.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-813,COAGULATION DISORDERS,Medical,Per Diem,$880.00 ,IP,880,"15,036.11",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,405.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"13,663.66",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"6,433.20",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"22,405.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"12,814.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"9,713.56",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"122,617.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"27,576.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"27,517.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"43,774.77",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"22,998.52",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"13,634.41",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"49,028.21",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"33,856.22",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"32,407.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"31,204.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,372.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"10,912.79",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"7,590.57",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"5,217.42",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"151,525.57",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"108,442.41",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"19,754.19",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"55,476.01",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical,Per Diem,$880.00 ,IP,880,"21,987.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"14,467.64",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"38,835.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical,Per Diem,$880.00 ,IP,880,"23,414.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"10,675.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,522.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"21,166.22",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"15,814.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"25,988.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical,Per Diem,$880.00 ,IP,880,"12,996.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"10,016.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-849,RADIOTHERAPY,Medical,Per Diem,$880.00 ,IP,880,"24,213.33",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"91,309.54",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"37,668.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"27,510.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"119,992.39",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"20,964.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"20,693.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"64,183.43",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"11,618.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical,Per Diem,$880.00 ,IP,880,"8,517.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,920.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,149.30",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"31,175.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical,Per Diem,$880.00 ,IP,880,"20,802.66",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"9,060.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical,Per Diem,$880.00 ,IP,880,"62,539.00",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"31,444.24",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"15,068.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Surgical,Per Diem,$930.00 ,IP,930,"31,745.49",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-880,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,Psychiatric,Per Diem,$485.00 ,IP,485,"8,406.28",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-881,DEPRESSIVE NEUROSES,Psychiatric,Per Diem,$485.00 ,IP,485,"7,800.83",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-882,NEUROSES EXCEPT DEPRESSIVE,Psychiatric,Per Diem,$485.00 ,IP,485,"8,011.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-883,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,Psychiatric,Per Diem,$485.00 ,IP,485,"15,363.17",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-884,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,Psychiatric,Per Diem,$485.00 ,IP,485,"14,053.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-885,PSYCHOSES,Psychiatric,Per Diem,$485.00 ,IP,485,"12,041.93",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-886,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,Psychiatric,Per Diem,$485.00 ,IP,485,"11,890.08",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-887,OTHER MENTAL DISORDER DIAGNOSES,Psychiatric,Per Diem,$485.00 ,IP,485,"10,500.07",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"41,488.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"23,640.59",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"11,230.37",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"36,224.11",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"15,982.25",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Surgical,Per Diem,$930.00 ,IP,930,"17,460.85",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"52,333.81",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"23,274.39",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"14,200.04",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,928.72",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"8,649.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"16,524.44",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"6,398.16",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"18,792.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,700.57",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"17,856.05",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical,Per Diem,$880.00 ,IP,880,"11,715.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"8,817.98",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"15,453.70",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"9,056.51",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Surgical,Per Diem,$930.00 ,IP,930,"204,714.78",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"63,456.92",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"29,288.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical,Per Diem,$880.00 ,IP,880,"21,975.48",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical,Per Diem,$880.00 ,IP,880,"18,857.68",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-935,NON-EXTENSIVE BURNS,Medical,Per Diem,$880.00 ,IP,880,"18,818.74",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"32,961.27",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"35,826.95",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"18,735.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"11,584.43",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Per Diem,$880.00 ,IP,880,"7,647.03",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"16,233.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"7,192.45",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical,Per Diem,$880.00 ,IP,880,"12,539.35",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Per Diem,$930.00 ,IP,930,"99,563.62",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Per Diem,$930.00 ,IP,930,"48,319.58",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"81,020.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"41,927.10",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"34,550.88",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"41,610.90",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical,Per Diem,$880.00 ,IP,880,"28,388.26",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"16,749.46",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"56,334.55",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Surgical,Per Diem,$930.00 ,IP,930,"28,667.60",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical,Per Diem,$880.00 ,IP,880,"95,225.61",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical,Per Diem,$880.00 ,IP,880,"34,297.84",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical,Per Diem,$880.00 ,IP,880,"20,273.82",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical,Per Diem,$880.00 ,IP,880,"32,684.59",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"51,698.29",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"34,570.65",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"16,317.63",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Per Diem,$930.00 ,IP,930,"55,966.14",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Per Diem,$930.00 ,IP,930,"18,900.02",,,,,,,,,,,,,
Evolutions Healthcare,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Per Diem,$930.00 ,IP,930,"12,784.87",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Surgical,Relative Weights,"$158,272.86 ",IP,930,"281,947.26",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Surgical,Relative Weights,"$81,947.36 ",IP,930,"155,072.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Surgical,Relative Weights,"$104,584.83 ",IP,930,"284,088.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Surgical,Relative Weights,"$65,264.59 ",IP,930,"224,999.56",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Surgical,Relative Weights,"$56,027.10 ",IP,930,"99,513.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Surgical,Relative Weights,"$25,708.42 ",IP,930,"45,669.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-007,LUNG TRANSPLANT,Surgical,Relative Weights,"$63,389.72 ",IP,930,"112,664.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Surgical,Relative Weights,"$29,742.26 ",IP,930,"52,824.47",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-010,PANCREAS TRANSPLANT,Surgical,Relative Weights,"$19,816.13 ",IP,930,"35,214.69",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Surgical,Relative Weights,"$27,487.49 ",IP,930,"48,829.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Surgical,Relative Weights,"$20,981.01 ",IP,930,"74,654.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$14,910.27 ",IP,930,"29,317.87",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Surgical,Relative Weights,"$58,446.64 ",IP,930,"124,388.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Surgical,Relative Weights,"$36,874.97 ",IP,930,"65,472.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Surgical,Relative Weights,"$26,580.44 ",IP,930,"47,017.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,Medical,Relative Weights,"$205,004.44 ",IP,880,"363,360.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Surgical,Relative Weights,"$36,565.14 ",IP,930,"64,846.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Surgical,Relative Weights,"$56,585.45 ",IP,930,"100,455.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Surgical,Relative Weights,"$41,293.64 ",IP,930,"73,312.59",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Surgical,Relative Weights,"$26,509.82 ",IP,930,"47,303.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Surgical,Relative Weights,"$31,048.37 ",IP,930,"73,951.33",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Surgical,Relative Weights,"$21,562.36 ",IP,930,"39,702.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$24,619.08 ",IP,930,"100,858.36",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Surgical,Relative Weights,"$16,761.60 ",IP,930,"47,469.26",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$13,763.45 ",IP,930,"29,826.86",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$31,876.05 ",IP,930,"56,651.88",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Surgical,Relative Weights,"$18,046.91 ",IP,930,"39,621.18",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$12,901.29 ",IP,930,"29,340.89",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Surgical,Relative Weights,"$23,930.99 ",IP,930,"42,499.62",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Surgical,Relative Weights,"$12,133.27 ",IP,930,"24,825.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,427.44 ",IP,930,"16,749.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Surgical,Relative Weights,"$21,776.39 ",IP,930,"38,688.76",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Surgical,Relative Weights,"$12,807.68 ",IP,930,"22,749.33",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,139.62 ",IP,930,"18,019.58",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,941.81 ",IP,930,"33,522.99",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Surgical,Relative Weights,"$9,080.39 ",IP,930,"22,772.44",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,235.51 ",IP,930,"14,297.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Surgical,Relative Weights,"$21,156.18 ",IP,930,"74,748.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Surgical,Relative Weights,"$12,862.42 ",IP,930,"22,882.69",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,407.30 ",IP,930,"20,244.51",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical,Relative Weights,"$10,146.19 ",IP,880,"17,960.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical,Relative Weights,"$6,220.73 ",IP,880,"11,058.80",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical,Relative Weights,"$7,490.17 ",IP,880,"26,640.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical,Relative Weights,"$5,718.21 ",IP,880,"16,029.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical,Relative Weights,"$12,017.22 ",IP,880,"21,291.18",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical,Relative Weights,"$6,938.38 ",IP,880,"12,305.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical,Relative Weights,"$9,512.84 ",IP,880,"16,905.04",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical,Relative Weights,"$6,170.92 ",IP,880,"11,554.38",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical,Relative Weights,"$5,023.55 ",IP,880,"9,686.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical,Relative Weights,"$15,826.63 ",IP,880,"28,113.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical,Relative Weights,"$10,884.09 ",IP,880,"19,343.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical,Relative Weights,"$9,359.02 ",IP,880,"16,644.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical,Relative Weights,"$10,504.19 ",IP,880,"29,588.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical,Relative Weights,"$5,583.55 ",IP,880,"15,543.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical,Relative Weights,"$3,895.35 ",IP,880,"12,253.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical,Relative Weights,"$7,804.93 ",IP,880,"13,867.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical,Relative Weights,"$4,865.90 ",IP,880,"12,660.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical,Relative Weights,"$4,308.64 ",IP,880,"9,563.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical,Relative Weights,"$9,194.25 ",IP,880,"16,318.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical,Relative Weights,"$5,538.66 ",IP,880,"9,839.13",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,224.34 ",IP,880,"9,341.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical,Relative Weights,"$7,953.28 ",IP,880,"17,444.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical,Relative Weights,"$5,578.08 ",IP,880,"9,913.11",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical,Relative Weights,"$8,906.31 ",IP,880,"15,827.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,391.41 ",IP,880,"9,548.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical,Relative Weights,"$8,391.20 ",IP,880,"14,911.51",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical,Relative Weights,"$5,199.82 ",IP,880,"9,237.57",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical,Relative Weights,"$3,989.50 ",IP,880,"7,074.67",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical,Relative Weights,"$11,470.36 ",IP,880,"20,363.53",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical,Relative Weights,"$4,232.55 ",IP,880,"10,010.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical,Relative Weights,"$12,392.75 ",IP,880,"21,980.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical,Relative Weights,"$7,357.15 ",IP,880,"16,494.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical,Relative Weights,"$4,957.32 ",IP,880,"8,801.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical,Relative Weights,"$12,654.41 ",IP,880,"45,763.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical,Relative Weights,"$6,976.70 ",IP,880,"17,459.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical,Relative Weights,"$4,727.41 ",IP,880,"9,138.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-088,CONCUSSION WITH MCC,Medical,Relative Weights,"$7,965.87 ",IP,880,"14,204.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-089,CONCUSSION WITH CC,Medical,Relative Weights,"$5,821.67 ",IP,880,"13,793.62",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical,Relative Weights,"$4,678.14 ",IP,880,"10,126.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical,Relative Weights,"$9,036.59 ",IP,880,"16,050.39",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical,Relative Weights,"$5,413.31 ",IP,880,"12,405.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$4,281.82 ",IP,880,"10,377.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical,Relative Weights,"$19,914.12 ",IP,880,"50,515.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical,Relative Weights,"$13,725.13 ",IP,880,"33,641.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$12,769.36 ",IP,880,"22,694.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical,Relative Weights,"$20,584.69 ",IP,880,"36,527.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical,Relative Weights,"$11,563.97 ",IP,880,"38,577.09",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Relative Weights,"$7,674.10 ",IP,880,"13,601.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-100,SEIZURES WITH MCC,Medical,Relative Weights,"$10,271.54 ",IP,880,"21,842.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-101,SEIZURES WITHOUT MCC,Medical,Relative Weights,"$4,863.16 ",IP,880,"8,634.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-102,HEADACHES WITH MCC,Medical,Relative Weights,"$6,312.15 ",IP,880,"11,210.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-103,HEADACHES WITHOUT MCC,Medical,Relative Weights,"$4,540.74 ",IP,880,"8,918.22",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$12,012.30 ",IP,930,"21,334.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,924.26 ",IP,930,"14,070.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Surgical,Relative Weights,"$7,973.53 ",IP,930,"14,146.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$10,306.03 ",IP,930,"18,272.66",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,699.60 ",IP,930,"10,112.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical,Relative Weights,"$6,517.43 ",IP,880,"11,570.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical,Relative Weights,"$3,533.51 ",IP,880,"6,709.38",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical,Relative Weights,"$4,197.52 ",IP,880,"8,500.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical,Relative Weights,"$7,674.64 ",IP,880,"13,615.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical,Relative Weights,"$4,581.80 ",IP,880,"8,131.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$11,733.67 ",IP,930,"20,836.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,872.69 ",IP,930,"12,221.04",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$8,264.20 ",IP,930,"14,295.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$4,688.54 ",IP,930,"11,787.56",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-139,SALIVARY GLAND PROCEDURES,Surgical,Relative Weights,"$6,755.55 ",IP,930,"11,941.67",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Medical,Relative Weights,"$21,775.30 ",IP,930,"38,747.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,Medical,Relative Weights,"$12,076.34 ",IP,930,"21,487.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$8,786.43 ",IP,930,"15,660.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$16,311.63 ",IP,930,"28,849.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$9,642.57 ",IP,930,"17,039.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$6,703.55 ",IP,930,"11,812.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical,Relative Weights,"$11,173.12 ",IP,880,"19,790.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical,Relative Weights,"$7,122.31 ",IP,880,"12,664.91",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$4,308.09 ",IP,880,"7,653.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-149,DYSEQUILIBRIUM,Medical,Relative Weights,"$4,034.39 ",IP,880,"7,392.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-150,EPISTAXIS WITH MCC,Medical,Relative Weights,"$7,266.83 ",IP,880,"12,894.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical,Relative Weights,"$4,042.05 ",IP,880,"7,173.96",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical,Relative Weights,"$5,914.73 ",IP,880,"10,482.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical,Relative Weights,"$3,904.11 ",IP,880,"6,916.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,467.29 ",IP,880,"15,014.70",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical,Relative Weights,"$4,978.67 ",IP,880,"8,892.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,604.13 ",IP,880,"7,456.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical,Relative Weights,"$8,628.23 ",IP,880,"15,305.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical,Relative Weights,"$4,927.76 ",IP,880,"9,313.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical,Relative Weights,"$3,629.86 ",IP,880,"6,737.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Surgical,Relative Weights,"$27,407.57 ",IP,930,"101,978.91",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Surgical,Relative Weights,"$14,536.94 ",IP,930,"39,411.86",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,491.60 ",IP,930,"18,578.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$20,382.70 ",IP,930,"46,767.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$9,955.69 ",IP,930,"30,246.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,414.08 ",IP,930,"22,687.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical,Relative Weights,"$8,462.91 ",IP,880,"18,304.55",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical,Relative Weights,"$4,859.88 ",IP,880,"15,051.96",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical,Relative Weights,"$10,122.10 ",IP,880,"28,695.97",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical,Relative Weights,"$6,611.58 ",IP,880,"23,962.45",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical,Relative Weights,"$4,777.22 ",IP,880,"12,328.33",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical,Relative Weights,"$9,524.33 ",IP,880,"24,073.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical,Relative Weights,"$6,131.50 ",IP,880,"16,177.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical,Relative Weights,"$4,335.46 ",IP,880,"9,666.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical,Relative Weights,"$8,533.53 ",IP,880,"18,222.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical,Relative Weights,"$5,697.96 ",IP,880,"15,216.38",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical,Relative Weights,"$4,241.86 ",IP,880,"8,201.76",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical,Relative Weights,"$8,450.87 ",IP,880,"40,210.79",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical,Relative Weights,"$5,654.17 ",IP,880,"12,210.89",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical,Relative Weights,"$3,993.33 ",IP,880,"9,884.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical,Relative Weights,"$6,711.76 ",IP,880,"16,929.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical,Relative Weights,"$6,158.88 ",IP,880,"14,531.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical,Relative Weights,"$4,840.72 ",IP,880,"13,266.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical,Relative Weights,"$3,807.76 ",IP,880,"9,118.38",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical,Relative Weights,"$7,181.98 ",IP,880,"19,397.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical,Relative Weights,"$4,729.05 ",IP,880,"11,652.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical,Relative Weights,"$3,644.64 ",IP,880,"7,432.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical,Relative Weights,"$9,517.22 ",IP,880,"17,102.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical,Relative Weights,"$5,512.39 ",IP,880,"17,659.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical,Relative Weights,"$4,069.42 ",IP,880,"9,378.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical,Relative Weights,"$9,798.58 ",IP,880,"19,033.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical,Relative Weights,"$5,892.84 ",IP,880,"15,173.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical,Relative Weights,"$3,884.40 ",IP,880,"7,175.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical,Relative Weights,"$5,293.42 ",IP,880,"9,399.15",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical,Relative Weights,"$3,870.17 ",IP,880,"6,867.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical,Relative Weights,"$4,344.22 ",IP,880,"8,328.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical,Relative Weights,"$9,222.71 ",IP,880,"34,334.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical,Relative Weights,"$4,850.03 ",IP,880,"8,606.80",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical,Relative Weights,"$31,399.81 ",IP,880,"76,148.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical,Relative Weights,"$13,930.41 ",IP,880,"31,656.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Surgical,Relative Weights,"$57,797.41 ",IP,930,"108,611.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$54,955.82 ",IP,930,"126,394.99",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Surgical,Relative Weights,"$35,491.13 ",IP,930,"74,069.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Relative Weights,"$33,442.73 ",IP,930,"50,063.91",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$44,107.86 ",IP,930,"95,509.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Surgical,Relative Weights,"$29,588.99 ",IP,930,"60,249.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Relative Weights,"$25,070.69 ",IP,930,"57,682.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Surgical,Relative Weights,"$43,524.32 ",IP,930,"81,970.99",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Surgical,Relative Weights,"$31,741.94 ",IP,930,"60,468.58",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Surgical,Relative Weights,"$41,160.07 ",IP,930,"71,663.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Surgical,Relative Weights,"$30,752.23 ",IP,930,"54,771.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$35,937.26 ",IP,930,"64,359.26",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Relative Weights,"$28,531.40 ",IP,930,"51,121.99",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Surgical,Relative Weights,"$29,178.43 ",IP,930,"60,499.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$18,837.37 ",IP,930,"57,167.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Surgical,Relative Weights,"$47,711.44 ",IP,930,"82,643.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Surgical,Relative Weights,"$32,591.51 ",IP,930,"57,414.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Surgical,Relative Weights,"$43,367.22 ",IP,930,"137,557.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Surgical,Relative Weights,"$29,209.63 ",IP,930,"52,820.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$33,414.27 ",IP,930,"94,461.59",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Relative Weights,"$22,427.26 ",IP,930,"49,122.62",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Surgical,Relative Weights,"$26,363.12 ",IP,930,"84,834.80",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Surgical,Relative Weights,"$15,266.08 ",IP,930,"54,863.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Surgical,Relative Weights,"$8,716.91 ",IP,930,"19,430.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Surgical,Relative Weights,"$20,405.14 ",IP,930,"41,106.15",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Surgical,Relative Weights,"$13,786.44 ",IP,930,"32,586.89",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Surgical,Relative Weights,"$11,294.65 ",IP,930,"20,107.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-245,AICD GENERATOR PROCEDURES,Surgical,Relative Weights,"$29,657.41 ",IP,930,"52,699.88",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Relative Weights,"$17,102.63 ",IP,930,"30,425.56",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Surgical,Relative Weights,"$10,801.43 ",IP,930,"19,353.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Relative Weights,"$17,310.10 ",IP,930,"30,894.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Surgical,Relative Weights,"$10,256.76 ",IP,930,"32,084.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Surgical,Relative Weights,"$13,804.51 ",IP,930,"24,556.94",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Surgical,Relative Weights,"$9,078.20 ",IP,930,"24,457.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Surgical,Relative Weights,"$18,205.11 ",IP,930,"61,448.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Surgical,Relative Weights,"$14,525.99 ",IP,930,"37,067.89",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,940.36 ",IP,930,"21,026.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Surgical,Relative Weights,"$13,878.41 ",IP,930,"24,753.56",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Surgical,Relative Weights,"$9,000.46 ",IP,930,"19,755.71",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,378.39 ",IP,930,"11,301.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Surgical,Relative Weights,"$17,342.40 ",IP,930,"31,161.45",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Surgical,Relative Weights,"$11,436.43 ",IP,930,"20,638.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Surgical,Relative Weights,"$19,527.65 ",IP,930,"34,888.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Surgical,Relative Weights,"$10,914.75 ",IP,930,"19,383.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Surgical,Relative Weights,"$9,339.86 ",IP,930,"16,626.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-263,VEIN LIGATION AND STRIPPING,Surgical,Relative Weights,"$12,662.62 ",IP,930,"22,439.79",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Surgical,Relative Weights,"$17,810.43 ",IP,930,"31,614.09",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-265,AICD LEAD PROCEDURES,Surgical,Relative Weights,"$18,422.98 ",IP,930,"32,732.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Surgical,Relative Weights,"$38,580.69 ",IP,930,"69,084.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$30,643.84 ",IP,930,"54,519.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Surgical,Relative Weights,"$38,117.59 ",IP,930,"67,696.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Surgical,Relative Weights,"$23,621.16 ",IP,930,"41,998.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Surgical,Relative Weights,"$28,394.00 ",IP,930,"50,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Surgical,Relative Weights,"$19,517.25 ",IP,930,"34,697.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$14,715.94 ",IP,930,"26,172.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Surgical,Relative Weights,"$20,947.62 ",IP,930,"37,351.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$17,991.08 ",IP,930,"31,980.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical,Relative Weights,"$8,796.28 ",IP,880,"29,690.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical,Relative Weights,"$5,094.17 ",IP,880,"23,082.57",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical,Relative Weights,"$3,974.72 ",IP,880,"20,276.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical,Relative Weights,"$10,207.50 ",IP,880,"38,792.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical,Relative Weights,"$3,959.94 ",IP,880,"25,216.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical,Relative Weights,"$2,708.02 ",IP,880,"4,831.96",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical,Relative Weights,"$11,694.25 ",IP,880,"31,281.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical,Relative Weights,"$6,104.13 ",IP,880,"20,170.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical,Relative Weights,"$14,700.07 ",IP,880,"47,943.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical,Relative Weights,"$8,997.18 ",IP,880,"15,989.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,621.32 ",IP,880,"9,963.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical,Relative Weights,"$6,942.76 ",IP,880,"24,955.04",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical,Relative Weights,"$4,726.86 ",IP,880,"13,086.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical,Relative Weights,"$3,229.15 ",IP,880,"9,312.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical,Relative Weights,"$7,022.14 ",IP,880,"12,745.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,387.03 ",IP,880,"9,551.97",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical,Relative Weights,"$8,732.24 ",IP,880,"15,523.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical,Relative Weights,"$3,870.17 ",IP,880,"6,858.58",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical,Relative Weights,"$2,675.73 ",IP,880,"4,752.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical,Relative Weights,"$8,389.56 ",IP,880,"17,496.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical,Relative Weights,"$5,713.83 ",IP,880,"10,144.77",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,067.78 ",IP,880,"8,251.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical,Relative Weights,"$5,993.01 ",IP,880,"17,024.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical,Relative Weights,"$3,709.23 ",IP,880,"13,191.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-304,HYPERTENSION WITH MCC,Medical,Relative Weights,"$6,005.05 ",IP,880,"10,664.57",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical,Relative Weights,"$4,050.26 ",IP,880,"8,013.43",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical,Relative Weights,"$8,251.61 ",IP,880,"14,637.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,764.63 ",IP,880,"8,453.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical,Relative Weights,"$6,573.81 ",IP,880,"18,068.11",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical,Relative Weights,"$4,108.29 ",IP,880,"10,737.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,061.10 ",IP,880,"7,351.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-311,ANGINA PECTORIS,Medical,Relative Weights,"$3,823.64 ",IP,880,"6,784.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical,Relative Weights,"$4,591.10 ",IP,880,"8,308.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-313,CHEST PAIN,Medical,Relative Weights,"$3,948.99 ",IP,880,"7,016.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical,Relative Weights,"$11,411.79 ",IP,880,"21,590.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical,Relative Weights,"$5,328.46 ",IP,880,"14,251.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,959.94 ",IP,880,"10,062.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Surgical,Relative Weights,"$23,636.48 ",IP,930,"42,010.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$13,168.42 ",IP,930,"23,786.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$29,101.79 ",IP,930,"72,806.55",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Surgical,Relative Weights,"$14,039.35 ",IP,930,"36,840.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,124.73 ",IP,930,"21,222.70",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Relative Weights,"$26,747.40 ",IP,930,"58,786.79",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Relative Weights,"$13,955.04 ",IP,930,"32,076.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,363.40 ",IP,930,"22,739.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-332,RECTAL RESECTION WITH MCC,Surgical,Relative Weights,"$22,780.34 ",IP,930,"40,490.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-333,RECTAL RESECTION WITH CC,Surgical,Relative Weights,"$11,721.62 ",IP,930,"23,168.53",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Surgical,Relative Weights,"$8,805.59 ",IP,930,"22,161.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Surgical,Relative Weights,"$21,422.77 ",IP,930,"40,376.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Surgical,Relative Weights,"$12,542.73 ",IP,930,"30,773.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$8,962.69 ",IP,930,"19,745.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$15,312.61 ",IP,930,"42,970.69",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$9,291.69 ",IP,930,"29,459.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,723.80 ",IP,930,"17,383.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$12,712.98 ",IP,930,"22,545.89",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$7,843.79 ",IP,930,"16,376.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,068.55 ",IP,930,"11,823.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,428.12 ",IP,930,"27,263.96",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Relative Weights,"$8,642.46 ",IP,930,"24,196.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,981.63 ",IP,930,"18,121.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$13,491.94 ",IP,930,"23,961.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Surgical,Relative Weights,"$7,379.59 ",IP,930,"14,526.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,360.76 ",IP,930,"9,532.51",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Surgical,Relative Weights,"$13,437.75 ",IP,930,"23,871.66",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Surgical,Relative Weights,"$8,171.14 ",IP,930,"14,886.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,045.56 ",IP,930,"10,736.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Surgical,Relative Weights,"$16,558.51 ",IP,930,"42,132.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Surgical,Relative Weights,"$9,770.12 ",IP,930,"22,629.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Surgical,Relative Weights,"$7,445.83 ",IP,930,"14,128.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$23,581.20 ",IP,930,"41,772.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$12,417.93 ",IP,930,"21,937.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,385.07 ",IP,930,"16,746.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical,Relative Weights,"$10,669.51 ",IP,880,"18,906.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical,Relative Weights,"$5,896.67 ",IP,880,"14,533.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,095.15 ",IP,880,"9,008.96",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical,Relative Weights,"$9,476.71 ",IP,880,"20,975.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical,Relative Weights,"$5,634.46 ",IP,880,"14,263.75",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical,Relative Weights,"$4,075.99 ",IP,880,"7,237.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical,Relative Weights,"$11,351.58 ",IP,880,"20,879.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical,Relative Weights,"$6,610.49 ",IP,880,"16,469.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$4,920.64 ",IP,880,"8,713.88",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical,Relative Weights,"$9,859.89 ",IP,880,"17,510.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical,Relative Weights,"$5,438.49 ",IP,880,"11,201.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical,Relative Weights,"$3,488.08 ",IP,880,"8,353.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical,Relative Weights,"$10,327.38 ",IP,880,"18,330.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical,Relative Weights,"$5,798.68 ",IP,880,"16,393.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical,Relative Weights,"$4,207.37 ",IP,880,"9,875.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical,Relative Weights,"$7,185.26 ",IP,880,"12,760.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical,Relative Weights,"$4,887.25 ",IP,880,"8,686.62",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical,Relative Weights,"$8,880.58 ",IP,880,"15,760.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical,Relative Weights,"$5,447.25 ",IP,880,"12,619.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical,Relative Weights,"$3,912.32 ",IP,880,"11,388.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical,Relative Weights,"$8,291.03 ",IP,880,"18,414.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical,Relative Weights,"$4,506.25 ",IP,880,"9,770.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical,Relative Weights,"$3,191.93 ",IP,880,"7,374.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical,Relative Weights,"$6,838.21 ",IP,880,"13,398.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,192.04 ",IP,880,"7,984.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical,Relative Weights,"$9,093.52 ",IP,880,"16,096.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical,Relative Weights,"$5,150.55 ",IP,880,"10,892.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,566.36 ",IP,880,"9,654.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Surgical,Relative Weights,"$31,408.02 ",IP,930,"112,898.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Surgical,Relative Weights,"$15,770.25 ",IP,930,"41,825.91",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$11,594.08 ",IP,930,"27,794.09",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Surgical,Relative Weights,"$20,543.63 ",IP,930,"39,095.75",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Surgical,Relative Weights,"$11,585.32 ",IP,930,"20,580.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$8,584.98 ",IP,930,"15,240.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Surgical,Relative Weights,"$20,546.92 ",IP,930,"36,525.86",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Surgical,Relative Weights,"$12,467.19 ",IP,930,"22,151.66",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$9,475.07 ",IP,930,"24,838.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Surgical,Relative Weights,"$19,861.57 ",IP,930,"47,586.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Surgical,Relative Weights,"$11,121.67 ",IP,930,"25,671.18",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$7,785.77 ",IP,930,"20,836.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Surgical,Relative Weights,"$13,270.79 ",IP,930,"23,590.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Surgical,Relative Weights,"$9,245.70 ",IP,930,"19,926.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$7,200.04 ",IP,930,"15,420.41",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Surgical,Relative Weights,"$19,249.56 ",IP,930,"34,206.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Surgical,Relative Weights,"$10,441.79 ",IP,930,"18,581.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,957.11 ",IP,930,"14,127.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$22,913.91 ",IP,930,"40,678.39",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$12,503.32 ",IP,930,"22,209.09",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,444.85 ",IP,930,"15,022.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical,Relative Weights,"$10,295.63 ",IP,880,"19,308.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical,Relative Weights,"$5,637.74 ",IP,880,"11,980.70",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Relative Weights,"$3,397.75 ",IP,880,"9,045.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical,Relative Weights,"$9,598.23 ",IP,880,"18,484.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical,Relative Weights,"$6,139.17 ",IP,880,"13,731.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical,Relative Weights,"$4,904.22 ",IP,880,"8,707.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical,Relative Weights,"$8,746.47 ",IP,880,"25,887.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical,Relative Weights,"$4,626.68 ",IP,880,"14,357.76",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$3,318.93 ",IP,880,"9,273.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical,Relative Weights,"$10,288.51 ",IP,880,"20,401.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical,Relative Weights,"$5,090.88 ",IP,880,"14,680.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Relative Weights,"$3,630.40 ",IP,880,"8,700.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical,Relative Weights,"$9,150.45 ",IP,880,"16,244.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical,Relative Weights,"$5,898.31 ",IP,880,"13,433.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical,Relative Weights,"$4,470.12 ",IP,880,"8,848.68",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Surgical,Relative Weights,"$50,295.75 ",IP,930,"89,490.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Surgical,Relative Weights,"$33,354.05 ",IP,930,"59,358.91",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Surgical,Relative Weights,"$26,173.17 ",IP,930,"46,635.59",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Surgical,Relative Weights,"$47,076.99 ",IP,930,"83,693.91",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Surgical,Relative Weights,"$35,559.01 ",IP,930,"63,290.47",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Surgical,Relative Weights,"$27,411.95 ",IP,930,"48,839.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Surgical,Relative Weights,"$36,859.64 ",IP,930,"65,527.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Surgical,Relative Weights,"$21,516.92 ",IP,930,"38,280.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Surgical,Relative Weights,"$33,291.65 ",IP,930,"59,145.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Surgical,Relative Weights,"$17,196.24 ",IP,930,"30,605.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Relative Weights,"$29,397.39 ",IP,930,"103,000.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Relative Weights,"$16,290.28 ",IP,930,"33,683.44",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$10,094.73 ",IP,930,"17,945.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Surgical,Relative Weights,"$29,262.73 ",IP,930,"52,028.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Surgical,Relative Weights,"$19,583.48 ",IP,930,"34,810.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Surgical,Relative Weights,"$15,340.53 ",IP,930,"27,294.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Surgical,Relative Weights,"$16,892.43 ",IP,930,"31,852.97",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Surgical,Relative Weights,"$10,402.37 ",IP,930,"18,493.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Surgical,Relative Weights,"$27,478.19 ",IP,930,"48,833.53",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Surgical,Relative Weights,"$16,716.17 ",IP,930,"29,719.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Surgical,Relative Weights,"$13,898.66 ",IP,930,"24,726.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Relative Weights,"$22,312.85 ",IP,930,"39,644.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Relative Weights,"$12,022.70 ",IP,930,"25,444.94",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,351.56 ",IP,930,"18,391.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Surgical,Relative Weights,"$18,386.85 ",IP,930,"32,676.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Surgical,Relative Weights,"$12,910.04 ",IP,930,"41,472.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Surgical,Relative Weights,"$9,905.33 ",IP,930,"17,611.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Surgical,Relative Weights,"$16,563.44 ",IP,930,"33,955.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Surgical,Relative Weights,"$11,474.20 ",IP,930,"27,785.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Surgical,Relative Weights,"$9,009.22 ",IP,930,"16,467.71",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Surgical,Relative Weights,"$13,059.49 ",IP,930,"23,228.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Surgical,Relative Weights,"$18,664.39 ",IP,930,"33,169.58",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Surgical,Relative Weights,"$11,765.96 ",IP,930,"37,924.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Relative Weights,"$8,978.57 ",IP,930,"16,429.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Surgical,Relative Weights,"$10,815.12 ",IP,930,"19,220.76",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Relative Weights,"$7,106.44 ",IP,930,"13,956.09",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Surgical,Relative Weights,"$18,995.02 ",IP,930,"33,759.46",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Surgical,Relative Weights,"$12,731.59 ",IP,930,"22,633.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Surgical,Relative Weights,"$10,136.33 ",IP,930,"18,026.39",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Surgical,Relative Weights,"$19,936.01 ",IP,930,"35,375.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Surgical,Relative Weights,"$10,873.69 ",IP,930,"19,327.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Surgical,Relative Weights,"$7,945.61 ",IP,930,"14,198.99",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Surgical,Relative Weights,"$14,143.35 ",IP,930,"25,155.58",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Surgical,Relative Weights,"$6,563.41 ",IP,930,"11,668.15",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,459.54 ",IP,930,"30,700.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Surgical,Relative Weights,"$9,602.06 ",IP,930,"18,582.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,295.84 ",IP,930,"12,954.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-503,FOOT PROCEDURES WITH MCC,Surgical,Relative Weights,"$14,454.83 ",IP,930,"25,587.77",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-504,FOOT PROCEDURES WITH CC,Surgical,Relative Weights,"$9,716.47 ",IP,930,"17,267.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,716.47 ",IP,930,"17,267.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Surgical,Relative Weights,"$8,121.33 ",IP,930,"22,732.26",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$11,281.51 ",IP,930,"19,685.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,716.80 ",IP,930,"13,763.88",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-509,ARTHROSCOPY,Surgical,Relative Weights,"$9,232.02 ",IP,930,"16,292.77",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,019.20 ",IP,930,"26,580.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Surgical,Relative Weights,"$10,769.68 ",IP,930,"19,161.38",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,509.44 ",IP,930,"15,148.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$8,605.24 ",IP,930,"16,495.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,469.14 ",IP,930,"9,677.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,191.86 ",IP,930,"30,535.56",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$10,744.50 ",IP,930,"20,939.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,653.84 ",IP,930,"17,164.18",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Surgical,Relative Weights,"$19,634.94 ",IP,930,"34,889.58",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Surgical,Relative Weights,"$10,729.18 ",IP,930,"19,056.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Surgical,Relative Weights,"$7,763.87 ",IP,930,"13,796.97",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Surgical,Relative Weights,"$16,784.59 ",IP,930,"29,819.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Surgical,Relative Weights,"$11,984.93 ",IP,930,"21,308.70",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical,Relative Weights,"$7,752.38 ",IP,880,"13,750.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical,Relative Weights,"$4,325.61 ",IP,880,"9,003.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical,Relative Weights,"$6,748.43 ",IP,880,"12,009.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical,Relative Weights,"$4,224.34 ",IP,880,"10,296.75",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical,Relative Weights,"$5,120.44 ",IP,880,"9,083.77",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical,Relative Weights,"$3,958.85 ",IP,880,"11,438.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical,Relative Weights,"$10,661.84 ",IP,880,"18,895.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical,Relative Weights,"$7,125.05 ",IP,880,"16,619.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical,Relative Weights,"$4,615.74 ",IP,880,"11,354.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical,Relative Weights,"$9,903.69 ",IP,880,"42,249.68",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical,Relative Weights,"$5,721.50 ",IP,880,"21,655.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$4,257.18 ",IP,880,"12,656.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical,Relative Weights,"$13,702.14 ",IP,880,"28,263.70",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical,Relative Weights,"$6,612.68 ",IP,880,"17,348.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,563.18 ",IP,880,"10,953.43",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical,Relative Weights,"$11,226.22 ",IP,880,"19,756.13",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical,Relative Weights,"$6,842.04 ",IP,880,"12,137.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical,Relative Weights,"$4,811.16 ",IP,880,"8,709.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical,Relative Weights,"$8,908.50 ",IP,880,"20,193.22",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical,Relative Weights,"$5,164.24 ",IP,880,"9,169.43",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical,Relative Weights,"$6,960.28 ",IP,880,"12,345.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical,Relative Weights,"$4,338.20 ",IP,880,"7,693.75",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Relative Weights,"$7,491.26 ",IP,880,"13,265.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical,Relative Weights,"$4,426.88 ",IP,880,"7,848.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical,Relative Weights,"$7,658.77 ",IP,880,"13,568.22",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical,Relative Weights,"$4,715.36 ",IP,880,"8,354.69",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Relative Weights,"$10,210.78 ",IP,880,"18,182.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical,Relative Weights,"$5,890.10 ",IP,880,"11,188.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical,Relative Weights,"$4,337.65 ",IP,880,"7,700.57",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical,Relative Weights,"$7,728.29 ",IP,880,"18,525.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical,Relative Weights,"$4,774.48 ",IP,880,"9,252.79",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,340.29 ",IP,880,"14,735.33",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical,Relative Weights,"$5,524.98 ",IP,880,"17,516.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$4,115.95 ",IP,880,"7,315.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Surgical,Relative Weights,"$15,555.66 ",IP,930,"27,608.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Surgical,Relative Weights,"$8,952.29 ",IP,930,"15,893.68",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Surgical,Relative Weights,"$6,045.56 ",IP,930,"10,732.71",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Relative Weights,"$30,321.42 ",IP,930,"53,900.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Relative Weights,"$17,771.57 ",IP,930,"31,618.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Relative Weights,"$9,651.88 ",IP,930,"17,146.44",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Relative Weights,"$27,719.04 ",IP,930,"49,165.46",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Relative Weights,"$13,956.69 ",IP,930,"40,864.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Relative Weights,"$8,732.24 ",IP,930,"15,873.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,215.40 ",IP,930,"28,499.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Surgical,Relative Weights,"$9,463.57 ",IP,930,"15,577.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,536.70 ",IP,930,"12,187.94",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$8,994.44 ",IP,930,"15,922.88",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$8,438.28 ",IP,930,"14,969.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$10,054.22 ",IP,930,"17,757.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,522.69 ",IP,930,"16,904.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-592,SKIN ULCERS WITH MCC,Medical,Relative Weights,"$9,274.72 ",IP,880,"16,418.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-593,SKIN ULCERS WITH CC,Medical,Relative Weights,"$6,243.72 ",IP,880,"11,065.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,466.84 ",IP,880,"7,969.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical,Relative Weights,"$11,038.46 ",IP,880,"19,585.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical,Relative Weights,"$5,445.06 ",IP,880,"9,628.87",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical,Relative Weights,"$8,999.37 ",IP,880,"15,931.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical,Relative Weights,"$6,092.09 ",IP,880,"10,816.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,675.29 ",IP,880,"6,533.46",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical,Relative Weights,"$5,457.10 ",IP,880,"9,692.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,759.59 ",IP,880,"8,644.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-602,CELLULITIS WITH MCC,Medical,Relative Weights,"$7,937.40 ",IP,880,"17,311.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical,Relative Weights,"$4,672.67 ",IP,880,"8,223.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical,Relative Weights,"$8,090.13 ",IP,880,"14,516.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical,Relative Weights,"$4,948.01 ",IP,880,"10,528.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical,Relative Weights,"$8,277.34 ",IP,880,"14,708.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,533.62 ",IP,880,"8,036.39",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$13,081.38 ",IP,930,"23,233.11",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,621.66 ",IP,930,"30,961.86",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Relative Weights,"$21,711.25 ",IP,930,"38,826.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Relative Weights,"$11,111.27 ",IP,930,"24,974.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$7,133.81 ",IP,930,"12,683.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Surgical,Relative Weights,"$16,759.96 ",IP,930,"46,417.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Surgical,Relative Weights,"$9,649.14 ",IP,930,"29,276.15",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Surgical,Relative Weights,"$8,742.64 ",IP,930,"21,824.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Relative Weights,"$19,788.21 ",IP,930,"35,167.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Relative Weights,"$10,244.72 ",IP,930,"20,650.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,015.45 ",IP,930,"10,651.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,547.45 ",IP,930,"27,656.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Surgical,Relative Weights,"$9,048.09 ",IP,930,"16,454.94",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,474.73 ",IP,930,"12,627.38",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$20,141.29 ",IP,930,"35,997.31",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$12,838.33 ",IP,930,"42,844.13",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,714.61 ",IP,930,"62,529.13",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-637,DIABETES WITH MCC,Medical,Relative Weights,"$7,535.60 ",IP,880,"16,384.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-638,DIABETES WITH CC,Medical,Relative Weights,"$4,813.90 ",IP,880,"11,497.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical,Relative Weights,"$3,336.99 ",IP,880,"6,523.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical,Relative Weights,"$6,737.48 ",IP,880,"16,032.71",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical,Relative Weights,"$4,128.54 ",IP,880,"8,705.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical,Relative Weights,"$7,060.45 ",IP,880,"12,532.53",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical,Relative Weights,"$9,129.11 ",IP,880,"16,190.56",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical,Relative Weights,"$5,582.46 ",IP,880,"9,912.13",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,207.37 ",IP,880,"7,473.77",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Neonate,Relative Weights,"$24,746.62 ",IP,930,"43,930.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Neonate,Relative Weights,"$20,245.30 ",IP,930,"35,953.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-652,KIDNEY TRANSPLANT,Surgical,Relative Weights,"$17,435.46 ",IP,930,"30,972.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Surgical,Relative Weights,"$29,884.04 ",IP,930,"53,042.51",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Surgical,Relative Weights,"$15,890.13 ",IP,930,"34,877.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$11,387.71 ",IP,930,"20,247.69",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Surgical,Relative Weights,"$17,982.32 ",IP,930,"31,944.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Surgical,Relative Weights,"$10,590.68 ",IP,930,"24,776.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Surgical,Relative Weights,"$8,637.53 ",IP,930,"18,687.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Surgical,Relative Weights,"$14,596.06 ",IP,930,"25,939.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Surgical,Relative Weights,"$7,899.63 ",IP,930,"22,402.18",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Surgical,Relative Weights,"$5,822.77 ",IP,930,"16,610.09",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Surgical,Relative Weights,"$16,078.98 ",IP,930,"28,518.67",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Surgical,Relative Weights,"$8,755.77 ",IP,930,"15,524.76",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,480.20 ",IP,930,"11,527.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-665,PROSTATECTOMY WITH MCC,Surgical,Relative Weights,"$16,650.48 ",IP,930,"29,559.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-666,PROSTATECTOMY WITH CC,Surgical,Relative Weights,"$9,523.24 ",IP,930,"16,881.68",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$5,460.38 ",IP,930,"9,684.36",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,361.88 ",IP,930,"34,290.18",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Surgical,Relative Weights,"$8,558.71 ",IP,930,"14,911.51",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,356.38 ",IP,930,"9,916.13",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$9,750.96 ",IP,930,"17,294.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,297.37 ",IP,930,"11,202.86",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Surgical,Relative Weights,"$18,985.71 ",IP,930,"72,221.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Surgical,Relative Weights,"$13,045.80 ",IP,930,"24,957.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,605.35 ",IP,930,"20,920.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-682,RENAL FAILURE WITH MCC,Medical,Relative Weights,"$8,061.66 ",IP,880,"28,276.40",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-683,RENAL FAILURE WITH CC,Medical,Relative Weights,"$4,813.35 ",IP,880,"15,981.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical,Relative Weights,"$3,327.69 ",IP,880,"11,604.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical,Relative Weights,"$10,265.52 ",IP,880,"18,233.73",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical,Relative Weights,"$5,748.32 ",IP,880,"15,308.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical,Relative Weights,"$3,754.12 ",IP,880,"6,670.71",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical,Relative Weights,"$6,099.21 ",IP,880,"13,266.88",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical,Relative Weights,"$4,346.41 ",IP,880,"7,711.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-693,URINARY STONES WITH MCC,Medical,Relative Weights,"$7,310.62 ",IP,880,"16,038.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical,Relative Weights,"$4,221.60 ",IP,880,"7,989.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical,Relative Weights,"$6,227.85 ",IP,880,"11,060.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Relative Weights,"$3,787.51 ",IP,880,"10,088.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-697,URETHRAL STRICTURE,Medical,Relative Weights,"$5,470.24 ",IP,880,"9,704.80",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,816.54 ",IP,880,"16,964.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical,Relative Weights,"$5,621.87 ",IP,880,"13,322.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$4,086.39 ",IP,880,"7,322.67",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$10,522.26 ",IP,930,"19,671.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,162.93 ",IP,930,"16,904.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$12,677.40 ",IP,930,"22,504.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,767.27 ",IP,930,"16,135.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$11,668.53 ",IP,930,"20,736.34",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,802.51 ",IP,930,"10,293.71",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Surgical,Relative Weights,"$8,174.97 ",IP,930,"14,519.23",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$5,084.32 ",IP,930,"9,038.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$11,066.38 ",IP,930,"19,651.97",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$6,983.82 ",IP,930,"12,425.45",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$9,856.61 ",IP,930,"17,506.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$6,758.29 ",IP,930,"12,033.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$9,374.89 ",IP,880,"16,635.41",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical,Relative Weights,"$5,977.14 ",IP,880,"10,601.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$3,547.74 ",IP,880,"12,900.09",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical,Relative Weights,"$7,036.92 ",IP,880,"12,478.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical,Relative Weights,"$4,076.54 ",IP,880,"7,235.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$7,778.65 ",IP,880,"13,803.79",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical,Relative Weights,"$4,410.46 ",IP,880,"7,821.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical,Relative Weights,"$5,515.12 ",IP,880,"9,780.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,114.20 ",IP,880,"5,506.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Surgical,Relative Weights,"$12,175.97 ",IP,930,"21,636.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$7,738.14 ",IP,930,"13,759.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Surgical,Relative Weights,"$23,323.37 ",IP,930,"41,449.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Surgical,Relative Weights,"$11,266.18 ",IP,930,"24,678.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$8,079.18 ",IP,930,"16,233.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Surgical,Relative Weights,"$20,932.84 ",IP,930,"37,200.43",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Surgical,Relative Weights,"$9,862.08 ",IP,930,"17,521.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$7,006.26 ",IP,930,"12,454.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$9,405.00 ",IP,930,"16,713.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$6,201.03 ",IP,930,"11,021.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Surgical,Relative Weights,"$9,828.14 ",IP,930,"17,462.80",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Surgical,Relative Weights,"$6,404.66 ",IP,930,"11,393.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$8,821.46 ",IP,930,"15,985.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,140.70 ",IP,930,"10,529.41",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Surgical,Relative Weights,"$7,376.86 ",IP,930,"13,124.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$14,855.53 ",IP,930,"26,353.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,012.94 ",IP,930,"14,269.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$9,996.75 ",IP,880,"17,725.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Relative Weights,"$6,181.87 ",IP,880,"13,542.79",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$5,027.39 ",IP,880,"9,899.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$8,346.31 ",IP,880,"14,816.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Relative Weights,"$5,308.20 ",IP,880,"9,412.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$3,740.98 ",IP,880,"7,933.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical,Relative Weights,"$5,036.69 ",IP,880,"12,819.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,234.08 ",IP,880,"9,742.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Surgical,Relative Weights,"$6,402.47 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Surgical,Relative Weights,"$8,854.85 ",IP,930,"16,800.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Surgical,Relative Weights,"$4,870.83 ",IP,930,"8,928.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical,Relative Weights,"$4,239.67 ",IP,880,"7,483.50",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-779,ABORTION WITHOUT D&C,Medical,Relative Weights,"$5,797.04 ",IP,880,"10,127.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,C-Section,Relative Weights,"$10,263.33 ",IP,"2,975.00","17,026.59",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,C-Section,Relative Weights,"$5,999.03 ",IP,"2,975.00","9,954.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,C-Section,Relative Weights,"$5,018.63 ",IP,"2,975.00","8,321.91",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,C-Section,Relative Weights,"$8,727.86 ",IP,"2,975.00","14,466.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,C-Section,Relative Weights,"$5,826.60 ",IP,"2,975.00","9,662.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,C-Section,Relative Weights,"$4,857.69 ",IP,"2,975.00","8,065.51",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-789,NEONATES- DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY,Medical,Relative Weights,"$9,415.40 ",IP,"9,415.40","15,624.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-790,EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME- NEONATE,Medical,Relative Weights,"$31,049.47 ",IP,"31,049.47","59,778.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-791,PREMATURITY WITH MAJOR PROBLEMS,Medical,Relative Weights,"$21,205.45 ",IP,"18,126.50","35,189.68",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-792,PREMATURITY WITHOUT MAJOR PROBLEMS,Medical,Relative Weights,"$12,795.09 ",IP,"8,021.48","21,232.55",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-793,FULL TERM NEONATE WITH MAJOR PROBLEMS,Medical,Relative Weights,"$21,782.42 ",IP,"6,433.54","36,147.06",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,Medical,Relative Weights,"$7,709.68 ",IP,"2,637.93","12,794.26",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-795,NORMAL NEWBORN,Medical,Relative Weights,"$1,043.90 ",IP,280,"1,732.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Vaginal Delivery,Relative Weights,"$5,861.63 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Vaginal Delivery,Relative Weights,"$5,032.86 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Vaginal Delivery,Relative Weights,"$4,529.79 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-799,SPLENECTOMY WITH MCC,Surgical,Relative Weights,"$28,177.22 ",IP,930,"50,070.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-800,SPLENECTOMY WITH CC,Surgical,Relative Weights,"$16,169.85 ",IP,930,"28,728.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$9,218.33 ",IP,930,"23,774.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Surgical,Relative Weights,"$20,318.10 ",IP,930,"36,100.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Surgical,Relative Weights,"$10,326.83 ",IP,930,"18,346.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Surgical,Relative Weights,"$7,477.03 ",IP,930,"13,279.12",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Vaginal Delivery,Relative Weights,"$5,637.74 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Vaginal Delivery,Relative Weights,"$4,021.25 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Vaginal Delivery,Relative Weights,"$3,515.99 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical,Relative Weights,"$11,965.22 ",IP,880,"21,199.68",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical,Relative Weights,"$6,696.98 ",IP,880,"13,075.41",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$5,264.41 ",IP,880,"10,300.53",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical,Relative Weights,"$7,550.38 ",IP,880,"15,949.69",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,818.82 ",IP,880,"8,563.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-813,COAGULATION DISORDERS,Medical,Relative Weights,"$8,457.98 ",IP,880,"15,036.11",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical,Relative Weights,"$10,355.30 ",IP,880,"18,405.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical,Relative Weights,"$5,437.94 ",IP,880,"13,663.66",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,618.91 ",IP,880,"6,433.20",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$12,627.58 ",IP,930,"22,405.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$7,443.64 ",IP,930,"12,814.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,404.00 ",IP,930,"9,713.56",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$31,156.76 ",IP,930,"122,617.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$11,797.71 ",IP,930,"27,576.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,850.80 ",IP,930,"27,517.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Surgical,Relative Weights,"$24,643.16 ",IP,930,"43,774.77",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Surgical,Relative Weights,"$12,942.89 ",IP,930,"22,998.52",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,671.91 ",IP,930,"13,634.41",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$27,613.94 ",IP,930,"49,028.21",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$13,688.46 ",IP,930,"33,856.22",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,163.59 ",IP,930,"32,407.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$17,563.00 ",IP,930,"31,204.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,112.57 ",IP,930,"14,372.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical,Relative Weights,"$6,140.81 ",IP,880,"10,912.79",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical,Relative Weights,"$4,260.47 ",IP,880,"7,590.57",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$2,939.58 ",IP,880,"5,217.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical,Relative Weights,"$33,130.16 ",IP,880,"151,525.57",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical,Relative Weights,"$11,570.54 ",IP,880,"108,442.41",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$6,423.82 ",IP,880,"19,754.19",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical,Relative Weights,"$31,198.36 ",IP,880,"55,476.01",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical,Relative Weights,"$12,372.49 ",IP,880,"21,987.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Relative Weights,"$8,141.04 ",IP,880,"14,467.64",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical,Relative Weights,"$17,629.24 ",IP,880,"38,835.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical,Relative Weights,"$8,876.75 ",IP,880,"23,414.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical,Relative Weights,"$6,005.05 ",IP,880,"10,675.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical,Relative Weights,"$10,442.33 ",IP,880,"18,522.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical,Relative Weights,"$6,482.39 ",IP,880,"21,166.22",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$4,646.94 ",IP,880,"15,814.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical,Relative Weights,"$14,631.64 ",IP,880,"25,988.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical,Relative Weights,"$7,313.90 ",IP,880,"12,996.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,650.88 ",IP,880,"10,016.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-849,RADIOTHERAPY,Medical,Relative Weights,"$13,650.14 ",IP,880,"24,213.33",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$27,194.08 ",IP,930,"91,309.54",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$11,617.07 ",IP,930,"37,668.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,319.49 ",IP,930,"27,510.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$25,530.51 ",IP,930,"119,992.39",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$11,508.68 ",IP,930,"20,964.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,442.54 ",IP,930,"20,693.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical,Relative Weights,"$10,382.67 ",IP,880,"64,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical,Relative Weights,"$5,536.47 ",IP,880,"11,618.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical,Relative Weights,"$4,798.02 ",IP,880,"8,517.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical,Relative Weights,"$8,089.58 ",IP,880,"15,920.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical,Relative Weights,"$4,592.74 ",IP,880,"8,149.30",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical,Relative Weights,"$12,246.04 ",IP,880,"31,175.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical,Relative Weights,"$5,835.36 ",IP,880,"20,802.66",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,987.86 ",IP,880,"9,060.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical,Relative Weights,"$35,247.53 ",IP,880,"62,539.00",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical,Relative Weights,"$10,248.55 ",IP,880,"31,444.24",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical,Relative Weights,"$5,618.04 ",IP,880,"15,068.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Surgical,Relative Weights,"$17,889.26 ",IP,930,"31,745.49",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-880,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,Medical,Relative Weights,"$4,732.33 ",IP,485,"8,406.28",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-881,DEPRESSIVE NEUROSES,Medical,Relative Weights,"$4,390.20 ",IP,485,"7,800.83",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-882,NEUROSES EXCEPT DEPRESSIVE,Medical,Relative Weights,"$4,508.44 ",IP,485,"8,011.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-883,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,Medical,Relative Weights,"$8,658.88 ",IP,485,"15,363.17",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-884,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,Medical,Relative Weights,"$7,922.62 ",IP,485,"14,053.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-885,PSYCHOSES,Medical,Relative Weights,"$6,784.56 ",IP,485,"12,041.93",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-886,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,Medical,Relative Weights,"$6,698.62 ",IP,485,"11,890.08",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-887,OTHER MENTAL DISORDER DIAGNOSES,Medical,Relative Weights,"$5,910.90 ",IP,485,"10,500.07",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-894,ALCOHOL- DRUG ABUSE OR DEPENDENCE- LEFT AMA,Medical,Relative Weights,"$3,005.26 ",IP,"3,005.26","5,329.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-895,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,Medical,Relative Weights,"$8,754.13 ",IP,"8,754.13","21,100.96",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-896,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC,Medical,Relative Weights,"$9,745.49 ",IP,"9,745.49","17,297.32",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-897,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC,Medical,Relative Weights,"$4,527.06 ",IP,"4,527.06","8,035.42",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Surgical,Relative Weights,"$23,367.16 ",IP,930,"41,488.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Surgical,Relative Weights,"$10,752.71 ",IP,930,"23,640.59",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,214.71 ",IP,930,"11,230.37",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Surgical,Relative Weights,"$20,401.86 ",IP,930,"36,224.11",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,032.21 ",IP,930,"15,982.25",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Surgical,Relative Weights,"$9,874.13 ",IP,930,"17,460.85",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Surgical,Relative Weights,"$21,612.72 ",IP,930,"52,333.81",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Surgical,Relative Weights,"$11,224.03 ",IP,930,"23,274.39",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,504.95 ",IP,930,"14,200.04",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical,Relative Weights,"$8,969.81 ",IP,880,"15,928.72",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical,Relative Weights,"$4,854.95 ",IP,880,"8,649.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical,Relative Weights,"$9,303.18 ",IP,880,"16,524.44",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical,Relative Weights,"$3,604.13 ",IP,880,"6,398.16",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical,Relative Weights,"$8,093.41 ",IP,880,"18,792.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical,Relative Weights,"$4,333.27 ",IP,880,"7,700.57",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical,Relative Weights,"$10,094.73 ",IP,880,"17,856.05",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical,Relative Weights,"$5,608.73 ",IP,880,"11,715.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical,Relative Weights,"$3,820.35 ",IP,880,"8,817.98",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,693.92 ",IP,880,"15,453.70",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical,Relative Weights,"$5,144.53 ",IP,880,"9,056.51",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Surgical,Relative Weights,"$115,455.24 ",IP,930,"204,714.78",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Surgical,Relative Weights,"$35,754.43 ",IP,930,"63,456.92",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Surgical,Relative Weights,"$16,498.30 ",IP,930,"29,288.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical,Relative Weights,"$12,387.27 ",IP,880,"21,975.48",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical,Relative Weights,"$10,624.62 ",IP,880,"18,857.68",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-935,NON-EXTENSIVE BURNS,Medical,Relative Weights,"$10,580.83 ",IP,880,"18,818.74",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Surgical,Relative Weights,"$18,472.79 ",IP,930,"32,961.27",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Surgical,Relative Weights,"$12,157.36 ",IP,930,"35,826.95",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,527.18 ",IP,930,"18,735.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-945,REHABILITATION WITH CC/MCC,Medical,Relative Weights,"$8,112.02 ",IP,"8,112.02","24,048.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-946,REHABILITATION WITHOUT CC/MCC,Medical,Relative Weights,"$6,164.90 ",IP,"6,164.90","13,242.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical,Relative Weights,"$6,536.04 ",IP,880,"11,584.43",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Relative Weights,"$4,308.64 ",IP,880,"7,647.03",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical,Relative Weights,"$6,075.67 ",IP,880,"16,233.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical,Relative Weights,"$4,051.91 ",IP,880,"7,192.45",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical,Relative Weights,"$3,063.29 ",IP,880,"12,539.35",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Relative Weights,"$34,428.06 ",IP,930,"99,563.62",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Relative Weights,"$21,075.17 ",IP,930,"48,319.58",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Surgical,Relative Weights,"$40,622.52 ",IP,930,"81,020.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Surgical,Relative Weights,"$23,022.29 ",IP,930,"41,927.10",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Surgical,Relative Weights,"$14,977.60 ",IP,930,"34,550.88",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical,Relative Weights,"$14,943.66 ",IP,880,"41,610.90",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical,Relative Weights,"$8,166.22 ",IP,880,"28,388.26",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical,Relative Weights,"$4,995.09 ",IP,880,"16,749.46",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$32,033.71 ",IP,930,"56,334.55",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$16,360.35 ",IP,930,"28,667.60",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical,Relative Weights,"$14,727.98 ",IP,880,"95,225.61",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical,Relative Weights,"$7,018.30 ",IP,880,"34,297.84",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical,Relative Weights,"$5,198.18 ",IP,880,"20,273.82",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical,Relative Weights,"$7,249.31 ",IP,880,"32,684.59",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$25,260.09 ",IP,930,"51,698.29",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$13,885.52 ",IP,930,"34,570.65",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$9,044.80 ",IP,930,"16,317.63",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$17,932.50 ",IP,930,"55,966.14",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$9,340.95 ",IP,930,"18,900.02",,,,,,,,,,,,,
Health Alliance MCR ADV,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,150.66 ",IP,930,"12,784.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,176,Anesth pharyngeal surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,211,Anesth cran surg hemotoma,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,214,Anesth skull drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,215,Anesth skull repair/fract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,524,Anesth chest drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,540,Anesth chest surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,542,Anesthesia removal pleura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,546,Anesth lung chest wall surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,560,Anesth heart surg w/o pump,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,561,Anesth heart surg <1 yr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,562,Anesth hrt surg w/pmp age 1+,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,567,Anesth cabg w/pump,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,580,Anesth heart/lung transplnt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,632,Anesth removal of nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,792,Anesth hemorr/excise liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,794,Anesth pancreas removal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,796,Anesth for liver transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,844,Anesth pelvis surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,846,Anesth hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,848,Anesth pelvic organ surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,864,Anesth removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,866,Anesth removal of adrenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,868,Anesth kidney transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,882,Anesth major vein ligation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,908,Anesth removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,932,Anesth amputation of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,934,Anesth penis nodes removal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,936,Anesth penis nodes removal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1272,Anesth femoral artery surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1442,Anesth knee artery surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1444,Anesth knee artery repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1502,Anesth lwr leg embolectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1652,Anesth shoulder vessel surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1654,Anesth shoulder vessel surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1656,Anesth arm-leg vessel surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,1990,Support for organ donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10005,Fna bx w/us gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10007,Fna bx w/fluor gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10009,Fna bx w/ct gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10011,Fna bx w/mr gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10021,Fna bx w/o img gdn 1st les,APC 5052,RVU Per Unit,$335.15 ,OP,220.23,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10030,Guide cathet fluid drainage,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10035,Perq dev soft tiss 1st imag,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10040,Acne surgery,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10060,Drainage of skin abscess,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,288.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10061,Drainage of skin abscess,APC 5052,RVU Per Unit,$335.15 ,OP,288.27,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10080,Drainage of pilonidal cyst,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10081,Drainage of pilonidal cyst,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"2,234.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10120,Remove foreign body,APC 5052,RVU Per Unit,$335.15 ,OP,288.27,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10121,Remove foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10140,Drainage of hematoma/fluid,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10160,Puncture drainage of lesion,APC 5052,RVU Per Unit,$335.15 ,OP,205.5,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,10180,Complex drainage wound,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11000,Debride infected skin,APC 5053,RVU Per Unit,$507.97 ,OP,218.7,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11004,Debride genitalia & perineum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11005,Debride abdom wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11006,Debride genit/per/abdom wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11008,Remove mesh from abd wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11010,Debride skin at fx site,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11011,Debride skin musc at fx site,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11012,Deb skin bone at fx site,APC 5073,RVU Per Case,"$2,296.73 ",OP,819.6,"2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11042,Deb subq tissue 20 sq cm/<,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11043,Deb musc/fascia 20 sq cm/<,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11044,Deb bone 20 sq cm/<,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,378.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11055,Trim skin lesion,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11056,Trim skin lesions 2 to 4,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11057,Trim skin lesions over 4,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11102,Tangntl bx skin single les,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11104,Punch bx skin single lesion,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11106,Incal bx skn single les,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11200,Removal of skin tags 2.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11305,Shave skin lesion 0.5 cm/<,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11306,Shave skin lesion 0.6-1.0 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11307,Shave skin lesion 1.1-2.0 cm,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11308,Shave skin lesion >2.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11310,Shave skin lesion 0.5 cm/<,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11311,Shave skin lesion 0.6-1.0 cm,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11312,Shave skin lesion 1.1-2.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,218.7,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11313,Shave skin lesion >2.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11400,Exc tr-ext b9+marg 0.5 cm<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11401,Exc tr-ext b9+marg 0.6-1 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11402,Exc tr-ext b9+marg 1.1-2 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11403,Exc tr-ext b9+marg 2.1-3cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11404,Exc tr-ext b9+marg 3.1-4 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11406,Exc tr-ext b9+marg >4.0 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11420,Exc h-f-nk-sp b9+marg 0.5/<,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11421,Exc h-f-nk-sp b9+marg 0.6-1,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11422,Exc h-f-nk-sp b9+marg 1.1-2,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11423,Exc h-f-nk-sp b9+marg 2.1-3,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11424,Exc h-f-nk-sp b9+marg 3.1-4,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11426,Exc h-f-nk-sp b9+marg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11440,Exc face-mm b9+marg 0.5 cm/<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11441,Exc face-mm b9+marg 0.6-1 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11442,Exc face-mm b9+marg 1.1-2 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11443,Exc face-mm b9+marg 2.1-3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11444,Exc face-mm b9+marg 3.1-4 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11446,Exc face-mm b9+marg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11450,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11451,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11462,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11463,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11470,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11471,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11600,Exc tr-ext mal+marg 0.5 cm/<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11601,Exc tr-ext mal+marg 0.6-1 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11602,Exc tr-ext mal+marg 1.1-2 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11603,Exc tr-ext mal+marg 2.1-3 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11604,Exc tr-ext mal+marg 3.1-4 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11606,Exc tr-ext mal+marg >4 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11620,Exc h-f-nk-sp mal+marg 0.5/<,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11621,Exc s/n/h/f/g mal+mrg 0.6-1,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11622,Exc s/n/h/f/g mal+mrg 1.1-2,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11623,Exc s/n/h/f/g mal+mrg 2.1-3,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11624,Exc s/n/h/f/g mal+mrg 3.1-4,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11626,Exc s/n/h/f/g mal+mrg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11640,Exc f/e/e/n/l mal+mrg 0.5cm<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11641,Exc f/e/e/n/l mal+mrg 0.6-1,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11642,Exc f/e/e/n/l mal+mrg 1.1-2,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11643,Exc f/e/e/n/l mal+mrg 2.1-3,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11644,Exc f/e/e/n/l mal+mrg 3.1-4,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11646,Exc f/e/e/n/l mal+mrg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11719,Trim nail(s) any number,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11720,Debride nail 1-5,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11721,Debride nail 6 or more,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11730,Removal of nail plate,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11740,Drain blood from under nail,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11750,Removal of nail bed,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11755,Biopsy nail unit,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11760,Repair of nail bed,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11762,Reconstruction of nail bed,APC 5054,RVU Per Unit,"$1,662.33 ",OP,297.3,"1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11765,Excision of nail fold toe,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11770,Remove pilonidal cyst simple,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11771,Remove pilonidal cyst exten,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11772,Remove pilonidal cyst compl,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11900,Inject skin lesions 7,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11920,Correct skin color 6.0 cm/<,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11921,Correct skn color 6.1-20.0cm,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11950,Tx contour defects 1 cc/<,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,297.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11951,Tx contour defects 1.1-5.0cc,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11952,Tx contour defects 5.1-10cc,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11954,Tx contour defects >10.0 cc,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11960,Insert tissue expander(s),APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11970,Rplcmt tiss xpndr perm implt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11971,Rmvl tis xpndr wo insj implt,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11976,Remove contraceptive capsule,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11980,Implant hormone pellet(s),APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11981,Insert drug implant device,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11982,Remove drug implant device,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,11983,Remove/insert drug implant,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12001,Rpr s/n/ax/gen/trnk 2.5cm/<,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12002,Rpr s/n/ax/gen/trnk2.6-7.5cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12004,Rpr s/n/ax/gen/trk7.6-12.5cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12005,Rpr s/n/a/gen/trk12.6-20.0cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12006,Rpr s/n/a/gen/trk20.1-30.0cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12007,Rpr s/n/ax/gen/trnk >30.0 cm,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,297.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12011,Rpr f/e/e/n/l/m 2.5 cm/<,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12013,Rpr f/e/e/n/l/m 2.6-5.0 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12014,Rpr f/e/e/n/l/m 5.1-7.5 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12015,Rpr f/e/e/n/l/m 7.6-12.5 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12016,Rpr fe/e/en/l/m 12.6-20.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12017,Rpr fe/e/en/l/m 20.1-30.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12018,Rpr f/e/e/n/l/m >30.0 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12020,Closure of split wound,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12021,Closure of split wound,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12031,Intmd rpr s/a/t/ext 2.5 cm/<,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12032,Intmd rpr s/a/t/ext 2.6-7.5,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12034,Intmd rpr s/tr/ext 7.6-12.5,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12035,Intmd rpr s/a/t/ext 12.6-20,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12036,Intmd rpr s/a/t/ext 20.1-30,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12037,Intmd rpr s/tr/ext >30.0 cm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12041,Intmd rpr n-hf/genit 2.5cm/<,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12042,Intmd rpr n-hf/genit2.6-7.5,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12044,Intmd rpr n-hf/genit7.6-12.5,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12045,Intmd rpr n-hf/genit12.6-20,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12046,Intmd rpr n-hf/genit20.1-30,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12047,Intmd rpr n-hf/genit >30.0cm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12051,Intmd rpr face/mm 2.5 cm/<,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12052,Intmd rpr face/mm 2.6-5.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12053,Intmd rpr face/mm 5.1-7.5 cm,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12054,Intmd rpr face/mm 7.6-12.5cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12055,Intmd rpr face/mm 12.6-20 cm,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12056,Intmd rpr face/mm 20.1-30.0,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,12057,Intmd rpr face/mm >30.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13100,Cmplx rpr trunk 1.1-2.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13101,Cmplx rpr trunk 2.6-7.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13120,Cmplx rpr s/a/l 1.1-2.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13121,Cmplx rpr s/a/l 2.6-7.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13131,Cmplx rpr f/c/c/m/n/ax/g/h/f,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13132,Cmplx rpr f/c/c/m/n/ax/g/h/f,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13151,Cmplx rpr e/n/e/l 1.1-2.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13152,Cmplx rpr e/n/e/l 2.6-7.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,13160,Late closure of wound,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14000,Tis trnfr trunk 10 sq cm/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14001,Tis trnfr trunk 10.1-30sqcm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14020,Tis trnfr s/a/l 10 sq cm/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14021,Tis trnfr s/a/l 10.1-30 sqcm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14040,Tis trnfr f/c/c/m/n/a/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14041,Tis trnfr f/c/c/m/n/a/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14060,Tis trnfr e/n/e/l 10 sq cm/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14061,Tis trnfr e/n/e/l10.1-30sqcm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14301,Tis trnfr any 30.1-60 sq cm,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,14350,Filleted finger/toe flap,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15002,Wound prep trk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15004,Wound prep f/n/hf/g,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15040,Harvest cultured skin graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,297.3,"1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15050,Skin pinch graft,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15100,Skin splt grft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15110,Epidrm autogrft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15115,Epidrm a-grft face/nck/hf/g,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15120,Skn splt a-grft fac/nck/hf/g,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15130,Derm autograft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15135,Derm autograft face/nck/hf/g,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15150,Cult skin grft t/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15155,Cult skin graft f/n/hf/g,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15200,Skin full graft trunk,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15220,Skin full graft sclp/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15240,Skin full grft face/genit/hf,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15260,Skin full graft een & lips,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15271,Skin sub graft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15273,Skin sub grft t/arm/lg child,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15275,Skin sub graft face/nk/hf/g,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15277,Skn sub grft f/n/hf/g child,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15570,Skin pedicle flap trunk,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15572,Skin pedicle flap arms/legs,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15574,Pedcle fh/ch/ch/m/n/ax/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15576,Pedicle e/n/e/l/ntroral,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15600,Delay flap trunk,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15610,Delay flap arms/legs,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15620,Delay flap f/c/c/n/ax/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15630,Delay flap eye/nos/ear/lip,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15650,Transfer skin pedicle flap,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15730,Mdfc flap w/prsrv vasc pedcl,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15731,Forehead flap w/vasc pedicle,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"2,811.11","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15733,Musc myoq/fscq flp h&n pedcl,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15734,Muscle-skin graft trunk,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15736,Muscle-skin graft arm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15738,Muscle-skin graft leg,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15740,Island pedicle flap graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15750,Neurovascular pedicle flap,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15756,Free myo/skin flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15757,Free skin flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15758,Free fascial flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15760,Composite skin graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15769,Grfg autol soft tiss dir exc,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15770,Derma-fat-fascia graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15771,Grfg autol fat lipo 50 cc/<,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15773,Grfg autol fat lipo 25 cc/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15775,Hair trnspl 1-15 punch grfts,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15776,Hair trnspl >15 punch grafts,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,"1,053.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15780,Dermabrasion total face,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15781,Dermabrasion segmental face,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15782,Dermabrasion other than face,APC 5073,RVU Per Case,"$2,296.73 ",OP,819.6,"2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15783,Dermabrasion suprfl any site,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15786,Abrasion lesion single,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15788,Chemical peel face epiderm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15789,Chemical peel face dermal,APC 5053,RVU Per Unit,$507.97 ,OP,325.32,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15792,Chemical peel nonfacial,APC 5053,RVU Per Case,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15793,Chemical peel nonfacial,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15819,Plastic surgery neck,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15820,Revision of lower eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15821,Revision of lower eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15822,Revision of upper eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15823,Revision of upper eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15824,Removal of forehead wrinkles,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15825,Removal of neck wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15826,Removal of brow wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15828,Removal of face wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15829,Removal of skin wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15830,Exc skin abd,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,019.12","5,362.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15832,Excise excessive skin thigh,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15833,Excise excessive skin leg,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15834,Excise excessive skin hip,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15835,Excise excessive skin buttck,APC 5073,RVU Per Case,"$2,296.73 ",OP,"1,053.46","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15836,Excise excessive skin arm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15837,Excise excess skin arm/hand,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15838,Excise excess skin fat pad,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15839,Excise excess skin & tissue,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15840,Nerve palsy fascial graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15841,Nerve palsy muscle graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15842,Nerve palsy microsurg graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15845,Skin and muscle repair face,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15850,Remove sutures same surgeon,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15851,Remove sutures diff surgeon,APC 5054,RVU Per Unit,"$1,662.33 ",OP,535.8,"1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15852,Dressing change not for burn,APC 5053,RVU Per Case,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15860,Test for blood flow in graft,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15876,Suction lipectomy head&neck,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15877,Suction lipectomy trunk,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15878,Suction lipectomy upr extrem,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15879,Suction lipectomy lwr extrem,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15920,Removal of tail bone ulcer,APC 5073,RVU Per Case,"$2,296.73 ",OP,819.6,"2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15922,Removal of tail bone ulcer,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15931,Remove sacrum pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15933,Remove sacrum pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15934,Remove sacrum pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15935,Remove sacrum pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15936,Remove sacrum pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15937,Remove sacrum pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15940,Remove hip pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15941,Remove hip pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15944,Remove hip pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15945,Remove hip pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15946,Remove hip pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15950,Remove thigh pressure sore,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15951,Remove thigh pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15952,Remove thigh pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15953,Remove thigh pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15956,Remove thigh pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15958,Remove thigh pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,15999,Removal of pressure sore,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,16000,Initial treatment of burn(s),APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,16020,Dress/debrid p-thick burn s,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,16025,Dress/debrid p-thick burn m,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,16030,Dress/debrid p-thick burn l,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,16035,Incision of burn scab initi,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,16036,Escharotomy addl incision,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17000,Destruct premalg lesion,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17004,Destroy premal lesions 15/>,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,514.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17106,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,514.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17107,Destruction of skin lesions,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,514.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17108,Destruction of skin lesions,APC 5054,RVU Per Unit,"$1,662.33 ",OP,514.08,"1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17110,Destruct b9 lesion 1-14,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17111,Destruct lesion 15 or more,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17250,Chem caut of granltj tissue,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17260,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17261,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17262,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17263,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17264,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17266,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17270,Destruction of skin lesions,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,325.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17271,Destruction of skin lesions,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17272,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17273,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17274,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17276,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17280,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17281,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17282,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17283,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17284,Destruction of skin lesions,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17286,Destruction of skin lesions,APC 5053,RVU Per Unit,$507.97 ,OP,325.32,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17311,Mohs 1 stage h/n/hf/g,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,746.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17313,Mohs 1 stage t/a/l,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,746.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17340,Cryotherapy of skin,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17360,Skin peel therapy,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17380,Hair removal by electrolysis,APC 5053,RVU Per Unit,$507.97 ,OP,218.7,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,17999,Skin tissue procedure,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19000,Drainage of breast lesion,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19020,Incision of breast lesion,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19081,Bx breast 1st lesion strtctc,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19083,Bx breast 1st lesion us imag,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19085,Bx breast 1st lesion mr imag,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19100,Bx breast percut w/o image,APC 5072,RVU Per Case,"$1,363.50 ",OP,782.08,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19101,Biopsy of breast open,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19105,Cryosurg ablate fa each,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19110,Nipple exploration,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19112,Excise breast duct fistula,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19120,Removal of breast lesion,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19125,Excision breast lesion,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19281,Perq device breast 1st imag,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19283,Perq dev breast 1st strtctc,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19285,Perq dev breast 1st us imag,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19287,Perq dev breast 1st mr guide,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19296,Place po breast cath for rad,APC 5093,RVU Per Case,"$8,644.27 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19298,Place breast rad tube/caths,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","5,362.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19300,Removal of breast tissue,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19301,Partial mastectomy,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19302,P-mastectomy w/ln removal,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,410.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19303,Mast simple complete,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","5,611.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19305,Mast radical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19306,Mast rad urban type,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19307,Mast mod rad,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19316,Suspension of breast,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","5,611.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19318,Breast reduction,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,410.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19325,Breast augmentation w/implt,APC 5093,RVU Per Case,"$8,644.27 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19328,Rmvl intact breast implant,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,060.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19330,Rmvl ruptured breast implant,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,060.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19340,Insj breast implt sm d mast,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19342,Insj/rplcmt brst implt sep d,APC 5093,RVU Per Case,"$8,644.27 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19350,Breast reconstruction,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19355,Correct inverted nipple(s),APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19357,Tiss xpndr plmt brst rcnstj,APC 5094,RVU Per Case,"$14,467.16 ",OP,"10,260.73","14,467.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19361,Brst rcnstj latsms drsi flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19364,Brst rcnstj free flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19367,Brst rcnstj 1 pdcl tram flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19368,Brst rcnstj 1pdcl tram anast,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19369,Brst rcnstj 2 pdcl tram flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19370,Revj peri-implt capsule brst,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19371,Peri-implt capslc brst compl,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19380,Revj reconstructed breast,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19396,Design custom breast implant,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,19499,Breast surgery procedure,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20100,Explore wound neck,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,845.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20101,Explore wound chest,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20102,Explore wound abdomen,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20103,Explore wound extremity,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,845.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20150,Excise epiphyseal bar,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20200,Muscle biopsy,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20205,Deep muscle biopsy,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20206,Needle biopsy muscle,APC 5072,RVU Per Case,"$1,363.50 ",OP,782.08,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20220,Bone biopsy trocar/needle,APC 5072,RVU Per Case,"$1,363.50 ",OP,819.6,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20225,Bone biopsy trocar/needle,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20240,Bone biopsy open superficial,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20245,Bone biopsy open deep,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20250,Open bone biopsy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20251,Open bone biopsy,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20500,Injection of sinus tract,APC 5163,RVU Per Case,"$1,310.96 ",OP,491.14,"1,310.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20520,Removal of foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,819.6,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20525,Removal of foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20526,Ther injection carp tunnel,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20527,Inj dupuytren cord w/enzyme,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20550,Inj tendon sheath/ligament,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20551,Inj tendon origin/insertion,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20552,Inj trigger point 1/2 muscl,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20553,Inject trigger points 3/>,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20555,Place ndl musc/tis for rt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20560,Ndl insj w/o njx 1 or 2 musc,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20561,Ndl insj w/o njx 3+ musc,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20600,Drain/inj joint/bursa w/o us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20604,Drain/inj joint/bursa w/us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20605,Drain/inj joint/bursa w/o us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20606,Drain/inj joint/bursa w/us,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20610,Drain/inj joint/bursa w/o us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20611,Drain/inj joint/bursa w/us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20612,Aspirate/inj ganglion cyst,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20615,Treatment of bone cyst,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20650,Insert and remove bone pin,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20660,Apply rem fixation device,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20661,Application of head brace,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20662,Application of pelvis brace,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20663,Application of thigh brace,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20664,Application of halo,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20665,Removal of fixation device,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20670,Removal of support implant,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20680,Removal of support implant,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20690,Apply bone fixation device,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20692,Apply bone fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20693,Adjust bone fixation device,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20694,Remove bone fixation device,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20696,Comp multiplane ext fixation,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20697,Comp ext fixate strut change,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20802,Replantation arm complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20805,Replant forearm complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20808,Replantation hand complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20816,Replantation digit complete,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20822,Replantation digit complete,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20824,Replantation thumb complete,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20827,Replantation thumb complete,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20838,Replantation foot complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20900,Removal of bone for graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20902,Removal of bone for graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20910,Remove cartilage for graft,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20912,Remove cartilage for graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20920,Removal of fascia for graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20922,Removal of fascia for graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20924,Removal of tendon for graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20950,Fluid pressure muscle,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20955,Fibula bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20956,Iliac bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20957,Mt bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20962,Other bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20969,Bone/skin graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20970,Bone/skin graft iliac crest,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20972,Bone/skin graft metatarsal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20973,Bone/skin graft great toe,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20974,Electrical bone stimulation,Lab Services,Per Unit,$50.41 ,OP,50.41,50.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20979,Us bone stimulation,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20982,Ablate bone tumor(s) perq,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20983,Ablate bone tumor(s) perq,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,20999,Musculoskeletal surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21010,Incision of jaw joint,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21011,Exc face les sc <2 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21012,Exc face les sbq 2 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21013,Exc face tum deep < 2 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21014,Exc face tum deep 2 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21015,Resect face/scalp tum < 2 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21016,Resect face/scalp tum 2 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21025,Excision of bone lower jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21026,Excision of facial bone(s),APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21029,Contour of face bone lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21030,Excise max/zygoma b9 tumor,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21031,Remove exostosis mandible,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21032,Remove exostosis maxilla,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21034,Excise max/zygoma mal tumor,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21040,Excise mandible lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21044,Removal of jaw bone lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21045,Extensive jaw surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21046,Remove mandible cyst complex,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21047,Excise lwr jaw cyst w/repair,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21048,Remove maxilla cyst complex,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21049,Excis uppr jaw cyst w/repair,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21050,Removal of jaw joint,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21060,Remove jaw joint cartilage,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21070,Remove coronoid process,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21073,Mnpj of tmj w/anesth,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21076,Prepare face/oral prosthesis,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21077,Prepare face/oral prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21079,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21080,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21081,Prepare face/oral prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21082,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21083,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21084,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21085,Prepare face/oral prosthesis,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,"3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21086,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21087,Prepare face/oral prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21088,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21089,Prepare face/oral prosthesis,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21100,Maxillofacial fixation,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21110,Interdental fixation,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21120,Reconstruction of chin,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21121,Reconstruction of chin,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21122,Reconstruction of chin,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21123,Reconstruction of chin,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21125,Augmentation lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21127,Augmentation lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21137,Reduction of forehead,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21138,Reduction of forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21139,Reduction of forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21141,Lefort i-1 piece w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21142,Lefort i-2 piece w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21143,Lefort i-3/> piece w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21145,Lefort i-1 piece w/ graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21146,Lefort i-2 piece w/ graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21147,Lefort i-3/> piece w/ graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21150,Lefort ii anterior intrusion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21151,Lefort ii w/bone grafts,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21154,Lefort iii w/o lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21155,Lefort iii w/ lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21159,Lefort iii w/fhdw/o lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21160,Lefort iii w/fhd w/ lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21172,Reconstruct orbit/forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21175,Reconstruct orbit/forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21179,Reconstruct entire forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21180,Reconstruct entire forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21181,Contour cranial bone lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21182,Reconstruct cranial bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21183,Reconstruct cranial bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21184,Reconstruct cranial bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21188,Reconstruction of midface,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21193,Reconst lwr jaw w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21194,Reconst lwr jaw w/graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21195,Reconst lwr jaw w/o fixation,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21196,Reconst lwr jaw w/fixation,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21198,Reconstr lwr jaw segment,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21199,Reconstr lwr jaw w/advance,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21206,Reconstruct upper jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21208,Augmentation of facial bones,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21209,Reduction of facial bones,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21210,Face bone graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21215,Lower jaw bone graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21230,Rib cartilage graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21235,Ear cartilage graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21240,Reconstruction of jaw joint,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21242,Reconstruction of jaw joint,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21243,Reconstruction of jaw joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"7,651.26","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21244,Reconstruction of lower jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21245,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21246,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21247,Reconstruct lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21248,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21249,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21255,Reconstruct lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21256,Reconstruction of orbit,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21260,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21261,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21263,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21267,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21268,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21270,Augmentation cheek bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21275,Revision orbitofacial bones,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21280,Revision of eyelid,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21282,Revision of eyelid,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21295,Revision of jaw muscle/bone,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21296,Revision of jaw muscle/bone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21299,Cranio/maxillofacial surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21310,Closed tx nose fx w/o manj,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21315,Closed tx nose fx w/o stablj,APC 5163,RVU Per Case,"$1,310.96 ",OP,491.14,"1,310.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21320,Closed tx nose fx w/ stablj,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21325,Open tx nose fx uncomplicatd,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21330,Open tx nose fx w/skele fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21335,Open tx nose & septal fx,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21336,Open tx septal fx w/wo stabj,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21337,Closed tx septal&nose fx,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21338,Open nasoethmoid fx w/o fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21339,Open nasoethmoid fx w/ fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21340,Perq tx nasoethmoid fx,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21343,Open tx dprsd front sinus fx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21344,Open tx compl front sinus fx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21345,Closed tx nose/jaw fx,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21346,Opn tx nasomax fx w/fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21347,Opn tx nasomax fx multple,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21348,Opn tx nasomax fx w/graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21355,Perq tx malar fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21356,Opn tx dprsd zygomatic arch,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21360,Opn tx dprsd malar fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21365,Opn tx complx malar fx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21366,Opn tx complx malar w/grft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21385,Opn tx orbit fx transantral,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21386,Opn tx orbit fx periorbital,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21387,Opn tx orbit fx combined,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21390,Opn tx orbit periorbtl implt,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21395,Opn tx orbit periorbt w/grft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21400,Closed tx orbit w/o manipulj,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21401,Closed tx orbit w/manipulj,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21406,Opn tx orbit fx w/o implant,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21407,Opn tx orbit fx w/implant,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21408,Opn tx orbit fx w/bone grft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21421,Treat mouth roof fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21422,Treat mouth roof fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21423,Treat mouth roof fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21431,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21432,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21433,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21435,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21436,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21440,Treat dental ridge fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21445,Treat dental ridge fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21450,Treat lower jaw fracture,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21451,Treat lower jaw fracture,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21452,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21453,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21454,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21461,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21462,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21465,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21470,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21480,Reset dislocated jaw,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21485,Reset dislocated jaw,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21490,Repair dislocated jaw,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21497,Interdental wiring,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21499,Head surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21501,Drain neck/chest lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21502,Drain chest lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21510,Drainage of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21550,Biopsy of neck/chest,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21552,Exc neck les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21554,Exc neck tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21555,Exc neck les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21556,Exc neck tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21557,Resect neck thorax tumor<5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21558,Resect neck tumor 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21600,Partial removal of rib,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21601,Exc chest wall tumor w/ribs,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21602,Exc ch wal tum w/o lymphadec,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21603,Exc ch wal tum w/lymphadec,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21610,Partial removal of rib,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21615,Removal of rib,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21616,Removal of rib and nerves,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21620,Partial removal of sternum,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21627,Sternal debridement,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21630,Extensive sternum surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21632,Extensive sternum surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21685,Hyoid myotomy & suspension,APC 5165,RVU Per Case,"$4,928.81 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21700,Revision of neck muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21705,Revision of neck muscle/rib,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21720,Revision of neck muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21725,Revision of neck muscle,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21740,Reconstruction of sternum,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21742,Repair stern/nuss w/o scope,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21743,Repair sternum/nuss w/scope,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21750,Repair of sternum separation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21811,Optx of rib fx w/fixj scope,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21812,Treatment of rib fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21813,Treatment of rib fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21820,Treat sternum fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21825,Treat sternum fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21899,Neck/chest surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21920,Biopsy soft tissue of back,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21925,Biopsy soft tissue of back,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21930,Exc back les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21931,Exc back les sc 3 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21932,Exc back tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21933,Exc back tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21935,Resect back tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,21936,Resect back tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22010,I&d p-spine c/t/cerv-thor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22015,I&d abscess p-spine l/s/ls,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22100,Remove part of neck vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22101,Remove part thorax vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22102,Remove part lumbar vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22110,Remove part of neck vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22112,Remove part thorax vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22114,Remove part lumbar vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22206,Incis spine 3 column thorac,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22207,Incis spine 3 column lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22210,Incis 1 vertebral seg cerv,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22212,Incis 1 vertebral seg thorac,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22214,Incis 1 vertebral seg lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22220,Incis w/discectomy cervical,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22222,Incis w/discectomy thoracic,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22224,Incis w/discectomy lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22310,Closed tx vert fx w/o manj,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22315,Closed tx vert fx w/manj,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22318,Treat odontoid fx w/o graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22319,Treat odontoid fx w/graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22325,Treat spine fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22326,Treat neck spine fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22327,Treat thorax spine fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22505,Manipulation of spine,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22510,Perq cervicothoracic inject,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22511,Perq lumbosacral injection,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22513,Perq vertebral augmentation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22514,Perq vertebral augmentation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22532,Lat thorax spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22533,Lat lumbar spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22548,Neck spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22551,Neck spine fuse&remov bel c2,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22554,Neck spine fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22556,Thorax spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22558,Lumbar spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22586,Prescrl fuse w/ instr l5-s1,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22590,Spine & skull spinal fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22595,Neck spinal fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22600,Neck spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22610,Thorax spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22612,Lumbar spine fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,843.00","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22630,Lumbar spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22633,Lumbar spine fusion combined,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22800,Post fusion 6 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22802,Post fusion 7-12 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22804,Post fusion 13/> vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22808,Ant fusion 2-3 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22810,Ant fusion 4-7 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22812,Ant fusion 8/> vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22818,Kyphectomy 1-2 segments,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22819,Kyphectomy 3 or more,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22830,Exploration of spinal fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22849,Reinsert spinal fixation,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22850,Remove spine fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22852,Remove spine fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22855,Remove spine fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22856,Cerv artific diskectomy,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22857,Lumbar artif diskectomy,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22861,Revise cerv artific disc,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22862,Revise lumbar artif disc,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22864,Remove cerv artif disc,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22865,Remove lumb artif disc,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22867,Insj stablj dev w/dcmprn,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22869,Insj stablj dev w/o dcmprn,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22899,Spine surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22900,Exc abdl tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22901,Exc abdl tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22902,Exc abd les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22903,Exc abd les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22904,Radical resect abd tumor<5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22905,Rad resect abd tumor 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,22999,Abdomen surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23000,Removal of calcium deposits,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23020,Release shoulder joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23030,Drain shoulder lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23031,Drain shoulder bursa,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23035,Drain shoulder bone lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23040,Exploratory shoulder surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23044,Exploratory shoulder surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23065,Biopsy shoulder tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23066,Biopsy shoulder tissues,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23071,Exc shoulder les sc 3 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23073,Exc shoulder tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23075,Exc shoulder les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23076,Exc shoulder tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23077,Resect shoulder tumor < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23078,Resect shoulder tumor 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23100,Biopsy of shoulder joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23101,Shoulder joint surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23105,Remove shoulder joint lining,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23106,Incision of collarbone joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23107,Explore treat shoulder joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23120,Partial removal collar bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23125,Removal of collar bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23130,Remove shoulder bone part,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23140,Removal of bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23145,Removal of bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23146,Removal of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23150,Removal of humerus lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23155,Removal of humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23156,Removal of humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23170,Remove collar bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23172,Remove shoulder blade lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23174,Remove humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23180,Remove collar bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23182,Remove shoulder blade lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23184,Remove humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23190,Partial removal of scapula,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23195,Removal of head of humerus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23200,Resect clavicle tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23210,Resect scapula tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23220,Resect prox humerus tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23330,Remove shoulder foreign body,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23333,Remove shoulder fb deep,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23334,Shoulder prosthesis removal,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23335,Shoulder prosthesis removal,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23395,Muscle transfer shoulder/arm,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23397,Muscle transfers,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23400,Fixation of shoulder blade,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23405,Incision of tendon & muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23406,Incise tendon(s) & muscle(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23410,Repair rotator cuff acute,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23412,Repair rotator cuff chronic,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23415,Release of shoulder ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23420,Repair of shoulder,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23430,Repair biceps tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23440,Remove/transplant tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23450,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23455,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23460,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23462,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23465,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23466,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23470,Reconstruct shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23472,Reconstruct shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23473,Revis reconst shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23474,Revis reconst shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23480,Revision of collar bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23485,Revision of collar bone,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23490,Reinforce clavicle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23491,Reinforce shoulder bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23500,Treat clavicle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23505,Treat clavicle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23515,Treat clavicle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23520,Treat clavicle dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23525,Treat clavicle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23530,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23532,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23540,Treat clavicle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23545,Treat clavicle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23550,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23552,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23570,Treat shoulder blade fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23575,Treat shoulder blade fx,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23585,Treat scapula fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23600,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23605,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23615,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23616,Treat humerus fracture,APC 5116,RVU Per Case,"$15,377.54 ",OP,"11,460.57","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23620,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23625,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23630,Treat humerus fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23650,Treat shoulder dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23655,Treat shoulder dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23660,Treat shoulder dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23665,Treat dislocation/fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23670,Treat dislocation/fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23675,Treat dislocation/fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23680,Treat dislocation/fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23700,Fixation of shoulder,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23800,Fusion of shoulder joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23802,Fusion of shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23900,Amputation of arm & girdle,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23920,Amputation at shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23921,Amputation follow-up surgery,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23929,Shoulder surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23930,Drainage of arm lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23931,Drainage of arm bursa,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,23935,Drain arm/elbow bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24000,Exploratory elbow surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24006,Release elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24065,Biopsy arm/elbow soft tissue,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24066,Biopsy arm/elbow soft tissue,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24071,Exc arm/elbow les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24073,Ex arm/elbow tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24075,Exc arm/elbow les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24076,Ex arm/elbow tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24077,Resect arm/elbow tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24079,Resect arm/elbow tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24100,Biopsy elbow joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24101,Explore/treat elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24102,Remove elbow joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24105,Removal of elbow bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24110,Remove humerus lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24115,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24116,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24120,Remove elbow lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24125,Remove/graft bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24126,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24130,Removal of head of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24134,Removal of arm bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24136,Remove radius bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24138,Remove elbow bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24140,Partial removal of arm bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24145,Partial removal of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24147,Partial removal of elbow,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24149,Radical resection of elbow,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24150,Resect distal humerus tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24152,Resect radius tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24155,Removal of elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24160,Remove elbow joint implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24164,Remove radius head implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24200,Removal of arm foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,819.6,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24201,Removal of arm foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24300,Manipulate elbow w/anesth,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24301,Muscle/tendon transfer,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24305,Arm tendon lengthening,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24310,Revision of arm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24320,Repair of arm tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24330,Revision of arm muscles,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24331,Revision of arm muscles,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24332,Tenolysis triceps,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24340,Repair of biceps tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24341,Repair arm tendon/muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24342,Repair of ruptured tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24343,Repr elbow lat ligmnt w/tiss,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24344,Reconstruct elbow lat ligmnt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24345,Repr elbw med ligmnt w/tissu,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24346,Reconstruct elbow med ligmnt,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24357,Repair elbow perc,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24358,Repair elbow w/deb open,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24359,Repair elbow deb/attch open,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24360,Reconstruct elbow joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24361,Reconstruct elbow joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24362,Reconstruct elbow joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24363,Replace elbow joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24365,Reconstruct head of radius,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24366,Reconstruct head of radius,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24370,Revise reconst elbow joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24371,Revise reconst elbow joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24400,Revision of humerus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24410,Revision of humerus,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24420,Revision of humerus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24430,Repair of humerus,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24435,Repair humerus with graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24470,Revision of elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24495,Decompression of forearm,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24498,Reinforce humerus,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24500,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24505,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24515,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24516,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24530,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24535,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24538,Treat humerus fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24545,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24546,Treat humerus fracture,APC 5116,RVU Per Case,"$15,377.54 ",OP,"11,460.57","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24560,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24565,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24566,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24575,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24576,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24577,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24579,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24582,Treat humerus fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24586,Treat elbow fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24587,Treat elbow fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24600,Treat elbow dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24605,Treat elbow dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24615,Treat elbow dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24620,Treat elbow fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24635,Treat elbow fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24640,Treat elbow dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24650,Treat radius fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24655,Treat radius fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24665,Treat radius fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24666,Treat radius fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24670,Treat ulnar fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24675,Treat ulnar fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24685,Treat ulnar fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24800,Fusion of elbow joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24802,Fusion/graft of elbow joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24900,Amputation of upper arm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24920,Amputation of upper arm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24925,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24930,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24931,Amputate upper arm & implant,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24935,Revision of amputation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24940,Revision of upper arm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,24999,Upper arm/elbow surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25000,Incision of tendon sheath,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25001,Incise flexor carpi radialis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25020,Decompress forearm 1 space,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25023,Decompress forearm 1 space,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25024,Decompress forearm 2 spaces,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25025,Decompress forearm 2 spaces,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25028,Drainage of forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25031,Drainage of forearm bursa,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25035,Treat forearm bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25040,Explore/treat wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25065,Biopsy forearm soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25066,Biopsy forearm soft tissues,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25071,Exc forearm les sc 3 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25073,Exc forearm tum deep 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25075,Exc forearm les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25076,Exc forearm tum deep < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25077,Resect forearm/wrist tum<3cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25078,Resect forarm/wrist tum 3cm>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25085,Incision of wrist capsule,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25100,Biopsy of wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25101,Explore/treat wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25105,Remove wrist joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25107,Remove wrist joint cartilage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25109,Excise tendon forearm/wrist,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25110,Remove wrist tendon lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25111,Remove wrist tendon lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25112,Reremove wrist tendon lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25115,Remove wrist/forearm lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25116,Remove wrist/forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25118,Excise wrist tendon sheath,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25119,Partial removal of ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25120,Removal of forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25125,Remove/graft forearm lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25126,Remove/graft forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25130,Removal of wrist lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25135,Remove & graft wrist lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25136,Remove & graft wrist lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25145,Remove forearm bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25150,Partial removal of ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25151,Partial removal of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25170,Resect radius/ulnar tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25210,Removal of wrist bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25215,Removal of wrist bones,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25230,Partial removal of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25240,Partial removal of ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25248,Remove forearm foreign body,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25250,Removal of wrist prosthesis,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25251,Removal of wrist prosthesis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25259,Manipulate wrist w/anesthes,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25260,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25263,Repair forearm tendon/muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25265,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25270,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25272,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25274,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25275,Repair forearm tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25280,Revise wrist/forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25290,Incise wrist/forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25295,Release wrist/forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25300,Fusion of tendons at wrist,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25301,Fusion of tendons at wrist,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25310,Transplant forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25312,Transplant forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25315,Revise palsy hand tendon(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25316,Revise palsy hand tendon(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25320,Repair/revise wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25332,Revise wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25335,Realignment of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25337,Reconstruct ulna/radioulnar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25350,Revision of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25355,Revision of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25360,Revision of ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25365,Revise radius & ulna,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25370,Revise radius or ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25375,Revise radius & ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25390,Shorten radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25391,Lengthen radius or ulna,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25392,Shorten radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25393,Lengthen radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25394,Repair carpal bone shorten,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25400,Repair radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25405,Repair/graft radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25415,Repair radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25420,Repair/graft radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25425,Repair/graft radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25426,Repair/graft radius & ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25430,Vasc graft into carpal bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25431,Repair nonunion carpal bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25440,Repair/graft wrist bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25441,Reconstruct wrist joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25442,Reconstruct wrist joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25443,Reconstruct wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25444,Reconstruct wrist joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25445,Reconstruct wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25446,Wrist replacement,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25447,Repair wrist joints,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25449,Remove wrist joint implant,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25450,Revision of wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25455,Revision of wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25490,Reinforce radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25491,Reinforce ulna,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25492,Reinforce radius and ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25500,Treat fracture of radius,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25505,Treat fracture of radius,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25515,Treat fracture of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25520,Treat fracture of radius,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25525,Treat fracture of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25526,Treat fracture of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25530,Treat fracture of ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25535,Treat fracture of ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25545,Treat fracture of ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25560,Treat fracture radius & ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25565,Treat fracture radius & ulna,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25574,Treat fracture radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25575,Treat fracture radius/ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25600,Treat fracture radius/ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25605,Treat fracture radius/ulna,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25606,Treat fx distal radial,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25607,Treat fx rad extra-articul,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25608,Treat fx rad intra-articul,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25609,Treat fx radial 3+ frag,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25622,Treat wrist bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25624,Treat wrist bone fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25628,Treat wrist bone fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25630,Treat wrist bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25635,Treat wrist bone fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25645,Treat wrist bone fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25650,Treat wrist bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25651,Pin ulnar styloid fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25652,Treat fracture ulnar styloid,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25660,Treat wrist dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25670,Treat wrist dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25671,Pin radioulnar dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25675,Treat wrist dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25676,Treat wrist dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25680,Treat wrist fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25685,Treat wrist fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25690,Treat wrist dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25695,Treat wrist dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25800,Fusion of wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25805,Fusion/graft of wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25810,Fusion/graft of wrist joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25820,Fusion of hand bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"3,235.63","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25825,Fuse hand bones with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25830,Fusion radioulnar jnt/ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25900,Amputation of forearm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25905,Amputation of forearm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25907,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25909,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25915,Amputation of forearm,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25920,Amputate hand at wrist,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25922,Amputate hand at wrist,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25924,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25927,Amputation of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25929,Amputation follow-up surgery,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25931,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,25999,Forearm or wrist surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26010,Drainage of finger abscess,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,288.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26011,Drainage of finger abscess,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26020,Drain hand tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26025,Drainage of palm bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26030,Drainage of palm bursas,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26034,Treat hand bone lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26035,Decompress fingers/hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26037,Decompress fingers/hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26040,Release palm contracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26045,Release palm contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26055,Incise finger tendon sheath,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26060,Incision of finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26070,Explore/treat hand joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26075,Explore/treat finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26080,Explore/treat finger joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26100,Biopsy hand joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26105,Biopsy finger joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26110,Biopsy finger joint lining,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26111,Exc hand les sc 1.5 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26113,Exc hand tum deep 1.5 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26115,Exc hand les sc < 1.5 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26116,Exc hand tum deep < 1.5 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26117,Rad resect hand tumor < 3 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26118,Rad resect hand tumor 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26121,Release palm contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26123,Release palm contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26130,Remove wrist joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26135,Revise finger joint each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26140,Revise finger joint each,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26145,Tendon excision palm/finger,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26160,Remove tendon sheath lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26170,Removal of palm tendon each,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26180,Removal of finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26185,Remove finger bone,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26200,Remove hand bone lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26205,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26210,Removal of finger lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26215,Remove/graft finger lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26230,Partial removal of hand bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26235,Partial removal finger bone,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26236,Partial removal finger bone,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26250,Extensive hand surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26260,Resect prox finger tumor,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26262,Resect distal finger tumor,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26320,Removal of implant from hand,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26340,Manipulate finger w/anesth,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26341,Manipulat palm cord post inj,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26350,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26352,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26356,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26357,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26358,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26370,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26372,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26373,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26390,Revise hand/finger tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26392,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26410,Repair hand tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26412,Repair/graft hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26415,Excision hand/finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26416,Graft hand or finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26418,Repair finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26420,Repair/graft finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26426,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26428,Repair/graft finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26432,Repair finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26433,Repair finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26434,Repair/graft finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26437,Realignment of tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26440,Release palm/finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26442,Release palm & finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26445,Release hand/finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26449,Release forearm/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26450,Incision of palm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26455,Incision of finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26460,Incise hand/finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26471,Fusion of finger tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26474,Fusion of finger tendons,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26476,Tendon lengthening,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26477,Tendon shortening,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26478,Lengthening of hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26479,Shortening of hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26480,Transplant hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26483,Transplant/graft hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26485,Transplant palm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26489,Transplant/graft palm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26490,Revise thumb tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26492,Tendon transfer with graft,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26494,Hand tendon/muscle transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26496,Revise thumb tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26497,Finger tendon transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26498,Finger tendon transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26499,Revision of finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26500,Hand tendon reconstruction,APC 5114,RVU Per Case,"$6,071.26 ",OP,"3,235.63","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26502,Hand tendon reconstruction,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26508,Release thumb contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26510,Thumb tendon transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26516,Fusion of knuckle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26517,Fusion of knuckle joints,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26518,Fusion of knuckle joints,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26520,Release knuckle contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26525,Release finger contracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26530,Revise knuckle joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26531,Revise knuckle with implant,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26535,Revise finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26536,Revise/implant finger joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26540,Repair hand joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26541,Repair hand joint with graft,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26542,Repair hand joint with graft,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26545,Reconstruct finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26546,Repair nonunion hand,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26548,Reconstruct finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26550,Construct thumb replacement,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26551,Great toe-hand transfer,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26553,Single transfer toe-hand,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26554,Double transfer toe-hand,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26555,Positional change of finger,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26556,Toe joint transfer,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26560,Repair of web finger,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26561,Repair of web finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26562,Repair of web finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26565,Correct metacarpal flaw,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26567,Correct finger deformity,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26568,Lengthen metacarpal/finger,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26580,Repair hand deformity,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26587,Reconstruct extra finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26590,Repair finger deformity,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26591,Repair muscles of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26593,Release muscles of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26596,Excision constricting tissue,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26600,Treat metacarpal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26605,Treat metacarpal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26607,Treat metacarpal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26608,Treat metacarpal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26615,Treat metacarpal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26641,Treat thumb dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26645,Treat thumb fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26650,Treat thumb fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26665,Treat thumb fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26670,Treat hand dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26675,Treat hand dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26676,Pin hand dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26685,Treat hand dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26686,Treat hand dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26700,Treat knuckle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26705,Treat knuckle dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26706,Pin knuckle dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26715,Treat knuckle dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26720,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26725,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26727,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26735,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26740,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26742,Treat finger fracture each,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26746,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26750,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26755,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26756,Pin finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26765,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26770,Treat finger dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26775,Treat finger dislocation,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,"2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26776,Pin finger dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26785,Treat finger dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26820,Thumb fusion with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26841,Fusion of thumb,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26842,Thumb fusion with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26843,Fusion of hand joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26844,Fusion/graft of hand joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26850,Fusion of knuckle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26852,Fusion of knuckle with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26860,Fusion of finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26862,Fusion/graft of finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26910,Amputate metacarpal bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26951,Amputation of finger/thumb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26952,Amputation of finger/thumb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26989,Hand/finger surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26990,Drainage of pelvis lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26991,Drainage of pelvis bursa,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,26992,Drainage of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27000,Incision of hip tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27001,Incision of hip tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27003,Incision of hip tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27005,Incision of hip tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27006,Incision of hip tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27025,Incision of hip/thigh fascia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27027,Buttock fasciotomy,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27030,Drainage of hip joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27033,Exploration of hip joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27035,Denervation of hip joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27036,Excision of hip joint/muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27040,Biopsy of soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27041,Biopsy of soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27043,Exc hip pelvis les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27045,Exc hip/pelv tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27047,Exc hip/pelvis les sc < 3 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27048,Exc hip/pelv tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27049,Resect hip/pelv tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27050,Biopsy of sacroiliac joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27052,Biopsy of hip joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27054,Removal of hip joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27057,Buttock fasciotomy w/dbrdmt,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27059,Resect hip/pelv tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27060,Removal of ischial bursa,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27062,Remove femur lesion/bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27065,Remove hip bone les super,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27066,Remove hip bone les deep,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27067,Remove/graft hip bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27070,Part remove hip bone super,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27071,Part removal hip bone deep,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27075,Resect hip tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27076,Resect hip tum incl acetabul,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27077,Resect hip tum w/innom bone,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27078,Rsect hip tum incl femur,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27080,Removal of tail bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27086,Remove hip foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"1,363.70","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27087,Remove hip foreign body,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27090,Removal of hip prosthesis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27091,Removal of hip prosthesis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27097,Revision of hip tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27098,Transfer tendon to pelvis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27100,Transfer of abdominal muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27105,Transfer of spinal muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27110,Transfer of iliopsoas muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27111,Transfer of iliopsoas muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27120,Reconstruction of hip socket,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27122,Reconstruction of hip socket,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27125,Partial hip replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27130,Total hip arthroplasty,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27132,Total hip arthroplasty,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27134,Revise hip joint replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27137,Revise hip joint replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27138,Revise hip joint replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27140,Transplant femur ridge,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27146,Incision of hip bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27147,Revision of hip bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27151,Incision of hip bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27156,Revision of hip bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27158,Revision of pelvis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27161,Incision of neck of femur,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27165,Incision/fixation of femur,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27170,Repair/graft femur head/neck,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27175,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27176,Treat slipped epiphysis,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27177,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27178,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27179,Revise head/neck of femur,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27181,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27185,Revision of femur epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27187,Reinforce hip bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27197,Clsd tx pelvic ring fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27198,Clsd tx pelvic ring fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27200,Treat tail bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27202,Treat tail bone fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27220,Treat hip socket fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27222,Treat hip socket fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27226,Treat hip wall fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27227,Treat hip fracture(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27228,Treat hip fracture(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27230,Treat thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27232,Treat thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27235,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27236,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27238,Treat thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27240,Treat thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27244,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27245,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27246,Treat thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27248,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27250,Treat hip dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27252,Treat hip dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27253,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27254,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27256,Treat hip dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27257,Treat hip dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27258,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27259,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27265,Treat hip dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27266,Treat hip dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27267,Cltx thigh fx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27268,Cltx thigh fx w/mnpj,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27269,Optx thigh fx,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27275,Manipulation of hip joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27279,Arthrodesis sacroiliac joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27280,Fusion of sacroiliac joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27282,Fusion of pubic bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27284,Fusion of hip joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27286,Fusion of hip joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27290,Amputation of leg at hip,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27295,Amputation of leg at hip,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27299,Pelvis/hip joint surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27301,Drain thigh/knee lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27303,Drainage of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27305,Incise thigh tendon & fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27306,Incision of thigh tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27307,Incision of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27310,Exploration of knee joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27323,Biopsy thigh soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27324,Biopsy thigh soft tissues,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27325,Neurectomy hamstring,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27326,Neurectomy popliteal,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27327,Exc thigh/knee les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27328,Exc thigh/knee tum deep <5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27329,Resect thigh/knee tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27330,Biopsy knee joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27331,Explore/treat knee joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27332,Removal of knee cartilage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27333,Removal of knee cartilage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27334,Remove knee joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27335,Remove knee joint lining,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27337,Exc thigh/knee les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27339,Exc thigh/knee tum dep 5cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27340,Removal of kneecap bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27345,Removal of knee cyst,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27347,Remove knee cyst,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27350,Removal of kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27355,Remove femur lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27356,Remove femur lesion/graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27357,Remove femur lesion/graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27360,Partial removal leg bone(s),APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27364,Resect thigh/knee tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27365,Resect femur/knee tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27372,Removal of foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27380,Repair of kneecap tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27381,Repair/graft kneecap tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27385,Repair of thigh muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27386,Repair/graft of thigh muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27390,Incision of thigh tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27391,Incision of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27392,Incision of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27393,Lengthening of thigh tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27394,Lengthening of thigh tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27395,Lengthening of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27396,Transplant of thigh tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27397,Transplants of thigh tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27400,Revise thigh muscles/tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27403,Repair of knee cartilage,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27405,Repair of knee ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27407,Repair of knee ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27409,Repair of knee ligaments,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27412,Autochondrocyte implant knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27415,Osteochondral knee allograft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27416,Osteochondral knee autograft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27418,Repair degenerated kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27420,Revision of unstable kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27422,Revision of unstable kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27424,Revision/removal of kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27425,Lat retinacular release open,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27427,Reconstruction knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27428,Reconstruction knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27429,Reconstruction knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27430,Revision of thigh muscles,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27435,Incision of knee joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27437,Revise kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27438,Revise kneecap with implant,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27440,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27441,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27442,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27443,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27445,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27446,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","41,197.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27447,Total knee arthroplasty,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27448,Incision of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27450,Incision of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27454,Realignment of thigh bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27455,Realignment of knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27457,Realignment of knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27465,Shortening of thigh bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27466,Lengthening of thigh bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27468,Shorten/lengthen thighs,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27470,Repair of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27472,Repair/graft of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27475,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27477,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27479,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27485,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27486,Revise/replace knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27487,Revise/replace knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27488,Removal of knee prosthesis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27495,Reinforce thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27496,Decompression of thigh/knee,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27497,Decompression of thigh/knee,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27498,Decompression of thigh/knee,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27499,Decompression of thigh/knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27500,Treatment of thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27501,Treatment of thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27502,Treatment of thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27503,Treatment of thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27506,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27507,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27508,Treatment of thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27509,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27510,Treatment of thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27511,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27513,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27514,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27516,Treat thigh fx growth plate,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27517,Treat thigh fx growth plate,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27519,Treat thigh fx growth plate,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27520,Treat kneecap fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27524,Treat kneecap fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27530,Treat knee fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27532,Treat knee fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27535,Treat knee fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27536,Treat knee fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27538,Treat knee fracture(s),APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27540,Treat knee fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27550,Treat knee dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27552,Treat knee dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27556,Treat knee dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27557,Treat knee dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27558,Treat knee dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27560,Treat kneecap dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27562,Treat kneecap dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27566,Treat kneecap dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27570,Fixation of knee joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27580,Fusion of knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27590,Amputate leg at thigh,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27591,Amputate leg at thigh,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27592,Amputate leg at thigh,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27594,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27596,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27598,Amputate lower leg at knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27599,Leg surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27600,Decompression of lower leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27601,Decompression of lower leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27602,Decompression of lower leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27603,Drain lower leg lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27604,Drain lower leg bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27605,Incision of achilles tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27606,Incision of achilles tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27607,Treat lower leg bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27610,Explore/treat ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27612,Exploration of ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27613,Biopsy lower leg soft tissue,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27614,Biopsy lower leg soft tissue,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27615,Resect leg/ankle tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27616,Resect leg/ankle tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27618,Exc leg/ankle tum < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27619,Exc leg/ankle tum deep <5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27620,Explore/treat ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27625,Remove ankle joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27626,Remove ankle joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27630,Removal of tendon lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27632,Exc leg/ankle les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27634,Exc leg/ankle tum dep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27635,Remove lower leg bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27637,Remove/graft leg bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27638,Remove/graft leg bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27640,Partial removal of tibia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27641,Partial removal of fibula,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27645,Resect tibia tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27646,Resect fibula tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27647,Resect talus/calcaneus tum,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27650,Repair achilles tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27652,Repair/graft achilles tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27654,Repair of achilles tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27656,Repair leg fascia defect,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27658,Repair of leg tendon each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27659,Repair of leg tendon each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27664,Repair of leg tendon each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27665,Repair of leg tendon each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27675,Repair lower leg tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27676,Repair lower leg tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27680,Release of lower leg tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27681,Release of lower leg tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27685,Revision of lower leg tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27686,Revise lower leg tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27687,Revision of calf tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27690,Revise lower leg tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27691,Revise lower leg tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27695,Repair of ankle ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27696,Repair of ankle ligaments,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27698,Repair of ankle ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27700,Revision of ankle joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27702,Reconstruct ankle joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27703,Reconstruction ankle joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27704,Removal of ankle implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27705,Incision of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27707,Incision of fibula,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27709,Incision of tibia & fibula,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27712,Realignment of lower leg,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27715,Revision of lower leg,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27720,Repair of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27722,Repair/graft of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27724,Repair/graft of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27725,Repair of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27726,Repair fibula nonunion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27727,Repair of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27730,Repair of tibia epiphysis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27732,Repair of fibula epiphysis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27734,Repair lower leg epiphyses,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27740,Repair of leg epiphyses,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27742,Repair of leg epiphyses,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27745,Reinforce tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27750,Treatment of tibia fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27752,Treatment of tibia fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27756,Treatment of tibia fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27758,Treatment of tibia fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27759,Treatment of tibia fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27760,Cltx medial ankle fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27762,Cltx med ankle fx w/mnpj,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27766,Optx medial ankle fx,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27767,Cltx post ankle fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27768,Cltx post ankle fx w/mnpj,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27769,Optx post ankle fx,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27780,Treatment of fibula fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27781,Treatment of fibula fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27784,Treatment of fibula fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27786,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27788,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27792,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27808,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27810,Treatment of ankle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27814,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27816,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27818,Treatment of ankle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27822,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27823,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27824,Treat lower leg fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27825,Treat lower leg fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27826,Treat lower leg fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27827,Treat lower leg fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27828,Treat lower leg fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27829,Treat lower leg joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27830,Treat lower leg dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27831,Treat lower leg dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27832,Treat lower leg dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27840,Treat ankle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27842,Treat ankle dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27846,Treat ankle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27848,Treat ankle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27860,Fixation of ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27870,Fusion of ankle joint open,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27871,Fusion of tibiofibular joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27880,Amputation of lower leg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27881,Amputation of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27882,Amputation of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27884,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27886,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27888,Amputation of foot at ankle,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27889,Amputation of foot at ankle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27892,Decompression of leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27893,Decompression of leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27894,Decompression of leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,27899,Leg/ankle surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28001,Drainage of bursa of foot,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28002,Treatment of foot infection,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28003,Treatment of foot infection,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28005,Treat foot bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28008,Incision of foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28010,Incision of toe tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28011,Incision of toe tendons,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28020,Exploration of foot joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28022,Exploration of foot joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28024,Exploration of toe joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28035,Decompression of tibia nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28039,Exc foot/toe tum sc 1.5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28041,Exc foot/toe tum dep 1.5cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28043,Exc foot/toe tum sc < 1.5 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28045,Exc foot/toe tum deep <1.5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28046,Resect foot/toe tumor < 3 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28047,Resect foot/toe tumor 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28050,Biopsy of foot joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28052,Biopsy of foot joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28054,Biopsy of toe joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28055,Neurectomy foot,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28060,Partial removal foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28062,Removal of foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28070,Removal of foot joint lining,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28072,Removal of foot joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28080,Removal of foot lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28086,Excise foot tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28088,Excise foot tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28090,Removal of foot lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28092,Removal of toe lesions,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28100,Removal of ankle/heel lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28102,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28103,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28104,Removal of foot lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28106,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28107,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28108,Removal of toe lesions,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28110,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28111,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28112,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28113,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28114,Removal of metatarsal heads,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28116,Revision of foot,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28118,Removal of heel bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28119,Removal of heel spur,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28120,Part removal of ankle/heel,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28122,Partial removal of foot bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28124,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28126,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28130,Removal of ankle bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28140,Removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28150,Removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28153,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28160,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28171,Resect tarsal tumor,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28173,Resect metatarsal tumor,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28175,Resect phalanx of toe tumor,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28190,Removal of foot foreign body,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28192,Removal of foot foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28193,Removal of foot foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28200,Repair of foot tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28202,Repair/graft of foot tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28208,Repair of foot tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28210,Repair/graft of foot tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28220,Release of foot tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28222,Release of foot tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28225,Release of foot tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28226,Release of foot tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28230,Incision of foot tendon(s),APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28232,Incision of toe tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28234,Incision of foot tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28238,Revision of foot tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28240,Release of big toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28250,Revision of foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28260,Release of midfoot joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28261,Revision of foot tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28262,Revision of foot and ankle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28264,Release of midfoot joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28270,Release of foot contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28272,Release of toe joint each,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28280,Fusion of toes,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28285,Repair of hammertoe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28286,Repair of hammertoe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28288,Partial removal of foot bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28289,Corrj halux rigdus w/o implt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28291,Corrj halux rigdus w/implt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28292,Correction hallux valgus,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,655.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28295,Correction hallux valgus,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28296,Correction hallux valgus,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,655.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28297,Correction hallux valgus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28298,Correction hallux valgus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28299,Correction hallux valgus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28300,Incision of heel bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28302,Incision of ankle bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28304,Incision of midfoot bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28305,Incise/graft midfoot bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28306,Incision of metatarsal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28307,Incision of metatarsal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28308,Incision of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28309,Incision of metatarsals,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28310,Revision of big toe,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28312,Revision of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28313,Repair deformity of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28315,Removal of sesamoid bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28320,Repair of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28322,Repair of metatarsals,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28340,Resect enlarged toe tissue,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28341,Resect enlarged toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28344,Repair extra toe(s),APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28345,Repair webbed toe(s),APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28360,Reconstruct cleft foot,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28400,Treatment of heel fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28405,Treatment of heel fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28406,Treatment of heel fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28415,Treat heel fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28420,Treat/graft heel fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28430,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28435,Treatment of ankle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28436,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28445,Treat ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28446,Osteochondral talus autogrft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28450,Treat midfoot fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28455,Treat midfoot fracture each,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28456,Treat midfoot fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28465,Treat midfoot fracture each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28470,Treat metatarsal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28475,Treat metatarsal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28476,Treat metatarsal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28485,Treat metatarsal fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28490,Treat big toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28495,Treat big toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28496,Treat big toe fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28505,Treat big toe fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28510,Treatment of toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28515,Treatment of toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28525,Treat toe fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28530,Treat sesamoid bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28531,Treat sesamoid bone fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28540,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28545,Treat foot dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28546,Treat foot dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28555,Repair foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28570,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28575,Treat foot dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28576,Treat foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28585,Repair foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28600,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28605,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28606,Treat foot dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28615,Repair foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28630,Treat toe dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28635,Treat toe dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28636,Treat toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28645,Repair toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28660,Treat toe dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28665,Treat toe dislocation,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,"2,923.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28666,Treat toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28675,Repair of toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28705,Fusion of foot bones,APC 5116,RVU Per Case,"$15,377.54 ",OP,"8,183.43","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28715,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28725,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28730,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28735,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28737,Revision of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28740,Fusion of foot bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28750,Fusion of big toe joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28755,Fusion of big toe joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28760,Fusion of big toe joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28800,Amputation of midfoot,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28805,Amputation thru metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28810,Amputation toe & metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28820,Amputation of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28825,Partial amputation of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28890,Hi enrgy eswt plantar fascia,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,28899,Foot/toes surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29000,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29010,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29015,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29035,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29040,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29044,Application of body cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29046,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29049,Application of figure eight,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29055,Application of shoulder cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29058,Application of shoulder cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29065,Application of long arm cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29075,Application of forearm cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29085,Apply hand/wrist cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29086,Apply finger cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29105,Apply long arm splint,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29125,Apply forearm splint,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29126,Apply forearm splint,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29130,Application of finger splint,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29131,Application of finger splint,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29200,Strapping of chest,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29240,Strapping of shoulder,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29260,Strapping of elbow or wrist,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29280,Strapping of hand or finger,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29305,Application of hip cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29325,Application of hip casts,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29345,Application of long leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29355,Application of long leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29358,Apply long leg cast brace,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29365,Application of long leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29405,Apply short leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29425,Apply short leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29435,Apply short leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29440,Addition of walker to cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29445,Apply rigid leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29450,Application of leg cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29505,Application long leg splint,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29515,Application lower leg splint,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29520,Strapping of hip,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29530,Strapping of knee,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29540,Strapping of ankle and/or ft,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29550,Strapping of toes,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29580,Application of paste boot,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29581,Apply multlay comprs lwr leg,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29584,Appl multlay comprs arm/hand,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29700,Removal/revision of cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29705,Removal/revision of cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29710,Removal/revision of cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29720,Repair of body cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29730,Windowing of cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29740,Wedging of cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29750,Wedging of clubfoot cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29799,Casting/strapping procedure,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29800,Jaw arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29804,Jaw arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29805,Sho arthrs dx +- synovial bx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29806,Sho arthrs srg capsulorpaphy,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29807,Sho arthrs srg rpr slap les,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29819,Sho arthrs srg rmvl loose/fb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29820,Sho arthrs srg prtl synvct,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29821,Sho arthrs srg compl synvct,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29822,Sho arthrs srg lmtd dbrdmt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29823,Sho arthrs srg xtnsv dbrdmt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29824,Sho arthrs srg dstl claviclc,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29825,Sho arthrs srg lss&rescj ads,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29827,Sho arthrs srg rt8tr cuf rpr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29828,Sho arthrs srg bicp tenodsis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29830,Elbow arthroscopy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29834,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29835,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29836,Elbow arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29837,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29838,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29840,Wrist arthroscopy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29843,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29844,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29845,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29846,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29847,Wrist arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29848,Wrist endoscopy/surgery,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29850,Knee arthroscopy/surgery,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29851,Knee arthroscopy/surgery,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29855,Tibial arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29856,Tibial arthroscopy/surgery,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,733.49","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29860,Hip arthroscopy dx,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29861,Hip arthro w/fb removal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29862,Hip arthr0 w/debridement,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29863,Hip arthr0 w/synovectomy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29866,Autgrft implnt knee w/scope,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29867,Allgrft implnt knee w/scope,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29868,Meniscal trnspl knee w/scpe,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29870,Knee arthroscopy dx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29871,Knee arthroscopy/drainage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29873,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29874,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29875,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29876,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29877,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29879,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29880,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29881,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29882,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29883,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29884,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29885,Knee arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29886,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29887,Knee arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29888,Knee arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29889,Knee arthroscopy/surgery,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29891,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29892,Ankle arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29893,Scope plantar fasciotomy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29894,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29895,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29897,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29898,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29899,Ankle arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29900,Mcp joint arthroscopy dx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29901,Mcp joint arthroscopy surg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29902,Mcp joint arthroscopy surg,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29904,Subtalar arthro w/fb rmvl,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29905,Subtalar arthro w/exc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29906,Subtalar arthro w/deb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29907,Subtalar arthro w/fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29914,Hip arthro w/femoroplasty,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29915,Hip arthro acetabuloplasty,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29916,Hip arthro w/labral repair,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,29999,Arthroscopy of joint,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"5,733.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30000,Drainage of nose lesion,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30020,Drainage of nose lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30100,Intranasal biopsy,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30110,Removal of nose polyp(s),APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30115,Removal of nose polyp(s),APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30117,Removal of intranasal lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30118,Removal of intranasal lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30120,Revision of nose,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30124,Removal of nose lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30125,Removal of nose lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30130,Excise inferior turbinate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30140,Resect inferior turbinate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30150,Partial removal of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30160,Removal of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30200,Injection treatment of nose,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30210,Nasal sinus therapy,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30220,Insert nasal septal button,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30300,Remove nasal foreign body,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30310,Remove nasal foreign body,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30320,Remove nasal foreign body,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30400,Reconstruction of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30410,Reconstruction of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30420,Reconstruction of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30430,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30435,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30450,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30460,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30462,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30465,Repair nasal stenosis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30468,Rpr nsl vlv collapse w/implt,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30520,Repair of nasal septum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30540,Repair nasal defect,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30545,Repair nasal defect,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30560,Release of nasal adhesions,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30580,Repair upper jaw fistula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30600,Repair mouth/nose fistula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30620,Intranasal reconstruction,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30630,Repair nasal septum defect,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30801,Ablate inf turbinate superf,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30802,Ablate inf turbinate submuc,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30901,Control of nosebleed,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30903,Control of nosebleed,APC 5734,RVU Per Unit,$108.49 ,OP,108.49,236.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30905,Control of nosebleed,APC 5734,RVU Per Unit,$108.49 ,OP,108.49,236.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30906,Repeat control of nosebleed,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,236.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30915,Ligation nasal sinus artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30920,Ligation upper jaw artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30930,Ther fx nasal inf turbinate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,30999,Nasal surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31000,Irrigation maxillary sinus,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31002,Irrigation sphenoid sinus,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31020,Exploration maxillary sinus,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31030,Exploration maxillary sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31032,Explore sinus remove polyps,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31040,Exploration behind upper jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31050,Exploration sphenoid sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31051,Sphenoid sinus surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31070,Exploration of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31075,Exploration of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31080,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31081,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31084,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31085,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31086,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31087,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31090,Exploration of sinuses,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31200,Removal of ethmoid sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31201,Removal of ethmoid sinus,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31205,Removal of ethmoid sinus,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31225,Removal of upper jaw,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31230,Removal of upper jaw,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31231,Nasal endoscopy dx,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,281.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31233,Nsl/sins ndsc dx max sinusc,APC 5152,RVU Per Unit,$364.87 ,OP,281.52,364.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31235,Nsl/sins ndsc dx sphn sinusc,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31237,Nasal/sinus endoscopy surg,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31238,Nasal/sinus endoscopy surg,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31239,Nasal/sinus endoscopy surg,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31240,Nasal/sinus endoscopy surg,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31241,Nsl/sins ndsc w/artery lig,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31253,Nsl/sins ndsc total,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31254,Nsl/sins ndsc w/prtl ethmdct,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31255,Nsl/sins ndsc w/tot ethmdct,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31256,Exploration maxillary sinus,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31257,Nsl/sins ndsc tot w/sphendt,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31259,Nsl/sins ndsc sphn tiss rmvl,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31267,Endoscopy maxillary sinus,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31276,Nsl/sins ndsc frnt tiss rmvl,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31287,Nasal/sinus endoscopy surg,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31288,Nasal/sinus endoscopy surg,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31290,Nasal/sinus endoscopy surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31291,Nasal/sinus endoscopy surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31292,Nsl/sins ndsc med/inf dcmprn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31293,Nsl/sins ndsc med&inf dcmprn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31294,Nsl/sins ndsc surg on dcmprn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31295,Nsl/sins ndsc surg max sins,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31296,Nsl/sins ndsc surg frnt sins,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31297,Nsl/sins ndsc surg sphn sins,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31298,Nsl/sins ndsc surg frnt&sphn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31299,Sinus surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31300,Removal of larynx lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31360,Removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31365,Removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31367,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31368,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31370,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31375,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31380,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31382,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31390,Removal of larynx & pharynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31395,Reconstruct larynx & pharynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31400,Revision of larynx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31420,Removal of epiglottis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31500,Insert emergency airway,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,485.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31502,Change of windpipe airway,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,472.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31505,Diagnostic laryngoscopy,APC 5151,RVU Per Unit,$159.31 ,OP,154.19,159.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31510,Laryngoscopy with biopsy,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31511,Remove foreign body larynx,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,281.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31512,Removal of larynx lesion,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31513,Injection into vocal cord,APC 5152,RVU Per Unit,$364.87 ,OP,281.52,364.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31515,Laryngoscopy for aspiration,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,"2,962.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31520,Dx laryngoscopy newborn,APC 5152,RVU Per Unit,$364.87 ,OP,281.52,364.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31525,Dx laryngoscopy excl nb,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31526,Dx laryngoscopy w/oper scope,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31527,Laryngoscopy for treatment,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31528,Laryngoscopy and dilation,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31529,Laryngoscopy and dilation,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31530,Laryngoscopy w/fb removal,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31531,Laryngoscopy w/fb & op scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31535,Laryngoscopy w/biopsy,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31536,Laryngoscopy w/bx & op scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31540,Laryngoscopy w/exc of tumor,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31541,Larynscop w/tumr exc + scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31545,Remove vc lesion w/scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31546,Remove vc lesion scope/graft,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31551,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31552,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31553,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31554,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31560,Laryngoscop w/arytenoidectom,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31561,Larynscop remve cart + scop,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31570,Laryngoscope w/vc inj,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31571,Laryngoscop w/vc inj + scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31572,Largsc w/laser dstrj les,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31573,Largsc w/ther injection,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31574,Largsc w/njx augmentation,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31575,Diagnostic laryngoscopy,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,281.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31576,Laryngoscopy with biopsy,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31577,Largsc w/rmvl foreign bdy(s),APC 5152,RVU Per Unit,$364.87 ,OP,364.87,770.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31578,Largsc w/removal lesion,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31579,Laryngoscopy telescopic,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,770.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31580,Laryngoplasty laryngeal web,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31584,Laryngoplasty fx rdctj fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31587,Laryngoplasty cricoid split,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31590,Reinnervate larynx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31591,Laryngoplasty medialization,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31592,Cricotracheal resection,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31599,Larynx surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31600,Incision of windpipe,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31601,Incision of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31603,Incision of windpipe,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31605,Incision of windpipe,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31610,Incision of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31611,Surgery/speech prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31612,Puncture/clear windpipe,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31613,Repair windpipe opening,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31614,Repair windpipe opening,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31615,Visualization of windpipe,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31622,Dx bronchoscope/wash,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31623,Dx bronchoscope/brush,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31624,Dx bronchoscope/lavage,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31625,Bronchoscopy w/biopsy(s),APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31626,Bronchoscopy w/markers,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31628,Bronchoscopy/lung bx each,APC 5154,RVU Per Case,"$3,002.24 ",OP,"1,907.43","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31629,Bronchoscopy/needle bx each,APC 5154,RVU Per Case,"$3,002.24 ",OP,"1,907.43","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31630,Bronchoscopy dilate/fx repr,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31631,Bronchoscopy dilate w/stent,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31634,Bronch w/balloon occlusion,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31635,Bronchoscopy w/fb removal,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31636,Bronchoscopy bronch stents,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31638,Bronchoscopy revise stent,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31640,Bronchoscopy w/tumor excise,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31641,Bronchoscopy treat blockage,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31643,Diag bronchoscope/catheter,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31645,Brnchsc w/ther aspir 1st,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31646,Brnchsc w/ther aspir sbsq,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,"1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31647,Bronchial valve init insert,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31648,Bronchial valve remov init,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31649,Bronchial valve remov addl,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31652,Bronch ebus samplng 1/2 node,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31653,Bronch ebus samplng 3/> node,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31660,Bronch thermoplsty 1 lobe,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31661,Bronch thermoplsty 2/> lobes,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31717,Bronchial brush biopsy,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,770.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31720,Clearance of airways,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31725,Clearance of airways,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31730,Intro windpipe wire/tube,APC 5153,RVU Per Case,"$1,450.13 ",OP,770.41,"1,450.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31750,Repair of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31755,Repair of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31760,Repair of windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31766,Reconstruction of windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31770,Repair/graft of bronchus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31775,Reconstruct bronchus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31780,Reconstruct windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31781,Reconstruct windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31785,Remove windpipe lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31786,Remove windpipe lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31800,Repair of windpipe injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31805,Repair of windpipe injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31820,Closure of windpipe lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31825,Repair of windpipe defect,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31830,Revise windpipe scar,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,31899,Airways surgical procedure,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,"1,907.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32035,Thoracostomy w/rib resection,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32036,Thoracostomy w/flap drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32096,Open wedge/bx lung infiltr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32097,Open wedge/bx lung nodule,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32098,Open biopsy of lung pleura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32100,Exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32110,Explore/repair chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32120,Re-exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32124,Explore chest free adhesions,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32140,Removal of lung lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32141,Remove/treat lung lesions,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32150,Removal of lung lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32151,Remove lung foreign body,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32160,Open chest heart massage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32200,Drain open lung lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32215,Treat chest lining,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32220,Release of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32225,Partial release of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32310,Removal of chest lining,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32320,Free/remove chest lining,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32400,Needle biopsy chest lining,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32408,Core ndl bx lng/med perq,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32440,Remove lung pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32442,Sleeve pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32445,Removal of lung extrapleural,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32480,Partial removal of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32482,Bilobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32484,Segmentectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32486,Sleeve lobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32488,Completion pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32491,Lung volume reduction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32501,Repair bronchus add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32503,Resect apical lung tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32504,Resect apical lung tum/chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32505,Wedge resect of lung initial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32506,Wedge resect of lung add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32507,Wedge resect of lung diag,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32540,Removal of lung lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32550,Insert pleural cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32551,Insertion of chest tube,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32552,Remove lung catheter,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32553,Ins mark thor for rt perq,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32554,Aspirate pleura w/o imaging,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32555,Aspirate pleura w/ imaging,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32556,Insert cath pleura w/o image,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32557,Insert cath pleura w/ image,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32560,Treat pleurodesis w/agent,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32561,Lyse chest fibrin init day,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32562,Lyse chest fibrin subq day,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32601,Thoracoscopy diagnostic,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32604,Thoracoscopy wbx sac,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32606,Thoracoscopy w/bx med space,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32607,Thoracoscopy w/bx infiltrate,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32608,Thoracoscopy w/bx nodule,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32609,Thoracoscopy w/bx pleura,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32650,Thoracoscopy w/pleurodesis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32651,Thoracoscopy remove cortex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32652,Thoracoscopy rem totl cortex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32653,Thoracoscopy remov fb/fibrin,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32654,Thoracoscopy contrl bleeding,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32655,Thoracoscopy resect bullae,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32656,Thoracoscopy w/pleurectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32658,Thoracoscopy w/sac fb remove,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32659,Thoracoscopy w/sac drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32661,Thoracoscopy w/pericard exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32662,Thoracoscopy w/mediast exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32663,Thoracoscopy w/lobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32664,Thoracoscopy w/ th nrv exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32665,Thoracoscop w/esoph musc exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32666,Thoracoscopy w/wedge resect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32667,Thoracoscopy w/w resect addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32668,Thoracoscopy w/w resect diag,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32669,Thoracoscopy remove segment,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32670,Thoracoscopy bilobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32671,Thoracoscopy pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32672,Thoracoscopy for lvrs,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32673,Thoracoscopy w/thymus resect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32674,Thoracoscopy lymph node exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32800,Repair lung hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32810,Close chest after drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32815,Close bronchial fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32820,Reconstruct injured chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32850,Donor pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32851,Lung transplant single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32852,Lung transplant with bypass,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32853,Lung transplant double,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32854,Lung transplant with bypass,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32855,Prepare donor lung single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32856,Prepare donor lung double,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32900,Removal of rib(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32905,Revise & repair chest wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32906,Revise & repair chest wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32940,Revision of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32960,Therapeutic pneumothorax,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,725.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32994,Ablate pulm tumor perq crybl,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32997,Total lung lavage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32998,Ablate pulm tumor perq rf,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,32999,Chest surgery procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,725.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33016,Pericardiocentesis w/imaging,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33017,Prcrd drg 6yr+ w/o cgen car,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33018,Prcrd drg 0-5yr or w/anomly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33019,Perq prcrd drg insj cath ct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33020,Incision of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33025,Incision of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33030,Partial removal of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33031,Partial removal of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33050,Resect heart sac lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33120,Removal of heart lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33130,Removal of heart lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33140,Heart revascularize (tmr),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33141,Heart tmr w/other procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33202,Insert epicard eltrd open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33203,Insert epicard eltrd endo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33206,Insert heart pm atrial,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","24,770.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33207,Insert heart pm ventricular,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","24,770.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33208,Insrt heart pm atrial & vent,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","30,573.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33210,Insert electrd/pm cath sngl,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33211,Insert card electrodes dual,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33212,Insert pulse gen sngl lead,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","19,689.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33213,Insert pulse gen dual leads,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","22,588.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33214,Upgrade of pacemaker system,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","30,573.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33215,Reposition pacing-defib lead,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,130.52",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33216,Insert 1 electrode pm-defib,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33217,Insert 2 electrode pm-defib,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33218,Repair lead pace-defib one,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","5,130.52",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33220,Repair lead pace-defib dual,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","5,130.52",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33221,Insert pulse gen mult leads,APC 5224,RVU Per Case,"$18,035.87 ",OP,"18,035.87","18,035.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33222,Relocation pocket pacemaker,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33223,Relocate pocket for defib,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33224,Insert pacing lead & connect,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","61,548.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33226,Reposition l ventric lead,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,130.52",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33227,Remove&replace pm gen singl,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33228,Remv&replc pm gen dual lead,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","10,078.61",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33229,Remv&replc pm gen mult leads,APC 5224,RVU Per Case,"$18,035.87 ",OP,"18,035.87","18,035.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33230,Insrt pulse gen w/dual leads,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33231,Insrt pulse gen w/mult leads,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33233,Removal of pm generator,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33234,Removal of pacemaker system,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33235,Removal pacemaker electrode,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33236,Remove electrode/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33237,Remove electrode/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33238,Remove electrode/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33240,Insrt pulse gen w/singl lead,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33241,Remove pulse generator,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33243,Remove eltrd/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33244,Remove elctrd transvenously,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33249,Insj/rplcmt defib w/lead(s),APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33250,Ablate heart dysrhythm focus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33251,Ablate heart dysrhythm focus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33254,Ablate atria lmtd,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33255,Ablate atria w/o bypass ext,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33256,Ablate atria w/bypass exten,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33257,Ablate atria lmtd add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33258,Ablate atria x10sv add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33259,Ablate atria w/bypass add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33261,Ablate heart dysrhythm focus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33262,Rmvl& replc pulse gen 1 lead,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33263,Rmvl & rplcmt dfb gen 2 lead,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33264,Rmvl & rplcmt dfb gen mlt ld,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33265,Ablate atria lmtd endo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33266,Ablate atria x10sv endo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33270,Ins/rep subq defibrillator,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33271,Insj subq impltbl dfb elctrd,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33272,Rmvl of subq defibrillator,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33273,Repos prev impltbl subq dfb,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33274,Tcat insj/rpl perm ldls pm,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33275,Tcat rmvl perm ldls pm w/img,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33285,Insj subq car rhythm mntr,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33286,Rmvl subq car rhythm mntr,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33289,Tcat impl wrls p-art prs snr,APC 5200,RVU Per Case,"$27,924.53 ",OP,"27,924.53","27,924.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33300,Repair of heart wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33305,Repair of heart wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33310,Exploratory heart surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33315,Exploratory heart surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33320,Repair major blood vessel(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33321,Repair major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33322,Repair major blood vessel(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33330,Insert major vessel graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33335,Insert major vessel graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33340,Perq clsr tcat l atr apndge,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33361,Replace aortic valve perq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33362,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33363,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33364,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33365,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33366,Trcath replace aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33367,Replace aortic valve w/byp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33368,Replace aortic valve w/byp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33369,Replace aortic valve w/byp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33390,Valvuloplasty aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33391,Valvuloplasty aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33404,Prepare heart-aorta conduit,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33405,Replacement aortic valve opn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33406,Replacement aortic valve opn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33410,Replacement aortic valve opn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33411,Replacement of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33412,Replacement of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33413,Replacement of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33414,Repair of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33415,Revision subvalvular tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33416,Revise ventricle muscle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33417,Repair of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33418,Repair tcat mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33420,Revision of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33422,Revision of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33425,Repair of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33426,Repair of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33427,Repair of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33430,Replacement of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33440,Rplcmt a-valve tlcj autol pv,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33460,Revision of tricuspid valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33463,Valvuloplasty tricuspid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33464,Valvuloplasty tricuspid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33465,Replace tricuspid valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33468,Revision of tricuspid valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33470,Revision of pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33471,Valvotomy pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33474,Revision of pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33475,Replacement pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33476,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33477,Implant tcat pulm vlv perq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33478,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33496,Repair prosth valve clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33500,Repair heart vessel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33501,Repair heart vessel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33502,Coronary artery correction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33503,Coronary artery graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33504,Coronary artery graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33505,Repair artery w/tunnel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33506,Repair artery translocation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33507,Repair art intramural,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33510,Cabg vein single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33511,Cabg vein two,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33512,Cabg vein three,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33513,Cabg vein four,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33514,Cabg vein five,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33516,Cabg vein six or more,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33517,Cabg artery-vein single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33518,Cabg artery-vein two,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33519,Cabg artery-vein three,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33521,Cabg artery-vein four,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33522,Cabg artery-vein five,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33523,Cabg art-vein six or more,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33530,Coronary artery bypass/reop,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33533,Cabg arterial single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33534,Cabg arterial two,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33535,Cabg arterial three,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33536,Cabg arterial four or more,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33542,Removal of heart lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33545,Repair of heart damage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33548,Restore/remodel ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33572,Open coronary endarterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33600,Closure of valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33602,Closure of valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33606,Anastomosis/artery-aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33608,Repair anomaly w/conduit,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33610,Repair by enlargement,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33611,Repair double ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33612,Repair double ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33615,Repair modified fontan,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33617,Repair single ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33619,Repair single ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33620,Apply r&l pulm art bands,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33621,Transthor cath for stent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33622,Redo compl cardiac anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33641,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33645,Revision of heart veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33647,Repair heart septum defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33660,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33665,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33670,Repair of heart chambers,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33675,Close mult vsd,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33676,Close mult vsd w/resection,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33677,Cl mult vsd w/rem pul band,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33681,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33684,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33688,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33690,Reinforce pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33692,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33694,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33697,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33702,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33710,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33720,Repair of heart defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33722,Repair of heart defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33724,Repair venous anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33726,Repair pul venous stenosis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33730,Repair heart-vein defect(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33732,Repair heart-vein defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33735,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33736,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33737,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33741,Tas congenital car anomal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33745,Tis cgen car anomal 1st shnt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33746,Tis cgen car anomal ea addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33750,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33755,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33762,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33764,Major vessel shunt & graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33766,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33767,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33768,Cavopulmonary shunting,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33770,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33771,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33774,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33775,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33776,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33777,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33778,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33779,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33780,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33781,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33782,Nikaidoh proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33783,Nikaidoh proc w/ostia implt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33786,Repair arterial trunk,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33788,Revision of pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33800,Aortic suspension,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33802,Repair vessel defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33803,Repair vessel defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33813,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33814,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33820,Revise major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33822,Revise major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33824,Revise major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33840,Remove aorta constriction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33845,Remove aorta constriction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33851,Remove aorta constriction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33852,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33853,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33858,As-aort grf f/aortic dsj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33859,As-aort grf f/ds oth/thn dsj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33863,Ascending aortic graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33864,Ascending aortic graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33871,Transvrs a-arch grf hypthrm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33875,Thoracic aortic graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33877,Thoracoabdominal graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33880,Endovasc taa repr incl subcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33881,Endovasc taa repr w/o subcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33883,Insert endovasc prosth taa,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33884,Endovasc prosth taa add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33886,Endovasc prosth delayed,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33889,Artery transpose/endovas taa,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33891,Car-car bp grft/endovas taa,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33910,Remove lung artery emboli,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33915,Remove lung artery emboli,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33916,Surgery of great vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33917,Repair pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33920,Repair pulmonary atresia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33922,Transect pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33924,Remove pulmonary shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33925,Rpr pul art unifocal w/o cpb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33926,Repr pul art unifocal w/cpb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33927,Impltj tot rplcmt hrt sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33928,Rmvl & rplcmt tot hrt sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33929,Rmvl rplcmt hrt sys f/trnspl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33930,Removal of donor heart/lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33933,Prepare donor heart/lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33935,Transplantation heart/lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33940,Removal of donor heart,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33944,Prepare donor heart,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33945,Transplantation of heart,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33946,Ecmo/ecls initiation venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33947,Ecmo/ecls initiation artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33948,Ecmo/ecls daily mgmt-venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33949,Ecmo/ecls daily mgmt artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33951,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33952,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33953,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33954,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33955,Ecmo/ecls insj ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33956,Ecmo/ecls insj ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33957,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33958,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33959,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33962,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33963,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33964,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33965,Ecmo/ecls rmvl perph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33966,Ecmo/ecls rmvl prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33967,Insert i-aort percut device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33968,Remove aortic assist device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33969,Ecmo/ecls rmvl perph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33970,Aortic circulation assist,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33971,Aortic circulation assist,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33973,Insert balloon device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33974,Remove intra-aortic balloon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33975,Implant ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33976,Implant ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33977,Remove ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33978,Remove ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33979,Insert intracorporeal device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33980,Remove intracorporeal device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33981,Replace vad pump ext,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33982,Replace vad intra w/o bp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33983,Replace vad intra w/bp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33984,Ecmo/ecls rmvl prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33985,Ecmo/ecls rmvl ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33986,Ecmo/ecls rmvl ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33987,Artery expos/graft artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33988,Insertion of left heart vent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33989,Removal of left heart vent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33990,Insj perq vad l hrt arterial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33991,Insj perq vad l hrt artl&ven,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33992,Rmvl perq left heart vad,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33993,Reposg perq r/l hrt vad,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33995,Insj perq vad r hrt venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33997,Rmvl perq right heart vad,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,33999,Cardiac surgery procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,725.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34001,Removal of artery clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34051,Removal of artery clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34101,Removal of artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34111,Removal of arm artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34151,Removal of artery clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34201,Removal of artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34203,Removal of leg artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34401,Removal of vein clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34421,Removal of vein clot,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34451,Removal of vein clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34471,Removal of vein clot,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,"7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34490,Removal of vein clot,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34501,Repair valve femoral vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34502,Reconstruct vena cava,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34510,Transposition of vein valve,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34520,Cross-over vein graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34530,Leg vein fusion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34701,Evasc rpr a-ao ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34702,Evasc rpr a-ao ndgft rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34703,Evasc rpr a-unilac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34704,Evasc rpr a-unilac ndgft rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34705,Evac rpr a-biiliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34706,Evasc rpr a-biiliac rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34707,Evasc rpr ilio-iliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34708,Evasc rpr ilio-iliac rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34709,Plmt xtn prosth evasc rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34710,Dlyd plmt xtn prosth 1st vsl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34711,Dlyd plmt xtn prosth ea addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34712,Tcat dlvr enhncd fixj dev,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34717,Evasc rpr a-iliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34718,Evasc rpr n/a a-iliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34808,Endovas iliac a device addon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34812,Opn fem art expos,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34813,Femoral endovas graft add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34820,Opn iliac art expos,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34830,Open aortic tube prosth repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34831,Open aortoiliac prosth repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34832,Open aortofemor prosth repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34833,Opn ilac art expos cndt crtj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34834,Opn brach art expos,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34841,Endovasc visc aorta 1 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34842,Endovasc visc aorta 2 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34843,Endovasc visc aorta 3 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34844,Endovasc visc aorta 4 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34845,Visc & infraren abd 1 prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34846,Visc & infraren abd 2 prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34847,Visc & infraren abd 3 prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,34848,Visc & infraren abd 4+ prost,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35001,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35002,Repair artery rupture neck,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35005,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35011,Repair defect of artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35013,Repair artery rupture arm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35021,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35022,Repair artery rupture chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35045,Repair defect of arm artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35081,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35082,Repair artery rupture aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35091,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35092,Repair artery rupture aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35102,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35103,Repair artery rupture aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35111,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35112,Repair artery rupture spleen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35121,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35122,Repair artery rupture belly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35131,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35132,Repair artery rupture groin,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35141,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35142,Repair artery rupture thigh,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35151,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35152,Repair ruptd popliteal art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35180,Repair blood vessel lesion,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35182,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35184,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35188,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35189,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35190,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35201,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35206,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35207,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35211,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35216,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35221,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35226,Repair blood vessel lesion,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35231,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35236,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35241,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35246,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35251,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35256,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35261,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,486.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35266,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35271,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35276,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35281,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35286,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35301,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35302,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35303,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35304,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35305,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35306,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35311,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35321,Rechanneling of artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35331,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35341,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35351,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35355,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35361,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35363,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35371,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35372,Rechanneling of artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35390,Reoperation carotid add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35400,Angioscopy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35501,Art byp grft ipsilat carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35506,Art byp grft subclav-carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35508,Art byp grft carotid-vertbrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35509,Art byp grft contral carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35510,Art byp grft carotid-brchial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35511,Art byp grft subclav-subclav,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35512,Art byp grft subclav-brchial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35515,Art byp grft subclav-vertbrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35516,Art byp grft subclav-axilary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35518,Art byp grft axillary-axilry,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35521,Art byp grft axill-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35522,Art byp grft axill-brachial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35523,Art byp grft brchl-ulnr-rdl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35525,Art byp grft brachial-brchl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35526,Art byp grft aor/carot/innom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35531,Art byp grft aorcel/aormesen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35533,Art byp grft axill/fem/fem,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35535,Art byp grft hepatorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35536,Art byp grft splenorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35537,Art byp grft aortoiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35538,Art byp grft aortobi-iliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35539,Art byp grft aortofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35540,Art byp grft aortbifemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35556,Art byp grft fem-popliteal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35558,Art byp grft fem-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35560,Art byp grft aortorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35563,Art byp grft ilioiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35565,Art byp grft iliofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35566,Art byp fem-ant-post tib/prl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35570,Art byp tibial-tib/peroneal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35571,Art byp pop-tibl-prl-other,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35583,Vein byp grft fem-popliteal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35585,Vein byp fem-tibial peroneal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35587,Vein byp pop-tibl peroneal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35600,Harvest art for cabg add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35601,Art byp common ipsi carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35606,Art byp carotid-subclavian,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35612,Art byp subclav-subclavian,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35616,Art byp subclav-axillary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35621,Art byp axillary-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35623,Art byp axillary-pop-tibial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35626,Art byp aorsubcl/carot/innom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35631,Art byp aor-celiac-msn-renal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35632,Art byp ilio-celiac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35633,Art byp ilio-mesenteric,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35634,Art byp iliorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35636,Art byp spenorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35637,Art byp aortoiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35638,Art byp aortobi-iliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35642,Art byp carotid-vertebral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35645,Art byp subclav-vertebrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35646,Art byp aortobifemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35647,Art byp aortofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35650,Art byp axillary-axillary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35654,Art byp axill-fem-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35656,Art byp femoral-popliteal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35661,Art byp femoral-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35663,Art byp ilioiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35665,Art byp iliofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35666,Art byp fem-ant-post tib/prl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35671,Art byp pop-tibl-prl-other,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35681,Composite byp grft pros&vein,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35682,Composite byp grft 2 veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35683,Composite byp grft 3/> segmt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35691,Art trnsposj vertbrl carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35693,Art trnsposj subclavian,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35694,Art trnsposj subclav carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35695,Art trnsposj carotid subclav,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35697,Reimplant artery each,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35700,Reoperation bypass graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35701,Expl n/flwd surg neck art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35702,Expl n/flwd surg uxtr art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35703,Expl n/flwd surg lxtr art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35800,Explore neck vessels,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35820,Explore chest vessels,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35840,Explore abdominal vessels,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35860,Explore limb vessels,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35870,Repair vessel graft defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35875,Removal of clot in graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35876,Removal of clot in graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35879,Revise graft w/vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35881,Revise graft w/vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35883,Revise graft w/nonauto graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35884,Revise graft w/vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35901,Excision graft neck,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35903,Excision graft extremity,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35905,Excision graft thorax,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,35907,Excision graft abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36002,Pseudoaneurysm injection trt,APC 5181,RVU Per Unit,$524.87 ,OP,492.86,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36221,Place cath thoracic aorta,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36222,Place cath carotid/inom art,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36223,Place cath carotid/inom art,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36224,Place cath carotd art,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36225,Place cath subclavian art,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36226,Place cath vertebral art,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36251,Ins cath ren art 1st unilat,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36252,Ins cath ren art 1st bilat,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36253,Ins cath ren art 2nd+ unilat,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36254,Ins cath ren art 2nd+ bilat,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36260,Insertion of infusion pump,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36261,Revision of infusion pump,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36262,Removal of infusion pump,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36415,Routine venipuncture,Lab Services,Per Unit,$3.00 ,OP,3,3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36420,Vein access cutdown < 1 yr,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36425,Vein access cutdown > 1 yr,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36430,Blood transfusion service,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36440,Bl push transfuse 2 yr/<,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36450,Bl exchange/transfuse nb,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36455,Bl exchange/transfuse non-nb,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36456,Prtl exchange transfuse nb,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36460,Transfusion service fetal,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36465,Njx noncmpnd sclrsnt 1 vein,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36466,Njx noncmpnd sclrsnt mlt vn,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36468,Njx sclrsnt spider veins,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36470,Njx sclrsnt 1 incmptnt vein,APC 5052,RVU Per Unit,$335.15 ,OP,216.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36471,Njx sclrsnt mlt incmptnt vn,APC 5052,RVU Per Unit,$335.15 ,OP,216.3,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36473,Endovenous mchnchem 1st vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36475,Endovenous rf 1st vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36478,Endovenous laser 1st vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36482,Endoven ther chem adhes 1st,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36511,Apheresis wbc,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36512,Apheresis rbc,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36513,Apheresis platelets,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,"2,346.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36514,Apheresis plasma,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36516,Apheresis immunoads slctv,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","6,053.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36522,Photopheresis,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","6,053.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36555,Insert non-tunnel cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"1,759.54","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36556,Insert non-tunnel cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"1,759.54","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36557,Insert tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,540.10","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36558,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36560,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36561,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36563,Insert tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36565,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36566,Insert tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","16,717.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36568,Insj picc <5 yr w/o imaging,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36569,Insj picc 5 yr+ w/o imaging,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36570,Insert picvad cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36571,Insert picvad cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36572,Insj picc rs&i <5 yr,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36573,Insj picc rs&i 5 yr+,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36575,Repair tunneled cv cath,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,"1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36576,Repair tunneled cv cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36578,Replace tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36580,Replace cvad cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36581,Replace tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36582,Replace tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36583,Replace tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36584,Compl rplcmt picc rs&i,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36585,Replace picvad cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36589,Removal tunneled cv cath,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36590,Removal tunneled cv cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36591,Draw blood off venous device,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36592,Collect blood from picc,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36593,Declot vascular device,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36595,Mech remov tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36596,Mech remov tunneled cv cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36597,Reposition venous catheter,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36598,Inj w/fluor eval cv device,APC 5693,RVU Per Unit,$197.21 ,OP,122.24,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36600,Withdrawal of arterial blood,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36640,Insertion catheter artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36660,Insertion catheter artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36680,Insert needle bone cavity,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36800,Insertion of cannula,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36810,Insertion of cannula,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36815,Insertion of cannula,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36818,Av fuse uppr arm cephalic,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36819,Av fuse uppr arm basilic,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36820,Av fusion/forearm vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36821,Av fusion direct any site,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36823,Insertion of cannula(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36825,Artery-vein autograft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36830,Artery-vein nonautograft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36831,Open thrombect av fistula,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36832,Av fistula revision open,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36833,Av fistula revision,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36835,Artery to vein shunt,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36838,Dist revas ligation hemo,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36860,External cannula declotting,APC 5182,RVU Per Case,"$1,362.67 ",OP,415.14,"1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36861,Cannula declotting,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36901,Intro cath dialysis circuit,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36902,Intro cath dialysis circuit,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36903,Intro cath dialysis circuit,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36904,Thrmbc/nfs dialysis circuit,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36905,Thrmbc/nfs dialysis circuit,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,36906,Thrmbc/nfs dialysis circuit,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37140,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37145,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37160,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37180,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37181,Splice spleen/kidney veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37182,Insert hepatic shunt (tips),APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37183,Remove hepatic shunt (tips),APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","13,714.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37184,Prim art m-thrmbc 1st vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"7,559.11","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37187,Venous mech thrombectomy,APC 5193,RVU Per Case,"$9,732.45 ",OP,"7,559.11","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37188,Ven mechnl thrmbc repeat tx,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37191,Ins endovas vena cava filtr,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37192,Redo endovas vena cava filtr,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37193,Rem endovas vena cava filter,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37195,Thrombolytic therapy stroke,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,415.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37197,Remove intrvas foreign body,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37200,Transcatheter biopsy,APC 5184,RVU Per Case,"$4,622.89 ",OP,"1,229.52","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37211,Thrombolytic art therapy,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37212,Thrombolytic venous therapy,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37213,Thromblytic art/ven therapy,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37214,Cessj therapy cath removal,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37215,Transcath stent cca w/eps,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37217,Stent placemt retro carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37218,Stent placemt ante carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37220,Iliac revasc,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37221,Iliac revasc w/stent,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37224,Fem/popl revas w/tla,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37225,Fem/popl revas w/ather,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37226,Fem/popl revasc w/stent,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37227,Fem/popl revasc stnt & ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37228,Tib/per revasc w/tla,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37229,Tib/per revasc w/ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37230,Tib/per revasc w/stent,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37231,Tib/per revasc stent & ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37236,Open/perq place stent 1st,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37238,Open/perq place stent same,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37241,Vasc embolize/occlude venous,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37242,Vasc embolize/occlude artery,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37243,Vasc embolize/occlude organ,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37244,Vasc embolize/occlude bleed,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37246,Trluml balo angiop 1st art,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37248,Trluml balo angiop 1st vein,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37500,Endoscopy ligate perf veins,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,956.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37501,Vascular endoscopy procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,"4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37565,Ligation of neck vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37600,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37605,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37606,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37607,Ligation of a-v fistula,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37609,Temporal artery procedure,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37615,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37616,Ligation of chest artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37617,Ligation of abdomen artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37618,Ligation of extremity artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37619,Ligation of inf vena cava,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37650,Revision of major vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37660,Revision of major vein,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37700,Revise leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37718,Ligate/strip short leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37722,Ligate/strip long leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37735,Removal of leg veins/lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37760,Ligate leg veins radical,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37761,Ligate leg veins open,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37765,Stab phleb veins xtr 10-20,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37766,Phleb veins - extrem 20+,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37780,Revision of leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37785,Ligate/divide/excise vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37788,Revascularization penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37790,Penile venous occlusion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,37799,Vascular surgery procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38100,Removal of spleen total,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38101,Removal of spleen partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38102,Removal of spleen total,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38115,Repair of ruptured spleen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38120,Laparoscopy splenectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38129,Laparoscope proc spleen,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38206,Harvest auto stem cells,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38207,Cryopreserve stem cells,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38208,Thaw preserved stem cells,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38209,Wash harvest stem cells,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38210,T-cell depletion of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38211,Tumor cell deplete of harvst,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38212,Rbc depletion of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38213,Platelet deplete of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38214,Volume deplete of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38215,Harvest stem cell concentrte,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38220,Dx bone marrow aspirations,APC 5072,RVU Per Case,"$1,363.50 ",OP,480.94,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38221,Dx bone marrow biopsies,APC 5072,RVU Per Case,"$1,363.50 ",OP,480.94,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38222,Dx bone marrow bx & aspir,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38230,Bone marrow harvest allogen,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","4,077.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38232,Bone marrow harvest autolog,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38240,Transplt allo hct/donor,APC 5244,RVU Per Case,"$30,853.81 ",OP,"4,077.73","30,853.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38241,Transplt autol hct/donor,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","4,077.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38242,Transplt allo lymphocytes,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38243,Transplj hematopoietic boost,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","1,321.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38300,Drainage lymph node lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,234.05","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38305,Drainage lymph node lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38308,Incision of lymph channels,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38380,Thoracic duct procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38381,Thoracic duct procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38382,Thoracic duct procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38500,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38505,Needle biopsy lymph nodes,APC 5072,RVU Per Case,"$1,363.50 ",OP,782.08,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38510,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38520,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38525,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38530,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38531,Open bx/exc inguinofem nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,060.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38542,Explore deep node(s) neck,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38550,Removal neck/armpit lesion,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38555,Removal neck/armpit lesion,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38562,Removal pelvic lymph nodes,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38564,Removal abdomen lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38570,Laparoscopy lymph node biop,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38571,Laparoscopy lymphadenectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38572,Laparoscopy lymphadenectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38573,Laps pelvic lymphadec,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38589,Laparoscope proc lymphatic,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38700,Removal of lymph nodes neck,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38720,Removal of lymph nodes neck,APC 5093,RVU Per Case,"$8,644.27 ",OP,"4,258.79","8,644.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38724,Removal of lymph nodes neck,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38740,Remove armpit lymph nodes,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38745,Remove armpit lymph nodes,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38746,Remove thoracic lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38747,Remove abdominal lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38760,Remove groin lymph nodes,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38765,Remove groin lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38770,Remove pelvis lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38780,Remove abdomen lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38792,Ra tracer id of sentinl node,APC 5591,RVU Per Case,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,38999,Blood/lymph system procedure,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39000,Exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39010,Exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39200,Resect mediastinal cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39220,Resect mediastinal tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39401,Mediastinoscpy w/medstnl bx,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39402,Mediastinoscpy w/lmph nod bx,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39499,Chest procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39501,Repair diaphragm laceration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39503,Repair of diaphragm hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39540,Repair of diaphragm hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39541,Repair of diaphragm hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39545,Revision of diaphragm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39560,Resect diaphragm simple,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39561,Resect diaphragm complex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,39599,Diaphragm surgery procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40490,Biopsy of lip,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40500,Partial excision of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40510,Partial excision of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40520,Partial excision of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40525,Reconstruct lip with flap,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40527,Reconstruct lip with flap,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40530,Partial removal of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40650,Repair lip,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40652,Repair lip,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40654,Repair lip,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40700,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40701,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40702,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40720,Repair cleft lip/nasal,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40761,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40799,Lip surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40800,Drainage of mouth lesion,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40801,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40804,Removal foreign body mouth,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40805,Removal foreign body mouth,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40806,Incision of lip fold,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40808,Biopsy of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40810,Excision of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40812,Excise/repair mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40814,Excise/repair mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40816,Excision of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40818,Excise oral mucosa for graft,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40819,Excise lip or cheek fold,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40820,Treatment of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40830,Repair mouth laceration,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40831,Repair mouth laceration,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40840,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40842,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40843,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40844,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40845,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,40899,Mouth surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41000,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41005,Drainage of mouth lesion,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41006,Drainage of mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41007,Drainage of mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41008,Drainage of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41009,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41010,Incision of tongue fold,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41015,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41016,Drainage of mouth lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41017,Drainage of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41018,Drainage of mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41019,Place needles h&n for rt,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41100,Biopsy of tongue,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41105,Biopsy of tongue,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41108,Biopsy of floor of mouth,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41110,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41112,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41113,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41114,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41115,Excision of tongue fold,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41116,Excision of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41120,Partial removal of tongue,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41130,Partial removal of tongue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41135,Tongue and neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41140,Removal of tongue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41145,Tongue removal neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41150,Tongue mouth jaw surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41153,Tongue mouth neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41155,Tongue jaw & neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41250,Repair tongue laceration,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41251,Repair tongue laceration,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41252,Repair tongue laceration,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41510,Tongue to lip surgery,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41512,Tongue suspension,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41520,Reconstruction tongue fold,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41530,Tongue base vol reduction,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41599,Tongue and mouth surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41800,Drainage of gum lesion,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41805,Removal foreign body gum,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41806,Removal foreign body jawbone,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41820,Excision gum each quadrant,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41821,Excision of gum flap,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41822,Excision of gum lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41823,Excision of gum lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41825,Excision of gum lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41826,Excision of gum lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41827,Excision of gum lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41828,Excision of gum lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41830,Removal of gum tissue,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41850,Treatment of gum lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41870,Gum graft,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41872,Repair gum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41874,Repair tooth socket,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,41899,Dental surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42000,Drainage mouth roof lesion,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42100,Biopsy roof of mouth,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42104,Excision lesion mouth roof,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42106,Excision lesion mouth roof,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42107,Excision lesion mouth roof,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42120,Remove palate/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42140,Excision of uvula,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42145,Repair palate pharynx/uvula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42160,Treatment mouth roof lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42180,Repair palate,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42182,Repair palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42200,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42205,Reconstruct cleft palate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42210,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42215,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42220,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42225,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42226,Lengthening of palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42227,Lengthening of palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42235,Repair palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42260,Repair nose to lip fistula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42280,Preparation palate mold,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42281,Insertion palate prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42299,Palate/uvula surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42300,Drainage of salivary gland,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42305,Drainage of salivary gland,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42310,Drainage of salivary gland,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42320,Drainage of salivary gland,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42330,Removal of salivary stone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42335,Removal of salivary stone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42340,Removal of salivary stone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42400,Biopsy of salivary gland,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,782.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42405,Biopsy of salivary gland,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42408,Excision of salivary cyst,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42409,Drainage of salivary cyst,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42410,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42415,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42420,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42425,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42426,Excise parotid gland/lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42440,Excise submaxillary gland,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42450,Excise sublingual gland,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42500,Repair salivary duct,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42505,Repair salivary duct,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42507,Parotid duct diversion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42509,Parotid duct diversion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42510,Parotid duct diversion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42600,Closure of salivary fistula,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42650,Dilation of salivary duct,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42660,Dilation of salivary duct,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42665,Ligation of salivary duct,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42699,Salivary surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42700,Drainage of tonsil abscess,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42720,Drainage of throat abscess,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42725,Drainage of throat abscess,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42800,Biopsy of throat,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42804,Biopsy of upper nose/throat,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42806,Biopsy of upper nose/throat,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42808,Excise pharynx lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42809,Remove pharynx foreign body,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42810,Excision of neck cyst,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42815,Excision of neck cyst,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42820,Remove tonsils and adenoids,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42821,Remove tonsils and adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42825,Removal of tonsils,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42826,Removal of tonsils,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42830,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42831,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42835,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42836,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42842,Extensive surgery of throat,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42844,Extensive surgery of throat,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42845,Extensive surgery of throat,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42860,Excision of tonsil tags,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42870,Excision of lingual tonsil,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42890,Partial removal of pharynx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42892,Revision of pharyngeal walls,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42894,Revision of pharyngeal walls,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42900,Repair throat wound,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42950,Reconstruction of throat,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42953,Repair throat esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42955,Surgical opening of throat,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42960,Control throat bleeding,APC 5162,RVU Per Unit,$438.38 ,OP,236.18,438.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42961,Control throat bleeding,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42962,Control throat bleeding,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42970,Control nose/throat bleeding,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,236.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42971,Control nose/throat bleeding,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42972,Control nose/throat bleeding,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,42999,Throat surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43020,Incision of esophagus,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43030,Throat muscle surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43045,Incision of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43100,Excision of esophagus lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43101,Excision of esophagus lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43107,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43108,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43112,Esphg tot w/thrcm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43113,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43116,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43117,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43118,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43121,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43122,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43123,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43124,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43130,Removal of esophagus pouch,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43135,Removal of esophagus pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43180,Esophagoscopy rigid trnso,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43191,Esophagoscopy rigid trnso dx,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43192,Esophagoscp rig trnso inject,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43193,Esophagoscp rig trnso biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43194,Esophagoscp rig trnso rem fb,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43195,Esophagoscopy rigid balloon,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43196,Esophagoscp guide wire dilat,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43197,Esophagoscopy flex dx brush,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43198,Esophagosc flex trnsn biopsy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43200,Esophagoscopy flexible brush,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43201,Esoph scope w/submucous inj,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43202,Esophagoscopy flex biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43204,Esoph scope w/sclerosis inj,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43205,Esophagus endoscopy/ligation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43206,Esoph optical endomicroscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43210,Egd esophagogastrc fndoplsty,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43211,Esophagoscop mucosal resect,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43212,Esophagoscop stent placement,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43213,Esophagoscopy retro balloon,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43214,Esophagosc dilate balloon 30,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43215,Esophagoscopy flex remove fb,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43216,Esophagoscopy lesion removal,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43217,Esophagoscopy snare les remv,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43220,Esophagoscopy balloon <30mm,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43226,Esoph endoscopy dilation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43227,Esophagoscopy control bleed,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43229,Esophagoscopy lesion ablate,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43231,Esophagoscop ultrasound exam,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43232,Esophagoscopy w/us needle bx,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43233,Egd balloon dil esoph30 mm/>,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43235,Egd diagnostic brush wash,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43236,Uppr gi scope w/submuc inj,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43237,Endoscopic us exam esoph,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43238,Egd us fine needle bx/aspir,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43239,Egd biopsy single/multiple,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43240,Egd w/transmural drain cyst,APC 5303,RVU Per Case,"$2,985.55 ",OP,"1,665.98","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43241,Egd tube/cath insertion,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43242,Egd us fine needle bx/aspir,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43243,Egd injection varices,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43244,Egd varices ligation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43245,Egd dilate stricture,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43246,Egd place gastrostomy tube,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43247,Egd remove foreign body,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43248,Egd guide wire insertion,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43249,Esoph egd dilation <30 mm,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43250,Egd cautery tumor polyp,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43251,Egd remove lesion snare,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43252,Egd optical endomicroscopy,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43253,Egd us transmural injxn/mark,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43254,Egd endo mucosal resection,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43255,Egd control bleeding any,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43257,Egd w/thrml txmnt gerd,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","5,158.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43259,Egd us exam duodenum/jejunum,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43260,Ercp w/specimen collection,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43261,Endo cholangiopancreatograph,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43262,Endo cholangiopancreatograph,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43263,Ercp sphincter pressure meas,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43264,Ercp remove duct calculi,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43265,Ercp lithotripsy calculi,APC 5331,RVU Per Case,"$4,873.06 ",OP,"3,973.57","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43266,Egd endoscopic stent place,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43270,Egd lesion ablation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43274,Ercp duct stent placement,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43275,Ercp remove forgn body duct,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43276,Ercp stent exchange w/dilate,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43277,Ercp ea duct/ampulla dilate,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43278,Ercp lesion ablate w/dilate,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43279,Lap myotomy heller,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43280,Laparoscopy fundoplasty,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43281,Lap paraesophag hern repair,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43282,Lap paraesoph her rpr w/mesh,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43283,Lap esoph lengthening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43284,Laps esophgl sphnctr agmntj,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43285,Rmvl esophgl sphnctr dev,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43286,Esphg tot w/laps moblj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43287,Esphg dstl 2/3 w/laps moblj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43288,Esphg thrsc moblj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43289,Laparoscope proc esoph,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43300,Repair of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43305,Repair esophagus and fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43310,Repair of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43312,Repair esophagus and fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43313,Esophagoplasty congenital,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43314,Tracheo-esophagoplasty cong,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43320,Fuse esophagus & stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43325,Revise esophagus & stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43327,Esoph fundoplasty lap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43328,Esoph fundoplasty thor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43330,Esophagomyotomy abdominal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43331,Esophagomyotomy thoracic,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43332,Transab esoph hiat hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43333,Transab esoph hiat hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43334,Transthor diaphrag hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43335,Transthor diaphrag hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43336,Thorabd diaphr hern repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43337,Thorabd diaphr hern repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43338,Esoph lengthening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43340,Fuse esophagus & intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43341,Fuse esophagus & intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43351,Surgical opening esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43352,Surgical opening esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43360,Gastrointestinal repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43361,Gastrointestinal repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43400,Ligate esophagus veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43405,Ligate/staple esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43410,Repair esophagus wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43415,Repair esophagus wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43420,Repair esophagus opening,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43425,Repair esophagus opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43450,Dilate esophagus 1/mult pass,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,092.95",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43453,Dilate esophagus,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,092.95","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43460,Pressure treatment esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43496,Free jejunum flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43499,Esophagus surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43500,Surgical opening of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43501,Surgical repair of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43502,Surgical repair of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43510,Surgical opening of stomach,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43520,Incision of pyloric muscle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43605,Biopsy of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43610,Excision of stomach lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43611,Excision of stomach lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43620,Removal of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43621,Removal of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43622,Removal of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43631,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43632,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43633,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43634,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43635,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43640,Vagotomy & pylorus repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43641,Vagotomy & pylorus repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43644,Lap gastric bypass/roux-en-y,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43645,Lap gastr bypass incl smll i,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43647,Lap impl electrode antrum,APC 5463,RVU Per Case,"$10,888.82 ",OP,"6,434.45","10,888.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43648,Lap revise/remv eltrd antrum,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43651,Laparoscopy vagus nerve,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43652,Laparoscopy vagus nerve,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43653,Laparoscopy gastrostomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43659,Laparoscope proc stom,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43752,Nasal/orogastric w/tube plmt,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43753,Tx gastro intub w/asp,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43754,Dx gastr intub w/asp spec,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43755,Dx gastr intub w/asp specs,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43756,Dx duod intub w/asp spec,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43757,Dx duod intub w/asp specs,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43761,Reposition gastrostomy tube,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,"1,498.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43762,Rplc gtube no revj trc,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43763,Rplc gtube revj gstrst trc,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43770,Lap place gastr adj device,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43771,Lap revise gastr adj device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43772,Lap rmvl gastr adj device,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43773,Lap replace gastr adj device,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43774,Lap rmvl gastr adj all parts,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43775,Lap sleeve gastrectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43800,Reconstruction of pylorus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43810,Fusion of stomach and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43820,Fusion of stomach and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43825,Fusion of stomach and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43830,Place gastrostomy tube,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","5,158.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43831,Place gastrostomy tube,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43832,Place gastrostomy tube,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43840,Repair of stomach lesion,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43843,Gastroplasty w/o v-band,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43845,Gastroplasty duodenal switch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43846,Gastric bypass for obesity,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43847,Gastric bypass incl small i,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43848,Revision gastroplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43850,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43855,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43860,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43865,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43870,Repair stomach opening,APC 5303,RVU Per Case,"$2,985.55 ",OP,"1,665.98","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43880,Repair stomach-bowel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43881,Impl/redo electrd antrum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43882,Revise/remove electrd antrum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43886,Revise gastric port open,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"1,053.46","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43887,Remove gastric port open,APC 5054,RVU Per Case,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43888,Change gastric port open,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"2,811.11","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,43999,Stomach surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44005,Freeing of bowel adhesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44010,Incision of small bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44015,Insert needle cath bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44020,Explore small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44021,Decompress small bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44025,Incision of large bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44050,Reduce bowel obstruction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44055,Correct malrotation of bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44100,Biopsy of bowel,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44110,Excise intestine lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44111,Excision of bowel lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44120,Removal of small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44121,Removal of small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44125,Removal of small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44126,Enterectomy w/o taper cong,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44127,Enterectomy w/taper cong,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44128,Enterectomy cong add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44130,Bowel to bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44132,Enterectomy cadaver donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44133,Enterectomy live donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44135,Intestine transplnt cadaver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44136,Intestine transplant live,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44137,Remove intestinal allograft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44139,Mobilization of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44140,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44141,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44143,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44144,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44145,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44146,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44147,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44150,Removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44151,Removal of colon/ileostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44155,Removal of colon/ileostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44156,Removal of colon/ileostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44157,Colectomy w/ileoanal anast,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44158,Colectomy w/neo-rectum pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44160,Removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44180,Lap enterolysis,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44186,Lap jejunostomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44187,Lap ileo/jejuno-stomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44188,Lap colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44202,Lap enterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44203,Lap resect s/intestine addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44204,Laparo partial colectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44205,Lap colectomy part w/ileum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44206,Lap part colectomy w/stoma,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44207,L colectomy/coloproctostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44208,L colectomy/coloproctostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44210,Laparo total proctocolectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44211,Lap colectomy w/proctectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44212,Laparo total proctocolectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44213,Lap mobil splenic fl add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44227,Lap close enterostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44238,Laparoscope proc intestine,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44300,Open bowel to skin,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44310,Ileostomy/jejunostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44312,Revision of ileostomy,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44314,Revision of ileostomy,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44316,Devise bowel pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44320,Colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44322,Colostomy with biopsies,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44340,Revision of colostomy,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44345,Revision of colostomy,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44346,Revision of colostomy,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44360,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44361,Small bowel endoscopy/biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44363,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44364,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44365,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44366,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44369,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44370,Small bowel endoscopy/stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44372,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44373,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44376,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44377,Small bowel endoscopy/biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44378,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44379,S bowel endoscope w/stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44380,Small bowel endoscopy br/wa,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44381,Small bowel endoscopy br/wa,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44382,Small bowel endoscopy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,901.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44384,Small bowel endoscopy,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44385,Endoscopy of bowel pouch,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44386,Endoscopy bowel pouch/biop,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44388,Colonoscopy thru stoma spx,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44389,Colonoscopy with biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44390,Colonoscopy for foreign body,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44391,Colonoscopy for bleeding,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44392,Colonoscopy & polypectomy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44394,Colonoscopy w/snare,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44401,Colonoscopy with ablation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44402,Colonoscopy w/stent plcmt,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44403,Colonoscopy w/resection,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44404,Colonoscopy w/injection,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44405,Colonoscopy w/dilation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44406,Colonoscopy w/ultrasound,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44407,Colonoscopy w/ndl aspir/bx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44408,Colonoscopy w/decompression,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44500,Intro gastrointestinal tube,APC 5301,RVU Per Unit,$784.57 ,OP,472.44,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44602,Suture small intestine,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44603,Suture small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44604,Suture large intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44605,Repair of bowel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44615,Intestinal stricturoplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44620,Repair bowel opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44625,Repair bowel opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44626,Repair bowel opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44640,Repair bowel-skin fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44650,Repair bowel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44660,Repair bowel-bladder fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44661,Repair bowel-bladder fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44680,Surgical revision intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44700,Suspend bowel w/prosthesis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44715,Prepare donor intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44720,Prep donor intestine/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44721,Prep donor intestine/artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44799,Unlisted px small intestine,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"4,423.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44800,Excision of bowel pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44820,Excision of mesentery lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44850,Repair of mesentery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44899,Bowel surgery procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44900,Drain appendix abscess open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44950,Appendectomy,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44960,Appendectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44970,Laparoscopy appendectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,44979,Laparoscope proc app,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45000,Drainage of pelvic abscess,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45005,Drainage of rectal abscess,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","2,551.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45020,Drainage of rectal abscess,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45100,Biopsy of rectum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45108,Removal of anorectal lesion,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45110,Removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45111,Partial removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45112,Removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45113,Partial proctectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45114,Partial removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45116,Partial removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45119,Remove rectum w/reservoir,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45120,Removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45121,Removal of rectum and colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45123,Partial proctectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45126,Pelvic exenteration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45130,Excision of rectal prolapse,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45135,Excision of rectal prolapse,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45136,Excise ileoanal reservior,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45150,Excision of rectal stricture,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45160,Excision of rectal lesion,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45171,Exc rect tum transanal part,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45172,Exc rect tum transanal full,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45190,Destruction rectal tumor,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45300,Proctosigmoidoscopy dx,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45303,Proctosigmoidoscopy dilate,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45305,Proctosigmoidoscopy w/bx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45307,Proctosigmoidoscopy fb,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45308,Proctosigmoidoscopy removal,APC 5313,RVU Per Case,"$2,367.85 ",OP,"1,712.09","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45309,Proctosigmoidoscopy removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45315,Proctosigmoidoscopy removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45317,Proctosigmoidoscopy bleed,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45320,Proctosigmoidoscopy ablate,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45321,Proctosigmoidoscopy volvul,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45327,Proctosigmoidoscopy w/stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45330,Diagnostic sigmoidoscopy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45331,Sigmoidoscopy and biopsy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45332,Sigmoidoscopy w/fb removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,975.12,"1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45333,Sigmoidoscopy & polypectomy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45334,Sigmoidoscopy for bleeding,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45335,Sigmoidoscopy w/submuc inj,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45337,Sigmoidoscopy & decompress,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45338,Sigmoidoscopy w/tumr remove,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45340,Sig w/tndsc balloon dilation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45341,Sigmoidoscopy w/ultrasound,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45342,Sigmoidoscopy w/us guide bx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45346,Sigmoidoscopy w/ablation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45347,Sigmoidoscopy w/plcmt stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45349,Sigmoidoscopy w/resection,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45350,Sgmdsc w/band ligation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45378,Diagnostic colonoscopy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45379,Colonoscopy w/fb removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45380,Colonoscopy and biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45381,Colonoscopy submucous njx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45382,Colonoscopy w/control bleed,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45384,Colonoscopy w/lesion removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45385,Colonoscopy w/lesion removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45386,Colonoscopy w/balloon dilat,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45388,Colonoscopy w/ablation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45389,Colonoscopy w/stent plcmt,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45390,Colonoscopy w/resection,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45391,Colonoscopy w/endoscope us,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45392,Colonoscopy w/endoscopic fnb,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45393,Colonoscopy w/decompression,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45395,Lap removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45397,Lap remove rectum w/pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45398,Colonoscopy w/band ligation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45399,Unlisted procedure colon,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45400,Laparoscopic proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45402,Lap proctopexy w/sig resect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45499,Laparoscope proc rectum,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45500,Repair of rectum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45505,Repair of rectum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45520,Treatment of rectal prolapse,APC 5311,RVU Per Case,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45540,Correct rectal prolapse,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45541,Correct rectal prolapse,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45550,Repair rectum/remove sigmoid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45560,Repair of rectocele,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45562,Exploration/repair of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45563,Exploration/repair of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45800,Repair rect/bladder fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45805,Repair fistula w/colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45820,Repair rectourethral fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45825,Repair fistula w/colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45900,Reduction of rectal prolapse,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45905,Dilation of anal sphincter,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45910,Dilation of rectal narrowing,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45915,Remove rectal obstruction,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45990,Surg dx exam anorectal,APC 5313,RVU Per Case,"$2,367.85 ",OP,"1,016.91","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,45999,Rectum surgery procedure,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46020,Placement of seton,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46030,Removal of rectal marker,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46040,Incision of rectal abscess,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46045,Incision of rectal abscess,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46050,Incision of anal abscess,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46060,Incision of rectal abscess,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46070,Incision of anal septum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46080,Incision of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46083,Incise external hemorrhoid,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46200,Removal of anal fissure,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46220,Excise anal ext tag/papilla,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46221,Ligation of hemorrhoid(s),APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46230,Removal of anal tags,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46250,Remove ext hem groups 2+,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46255,Remove int/ext hem 1 group,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46257,Remove in/ex hem grp & fiss,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46258,Remove in/ex hem grp w/fistu,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46260,Remove in/ex hem groups 2+,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46261,Remove in/ex hem grps & fiss,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46262,Remove in/ex hem grps w/fist,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46270,Remove anal fist subq,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46275,Remove anal fist inter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46280,Remove anal fist complex,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46285,Remove anal fist 2 stage,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46288,Repair anal fistula,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46320,Removal of hemorrhoid clot,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","2,551.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46500,Injection into hemorrhoid(s),APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"2,551.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46505,Chemodenervation anal musc,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46600,Diagnostic anoscopy spx,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46601,Diagnostic anoscopy,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46604,Anoscopy and dilation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46606,Anoscopy and biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,975.12,"1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46607,Diagnostic anoscopy & biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46608,Anoscopy remove for body,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46610,Anoscopy remove lesion,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46611,Anoscopy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46612,Anoscopy remove lesions,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46614,Anoscopy control bleeding,APC 5312,RVU Per Unit,"$1,004.90 ",OP,975.12,"1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46615,Anoscopy,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46700,Repair of anal stricture,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46705,Repair of anal stricture,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46706,Repr of anal fistula w/glue,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46707,Repair anorectal fist w/plug,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46710,Repr per/vag pouch sngl proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46712,Repr per/vag pouch dbl proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46715,Rep perf anoper fistu,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46716,Rep perf anoper/vestib fistu,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46730,Construction of absent anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46735,Construction of absent anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46740,Construction of absent anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46742,Repair of imperforated anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46744,Repair of cloacal anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46746,Repair of cloacal anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46748,Repair of cloacal anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46750,Repair of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46751,Repair of anal sphincter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46753,Reconstruction of anus,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46754,Removal of suture from anus,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46760,Repair of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46761,Repair of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46900,Destruction anal lesion(s),APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46910,Destruction anal lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46916,Cryosurgery anal lesion(s),APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46917,Laser surgery anal lesions,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46922,Excision of anal lesion(s),APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46924,Destruction anal lesion(s),APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46930,Destroy internal hemorrhoids,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46940,Treatment of anal fissure,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46942,Treatment of anal fissure,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46945,Int hrhc lig 1 hroid w/o img,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46946,Int hrhc lig 2+hroid w/o img,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46947,Hemorrhoidopexy by stapling,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46948,Int hrhc tranal dartlzj 2+,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,46999,Anus surgery procedure,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47000,Needle biopsy of liver,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47010,Open drainage liver lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47015,Inject/aspirate liver cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47100,Wedge biopsy of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47120,Partial removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47122,Extensive removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47125,Partial removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47130,Partial removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47133,Removal of donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47135,Transplantation of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47140,Partial removal donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47141,Partial removal donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47142,Partial removal donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47143,Prep donor liver whole,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47144,Prep donor liver 3-segment,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47145,Prep donor liver lobe split,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47146,Prep donor liver/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47147,Prep donor liver/arterial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47300,Surgery for liver lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47350,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47360,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47361,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47362,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47370,Laparo ablate liver tumor rf,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47371,Laparo ablate liver cryosurg,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47379,Laparoscope procedure liver,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47380,Open ablate liver tumor rf,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47381,Open ablate liver tumor cryo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47382,Percut ablate liver rf,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47383,Perq abltj lvr cryoablation,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47399,Liver surgery procedure,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47400,Incision of liver duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47420,Incision of bile duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47425,Incision of bile duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47460,Incise bile duct sphincter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47480,Incision of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47490,Incision of gallbladder,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47531,Injection for cholangiogram,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47532,Injection for cholangiogram,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47533,Plmt biliary drainage cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47534,Plmt biliary drainage cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47535,Conversion ext bil drg cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47536,Exchange biliary drg cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47537,Removal biliary drg cath,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47538,Perq plmt bile duct stent,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47539,Perq plmt bile duct stent,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47540,Perq plmt bile duct stent,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47541,Plmt access bil tree sm bwl,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47550,Bile duct endoscopy add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47552,Biliary endo perq dx w/speci,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47553,Biliary endoscopy thru skin,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47554,Biliary endoscopy thru skin,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,059.72","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47555,Biliary endoscopy thru skin,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47556,Biliary endoscopy thru skin,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,059.72","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47562,Laparoscopic cholecystectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47563,Laparo cholecystectomy/graph,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47564,Laparo cholecystectomy/explr,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47570,Laparo cholecystoenterostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47579,Laparoscope proc biliary,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47600,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47605,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47610,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47612,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47620,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47700,Exploration of bile ducts,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47701,Bile duct revision,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47711,Excision of bile duct tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47712,Excision of bile duct tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47715,Excision of bile duct cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47720,Fuse gallbladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47721,Fuse upper gi structures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47740,Fuse gallbladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47741,Fuse gallbladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47760,Fuse bile ducts and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47765,Fuse liver ducts & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47780,Fuse bile ducts and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47785,Fuse bile ducts and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47800,Reconstruction of bile ducts,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47801,Placement bile duct support,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47802,Fuse liver duct & intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47900,Suture bile duct injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,47999,Bile tract surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"4,059.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48000,Drainage of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48001,Placement of drain pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48020,Removal of pancreatic stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48100,Biopsy of pancreas open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48102,Needle biopsy pancreas,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48105,Resect/debride pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48120,Removal of pancreas lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48140,Partial removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48145,Partial removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48146,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48148,Removal of pancreatic duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48150,Partial removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48152,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48153,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48154,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48155,Removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48400,Injection intraop add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48500,Surgery of pancreatic cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48510,Drain pancreatic pseudocyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48520,Fuse pancreas cyst and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48540,Fuse pancreas cyst and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48545,Pancreatorrhaphy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48547,Duodenal exclusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48548,Fuse pancreas and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48551,Prep donor pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48552,Prep donor pancreas/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48554,Transpl allograft pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48556,Removal allograft pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,48999,Pancreas surgery procedure,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49000,Exploration of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49002,Reopening of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49010,Exploration behind abdomen,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49013,Prpertl pel pack hemrrg trma,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49014,Reexploration pelvic wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49020,Drainage abdom abscess open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49040,Drain open abdom abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49060,Drain open retroperi abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49062,Drain to peritoneal cavity,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49082,Abd paracentesis,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49083,Abd paracentesis w/imaging,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49084,Peritoneal lavage,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49180,Biopsy abdominal mass,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49185,Sclerotx fluid collection,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49203,Exc abd tum 5 cm or less,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49204,Exc abd tum over 5 cm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49205,Exc abd tum over 10 cm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49215,Excise sacral spine tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49250,Excision of umbilicus,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49255,Removal of omentum,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49320,Diag laparo separate proc,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49321,Laparoscopy biopsy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49322,Laparoscopy aspiration,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49323,Laparo drain lymphocele,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49324,Lap insert tunnel ip cath,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49325,Lap revision perm ip cath,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49329,Laparo proc abdm/per/oment,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49402,Remove foreign body adbomen,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49405,Image cath fluid colxn visc,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49406,Image cath fluid peri/retro,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49407,Image cath fluid trns/vgnl,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49411,Ins mark abd/pel for rt perq,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49412,Ins device for rt guide open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49418,Insert tun ip cath perc,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49419,Insert tun ip cath w/port,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49421,Ins tun ip cath for dial opn,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,917.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49422,Remove tunneled ip cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49423,Exchange drainage catheter,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","2,334.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49425,Insert abdomen-venous drain,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49426,Revise abdomen-venous shunt,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49428,Ligation of shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49429,Removal of shunt,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49436,Embedded ip cath exit-site,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","2,334.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49440,Place gastrostomy tube perc,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49441,Place duod/jej tube perc,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49442,Place cecostomy tube perc,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49446,Change g-tube to g-j perc,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49450,Replace g/c tube perc,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49451,Replace duod/jej tube perc,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49452,Replace g-j tube perc,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49460,Fix g/colon tube w/device,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49465,Fluoro exam of g/colon tube,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49491,Rpr hern preemie reduc,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49492,Rpr ing hern premie blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49495,Rpr ing hernia baby reduc,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49496,Rpr ing hernia baby blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49500,Rpr ing hernia init reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49501,Rpr ing hernia init blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49505,Prp i/hern init reduc >5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49507,Prp i/hern init block >5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49520,Rerepair ing hernia reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49521,Rerepair ing hernia blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49525,Repair ing hernia sliding,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49540,Repair lumbar hernia,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49550,Rpr rem hernia init reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49553,Rpr fem hernia init blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49555,Rerepair fem hernia reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49557,Rerepair fem hernia blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49560,Rpr ventral hern init reduc,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49561,Rpr ventral hern init block,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49565,Rerepair ventrl hern reduce,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49566,Rerepair ventrl hern block,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49570,Rpr epigastric hern reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49572,Rpr epigastric hern blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49580,Rpr umbil hern reduc < 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49582,Rpr umbil hern block < 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49585,Rpr umbil hern reduc > 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49587,Rpr umbil hern block > 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49590,Repair spigelian hernia,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49600,Repair umbilical lesion,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49605,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49606,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49610,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49611,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49650,Lap ing hernia repair init,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49651,Lap ing hernia repair recur,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49652,Lap vent/abd hernia repair,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49653,Lap vent/abd hern proc comp,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49654,Lap inc hernia repair,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49655,Lap inc hern repair comp,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49656,Lap inc hernia repair recur,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49657,Lap inc hern recur comp,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49659,Laparo proc hernia repair,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49900,Repair of abdominal wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49904,Omental flap extra-abdom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49905,Omental flap intra-abdom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49906,Free omental flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,49999,Abdomen surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"4,423.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50010,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50020,Renal abscess open drain,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50040,Drainage of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50045,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50060,Removal of kidney stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50065,Incision of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50070,Incision of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50075,Removal of kidney stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50080,Removal of kidney stone,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,632.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50081,Removal of kidney stone,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,632.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50100,Revise kidney blood vessels,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50120,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50125,Explore and drain kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50130,Removal of kidney stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50135,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50200,Renal biopsy perq,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50205,Renal biopsy open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50220,Remove kidney open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50225,Removal kidney open complex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50230,Removal kidney open radical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50234,Removal of kidney & ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50236,Removal of kidney & ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50240,Partial removal of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50250,Cryoablate renal mass open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50280,Removal of kidney lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50290,Removal of kidney lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50300,Remove cadaver donor kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50320,Remove kidney living donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50323,Prep cadaver renal allograft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50325,Prep donor renal graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50327,Prep renal graft/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50328,Prep renal graft/arterial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50329,Prep renal graft/ureteral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50340,Removal of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50360,Transplantation of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50365,Transplantation of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50370,Remove transplanted kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50380,Reimplantation of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50382,Change ureter stent percut,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50384,Remove ureter stent percut,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50385,Change stent via transureth,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50386,Remove stent via transureth,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50387,Change nephroureteral cath,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,498.24","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50389,Remove renal tube w/fluoro,APC 5372,RVU Per Case,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50390,Drainage of kidney lesion,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,229.52",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50391,Instll rx agnt into rnal tub,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50396,Measure kidney pressure,APC 5372,RVU Per Unit,$557.00 ,OP,428.48,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50400,Revision of kidney/ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50405,Revision of kidney/ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50430,Njx px nfrosgrm &/urtrgrm,APC 5372,RVU Per Case,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50431,Njx px nfrosgrm &/urtrgrm,APC 5372,RVU Per Case,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50432,Plmt nephrostomy catheter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50433,Plmt nephroureteral catheter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50434,Convert nephrostomy catheter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50435,Exchange nephrostomy cath,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50436,Dilat xst trc ndurlgc px,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50437,Dilat xst trc new access rcs,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50500,Repair of kidney wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50520,Close kidney-skin fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50525,Close nephrovisceral fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50526,Close nephrovisceral fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50540,Revision of horseshoe kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50541,Laparo ablate renal cyst,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50542,Laparo ablate renal mass,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50543,Laparo partial nephrectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50544,Laparoscopy pyeloplasty,APC 5362,RVU Per Case,"$8,632.26 ",OP,"6,434.45","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50545,Laparo radical nephrectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50546,Laparoscopic nephrectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50547,Laparo removal donor kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50548,Laparo remove w/ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50549,Laparoscope proc renal,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50551,Kidney endoscopy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"1,300.97","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50553,Kidney endoscopy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50555,Kidney endoscopy & biopsy,APC 5376,RVU Per Case,"$8,002.82 ",OP,"1,300.97","8,002.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50557,Kidney endoscopy & treatment,APC 5376,RVU Per Case,"$8,002.82 ",OP,"4,781.15","8,002.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50561,Kidney endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50562,Renal scope w/tumor resect,APC 5376,RVU Per Case,"$8,002.82 ",OP,"1,300.97","8,002.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50570,Kidney endoscopy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50572,Kidney endoscopy,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,300.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50574,Kidney endoscopy & biopsy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50575,Kidney endoscopy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50576,Kidney endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50580,Kidney endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50590,Fragmenting of kidney stone,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","8,721.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50592,Perc rf ablate renal tumor,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50593,Perc cryo ablate renal tum,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50600,Exploration of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50605,Insert ureteral support,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50610,Removal of ureter stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50620,Removal of ureter stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50630,Removal of ureter stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50650,Removal of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50660,Removal of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50686,Measure ureter pressure,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50688,Change of ureter tube/stent,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,498.24","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50693,Plmt ureteral stent prq,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50694,Plmt ureteral stent prq,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50695,Plmt ureteral stent prq,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50700,Revision of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50715,Release of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50722,Release of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50725,Release/revise ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50727,Revise ureter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50728,Revise ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50740,Fusion of ureter & kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50750,Fusion of ureter & kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50760,Fusion of ureters,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50770,Splicing of ureters,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50780,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50782,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50783,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50785,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50800,Implant ureter in bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50810,Fusion of ureter & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50815,Urine shunt to intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50820,Construct bowel bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50825,Construct bowel bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50830,Revise urine flow,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50840,Replace ureter by bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50845,Appendico-vesicostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50860,Transplant ureter to skin,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50900,Repair of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50920,Closure ureter/skin fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50930,Closure ureter/bowel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50940,Release of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50945,Laparoscopy ureterolithotomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50947,Laparo new ureter/bladder,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50948,Laparo new ureter/bladder,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50949,Laparoscope proc ureter,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50951,Endoscopy of ureter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50953,Endoscopy of ureter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50955,Ureter endoscopy & biopsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50957,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50961,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50970,Ureter endoscopy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50972,Ureter endoscopy & catheter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50974,Ureter endoscopy & biopsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50976,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,50980,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51020,Incise & treat bladder,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51030,Incise & treat bladder,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51040,Incise & drain bladder,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51045,Incise bladder/drain ureter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51050,Removal of bladder stone,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51060,Removal of ureter stone,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51065,Remove ureter calculus,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51080,Drainage of bladder abscess,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51100,Drain bladder by needle,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51101,Drain bladder by trocar/cath,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51102,Drain bl w/cath insertion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51500,Removal of bladder cyst,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51520,Removal of bladder lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51525,Removal of bladder lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51530,Removal of bladder lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51535,Repair of ureter lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51550,Partial removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51555,Partial removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51565,Revise bladder & ureter(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51570,Removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51575,Removal of bladder & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51580,Remove bladder/revise tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51585,Removal of bladder & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51590,Remove bladder/revise tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51595,Remove bladder/revise tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51596,Remove bladder/create pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51597,Removal of pelvic structures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51700,Irrigation of bladder,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51701,Insert bladder catheter,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51702,Insert temp bladder cath,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51703,Insert bladder cath complex,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51705,Change of bladder tube,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,472.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51710,Change of bladder tube,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,498.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51715,Endoscopic injection/implant,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51720,Treatment of bladder lesion,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51725,Simple cystometrogram,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51726,Complex cystometrogram,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,682.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51727,Cystometrogram w/up,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51728,Cystometrogram w/vp,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51729,Cystometrogram w/vp&up,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51736,Urine flow measurement,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51741,Electro-uroflowmetry first,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51784,Anal/urinary muscle study,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51785,Anal/urinary muscle study,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51792,Urinary reflex study,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51798,Us urine capacity measure,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51800,Revision of bladder/urethra,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51820,Revision of urinary tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51840,Attach bladder/urethra,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51841,Attach bladder/urethra,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51845,Repair bladder neck,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51860,Repair of bladder wound,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51865,Repair of bladder wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51880,Repair of bladder opening,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51900,Repair bladder/vagina lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51920,Close bladder-uterus fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51925,Hysterectomy/bladder repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51940,Correction of bladder defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51960,Revision of bladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51980,Construct bladder opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51990,Laparo urethral suspension,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51992,Laparo sling operation,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,51999,Laparoscope proc bla,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52000,Cystoscopy,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,300.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52001,Cystoscopy removal of clots,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52005,Cystoscopy & ureter catheter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52007,Cystoscopy and biopsy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52010,Cystoscopy & duct catheter,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,300.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52204,Cystoscopy w/biopsy(s),APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52214,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52224,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52234,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52235,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52240,Cystoscopy and treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52250,Cystoscopy and radiotracer,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52260,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52265,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52270,Cystoscopy & revise urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52275,Cystoscopy & revise urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52276,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52277,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52281,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52282,Cystoscopy implant stent,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,995.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52283,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52285,Cystoscopy and treatment,APC 5372,RVU Per Unit,$557.00 ,OP,557,"3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52287,Cystoscopy chemodenervation,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52290,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52300,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52301,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52305,Cystoscopy and treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52310,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52315,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52317,Remove bladder stone,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52318,Remove bladder stone,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52320,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52325,Cystoscopy stone removal,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52327,Cystoscopy inject material,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52330,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52332,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52334,Create passage to kidney,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52341,Cysto w/ureter stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52342,Cysto w/up stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52343,Cysto w/renal stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52344,Cysto/uretero stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52345,Cysto/uretero w/up stricture,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52346,Cystouretero w/renal strict,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52351,Cystouretero & or pyeloscope,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52352,Cystouretero w/stone remove,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52353,Cystouretero w/lithotripsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52354,Cystouretero w/biopsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52355,Cystouretero w/excise tumor,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52356,Cysto/uretero w/lithotripsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52400,Cystouretero w/congen repr,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52402,Cystourethro cut ejacul duct,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52450,Incision of prostate,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52500,Revision of bladder neck,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52601,Prostatectomy (turp),APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52630,Remove prostate regrowth,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52640,Relieve bladder contracture,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52647,Laser surgery of prostate,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","8,632.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52648,Laser surgery of prostate,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","8,632.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52649,Prostate laser enucleation,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,52700,Drainage of prostate abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53000,Incision of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53010,Incision of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53020,Incision of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53025,Incision of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53040,Drainage of urethra abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53060,Drainage of urethra abscess,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53080,Drainage of urinary leakage,APC 5372,RVU Per Unit,$557.00 ,OP,557,"3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53085,Drainage of urinary leakage,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53200,Biopsy of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53210,Removal of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53215,Removal of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53220,Treatment of urethra lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53230,Removal of urethra lesion,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53235,Removal of urethra lesion,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53240,Surgery for urethra pouch,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53250,Removal of urethra gland,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53260,Treatment of urethra lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53265,Treatment of urethra lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53270,Removal of urethra gland,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53275,Repair of urethra defect,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53400,Revise urethra stage 1,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53405,Revise urethra stage 2,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53410,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53415,Reconstruction of urethra,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53420,Reconstruct urethra stage 1,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53425,Reconstruct urethra stage 2,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53430,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53431,Reconstruct urethra/bladder,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53440,Male sling procedure,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","15,865.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53442,Remove/revise male sling,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53444,Insert tandem cuff,APC 5378,RVU Per Case,"$17,693.87 ",OP,"15,865.56","17,693.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53445,Insert uro/ves nck sphincter,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53446,Remove uro sphincter,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53447,Remove/replace ur sphincter,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53448,Remov/replc ur sphinctr comp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53449,Repair uro sphincter,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53450,Revision of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53460,Revision of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53500,Urethrlys transvag w/ scope,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53502,Repair of urethra injury,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53505,Repair of urethra injury,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53510,Repair of urethra injury,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53515,Repair of urethra injury,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53520,Repair of urethra defect,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53600,Dilate urethra stricture,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,682.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53601,Dilate urethra stricture,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53605,Dilate urethra stricture,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53620,Dilate urethra stricture,APC 5372,RVU Per Unit,$557.00 ,OP,557,"3,639.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53621,Dilate urethra stricture,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53660,Dilation of urethra,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53661,Dilation of urethra,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53665,Dilation of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53850,Prostatic microwave thermotx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","8,239.83",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53852,Prostatic rf thermotx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","8,239.83",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53854,Trurl dstrj prst8 tiss rf wv,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53855,Insert prost urethral stent,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53860,Transurethral rf treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,53899,Urology surgery procedure,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54000,Slitting of prepuce,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54001,Slitting of prepuce,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54015,Drain penis lesion,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54050,Destruction penis lesion(s),APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54055,Destruction penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54056,Cryosurgery penis lesion(s),APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54057,Laser surg penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54060,Excision of penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54065,Destruction penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,091.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54100,Biopsy of penis,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54105,Biopsy of penis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54110,Treatment of penis lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54111,Treat penis lesion graft,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54112,Treat penis lesion graft,APC 5376,RVU Per Case,"$8,002.82 ",OP,"6,607.35","8,002.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54115,Treatment of penis lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54120,Partial removal of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54125,Removal of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54130,Remove penis & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54135,Remove penis & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54150,Circumcision w/regionl block,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54160,Circumcision neonate,APC 5372,RVU Per Unit,$557.00 ,OP,557,"4,116.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54161,Circum 28 days or older,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54162,Lysis penil circumic lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54163,Repair of circumcision,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54164,Frenulotomy of penis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54200,Treatment of penis lesion,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54205,Treatment of penis lesion,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54220,Treatment of penis lesion,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54231,Dynamic cavernosometry,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,"3,639.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54235,Penile injection,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54240,Penis study,APC 5722,RVU Per Unit,$256.27 ,OP,218.06,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54250,Penis study,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54300,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54304,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54308,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54312,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54316,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54318,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54322,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54324,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54326,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54328,Revise penis/urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54332,Revise penis/urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54336,Revise penis/urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54340,Secondary urethral surgery,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54344,Secondary urethral surgery,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54348,Secondary urethral surgery,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54352,Reconstruct urethra/penis,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54360,Penis plastic surgery,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54380,Repair penis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54385,Repair penis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54390,Repair penis and bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54400,Insert semi-rigid prosthesis,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","15,865.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54401,Insert self-contd prosthesis,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54405,Insert multi-comp penis pros,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54406,Remove muti-comp penis pros,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54408,Repair multi-comp penis pros,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54410,Remove/replace penis prosth,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54411,Remov/replc penis pros comp,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","17,693.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54415,Remove self-contd penis pros,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54416,Remv/repl penis contain pros,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54417,Remv/replc penis pros compl,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","11,132.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54420,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54430,Revision of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54435,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54437,Repair corporeal tear,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54438,Replantation of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54440,Repair of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54450,Preputial stretching,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,682.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54500,Biopsy of testis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,056.18","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54505,Biopsy of testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54512,Excise lesion testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54520,Removal of testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54522,Orchiectomy partial,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54530,Removal of testis,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54535,Extensive testis surgery,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54550,Exploration for testis,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54560,Exploration for testis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54600,Reduce testis torsion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54620,Suspension of testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54640,Orchiopexy ingun/scrot appr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54650,Orchiopexy (fowler-stephens),APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54660,Revision of testis,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54670,Repair testis injury,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54680,Relocation of testis(es),APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54690,Laparoscopy orchiectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54692,Laparoscopy orchiopexy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54699,Laparoscope proc testis,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54700,Drainage of scrotum,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54800,Biopsy of epididymis,APC 5072,RVU Per Case,"$1,363.50 ",OP,414.36,"1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54830,Remove epididymis lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54840,Remove epididymis lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54860,Removal of epididymis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54861,Removal of epididymis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54865,Explore epididymis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54900,Fusion of spermatic ducts,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,54901,Fusion of spermatic ducts,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55000,Drainage of hydrocele,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55040,Removal of hydrocele,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55041,Removal of hydroceles,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55060,Repair of hydrocele,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55100,Drainage of scrotum abscess,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55110,Explore scrotum,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55120,Removal of scrotum lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55150,Removal of scrotum,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55175,Revision of scrotum,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55180,Revision of scrotum,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55200,Incision of sperm duct,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55250,Removal of sperm duct(s),APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55400,Repair of sperm duct,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55500,Removal of hydrocele,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55520,Removal of sperm cord lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55530,Revise spermatic cord veins,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55535,Revise spermatic cord veins,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55540,Revise hernia & sperm veins,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55550,Laparo ligate spermatic vein,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55559,Laparo proc spermatic cord,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55600,Incise sperm duct pouch,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55605,Incise sperm duct pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55650,Remove sperm duct pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55680,Remove sperm pouch lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55700,Biopsy of prostate,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,126.92","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55705,Biopsy of prostate,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,126.92","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55706,Prostate saturation sampling,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55720,Drainage of prostate abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55725,Drainage of prostate abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55801,Removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55810,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55812,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55815,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55821,Removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55831,Removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55840,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55842,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55845,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55860,Surgical exposure prostate,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,639.02","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55862,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55865,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55866,Laparo radical prostatectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55870,Electroejaculation,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,801.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55873,Cryoablate prostate,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","21,783.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55874,Tprnl plmt biodegrdabl matrl,APC 5375,RVU Per Unit,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55875,Transperi needle place pros,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55876,Place rt device/marker pros,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55880,Abltj mal prst8 tiss hifu,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55899,Genital surgery procedure,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55920,Place needles pelvic for rt,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55970,Sex transformation m to f,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,55980,Sex transformation f to m,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56405,I & d of vulva/perineum,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56420,Drainage of gland abscess,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56440,Surgery for vulva lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56441,Lysis of labial lesion(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56442,Hymenotomy,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56501,Destroy vulva lesions sim,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56515,Destroy vulva lesion/s compl,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,091.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56605,Biopsy of vulva/perineum,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56620,Partial removal of vulva,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56625,Complete removal of vulva,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56630,Extensive vulva surgery,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56631,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56632,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56633,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56634,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56637,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56640,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56700,Partial removal of hymen,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56740,Remove vagina gland lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56800,Repair of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56805,Repair clitoris,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56810,Repair of perineum,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56820,Exam of vulva w/scope,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,56821,Exam/biopsy of vulva w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57000,Exploration of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57010,Drainage of pelvic abscess,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57020,Drainage of pelvic fluid,APC 5415,RVU Per Case,"$4,273.21 ",OP,"1,333.83","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57022,I & d vaginal hematoma pp,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,234.05","2,296.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57023,I & d vag hematoma non-ob,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57061,Destroy vag lesions simple,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57065,Destroy vag lesions complex,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57100,Biopsy of vagina,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,"1,333.83",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57105,Biopsy of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57106,Remove vagina wall partial,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57107,Remove vagina tissue part,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57109,Vaginectomy partial w/nodes,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57110,Remove vagina wall complete,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57111,Remove vagina tissue compl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57120,Closure of vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57130,Remove vagina lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57135,Remove vagina lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57150,Treat vagina infection,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57155,Insert uteri tandem/ovoids,APC 5415,RVU Per Case,"$4,273.21 ",OP,"1,333.83","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57156,Ins vag brachytx device,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,272.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57160,Insert pessary/other device,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57170,Fitting of diaphragm/cap,APC 5411,RVU Per Unit,$165.06 ,OP,29.41,165.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57180,Treat vaginal bleeding,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57200,Repair of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57210,Repair vagina/perineum,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57220,Revision of urethra,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57230,Repair of urethral lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57240,Anterior colporrhaphy,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57250,Repair rectum & vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57260,Cmbn ant pst colprhy,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57265,Cmbn ap colprhy w/ntrcl rpr,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57268,Repair of bowel bulge,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57270,Repair of bowel pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57280,Suspension of vagina,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57282,Colpopexy extraperitoneal,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57283,Colpopexy intraperitoneal,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57284,Repair paravag defect open,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57285,Repair paravag defect vag,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","6,584.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57287,Revise/remove sling repair,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57288,Repair bladder defect,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57289,Repair bladder & vagina,APC 5416,RVU Per Case,"$6,584.25 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57291,Construction of vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57292,Construct vagina with graft,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57295,Revise vag graft via vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57296,Revise vag graft open abd,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57300,Repair rectum-vagina fistula,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57305,Repair rectum-vagina fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57307,Fistula repair & colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57308,Fistula repair transperine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57310,Repair urethrovaginal lesion,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57311,Repair urethrovaginal lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57320,Repair bladder-vagina lesion,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57330,Repair bladder-vagina lesion,APC 5416,RVU Per Case,"$6,584.25 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57335,Repair vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57400,Dilation of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57410,Pelvic examination,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57415,Remove vaginal foreign body,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57420,Exam of vagina w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57421,Exam/biopsy of vag w/scope,APC 5413,RVU Per Unit,$613.82 ,OP,580.19,613.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57423,Repair paravag defect lap,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57425,Laparoscopy surg colpopexy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"6,434.45","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57426,Revise prosth vag graft lap,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","6,584.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57452,Exam of cervix w/scope,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57454,Bx/curett of cervix w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57455,Biopsy of cervix w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57456,Endocerv curettage w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57460,Bx of cervix w/scope leep,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57461,Conz of cervix w/scope leep,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57500,Biopsy of cervix,APC 5413,RVU Per Unit,$613.82 ,OP,580.19,613.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57505,Endocervical curettage,APC 5413,RVU Per Unit,$613.82 ,OP,580.19,613.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57510,Cauterization of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57511,Cryocautery of cervix,APC 5412,RVU Per Unit,$272.78 ,OP,258.38,272.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57513,Laser surgery of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57520,Conization of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57522,Conization of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57530,Removal of cervix,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57531,Removal of cervix radical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57540,Removal of residual cervix,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57545,Remove cervix/repair pelvis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57550,Removal of residual cervix,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57555,Remove cervix/repair vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57556,Remove cervix repair bowel,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57558,D&c of cervical stump,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57700,Revision of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57720,Revision of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,57800,Dilation of cervical canal,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58100,Biopsy of uterus lining,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58120,Dilation and curettage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58140,Myomectomy abdom method,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58145,Myomectomy vag method,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58146,Myomectomy abdom complex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58150,Total hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58152,Total hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58180,Partial hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58200,Extensive hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58210,Extensive hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58240,Removal of pelvis contents,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58260,Vaginal hysterectomy,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58262,Vag hyst including t/o,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58263,Vag hyst w/t/o & vag repair,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58267,Vag hyst w/urinary repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58270,Vag hyst w/enterocele repair,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58275,Hysterectomy/revise vagina,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58280,Hysterectomy/revise vagina,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58285,Extensive hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58290,Vag hyst complex,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58291,Vag hyst incl t/o complex,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58292,Vag hyst t/o & repair compl,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58294,Vag hyst w/enterocele compl,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58301,Remove intrauterine device,APC 5412,RVU Per Case,$272.78 ,OP,272.78,272.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58321,Artificial insemination,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,801.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58322,Artificial insemination,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,801.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58323,Sperm washing,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,801.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58345,Reopen fallopian tube,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58346,Insert heyman uteri capsule,APC 5415,RVU Per Case,"$4,273.21 ",OP,"2,974.23","4,273.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58350,Reopen fallopian tube,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58353,Endometr ablate thermal,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58356,Endometrial cryoablation,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58400,Suspension of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58410,Suspension of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58520,Repair of ruptured uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58540,Revision of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58541,Lsh uterus 250 g or less,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58542,Lsh w/t/o ut 250 g or less,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58543,Lsh uterus above 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58544,Lsh w/t/o uterus above 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58545,Laparoscopic myomectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58546,Laparo-myomectomy complex,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58548,Lap radical hyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58550,Laparo-asst vag hysterectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58552,Laparo-vag hyst incl t/o,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58553,Laparo-vag hyst complex,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58554,Laparo-vag hyst w/t/o compl,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58555,Hysteroscopy dx sep proc,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58558,Hysteroscopy biopsy,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58559,Hysteroscopy lysis,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,278.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58560,Hysteroscopy resect septum,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58561,Hysteroscopy remove myoma,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58562,Hysteroscopy remove fb,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58563,Hysteroscopy ablation,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58565,Hysteroscopy sterilization,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58570,Tlh uterus 250 g or less,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58571,Tlh w/t/o 250 g or less,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58572,Tlh uterus over 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58573,Tlh w/t/o uterus over 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58575,Laps tot hyst resj mal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58578,Laparo proc uterus,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58579,Hysteroscope procedure,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,"4,278.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58600,Division of fallopian tube,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58605,Division of fallopian tube,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58611,Ligate oviduct(s) add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58615,Occlude fallopian tube(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58660,Laparoscopy lysis,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58661,Laparoscopy remove adnexa,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58662,Laparoscopy excise lesions,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58670,Laparoscopy tubal cautery,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58671,Laparoscopy tubal block,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58672,Laparoscopy fimbrioplasty,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58673,Laparoscopy salpingostomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58674,Laps abltj uterine fibroids,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58679,Laparo proc oviduct-ovary,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58700,Removal of fallopian tube,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58720,Removal of ovary/tube(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58740,Adhesiolysis tube ovary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58750,Repair oviduct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58752,Revise ovarian tube(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58760,Fimbrioplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58770,Create new tubal opening,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58800,Drainage of ovarian cyst(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58805,Drainage of ovarian cyst(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58820,Drain ovary abscess open,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58822,Drain ovary abscess percut,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58825,Transposition ovary(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58900,Biopsy of ovary(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58920,Partial removal of ovary(s),APC 5416,RVU Per Case,"$6,584.25 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58925,Removal of ovarian cyst(s),APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58940,Removal of ovary(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58943,Removal of ovary(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58950,Resect ovarian malignancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58951,Resect ovarian malignancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58952,Resect ovarian malignancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58953,Tah rad dissect for debulk,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58954,Tah rad debulk/lymph remove,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58956,Bso omentectomy w/tah,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58957,Resect recurrent gyn mal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58958,Resect recur gyn mal w/lym,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58960,Exploration of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58970,Retrieval of oocyte,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,801.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58974,Transfer of embryo,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,801.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58976,Transfer of embryo,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,801.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,58999,Genital surgery procedure,APC 5411,RVU Per Unit,$165.06 ,OP,29.41,165.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59000,Amniocentesis diagnostic,APC 5413,RVU Per Unit,$613.82 ,OP,284.88,613.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59001,Amniocentesis therapeutic,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,"1,333.83",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59012,Fetal cord puncture prenatal,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59015,Chorion biopsy,APC 5413,RVU Per Unit,$613.82 ,OP,284.88,613.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59020,Fetal contract stress test,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59025,Fetal non-stress test,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59030,Fetal scalp blood sample,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59070,Transabdom amnioinfus w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59072,Umbilical cord occlud w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59074,Fetal fluid drainage w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59076,Fetal shunt placement w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59100,Remove uterus lesion,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59120,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59121,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59130,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59135,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59136,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59140,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59150,Treat ectopic pregnancy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59151,Treat ectopic pregnancy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59160,D & c after delivery,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59200,Insert cervical dilator,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59300,Episiotomy or vaginal repair,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59320,Revision of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59325,Revision of cervix,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59350,Repair of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59409,Obstetrical care,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59412,Antepartum manipulation,APC 5414,RVU Per Case,"$2,542.11 ",OP,477.99,"2,542.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59414,Deliver placenta,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59514,Cesarean delivery only,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59525,Remove uterus after cesarean,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59612,Vbac delivery only,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59620,Attempted vbac delivery only,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59812,Treatment of miscarriage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59820,Care of miscarriage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59821,Treatment of miscarriage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59830,Treat uterus infection,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59840,Abortion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,391.64",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59841,Abortion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,391.64",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59850,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59851,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59852,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59855,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59856,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59857,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59866,Abortion (mpr),APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59870,Evacuate mole of uterus,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59871,Remove cerclage suture,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59897,Fetal invas px w/us,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59898,Laparo proc ob care/deliver,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,59899,Maternity care procedure,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,284.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60000,Drain thyroid/tongue cyst,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60100,Biopsy of thyroid,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60200,Remove thyroid lesion,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60210,Partial thyroid excision,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60212,Partial thyroid excision,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60220,Partial removal of thyroid,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60225,Partial removal of thyroid,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60240,Removal of thyroid,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60252,Removal of thyroid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60254,Extensive thyroid surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60260,Repeat thyroid surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60270,Removal of thyroid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60271,Removal of thyroid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60280,Remove thyroid duct lesion,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60281,Remove thyroid duct lesion,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60300,Aspir/inj thyroid cyst,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60500,Explore parathyroid glands,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60502,Re-explore parathyroids,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60505,Explore parathyroid glands,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60520,Removal of thymus gland,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60521,Removal of thymus gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60522,Removal of thymus gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60540,Explore adrenal gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60545,Explore adrenal gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60600,Remove carotid body lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60605,Remove carotid body lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60650,Laparoscopy adrenalectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60659,Laparo proc endocrine,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,60699,Endocrine surgery procedure,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61000,Remove cranial cavity fluid,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61001,Remove cranial cavity fluid,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61020,Remove brain cavity fluid,APC 5443,RVU Per Unit,$797.03 ,OP,599.04,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61026,Injection into brain canal,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61050,Remove brain canal fluid,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,599.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61055,Injection into brain canal,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,599.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61070,Brain canal shunt procedure,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61105,Twist drill hole,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61107,Drill skull for implantation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61108,Drill skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61120,Burr hole for puncture,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61140,Pierce skull for biopsy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61150,Pierce skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61151,Pierce skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61154,Pierce skull & remove clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61156,Pierce skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61210,Pierce skull implant device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61215,Insert brain-fluid device,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","9,420.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61250,Pierce skull & explore,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61253,Pierce skull & explore,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61304,Open skull for exploration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61305,Open skull for exploration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61312,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61313,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61314,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61315,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61316,Implt cran bone flap to abdo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61320,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61321,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61322,Decompressive craniotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61323,Decompressive lobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61330,Decompress eye socket,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61333,Explore orbit/remove lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61340,Subtemporal decompression,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61343,Incise skull (press relief),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61345,Relieve cranial pressure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61450,Incise skull for surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61458,Incise skull for brain wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61460,Incise skull for surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61500,Removal of skull lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61501,Remove infected skull bone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61510,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61512,Remove brain lining lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61514,Removal of brain abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61516,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61517,Implt brain chemotx add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61518,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61519,Remove brain lining lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61520,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61521,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61522,Removal of brain abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61524,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61526,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61530,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61531,Implant brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61533,Implant brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61534,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61535,Remove brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61536,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61537,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61538,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61539,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61540,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61541,Incision of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61543,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61544,Remove & treat brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61545,Excision of brain tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61546,Removal of pituitary gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61548,Removal of pituitary gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61550,Release of skull seams,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61552,Release of skull seams,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61556,Incise skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61557,Incise skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61558,Excision of skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61559,Excision of skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61563,Excision of skull tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61564,Excision of skull tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61566,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61567,Incision of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61570,Remove foreign body brain,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61571,Incise skull for brain wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61575,Skull base/brainstem surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61576,Skull base/brainstem surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61580,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61581,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61582,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61583,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61584,Orbitocranial approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61585,Orbitocranial approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61586,Resect nasopharynx skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61590,Infratemporal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61591,Infratemporal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61592,Orbitocranial approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61595,Transtemporal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61596,Transcochlear approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61597,Transcondylar approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61598,Transpetrosal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61600,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61601,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61605,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61606,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61607,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61608,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61611,Transect artery sinus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61613,Remove aneurysm sinus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61615,Resect/excise lesion skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61616,Resect/excise lesion skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61618,Repair dura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61619,Repair dura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61623,Endovasc tempory vessel occl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"8,600.07","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61624,Transcath occlusion cns,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61626,Transcath occlusion non-cns,APC 5193,RVU Per Case,"$9,732.45 ",OP,"8,600.07","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61630,Intracranial angioplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61635,Intracran angioplsty w/stent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61645,Perq art m-thrombect &/nfs,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61650,Evasc prlng admn rx agnt 1st,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61651,Evasc prlng admn rx agnt add,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61680,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61682,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61684,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61686,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61690,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61692,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61697,Brain aneurysm repr complx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61698,Brain aneurysm repr complx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61700,Brain aneurysm repr simple,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61702,Inner skull vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61703,Clamp neck artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61705,Revise circulation to head,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61708,Revise circulation to head,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61710,Revise circulation to head,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61711,Fusion of skull arteries,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61720,Incise skull/brain surgery,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61735,Incise skull/brain surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61750,Incise skull/brain biopsy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61751,Brain biopsy w/ct/mr guide,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61760,Implant brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61770,Incise skull for treatment,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61790,Treat trigeminal nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61791,Treat trigeminal tract,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,146.78","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61850,Implant neuroelectrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61860,Implant neuroelectrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61863,Implant neuroelectrode,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61864,Implant neuroelectrde addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61867,Implant neuroelectrode,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61868,Implant neuroelectrde addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61880,Revise/remove neuroelectrode,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61885,Insrt/redo neurostim 1 array,APC 5464,RVU Per Case,"$19,846.62 ",OP,"19,846.62","37,532.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61886,Implant neurostim arrays,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","48,660.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,61888,Revise/remove neuroreceiver,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62000,Treat skull fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62005,Treat skull fracture,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62010,Treatment of head injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62100,Repair brain fluid leakage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62115,Reduction of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62117,Reduction of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62120,Repair skull cavity lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62121,Incise skull repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62140,Repair of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62141,Repair of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62142,Remove skull plate/flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62143,Replace skull plate/flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62145,Repair of skull & brain,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62146,Repair of skull with graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62147,Repair of skull with graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62148,Retr bone flap to fix skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62161,Dissect brain w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62162,Remove colloid cyst w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62164,Remove brain tumor w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62165,Remove pituit tumor w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62180,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62190,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62192,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62194,Replace/irrigate catheter,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","2,334.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62200,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62201,Brain cavity shunt w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62220,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62223,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62225,Replace/irrigate catheter,APC 5432,RVU Per Case,"$5,524.06 ",OP,"2,334.99","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62230,Replace/revise brain shunt,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","9,420.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62252,Csf shunt reprogram,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,579.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62256,Remove brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62258,Replace brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62263,Epidural lysis mult sessions,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62264,Epidural lysis on single day,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62267,Interdiscal perq aspir dx,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62268,Drain spinal cord cyst,APC 5443,RVU Per Unit,$797.03 ,OP,599.04,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62269,Needle biopsy spinal cord,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62270,Dx lmbr spi pnxr,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62272,Ther spi pnxr drg csf,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62273,Inject epidural patch,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,"1,146.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62280,Treat spinal cord lesion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62281,Treat spinal cord lesion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62282,Treat spinal canal lesion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62287,Percutaneous diskectomy,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62292,Njx chemonucleolysis lmbr,APC 5431,RVU Per Case,"$1,700.15 ",OP,599.04,"1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62294,Injection into spinal artery,APC 5443,RVU Per Unit,$797.03 ,OP,599.04,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62302,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62303,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62304,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62305,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62320,Njx interlaminar crv/thrc,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62321,Njx interlaminar crv/thrc,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62322,Njx interlaminar lmbr/sac,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62323,Njx interlaminar lmbr/sac,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62324,Njx interlaminar crv/thrc,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62325,Njx interlaminar crv/thrc,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62326,Njx interlaminar lmbr/sac,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62327,Njx interlaminar lmbr/sac,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62328,Dx lmbr spi pnxr w/fluor/ct,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62329,Ther spi pnxr csf fluor/ct,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62350,Implant spinal canal cath,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,177.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62351,Implant spinal canal cath,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62355,Remove spinal canal catheter,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62360,Insert spine infusion device,APC 5471,RVU Per Case,"$16,505.33 ",OP,"16,505.33","22,560.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62361,Implant spine infusion pump,APC 5471,RVU Per Case,"$16,505.33 ",OP,"16,505.33","34,933.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62362,Implant spine infusion pump,APC 5471,RVU Per Case,"$16,505.33 ",OP,"16,505.33","34,933.34",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62365,Remove spine infusion device,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62367,Analyze spine infus pump,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,579.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62368,Analyze sp inf pump w/reprog,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,579.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62369,Anal sp inf pmp w/reprg&fill,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62370,Anl sp inf pmp w/mdreprg&fil,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,62380,Ndsc dcmprn 1 ntrspc lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63001,Remove spine lamina 1/2 crvl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63003,Remove spine lamina 1/2 thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63005,Remove spine lamina 1/2 lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63011,Remove spine lamina 1/2 scrl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63012,Remove lamina/facets lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63015,Remove spine lamina >2 crvcl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63016,Remove spine lamina >2 thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63017,Remove spine lamina >2 lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63020,Neck spine disk surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63030,Low back disk surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63040,Laminotomy single cervical,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63042,Laminotomy single lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63045,Remove spine lamina 1 crvl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63046,Remove spine lamina 1 thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63047,Remove spine lamina 1 lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63050,Cervical laminoplsty 2/> seg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63051,C-laminoplasty w/graft/plate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63055,Decompress spinal cord thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63056,Decompress spinal cord lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63064,Decompress spinal cord thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63075,Neck spine disk surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63077,Spine disk surgery thorax,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63078,Spine disk surgery thorax,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63081,Remove vert body dcmprn crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63082,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63085,Remove vert body dcmprn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63086,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63087,Remov vertbr dcmprn thrclmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63088,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63090,Remove vert body dcmprn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63091,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63101,Remove vert body dcmprn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63102,Remove vert body dcmprn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63103,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63170,Incise spinal cord tract(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63172,Drainage of spinal cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63173,Drainage of spinal cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63185,Incise spine nrv half segmnt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63190,Incise spine nrv >2 segmnts,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63191,Incise spine accessory nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63194,Incise spine & cord cervical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63195,Incise spine & cord thoracic,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63196,Incise spine&cord 2 trx crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63197,Incise spine&cord 2 trx thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63198,Incise spin&cord 2 stgs crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63199,Incise spin&cord 2 stgs thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63200,Release spinal cord lumbar,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63250,Revise spinal cord vsls crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63251,Revise spinal cord vsls thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63252,Revise spine cord vsl thrlmb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63265,Excise intraspinl lesion crv,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63266,Excise intrspinl lesion thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63267,Excise intrspinl lesion lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63268,Excise intrspinl lesion scrl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63270,Excise intrspinl lesion crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63271,Excise intrspinl lesion thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63272,Excise intrspinl lesion lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63273,Excise intrspinl lesion scrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63275,Bx/exc xdrl spine lesn crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63276,Bx/exc xdrl spine lesn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63277,Bx/exc xdrl spine lesn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63278,Bx/exc xdrl spine lesn scrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63280,Bx/exc idrl spine lesn crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63281,Bx/exc idrl spine lesn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63282,Bx/exc idrl spine lesn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63283,Bx/exc idrl spine lesn scrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63285,Bx/exc idrl imed lesn cervl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63286,Bx/exc idrl imed lesn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63287,Bx/exc idrl imed lesn thrlmb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63290,Bx/exc xdrl/idrl lsn any lvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63295,Repair laminectomy defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63300,Remove vert xdrl body crvcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63301,Remove vert xdrl body thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63302,Remove vert xdrl body thrlmb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63303,Remov vert xdrl bdy lmbr/sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63304,Remove vert idrl body crvcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63305,Remove vert idrl body thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63306,Remov vert idrl bdy thrclmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63307,Remov vert idrl bdy lmbr/sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63308,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63600,Remove spinal cord lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63610,Stimulation of spinal cord,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63650,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63655,Implant neuroelectrodes,APC 5464,RVU Per Case,"$19,846.62 ",OP,"16,864.55","19,846.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63661,Remove spine eltrd perq aray,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63662,Remove spine eltrd plate,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63663,Revise spine eltrd perq aray,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","5,970.22",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63664,Revise spine eltrd plate,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63685,Insrt/redo spine n generator,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","36,379.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63688,Revise/remove neuroreceiver,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63700,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63702,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63704,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63706,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63707,Repair spinal fluid leakage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63709,Repair spinal fluid leakage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63710,Graft repair of spine defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63740,Install spinal shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63741,Install spinal shunt,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","7,864.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63744,Revision of spinal shunt,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","7,864.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,63746,Removal of spinal shunt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64400,Njx aa&/strd trigeminal nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64405,Njx aa&/strd gr ocpl nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64408,Njx aa&/strd vagus nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64415,Njx aa&/strd brach plexus,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64416,Njx aa&/strd brach plex nfs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64417,Njx aa&/strd axillary nrv,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64418,Njx aa&/strd sprscap nrv,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64420,Njx aa&/strd ntrcost nrv 1,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64421,Njx aa&/strd ntrcost nrv ea,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64425,Njx aa&/strd ii ih nerves,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64430,Njx aa&/strd pudendal nerve,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64435,Njx aa&/strd paracrv nrv,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64445,Njx aa&/strd sciatic nerve,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64446,Njx aa&/strd sciatic nrv nfs,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64447,Njx aa&/strd femoral nerve,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64448,Njx aa&/strd fem nerve nfs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64449,Njx aa&/strd lmbr plex nfs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64450,Njx aa&/strd other pn/branch,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64451,Njx aa&/strd nrv nrvtg si jt,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64454,Njx aa&/strd gnclr nrv brnch,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64455,Njx aa&/strd pltr com dg nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64461,Pvb thoracic single inj site,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64463,Pvb thoracic cont infusion,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64479,Njx aa&/strd tfrm epi c/t 1,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64483,Njx aa&/strd tfrm epi l/s 1,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64490,Inj paravert f jnt c/t 1 lev,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64493,Inj paravert f jnt l/s 1 lev,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64505,N block spenopalatine gangl,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64510,N block stellate ganglion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64517,N block inj hypogas plxs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64520,N block lumbar/thoracic,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64530,N block inj celiac pelus,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64553,Implant neuroelectrodes,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","44,296.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64555,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64561,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64566,Neuroeltrd stim post tibial,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64568,Inc for vagus n elect impl,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64569,Revise/repl vagus n eltrd,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64570,Remove vagus n eltrd,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64575,Implant neuroelectrodes,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","16,864.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64580,Implant neuroelectrodes,APC 5464,RVU Per Case,"$19,846.62 ",OP,"16,864.55","19,846.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64581,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","16,864.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64585,Revise/remove neuroelectrode,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64590,Insrt/redo pn/gastr stimul,APC 5464,RVU Per Case,"$19,846.62 ",OP,"19,846.62","36,379.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64595,Revise/rmv pn/gastr stimul,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64600,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64605,Injection treatment of nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","2,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64610,Injection treatment of nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","2,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64611,Chemodenerv saliv glands,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64612,Destroy nerve face muscle,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64615,Chemodenerv musc migraine,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64616,Chemodenerv musc neck dyston,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64617,Chemodener muscle larynx emg,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64620,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64624,Dstrj nulyt agt gnclr nrv,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64625,Rf abltj nrv nrvtg si jt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64630,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64632,N block inj common digit,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64633,Destroy cerv/thor facet jnt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64635,Destroy lumb/sac facet jnt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64640,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64642,Chemodenerv 1 extremity 1-4,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64644,Chemodenerv 1 extrem 5/> mus,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64646,Chemodenerv trunk musc 1-5,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64647,Chemodenerv trunk musc 6/>,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64650,Chemodenerv eccrine glands,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64653,Chemodenerv eccrine glands,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64680,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64681,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64702,Revise finger/toe nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64704,Revise hand/foot nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64708,Revise arm/leg nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64712,Revision of sciatic nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64713,Revision of arm nerve(s),APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64714,Revise low back nerve(s),APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64716,Revision of cranial nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64718,Revise ulnar nerve at elbow,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64719,Revise ulnar nerve at wrist,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64721,Carpal tunnel surgery,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64722,Relieve pressure on nerve(s),APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64726,Release foot/toe nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64732,Incision of brow nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64734,Incision of cheek nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64736,Incision of chin nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64738,Incision of jaw nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64740,Incision of tongue nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64742,Incision of facial nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64744,Incise nerve back of head,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64746,Incise diaphragm nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64755,Incision of stomach nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64760,Incision of vagus nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64763,Incise hip/thigh nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64766,Incise hip/thigh nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64771,Sever cranial nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64772,Incision of spinal nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64774,Remove skin nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64776,Remove digit nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64782,Remove limb nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64784,Remove nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64786,Remove sciatic nerve lesion,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64788,Remove skin nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64790,Removal of nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64792,Removal of nerve lesion,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64795,Biopsy of nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64802,Sympathectomy cervical,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64804,Remove sympathetic nerves,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64809,Remove sympathetic nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64818,Remove sympathetic nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64820,Sympathectomy digital artery,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64821,Remove sympathetic nerves,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64822,Remove sympathetic nerves,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64823,Sympathectomy supfc palmar,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64831,Repair of digit nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64834,Repair of hand or foot nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64835,Repair of hand or foot nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64836,Repair of hand or foot nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64840,Repair of leg nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64856,Repair/transpose nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64857,Repair arm/leg nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64858,Repair sciatic nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64861,Repair of arm nerves,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64862,Repair of low back nerves,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64864,Repair of facial nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64865,Repair of facial nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64866,Fusion of facial/other nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64868,Fusion of facial/other nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64885,Nerve graft head/neck 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64886,Nerve graft head/neck >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64890,Nerve graft hand/foot 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64891,Nerve graft hand/foot >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64892,Nerve graft arm/leg <4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64893,Nerve graft arm/leg >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64895,Nerve graft hand/foot 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64896,Nerve graft hand/foot >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64897,Nerve graft arm/leg 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64898,Nerve graft arm/leg >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64905,Nerve pedicle transfer,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64907,Nerve pedicle transfer,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64910,Nerve repair w/allograft,APC 5432,RVU Per Case,"$5,524.06 ",OP,"3,575.33","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64911,Neurorraphy w/vein autograft,APC 5432,RVU Per Case,"$5,524.06 ",OP,"3,575.33","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64912,Nrv rpr w/nrv algrft 1st,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,64999,Nervous system surgery,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65091,Revise eye,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65093,Revise eye with implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65101,Removal of eye,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65103,Remove eye/insert implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65105,Remove eye/attach implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65110,Removal of eye,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65112,Remove eye/revise socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65114,Remove eye/revise socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65125,Revise ocular implant,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65130,Insert ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65135,Insert ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65140,Attach ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65150,Revise ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65155,Reinsert ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65175,Removal of ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,203.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65205,Remove foreign body from eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65210,Remove foreign body from eye,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65220,Remove foreign body from eye,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65222,Remove foreign body from eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65235,Remove foreign body from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65260,Remove foreign body from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65265,Remove foreign body from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65270,Repair of eye wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65272,Repair of eye wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65273,Repair of eye wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65275,Repair of eye wound,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65280,Repair of eye wound,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,309.75","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65285,Repair of eye wound,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65286,Repair of eye wound,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65290,Repair of eye socket wound,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65400,Removal of eye lesion,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65410,Biopsy of cornea,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65420,Removal of eye lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65426,Removal of eye lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65430,Corneal smear,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65435,Curette/treat cornea,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65436,Curette/treat cornea,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65450,Treatment of corneal lesion,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65600,Revision of cornea,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65710,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65730,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65750,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65755,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65756,Corneal trnspl endothelial,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65770,Revise cornea with implant,APC 5493,RVU Per Case,"$7,109.07 ",OP,"7,109.07","10,413.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65772,Correction of astigmatism,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65775,Correction of astigmatism,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65778,Cover eye w/membrane,APC 5502,RVU Per Case,$784.51 ,OP,784.51,784.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65779,Cover eye w/membrane suture,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,203.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65780,Ocular reconst transplant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,665.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65781,Ocular reconst transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65782,Ocular reconst transplant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,665.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65785,Impltj ntrstrml crnl rng seg,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65800,Drainage of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65810,Drainage of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65815,Drainage of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65820,Relieve inner eye pressure,APC 5492,RVU Per Case,"$3,796.62 ",OP,"1,215.27","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65850,Incision of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65855,Trabeculoplasty laser surg,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65860,Incise inner eye adhesions,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65865,Incise inner eye adhesions,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65870,Incise inner eye adhesions,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65875,Incise inner eye adhesions,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65880,Incise inner eye adhesions,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,049.73","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65900,Remove eye lesion,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65920,Remove implant of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,65930,Remove blood clot from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66020,Injection treatment of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66030,Injection treatment of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66130,Remove eye lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66150,Glaucoma surgery,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66155,Glaucoma surgery,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66160,Glaucoma surgery,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66170,Glaucoma surgery,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66172,Incision of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66174,Translum dil eye canal,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66175,Trnslum dil eye canal w/stnt,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66179,Aqueous shunt eye w/o graft,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66180,Aqueous shunt eye w/graft,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,590.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66183,Insert ant drainage device,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66184,Revision of aqueous shunt,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66185,Revise aqueous shunt eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","7,590.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66225,Repair/graft eye lesion,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,590.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66250,Follow-up surgery of eye,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66500,Incision of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66505,Incision of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66600,Remove iris and lesion,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66605,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66625,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66630,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66635,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66680,Repair iris & ciliary body,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66682,Repair iris & ciliary body,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66700,Destruction ciliary body,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66710,Ciliary transsleral therapy,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66711,Ecp ciliary body destruction,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66720,Destruction ciliary body,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66740,Destruction ciliary body,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66761,Revision of iris,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66762,Revision of iris,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66770,Removal of inner eye lesion,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66820,Incision secondary cataract,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66821,After cataract laser surgery,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66825,Reposition intraocular lens,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66830,Removal of lens lesion,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66840,Removal of lens material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,978.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66850,Removal of lens material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,854.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66852,Removal of lens material,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","5,854.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66920,Extraction of lens,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,854.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66930,Extraction of lens,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","5,854.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66940,Extraction of lens,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,978.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66982,Xcapsl ctrc rmvl cplx wo ecp,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66983,Cataract surg w/iol 1 stage,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66984,Xcapsl ctrc rmvl w/o ecp,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66985,Insert lens prosthesis,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66986,Exchange lens prosthesis,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66987,Xcapsl ctrc rmvl cplx w/ecp,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66988,Xcapsl ctrc rmvl w/ecp,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,66999,Eye surgery procedure,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67005,Partial removal of eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67010,Partial removal of eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67015,Release of eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67025,Replace eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67027,Implant eye drug system,APC 5494,RVU Per Case,"$14,545.35 ",OP,"7,497.01","14,545.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67028,Injection eye drug,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,787.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67030,Incise inner eye strands,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67031,Laser surgery eye strands,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67036,Removal of inner eye fluid,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67039,Laser treatment of retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67040,Laser treatment of retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67041,Vit for macular pucker,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67042,Vit for macular hole,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67043,Vit for membrane dissect,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67101,Repair detached retina crtx,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67105,Repair detached retina pc,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67107,Repair detached retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67108,Repair detached retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67110,Repair detached retina,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67113,Repair retinal detach cplx,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67115,Release encircling material,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,309.75","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67120,Remove eye implant material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67121,Remove eye implant material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67141,Treatment of retina,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,787.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67145,Treatment of retina,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67208,Treatment of retinal lesion,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,"3,309.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67210,Treatment of retinal lesion,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67218,Treatment of retinal lesion,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,309.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67220,Treatment of choroid lesion,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,787.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67221,Ocular photodynamic ther,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,787.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67227,Dstrj extensive retinopathy,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67228,Treatment x10sv retinopathy,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67229,Tr retinal les preterm inf,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,488.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67250,Reinforce eye wall,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67255,Reinforce/graft eye wall,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67299,Eye surgery procedure,APC 5491,RVU Per Case,"$2,014.88 ",OP,787.83,"2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67311,Revise eye muscle,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67312,Revise two eye muscles,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67314,Revise eye muscle,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67316,Revise two eye muscles,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67318,Revise eye muscle(s),APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67343,Release eye tissue,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67345,Destroy nerve of eye muscle,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67346,Biopsy eye muscle,APC 5504,RVU Per Case,"$3,203.25 ",OP,"2,881.19","3,203.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67399,Unlisted px extraocular musc,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,"4,262.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67400,Explore/biopsy eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67405,Explore/drain eye socket,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67412,Explore/treat eye socket,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67413,Explore/treat eye socket,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67414,Explr/decompress eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67415,Aspiration orbital contents,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67420,Explore/treat eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67430,Explore/treat eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67440,Explore/drain eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67445,Explr/decompress eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67450,Explore/biopsy eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67500,Inject/treat eye socket,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67505,Inject/treat eye socket,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67515,Inject/treat eye socket,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67550,Insert eye socket implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67560,Revise eye socket implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67570,Decompress optic nerve,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67599,Orbit surgery procedure,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67700,Drainage of eyelid abscess,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67710,Incision of eyelid,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67715,Incision of eyelid fold,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67800,Remove eyelid lesion,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67801,Remove eyelid lesions,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67805,Remove eyelid lesions,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67808,Remove eyelid lesion(s),APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67810,Biopsy eyelid & lid margin,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67820,Revise eyelashes,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67825,Revise eyelashes,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67830,Revise eyelashes,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67835,Revise eyelashes,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67840,Remove eyelid lesion,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67850,Treat eyelid lesion,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67875,Closure of eyelid by suture,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67880,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67882,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67900,Repair brow defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67901,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67902,Repair eyelid defect,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67903,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67904,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67906,Repair eyelid defect,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67908,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67909,Revise eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67911,Revise eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67912,Correction eyelid w/implant,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67914,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67915,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67916,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67917,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67921,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67922,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67923,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67924,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67930,Repair eyelid wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67935,Repair eyelid wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67938,Remove eyelid foreign body,APC 5501,RVU Per Unit,$253.20 ,OP,232.5,253.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67950,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67961,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67966,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67971,Reconstruction of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67973,Reconstruction of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67974,Reconstruction of eyelid,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67975,Reconstruction of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,67999,Revision of eyelid,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68020,Incise/drain eyelid lining,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68040,Treatment of eyelid lesions,APC 5501,RVU Per Unit,$253.20 ,OP,232.5,253.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68100,Biopsy of eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,215.27","1,940.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68110,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","2,881.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68115,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68130,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68135,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,458.56","1,940.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68200,Treat eyelid by injection,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68320,Revise/graft eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68325,Revise/graft eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68326,Revise/graft eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68328,Revise/graft eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68330,Revise eyelid lining,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68335,Revise/graft eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68340,Separate eyelid adhesions,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68360,Revise eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68362,Revise eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68371,Harvest eye tissue alograft,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68399,Eyelid lining surgery,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68400,Incise/drain tear gland,APC 5502,RVU Per Unit,$784.51 ,OP,579.95,784.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68420,Incise/drain tear sac,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68440,Incise tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68500,Removal of tear gland,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68505,Partial removal tear gland,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68510,Biopsy of tear gland,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68520,Removal of tear sac,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68525,Biopsy of tear sac,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68530,Clearance of tear duct,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,"3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68540,Remove tear gland lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68550,Remove tear gland lesion,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68700,Repair tear ducts,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68705,Revise tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68720,Create tear sac drain,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68745,Create tear duct drain,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68750,Create tear duct drain,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68760,Close tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68761,Close tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68770,Close tear system fistula,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68801,Dilate tear duct opening,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68810,Probe nasolacrimal duct,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68811,Probe nasolacrimal duct,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68815,Probe nasolacrimal duct,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68816,Probe nl duct w/balloon,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68840,Explore/irrigate tear ducts,APC 5501,RVU Per Unit,$253.20 ,OP,232.5,253.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,68899,Tear duct system surgery,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69000,Drain external ear lesion,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69005,Drain external ear lesion,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69020,Drain outer ear canal lesion,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69100,Biopsy of external ear,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,819.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69105,Biopsy of external ear canal,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69110,Remove external ear partial,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69120,Removal of external ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69140,Remove ear canal lesion(s),APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69145,Remove ear canal lesion(s),APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69150,Extensive ear canal surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69155,Extensive ear/neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69200,Clear outer ear canal,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69205,Clear outer ear canal,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69209,Remove impacted ear wax uni,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69210,Remove impacted ear wax uni,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69220,Clean out mastoid cavity,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69222,Clean out mastoid cavity,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69300,Revise external ear,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69310,Rebuild outer ear canal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69320,Rebuild outer ear canal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69399,Outer ear surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69420,Incision of eardrum,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69421,Incision of eardrum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69424,Remove ventilating tube,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69433,Create eardrum opening,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69436,Create eardrum opening,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69440,Exploration of middle ear,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69450,Eardrum revision,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69501,Mastoidectomy,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69502,Mastoidectomy,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69505,Remove mastoid structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69511,Extensive mastoid surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69530,Extensive mastoid surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69535,Remove part of temporal bone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69540,Remove ear lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69550,Remove ear lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69552,Remove ear lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69554,Remove ear lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69601,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69602,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69603,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69604,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69610,Repair of eardrum,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69620,Repair of eardrum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69631,Repair eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69632,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69633,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69635,Repair eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69636,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69637,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69641,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69642,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69643,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69644,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69645,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69646,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69650,Release middle ear bone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69660,Revise middle ear bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69661,Revise middle ear bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69662,Revise middle ear bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69666,Repair middle ear structures,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69667,Repair middle ear structures,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69670,Remove mastoid air cells,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69676,Remove middle ear nerve,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69700,Close mastoid fistula,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69705,Nps surg dilat eust tube uni,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69706,Nps surg dilat eust tube bi,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69711,Remove/repair hearing aid,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69714,Implant temple bone w/stimul,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,651.26","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69715,Temple bne implnt w/stimulat,APC 5116,RVU Per Case,"$15,377.54 ",OP,"7,651.26","15,377.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69717,Temple bone implant revision,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69718,Revise temple bone implant,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,651.26","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69720,Release facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69725,Release facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69740,Repair facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69745,Repair facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69799,Middle ear surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69801,Incise inner ear,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69805,Explore inner ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69806,Explore inner ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69905,Remove inner ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69910,Remove inner ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69915,Incise inner ear nerve,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69930,Implant cochlear device,APC 5166,RVU Per Case,"$33,363.18 ",OP,"33,363.18","83,093.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69949,Inner ear surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69950,Incise inner ear nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69955,Release facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69960,Release inner ear canal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69970,Remove inner ear lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,69979,Temporal bone surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70010,Contrast x-ray of brain,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70015,Contrast x-ray of brain,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70030,X-ray eye for foreign body,APC 5521,RVU Per Case,$78.40 ,OP,78.4,133.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70100,X-ray exam of jaw <4views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,195.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70110,X-ray exam of jaw 4/> views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,494.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70120,X-ray exam of mastoids,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70130,X-ray exam of mastoids,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70134,X-ray exam of middle ear,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70140,X-ray exam of facial bones,APC 5521,RVU Per Case,$78.40 ,OP,78.4,219.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70150,X-ray exam of facial bones,APC 5522,RVU Per Case,$105.60 ,OP,105.6,393.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70160,X-ray exam of nasal bones,APC 5521,RVU Per Case,$78.40 ,OP,78.4,160.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70170,X-ray exam of tear duct,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70190,X-ray exam of eye sockets,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70200,X-ray exam of eye sockets,APC 5522,RVU Per Case,$105.60 ,OP,105.6,252.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70210,X-ray exam of sinuses,APC 5521,RVU Per Case,$78.40 ,OP,78.4,178.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70220,X-ray exam of sinuses,APC 5521,RVU Per Case,$78.40 ,OP,78.4,208.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70240,X-ray exam pituitary saddle,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70250,X-ray exam of skull,APC 5522,RVU Per Case,$105.60 ,OP,105.6,219.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70260,X-ray exam of skull,APC 5522,RVU Per Case,$105.60 ,OP,105.6,303.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70300,X-ray exam of teeth,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70310,X-ray exam of teeth,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70320,Full mouth x-ray of teeth,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70328,X-ray exam of jaw joint,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70330,X-ray exam of jaw joints,APC 5521,RVU Per Case,$78.40 ,OP,78.4,249.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70332,X-ray exam of jaw joint,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70336,Magnetic image jaw joint,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70350,X-ray head for orthodontia,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70355,Panoramic x-ray of jaws,APC 5521,RVU Per Case,$78.40 ,OP,78.4,170.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70360,X-ray exam of neck,APC 5521,RVU Per Case,$78.40 ,OP,78.4,154.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70370,Throat x-ray & fluoroscopy,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70371,Speech evaluation complex,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70380,X-ray exam of salivary gland,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70390,X-ray exam of salivary duct,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70450,Ct head/brain w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,829.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70460,Ct head/brain w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,760.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70470,Ct head/brain w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,016.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70480,Ct orbit/ear/fossa w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,180.07",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70481,Ct orbit/ear/fossa w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"2,744.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70482,Ct orbit/ear/fossa w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70486,Ct maxillofacial w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,722.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70487,Ct maxillofacial w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70488,Ct maxillofacial w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70490,Ct soft tissue neck w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,070.58",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70491,Ct soft tissue neck w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,062.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70492,Ct sft tsue nck w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"2,286.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70496,Ct angiography head,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70498,Ct angiography neck,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70540,Mri orbit/face/neck w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70542,Mri orbit/face/neck w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70543,Mri orbt/fac/nck w/o &w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,347.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70544,Mr angiography head w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,445.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70545,Mr angiography head w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70546,Mr angiograph head w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70547,Mr angiography neck w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70548,Mr angiography neck w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70549,Mr angiograph neck w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,998.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70551,Mri brain stem w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,477.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70552,Mri brain stem w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70553,Mri brain stem w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,053.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70554,Fmri brain by tech,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70555,Fmri brain by phys/psych,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70557,Mri brain w/o dye,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70558,Mri brain w/dye,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,70559,Mri brain w/o & w/dye,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71045,X-ray exam chest 1 view,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71046,X-ray exam chest 2 views,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71047,X-ray exam chest 3 views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71048,X-ray exam chest 4+ views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71100,X-ray exam ribs uni 2 views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,473.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71101,X-ray exam unilat ribs/chest,APC 5522,RVU Per Case,$105.60 ,OP,105.6,234.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71110,X-ray exam ribs bil 3 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,250.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71111,X-ray exam ribs/chest4/> vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,295.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71120,X-ray exam breastbone 2/>vws,APC 5521,RVU Per Case,$78.40 ,OP,78.4,198.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71130,X-ray strenoclavic jt 3/>vws,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71250,Ct thorax dx c-,APC 5522,RVU Per Case,$105.60 ,OP,105.6,957,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71260,Ct thorax dx c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,120.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71270,Ct thorax dx c-/c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,131.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71271,Ct thorax lung cancer scr c-,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71275,Ct angiography chest,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"2,406.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71550,Mri chest w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71551,Mri chest w/dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,71552,Mri chest w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72020,X-ray exam of spine 1 view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,141.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72040,X-ray exam neck spine 2-3 vw,APC 5521,RVU Per Case,$78.40 ,OP,78.4,186.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72050,X-ray exam neck spine 4/5vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,234.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72052,X-ray exam neck spine 6/>vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,417.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72070,X-ray exam thorac spine 2vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,476.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72072,X-ray exam thorac spine 3vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,228.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72074,X-ray exam thorac spine4/>vw,APC 5522,RVU Per Case,$105.60 ,OP,105.6,692.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72080,X-ray exam thoracolmb 2/> vw,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72081,X-ray exam entire spi 1 vw,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72082,X-ray exam entire spi 2/3 vw,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72083,X-ray exam entire spi 4/5 vw,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72084,X-ray exam entire spi 6/> vw,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72100,X-ray exam l-s spine 2/3 vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,177.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72110,X-ray exam l-2 spine 4/>vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,236.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72114,X-ray exam l-s spine bending,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72120,X-ray bend only l-s spine,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72125,Ct neck spine w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,064.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72126,Ct neck spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72127,Ct neck spine w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72128,Ct chest spine w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"2,151.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72129,Ct chest spine w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72130,Ct chest spine w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72131,Ct lumbar spine w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,137.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72132,Ct lumbar spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,967.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72133,Ct lumbar spine w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72141,Mri neck spine w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,451.99",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72142,Mri neck spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72146,Mri chest spine w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,566.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72147,Mri chest spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72148,Mri lumbar spine w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,418.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72149,Mri lumbar spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72156,Mri neck spine w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,270.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72157,Mri chest spine w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,927.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72158,Mri lumbar spine w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,303.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72170,X-ray exam of pelvis,APC 5522,RVU Per Case,$105.60 ,OP,105.6,115.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72190,X-ray exam of pelvis,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72191,Ct angiograph pelv w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72192,Ct pelvis w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,859.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72193,Ct pelvis w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,989.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72194,Ct pelvis w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,102.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72195,Mri pelvis w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,378.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72196,Mri pelvis w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72197,Mri pelvis w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72200,X-ray exam si joints,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72202,X-ray exam si joints 3/> vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,189.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72220,X-ray exam sacrum tailbone,APC 5521,RVU Per Case,$78.40 ,OP,78.4,306.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72240,Myelography neck spine,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72255,Myelography thoracic spine,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72265,Myelography l-s spine,APC 5573,RVU Per Case,$693.07 ,OP,693.07,"1,935.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72270,Myelogphy 2/> spine regions,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72285,Discography cerv/thor spine,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,72295,X-ray of lower spine disk,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73000,X-ray exam of collar bone,APC 5521,RVU Per Case,$78.40 ,OP,78.4,162.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73010,X-ray exam of shoulder blade,APC 5522,RVU Per Case,$105.60 ,OP,105.6,167.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73020,X-ray exam of shoulder,APC 5521,RVU Per Case,$78.40 ,OP,78.4,168.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73030,X-ray exam of shoulder,APC 5521,RVU Per Case,$78.40 ,OP,78.4,176.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73040,Contrast x-ray of shoulder,APC 5572,RVU Per Case,$356.73 ,OP,356.73,771.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73050,X-ray exam of shoulders,APC 5521,RVU Per Case,$78.40 ,OP,78.4,333.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73060,X-ray exam of humerus,APC 5521,RVU Per Case,$78.40 ,OP,78.4,152.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73070,X-ray exam of elbow,APC 5521,RVU Per Case,$78.40 ,OP,78.4,193.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73080,X-ray exam of elbow,APC 5521,RVU Per Case,$78.40 ,OP,78.4,139.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73085,Contrast x-ray of elbow,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73090,X-ray exam of forearm,APC 5521,RVU Per Case,$78.40 ,OP,78.4,133.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73092,X-ray exam of arm infant,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73100,X-ray exam of wrist,APC 5521,RVU Per Case,$78.40 ,OP,78.4,143.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73110,X-ray exam of wrist,APC 5521,RVU Per Case,$78.40 ,OP,78.4,129.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73115,Contrast x-ray of wrist,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73120,X-ray exam of hand,APC 5522,RVU Per Case,$105.60 ,OP,105.6,234.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73130,X-ray exam of hand,APC 5521,RVU Per Case,$78.40 ,OP,78.4,150.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73140,X-ray exam of finger(s),APC 5521,RVU Per Case,$78.40 ,OP,78.4,102.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73200,Ct upper extremity w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,246.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73201,Ct upper extremity w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73202,Ct uppr extremity w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73206,Ct angio upr extrm w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73218,Mri upper extremity w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"2,922.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73219,Mri upper extremity w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73220,Mri uppr extremity w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73221,Mri joint upr extrem w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,534.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73222,Mri joint upr extrem w/dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73223,Mri joint upr extr w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,768.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73501,X-ray exam hip uni 1 view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73502,X-ray exam hip uni 2-3 views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73503,X-ray exam hip uni 4/> views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73521,X-ray exam hips bi 2 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73522,X-ray exam hips bi 3-4 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73523,X-ray exam hips bi 5/> views,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73525,Contrast x-ray of hip,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73551,X-ray exam of femur 1,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73552,X-ray exam of femur 2/>,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73560,X-ray exam of knee 1 or 2,APC 5521,RVU Per Case,$78.40 ,OP,78.4,131.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73562,X-ray exam of knee 3,APC 5521,RVU Per Case,$78.40 ,OP,78.4,140.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73564,X-ray exam knee 4 or more,APC 5522,RVU Per Case,$105.60 ,OP,105.6,195.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73565,X-ray exam of knees,APC 5521,RVU Per Case,$78.40 ,OP,78.4,116.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73580,Contrast x-ray of knee joint,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73590,X-ray exam of lower leg,APC 5521,RVU Per Case,$78.40 ,OP,78.4,142.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73592,X-ray exam of leg infant,APC 5521,RVU Per Case,$78.40 ,OP,78.4,280.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73600,X-ray exam of ankle,APC 5521,RVU Per Case,$78.40 ,OP,78.4,253.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73610,X-ray exam of ankle,APC 5521,RVU Per Case,$78.40 ,OP,78.4,159.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73615,Contrast x-ray of ankle,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73620,X-ray exam of foot,APC 5521,RVU Per Case,$78.40 ,OP,78.4,200.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73630,X-ray exam of foot,APC 5521,RVU Per Case,$78.40 ,OP,78.4,140.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73650,X-ray exam of heel,APC 5521,RVU Per Case,$78.40 ,OP,78.4,144.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73660,X-ray exam of toe(s),APC 5521,RVU Per Case,$78.40 ,OP,78.4,118.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73700,Ct lower extremity w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,787.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73701,Ct lower extremity w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73702,Ct lwr extremity w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73706,Ct angio lwr extr w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73718,Mri lower extremity w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,563.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73719,Mri lower extremity w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73720,Mri lwr extremity w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,492.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73721,Mri jnt of lwr extre w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,518.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73722,Mri joint of lwr extr w/dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,73723,Mri joint lwr extr w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74018,X-ray exam abdomen 1 view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74019,X-ray exam abdomen 2 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74021,X-ray exam abdomen 3+ views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74022,X-ray exam complete abdomen,APC 5522,RVU Per Case,$105.60 ,OP,105.6,252,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74150,Ct abdomen w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,924.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74160,Ct abdomen w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,231.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74170,Ct abdomen w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,221.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74174,Ct angio abd&pelv w/o&w/dye,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74175,Ct angio abdom w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74176,Ct abd & pelvis w/o contrast,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74177,Ct abd & pelv w/contrast,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74178,Ct abd & pelv 1/> regns,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74181,Mri abdomen w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74182,Mri abdomen w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74183,Mri abdomen w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,284.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74190,X-ray exam of peritoneum,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74210,X-ray xm phrnx&/crv esoph c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74220,X-ray xm esophagus 1cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,295.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74221,X-ray xm esophagus 2cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74230,X-ray xm swlng funcj c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,568.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74240,X-ray xm upr gi trc 1cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,431.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74246,X-ray xm upr gi trc 2cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,474.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74250,X-ray xm sm int 1cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,316.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74251,X-ray xm sm int 2cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74261,Ct colonography dx,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74262,Ct colonography dx w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74270,X-ray xm colon 1cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,675.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74280,X-ray xm colon 2cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,500.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74283,Ther nma rdctj intus/obstrcj,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74290,Contrast x-ray gallbladder,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74400,Urography iv +-kub tomog,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,411.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74410,Urography nfs drip&/bolus,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74415,Urography nfs drip&/bls w/nf,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,639.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74420,Urography rtrgr +-kub,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,397.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74425,Urography antegrade rs&i,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74430,Contrast x-ray bladder,APC 5572,RVU Per Case,$356.73 ,OP,334.58,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74440,X-ray male genital tract,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74445,X-ray exam of penis,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74450,X-ray urethra/bladder,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74455,X-ray urethra/bladder,APC 5523,RVU Per Case,$223.01 ,OP,223.01,299.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74470,X-ray exam of kidney lesion,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74485,Dilation urtr/urt rs&i,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74710,X-ray measurement of pelvis,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74712,Mri fetal sngl/1st gestation,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74740,X-ray female genital tract,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,538.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,74775,X-ray exam of perineum,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75557,Cardiac mri for morph,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75559,Cardiac mri w/stress img,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75561,Cardiac mri for morph w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75563,Card mri w/stress img & dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75571,Ct hrt w/o dye w/ca test,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75572,Ct hrt w/3d image,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75573,Ct hrt w/3d image congen,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75574,Ct angio hrt w/3d image,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75600,Contrast exam thoracic aorta,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75605,Contrast exam thoracic aorta,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75625,Contrast exam abdominl aorta,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75630,X-ray aorta leg arteries,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,687.18","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75635,Ct angio abdominal arteries,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75705,Artery x-rays spine,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75710,Artery x-rays arm/leg,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75716,Artery x-rays arms/legs,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75726,Artery x-rays abdomen,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75731,Artery x-rays adrenal gland,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75733,Artery x-rays adrenals,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75736,Artery x-rays pelvis,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75741,Artery x-rays lung,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75743,Artery x-rays lungs,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75746,Artery x-rays lung,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75756,Artery x-rays chest,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75801,Lymph vessel x-ray arm/leg,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75803,Lymph vessel x-ray arms/legs,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75805,Lymph vessel x-ray trunk,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75807,Lymph vessel x-ray trunk,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75809,Nonvascular shunt x-ray,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75810,Vein x-ray spleen/liver,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75820,Vein x-ray arm/leg,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75822,Vein x-ray arms/legs,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75825,Vein x-ray trunk,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75827,Vein x-ray chest,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75831,Vein x-ray kidney,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75833,Vein x-ray kidneys,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75840,Vein x-ray adrenal gland,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75842,Vein x-ray adrenal glands,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75860,Vein x-ray neck,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75870,Vein x-ray skull,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75872,Vein x-ray skull epidural,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75880,Vein x-ray eye socket,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75885,Vein x-ray liver w/hemodynam,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75887,Vein x-ray liver w/o hemodyn,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75889,Vein x-ray liver w/hemodynam,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75891,Vein x-ray liver,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75893,Venous sampling by catheter,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75898,Follow-up angiography,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75956,Xray endovasc thor ao repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75957,Xray endovasc thor ao repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75958,Xray place prox ext thor ao,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,75959,Xray place dist ext thor ao,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76000,Fluoroscopy <1 hr phys/qhp,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,232.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76010,X-ray nose to rectum,APC 5521,RVU Per Case,$78.40 ,OP,78.4,126.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76080,X-ray exam of fistula,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76098,X-ray exam surgical specimen,APC 5524,RVU Per Case,$467.96 ,OP,59.28,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76100,X-ray exam of body section,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76101,Complex body section x-ray,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76102,Complex body section x-rays,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76120,Cine/video x-rays,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76145,Med physic dos eval rad exps,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76380,Cat scan follow-up study,APC 5521,RVU Per Case,$78.40 ,OP,78.4,643.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76390,Mr spectroscopy,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76391,Mr elastography,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76496,Fluoroscopic procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76497,Ct procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76498,Mri procedure,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76499,Radiographic procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76506,Echo exam of head,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76510,Oph us dx b-scan&quan a-scan,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76511,Oph us dx quan a-scan only,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76512,Oph us dx b-scan,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76513,Oph us dx ant sgm us uni/bi,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76514,Echo exam of eye thickness,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76516,Echo exam of eye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76519,Echo exam of eye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76529,Echo exam of eye,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76536,Us exam of head and neck,APC 5522,RVU Per Case,$105.60 ,OP,105.6,294.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76604,Us exam chest,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76641,Ultrasound breast complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76642,Ultrasound breast limited,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76700,Us exam abdom complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,397.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76705,Echo exam of abdomen,APC 5522,RVU Per Case,$105.60 ,OP,105.6,534.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76706,Us abdl aorta screen aaa,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76770,Us exam abdo back wall comp,APC 5522,RVU Per Case,$105.60 ,OP,105.6,287.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76775,Us exam abdo back wall lim,APC 5522,RVU Per Case,$105.60 ,OP,105.6,558.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76776,Us exam k transpl w/doppler,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76800,Us exam spinal canal,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76801,Ob us < 14 wks single fetus,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,400.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76805,Ob us >= 14 wks sngl fetus,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,302.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76811,Ob us detailed sngl fetus,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,533,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76813,Ob us nuchal meas 1 gest,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76815,Ob us limited fetus(s),APC 5522,RVU Per Case,$105.60 ,OP,105.6,262.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76816,Ob us follow-up per fetus,APC 5522,RVU Per Case,$105.60 ,OP,105.6,374.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76817,Transvaginal us obstetric,APC 5522,RVU Per Case,$105.60 ,OP,105.6,305.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76818,Fetal biophys profile w/nst,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,343.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76819,Fetal biophys profil w/o nst,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76820,Umbilical artery echo,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76821,Middle cerebral artery echo,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76825,Echo exam of fetal heart,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76826,Echo exam of fetal heart,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76827,Echo exam of fetal heart,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76828,Echo exam of fetal heart,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76830,Transvaginal us non-ob,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,247.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76831,Echo exam uterus,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76856,Us exam pelvic complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,321.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76857,Us exam pelvic limited,APC 5522,RVU Per Case,$105.60 ,OP,105.6,265.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76870,Us exam scrotum,APC 5522,RVU Per Case,$105.60 ,OP,105.6,263.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76872,Us transrectal,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,891.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76873,Echograp trans r pros study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76881,Us compl joint r-t w/img,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76882,Us lmtd jt/nonvasc xtr strux,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76885,Us exam infant hips dynamic,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76886,Us exam infant hips static,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76936,Echo guide for artery repair,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76975,Gi endoscopic ultrasound,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76977,Us bone density measure,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76978,Us trgt dyn mbubb 1st les,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76981,Use parenchyma,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76982,Use 1st target lesion,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,76999,Echo examination procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77046,Mri breast c- unilateral,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77047,Mri breast c- bilateral,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77053,X-ray of mammary duct,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77054,X-ray of mammary ducts,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77063,Breast tomosynthesis bi,Lab Services,Per Unit,$23.23 ,OP,23.23,23.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77065,Dx mammo incl cad uni,Lab Services,Per Unit,$83.47 ,OP,83.47,83.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77066,Dx mammo incl cad bi,Lab Services,Per Unit,$106.70 ,OP,106.7,106.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77067,Scr mammo bi incl cad,Lab Services,Per Unit,$88.24 ,OP,88.24,88.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77071,X-ray stress view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77072,X-rays for bone age,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77073,X-rays bone length studies,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77074,X-rays bone survey limited,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77075,X-rays bone survey complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77076,X-rays bone survey infant,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77077,Joint survey single view,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77078,Ct bone density axial,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77080,Dxa bone density axial,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77081,Dxa bone density/peripheral,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77084,Magnetic image bone marrow,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77085,Dxa bone density study,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77086,Fracture assessment via dxa,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77280,Set radiation therapy field,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,"1,135.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77285,Set radiation therapy field,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77290,Set radiation therapy field,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,"2,127.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77295,3-d radiotherapy plan,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","2,465.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77299,Radiation therapy planning,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77300,Radiation therapy dose plan,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,186.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77301,Radiotherapy dose plan imrt,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77306,Telethx isodose plan simple,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77307,Telethx isodose plan cplx,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77316,Brachytx isodose plan simple,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77317,Brachytx isodose intermed,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77318,Brachytx isodose complex,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77321,Special teletx port plan,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77331,Special radiation dosimetry,APC 5611,RVU Per Unit,$122.95 ,OP,102.17,122.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77332,Radiation treatment aid(s),APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77333,Radiation treatment aid(s),APC 5611,RVU Per Unit,$122.95 ,OP,122.95,659.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77334,Radiation treatment aid(s),APC 5612,RVU Per Unit,$328.21 ,OP,328.21,464.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77336,Radiation physics consult,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,218.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77338,Design mlc device for imrt,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77370,Radiation physics consult,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77371,Srs multisource,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77372,Srs linear based,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77373,Sbrt delivery,APC 5626,RVU Per Unit,"$1,680.14 ",OP,"1,680.14","1,680.14",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77385,Ntsty modul rad tx dlvr smpl,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77386,Ntsty modul rad tx dlvr cplx,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77399,External radiation dosimetry,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77401,Radiation treatment delivery,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77402,Radiation treatment delivery,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77407,Radiation treatment delivery,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77412,Radiation treatment delivery,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,490.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77423,Neutron beam tx complex,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77424,Io rad tx delivery by x-ray,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77425,Io rad tx deliver by elctrns,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77470,Special radiation treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77520,Proton trmt simple w/o comp,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77522,Proton trmt simple w/comp,APC 5625,RVU Per Unit,"$1,257.79 ",OP,"1,257.79","1,257.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77523,Proton trmt intermediate,APC 5625,RVU Per Unit,"$1,257.79 ",OP,"1,257.79","1,257.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77525,Proton treatment complex,APC 5625,RVU Per Unit,"$1,257.79 ",OP,"1,257.79","1,257.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77600,Hyperthermia treatment,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77605,Hyperthermia treatment,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77610,Hyperthermia treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77615,Hyperthermia treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77620,Hyperthermia treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77750,Infuse radioactive materials,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77761,Apply intrcav radiat simple,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77762,Apply intrcav radiat interm,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77763,Apply intrcav radiat compl,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77767,Hdr rdncl skn surf brachytx,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77768,Hdr rdncl skn surf brachytx,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77770,Hdr rdncl ntrstl/icav brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77771,Hdr rdncl ntrstl/icav brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77772,Hdr rdncl ntrstl/icav brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77778,Apply interstit radiat compl,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77789,Apply surf ldr radionuclide,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,77799,Radium/radioisotope therapy,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78012,Thyroid uptake measurement,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78013,Thyroid imaging w/blood flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78014,Thyroid imaging w/blood flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78015,Thyroid met imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78016,Thyroid met imaging/studies,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78018,Thyroid met imaging body,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78070,Parathyroid planar imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,609.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78071,Parathyrd planar w/wo subtrj,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78072,Parathyrd planar w/spect&ct,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78075,Adrenal cortex & medulla img,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78099,Endocrine nuclear procedure,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78102,Bone marrow imaging ltd,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78103,Bone marrow imaging mult,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78104,Bone marrow imaging body,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78110,Plasma volume single,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78111,Plasma volume multiple,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78120,Red cell mass single,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78121,Red cell mass multiple,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78122,Blood volume,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78130,Red cell survival study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78140,Red cell sequestration,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78185,Spleen imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78191,Platelet survival,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78195,Lymph system imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78199,Blood/lymph nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78201,Liver imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78202,Liver imaging with flow,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78215,Liver and spleen imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78216,Liver & spleen image/flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78226,Hepatobiliary system imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78227,Hepatobil syst image w/drug,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78230,Salivary gland imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78231,Serial salivary imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78232,Salivary gland function exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78258,Esophageal motility study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78261,Gastric mucosa imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78262,Gastroesophageal reflux exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78264,Gastric emptying imag study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,902.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78265,Gastric emptying imag study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78266,Gastric emptying imag study,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78267,Breath tst attain/anal c-14,Lab Services,Per Unit,$11.06 ,OP,11.06,11.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78268,Breath test analysis c-14,Lab Services,Per Unit,$94.41 ,OP,94.41,94.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78278,Acute gi blood loss imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78282,Gi protein loss exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78290,Meckels divert exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78291,Leveen/shunt patency exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78299,Gi nuclear procedure,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78300,Bone imaging limited area,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,101.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78305,Bone imaging multiple areas,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78306,Bone imaging whole body,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,737.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78315,Bone imaging 3 phase,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,717.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78399,Musculoskeletal nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78414,Non-imaging heart function,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78428,Cardiac shunt imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78429,Myocrd img pet 1 std w/ct,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78430,Myocrd img pet rst/strs w/ct,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78431,Myocrd img pet rst&strs ct,APC 1522,RVU Per Unit,"$2,180.92 ",OP,"2,180.92","2,180.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78432,Myocrd img pet 2rtracer,APC 1523,RVU Per Unit,"$2,665.46 ",OP,"2,665.46","2,665.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78433,Myocrd img pet 2rtracer ct,APC 1523,RVU Per Unit,"$2,665.46 ",OP,"2,665.46","2,665.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78445,Vascular flow imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78451,Ht muscle image spect sing,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78452,Ht muscle image spect mult,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78453,Ht muscle image planar sing,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78454,Ht musc image planar mult,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78456,Acute venous thrombus image,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78457,Venous thrombosis imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78458,Ven thrombosis images bilat,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78459,Myocrd img pet single study,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78466,Heart infarct image,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78468,Heart infarct image (ef),APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78469,Heart infarct image (3d),APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78472,Gated heart planar single,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,150.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78473,Gated heart multiple,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,535.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78481,Heart first pass single,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78483,Heart first pass multiple,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78491,Myocrd img pet 1std rst/strs,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78492,Myocrd img pet mlt rst&strs,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78494,Heart image spect,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78499,Cardiovascular nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78579,Lung ventilation imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78580,Lung perfusion imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78582,Lung ventilat&perfus imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78597,Lung perfusion differential,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78598,Lung perf&ventilat diferentl,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78599,Respiratory nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78600,Brain image < 4 views,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78601,Brain image w/flow < 4 views,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78605,Brain image 4+ views,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78606,Brain image w/flow 4 + views,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78608,Brain imaging (pet),APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78610,Brain flow imaging only,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78630,Cerebrospinal fluid scan,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78635,Csf ventriculography,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78645,Csf shunt evaluation,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78650,Csf leakage imaging,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78660,Nuclear exam of tear flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78699,Nervous system nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78700,Kidney imaging morphol,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78701,Kidney imaging with flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78707,K flow/funct image w/o drug,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,"1,550.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78708,K flow/funct image w/drug,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,"2,347.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78709,K flow/funct image multiple,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78725,Kidney function study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78740,Ureteral reflux study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78761,Testicular imaging w/flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78799,Genitourinary nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78800,Rp loclzj tum 1 area 1 d img,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78801,Rp loclzj tum 2+area 1+d img,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78802,Rp loclzj tum whbdy 1 d img,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78803,Rp loclzj tum spect 1 area,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78804,Rp loclzj tum whbdy 2+d img,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78808,Iv inj ra drug dx study,APC 5591,RVU Per Case,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78811,Pet image ltd area,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78812,Pet image skull-thigh,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78813,Pet image full body,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78814,Pet image w/ct lmtd,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78815,Pet image w/ct skull-thigh,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78816,Pet image w/ct full body,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78830,Rp loclzj tum spect w/ct 1,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78831,Rp loclzj tum spect 2 areas,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78832,Rp loclzj tum spect w/ct 2,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,78999,Nuclear diagnostic exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79005,Nuclear rx oral admin,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79101,Nuclear rx iv admin,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79200,Nuclear rx intracav admin,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79300,Nuclr rx interstit colloid,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79403,Hematopoietic nuclear tx,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79440,Nuclear rx intra-articular,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79445,Nuclear rx intra-arterial,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,79999,Nuclear medicine therapy,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80047,Metabolic panel ionized ca,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80048,Metabolic panel total ca,Lab Services,Per Unit,$8.46 ,OP,8.46,75.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80051,Electrolyte panel,Lab Services,Per Unit,$7.01 ,OP,7.01,122.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80053,Comprehen metabolic panel,Lab Services,Per Unit,$10.56 ,OP,10.56,110.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80055,Obstetric panel,Lab Services,Per Unit,$47.81 ,OP,47.81,198.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80061,Lipid panel,Lab Services,Per Unit,$13.39 ,OP,13.39,115.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80069,Renal function panel,Lab Services,Per Unit,$8.68 ,OP,8.68,126.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80074,Acute hepatitis panel,Lab Services,Per Unit,$47.63 ,OP,47.63,293.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80076,Hepatic function panel,Lab Services,Per Unit,$8.17 ,OP,8.17,126.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80081,Obstetric panel,Lab Services,Per Unit,$74.86 ,OP,74.86,74.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80143,Drug assay acetaminophen,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80145,Drug assay adalimumab,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80150,Assay of amikacin,Lab Services,Per Unit,$15.08 ,OP,15.08,15.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80151,Drug assay amiodarone,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80155,Drug assay caffeine,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80156,Assay carbamazepine total,Lab Services,Per Unit,$14.57 ,OP,14.57,89.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80157,Assay carbamazepine free,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80158,Drug assay cyclosporine,Lab Services,Per Unit,$18.05 ,OP,18.05,191.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80159,Drug assay clozapine,Lab Services,Per Unit,$20.15 ,OP,20.15,20.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80161,Asy carbamazepin 10-11-epxid,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80162,Assay of digoxin total,Lab Services,Per Unit,$13.28 ,OP,13.28,85.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80163,Assay of digoxin free,Lab Services,Per Unit,$13.28 ,OP,13.28,13.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80164,Assay dipropylacetic acd tot,Lab Services,Per Unit,$13.54 ,OP,13.54,79.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80165,Dipropylacetic acid free,Lab Services,Per Unit,$13.54 ,OP,13.54,13.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80167,Drug assay felbamate,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80168,Assay of ethosuximide,Lab Services,Per Unit,$16.34 ,OP,16.34,16.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80169,Drug assay everolimus,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80170,Assay of gentamicin,Lab Services,Per Unit,$16.38 ,OP,16.38,111,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80171,Drug screen quant gabapentin,Lab Services,Per Unit,$21.67 ,OP,21.67,21.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80173,Assay of haloperidol,Lab Services,Per Unit,$15.78 ,OP,15.78,15.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80175,Drug screen quan lamotrigine,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80176,Assay of lidocaine,Lab Services,Per Unit,$14.69 ,OP,14.69,14.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80177,Drug scrn quan levetiracetam,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80178,Assay of lithium,Lab Services,Per Unit,$6.61 ,OP,6.61,57.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80179,Drug assay salicylate,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80180,Drug scrn quan mycophenolate,Lab Services,Per Unit,$18.05 ,OP,18.05,18.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80181,Drug assay flecainide,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80183,Drug scrn quant oxcarbazepin,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80184,Assay of phenobarbital,Lab Services,Per Unit,$15.30 ,OP,15.3,113.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80185,Assay of phenytoin total,Lab Services,Per Unit,$13.25 ,OP,13.25,88.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80186,Assay of phenytoin free,Lab Services,Per Unit,$13.76 ,OP,13.76,13.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80187,Drug assay posaconazole,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80188,Assay of primidone,Lab Services,Per Unit,$16.59 ,OP,16.59,16.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80189,Drug assay itraconzaole,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80190,Assay of procainamide,Lab Services,Per Unit,$60.00 ,OP,60,60,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80192,Assay of procainamide,Lab Services,Per Unit,$16.75 ,OP,16.75,16.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80193,Drug assay leflunomide,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80194,Assay of quinidine,Lab Services,Per Unit,$14.60 ,OP,14.6,14.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80195,Assay of sirolimus,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80197,Assay of tacrolimus,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80198,Assay of theophylline,Lab Services,Per Unit,$14.14 ,OP,14.14,121.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80199,Drug screen quant tiagabine,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80200,Assay of tobramycin,Lab Services,Per Unit,$16.13 ,OP,16.13,16.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80201,Assay of topiramate,Lab Services,Per Unit,$11.92 ,OP,11.92,11.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80202,Assay of vancomycin,Lab Services,Per Unit,$13.54 ,OP,13.54,88.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80203,Drug screen quant zonisamide,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80204,Drug assay methotrexate,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80210,Drug assay rufinamide,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80230,Drug assay infliximab,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80235,Drug assay lacosamide,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80280,Drug assay vedolizumab,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80285,Drug assay voriconazole,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80299,Quantitative assay drug,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80305,Drug test prsmv dir opt obs,Lab Services,Per Unit,$12.60 ,OP,12.6,12.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80306,Drug test prsmv instrmnt,Lab Services,Per Unit,$17.14 ,OP,17.14,17.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80307,Drug test prsmv chem anlyzr,Lab Services,Per Unit,$62.14 ,OP,62.14,62.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80400,Acth stimulation panel,Lab Services,Per Unit,$32.62 ,OP,32.62,32.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80402,Acth stimulation panel,Lab Services,Per Unit,$86.96 ,OP,86.96,86.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80406,Acth stimulation panel,Lab Services,Per Unit,$78.26 ,OP,78.26,78.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80408,Aldosterone suppression eval,Lab Services,Per Unit,$125.50 ,OP,125.5,125.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80410,Calcitonin stimul panel,Lab Services,Per Unit,$80.37 ,OP,80.37,80.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80412,Crh stimulation panel,Lab Services,Per Unit,$801.62 ,OP,801.62,801.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80414,Testosterone response panel,Lab Services,Per Unit,$51.64 ,OP,51.64,51.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80415,Tot estradiol response panel,Lab Services,Per Unit,$55.89 ,OP,55.89,55.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80416,Renin stimulation panel,Lab Services,Per Unit,$209.32 ,OP,209.32,209.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80417,Renin stimulation panel,Lab Services,Per Unit,$43.99 ,OP,43.99,43.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80418,Pituitary evaluation panel,Lab Services,Per Unit,$579.48 ,OP,579.48,579.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80420,Dexamethasone panel,Lab Services,Per Unit,$161.88 ,OP,161.88,161.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80422,Glucagon tolerance panel,Lab Services,Per Unit,$46.07 ,OP,46.07,46.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80424,Glucagon tolerance panel,Lab Services,Per Unit,$50.50 ,OP,50.5,50.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80426,Gonadotropin hormone panel,Lab Services,Per Unit,$148.41 ,OP,148.41,148.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80428,Growth hormone panel,Lab Services,Per Unit,$66.70 ,OP,66.7,66.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80430,Growth hormone panel,Lab Services,Per Unit,$129.33 ,OP,129.33,129.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80432,Insulin suppression panel,Lab Services,Per Unit,$165.61 ,OP,165.61,165.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80434,Insulin tolerance panel,Lab Services,Per Unit,$285.03 ,OP,285.03,285.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80435,Insulin tolerance panel,Lab Services,Per Unit,$103.00 ,OP,103,103,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80436,Metyrapone panel,Lab Services,Per Unit,$91.16 ,OP,91.16,91.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80438,Trh stimulation panel,Lab Services,Per Unit,$50.41 ,OP,50.41,50.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80439,Trh stimulation panel,Lab Services,Per Unit,$67.21 ,OP,67.21,67.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80500,Lab pathology consultation,APC 5671,RVU Per Case,$48.22 ,OP,15.72,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,80502,Lab pathology consultation,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81000,Urinalysis nonauto w/scope,Lab Services,Per Unit,$4.02 ,OP,4.02,33.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81001,Urinalysis auto w/scope,Lab Services,Per Unit,$3.17 ,OP,3.17,33.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81002,Urinalysis nonauto w/o scope,Lab Services,Per Unit,$3.48 ,OP,3.48,22.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81003,Urinalysis auto w/o scope,Lab Services,Per Unit,$2.25 ,OP,2.25,25.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81005,Urinalysis,Lab Services,Per Unit,$2.17 ,OP,2.17,2.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81007,Urine screen for bacteria,Lab Services,Per Unit,$29.98 ,OP,29.98,29.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81015,Microscopic exam of urine,Lab Services,Per Unit,$3.05 ,OP,3.05,33.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81020,Urinalysis glass test,Lab Services,Per Unit,$4.70 ,OP,4.7,4.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81025,Urine pregnancy test,Lab Services,Per Unit,$8.61 ,OP,8.61,62.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81050,Urinalysis volume measure,Lab Services,Per Unit,$3.64 ,OP,3.64,12.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81105,Hpa-1 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81106,Hpa-2 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81107,Hpa-3 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81108,Hpa-4 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81109,Hpa-5 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81110,Hpa-6 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81111,Hpa-9 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81112,Hpa-15 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81120,Idh1 common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81121,Idh2 common variants,Lab Services,Per Unit,$295.79 ,OP,295.79,295.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81161,Dmd dup/delet analysis,Lab Services,Per Unit,$279.00 ,OP,279,279,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81162,Brca1&2 gen full seq dup/del,Lab Services,Per Unit,"$1,824.88 ",OP,"1,824.88","1,824.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81163,Brca1&2 gene full seq alys,Lab Services,Per Unit,$468.00 ,OP,468,468,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81164,Brca1&2 gen ful dup/del alys,Lab Services,Per Unit,$584.23 ,OP,584.23,584.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81165,Brca1 gene full seq alys,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81166,Brca1 gene full dup/del alys,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81167,Brca2 gene full dup/del alys,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81168,Ccnd1/igh translocation alys,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81170,Abl1 gene,Lab Services,Per Unit,$300.00 ,OP,300,300,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81171,Aff2 gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81172,Aff2 gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81173,Ar gene full gene sequence,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81174,Ar gene known famil variant,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81175,Asxl1 full gene sequence,Lab Services,Per Unit,$676.50 ,OP,676.5,676.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81176,Asxl1 gene target seq alys,Lab Services,Per Unit,$241.90 ,OP,241.9,241.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81177,Atn1 gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81178,Atxn1 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81179,Atxn2 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81180,Atxn3 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81181,Atxn7 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81182,Atxn8os gen detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81183,Atxn10 gene detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81184,Cacna1a gen detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81185,Cacna1a gene full gene seq,Lab Services,Per Unit,$846.27 ,OP,846.27,846.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81186,Cacna1a gen known famil vrnt,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81187,Cnbp gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81188,Cstb gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81189,Cstb gene full gene sequence,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81190,Cstb gene known famil vrnt,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81191,Ntrk1 translocation analysis,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81192,Ntrk2 translocation analysis,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81193,Ntrk3 translocation analysis,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81194,Ntrk translocation analysis,Lab Services,Per Unit,$518.28 ,OP,518.28,518.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81200,Aspa gene,Lab Services,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81201,Apc gene full sequence,Lab Services,Per Unit,$780.00 ,OP,780,780,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81202,Apc gene known fam variants,Lab Services,Per Unit,$280.00 ,OP,280,280,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81203,Apc gene dup/delet variants,Lab Services,Per Unit,$200.00 ,OP,200,200,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81204,Ar gene charac alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81205,Bckdhb gene,Lab Services,Per Unit,$94.99 ,OP,94.99,94.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81206,Bcr/abl1 gene major bp,Lab Services,Per Unit,$163.96 ,OP,163.96,163.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81207,Bcr/abl1 gene minor bp,Lab Services,Per Unit,$144.84 ,OP,144.84,144.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81208,Bcr/abl1 gene other bp,Lab Services,Per Unit,$214.62 ,OP,214.62,214.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81209,Blm gene,Lab Services,Per Unit,$39.31 ,OP,39.31,39.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81210,Braf gene,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81212,Brca1&2 185&5385&6174 vrnt,Lab Services,Per Unit,$440.00 ,OP,440,440,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81215,Brca1 gene known famil vrnt,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81216,Brca2 gene full seq alys,Lab Services,Per Unit,$185.12 ,OP,185.12,185.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81217,Brca2 gene known famil vrnt,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81218,Cebpa gene full sequence,Lab Services,Per Unit,$241.90 ,OP,241.9,241.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81219,Calr gene com variants,Lab Services,Per Unit,$121.63 ,OP,121.63,121.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81220,Cftr gene com variants,Lab Services,Per Unit,$556.60 ,OP,556.6,556.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81221,Cftr gene known fam variants,Lab Services,Per Unit,$97.22 ,OP,97.22,97.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81222,Cftr gene dup/delet variants,Lab Services,Per Unit,$435.07 ,OP,435.07,435.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81223,Cftr gene full sequence,Lab Services,Per Unit,$499.00 ,OP,499,499,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81224,Cftr gene intron poly t,Lab Services,Per Unit,$168.75 ,OP,168.75,168.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81225,Cyp2c19 gene com variants,Lab Services,Per Unit,$291.36 ,OP,291.36,291.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81226,Cyp2d6 gene com variants,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81227,Cyp2c9 gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81228,Cytogen micrarray copy nmbr,Lab Services,Per Unit,$900.00 ,OP,900,900,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81229,Cytogen m array copy no&snp,Lab Services,Per Unit,"$1,160.00 ",OP,"1,160.00","1,160.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81230,Cyp3a4 gene common variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81231,Cyp3a5 gene common variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81232,Dpyd gene common variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81233,Btk gene common variants,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81234,Dmpk gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81235,Egfr gene com variants,Lab Services,Per Unit,$324.58 ,OP,324.58,324.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81236,Ezh2 gene full gene sequence,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81237,Ezh2 gene common variants,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81238,F9 full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81239,Dmpk gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81240,F2 gene,Lab Services,Per Unit,$65.69 ,OP,65.69,65.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81241,F5 gene,Lab Services,Per Unit,$73.37 ,OP,73.37,73.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81242,Fancc gene,Lab Services,Per Unit,$36.62 ,OP,36.62,36.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81243,Fmr1 gene detection,Lab Services,Per Unit,$57.04 ,OP,57.04,57.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81244,Fmr1 gene charac alleles,Lab Services,Per Unit,$44.89 ,OP,44.89,44.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81245,Flt3 gene,Lab Services,Per Unit,$165.51 ,OP,165.51,165.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81246,Flt3 gene analysis,Lab Services,Per Unit,$83.00 ,OP,83,83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81247,G6pd gene alys cmn variant,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81248,G6pd known familial variant,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81249,G6pd full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81250,G6pc gene,Lab Services,Per Unit,$58.49 ,OP,58.49,58.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81251,Gba gene,Lab Services,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81252,Gjb2 gene full sequence,Lab Services,Per Unit,$101.12 ,OP,101.12,101.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81253,Gjb2 gene known fam variants,Lab Services,Per Unit,$61.52 ,OP,61.52,61.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81254,Gjb6 gene com variants,Lab Services,Per Unit,$35.00 ,OP,35,35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81255,Hexa gene,Lab Services,Per Unit,$51.45 ,OP,51.45,51.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81256,Hfe gene,Lab Services,Per Unit,$65.36 ,OP,65.36,65.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81257,Hba1/hba2 gene,Lab Services,Per Unit,$102.26 ,OP,102.26,102.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81258,Hba1/hba2 gene fam vrnt,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81259,Hba1/hba2 full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81260,Ikbkap gene,Lab Services,Per Unit,$39.31 ,OP,39.31,39.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81261,Igh gene rearrange amp meth,Lab Services,Per Unit,$197.99 ,OP,197.99,197.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81262,Igh gene rearrang dir probe,Lab Services,Per Unit,$68.55 ,OP,68.55,68.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81263,Igh vari regional mutation,Lab Services,Per Unit,$294.52 ,OP,294.52,294.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81264,Igk rearrangeabn clonal pop,Lab Services,Per Unit,$172.73 ,OP,172.73,172.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81265,Str markers specimen anal,Lab Services,Per Unit,$233.07 ,OP,233.07,233.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81266,Str markers spec anal addl,Lab Services,Per Unit,$304.81 ,OP,304.81,304.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81267,Chimerism anal no cell selec,Lab Services,Per Unit,$207.46 ,OP,207.46,207.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81268,Chimerism anal w/cell select,Lab Services,Per Unit,$260.79 ,OP,260.79,260.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81269,Hba1/hba2 gene dup/del vrnts,Lab Services,Per Unit,$202.40 ,OP,202.4,202.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81270,Jak2 gene,Lab Services,Per Unit,$91.66 ,OP,91.66,91.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81271,Htt gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81272,Kit gene targeted seq analys,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81273,Kit gene analys d816 variant,Lab Services,Per Unit,$124.87 ,OP,124.87,124.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81274,Htt gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81275,Kras gene variants exon 2,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81276,Kras gene addl variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81277,Cytogenomic neo microra alys,Lab Services,Per Unit,"$1,160.00 ",OP,"1,160.00","1,160.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81278,Igh@/bcl2 translocation alys,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81279,Jak2 gene trgt sequence alys,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81283,Ifnl3 gene,Lab Services,Per Unit,$73.37 ,OP,73.37,73.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81284,Fxn gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81285,Fxn gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81286,Fxn gene full gene sequence,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81287,Mgmt gene prmtr mthyltn alys,Lab Services,Per Unit,$124.64 ,OP,124.64,124.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81288,Mlh1 gene,Lab Services,Per Unit,$192.32 ,OP,192.32,192.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81289,Fxn gene known famil variant,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81290,Mcoln1 gene,Lab Services,Per Unit,$39.31 ,OP,39.31,39.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81291,Mthfr gene,Lab Services,Per Unit,$65.34 ,OP,65.34,65.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81292,Mlh1 gene full seq,Lab Services,Per Unit,$675.40 ,OP,675.4,675.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81293,Mlh1 gene known variants,Lab Services,Per Unit,$331.00 ,OP,331,331,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81294,Mlh1 gene dup/delete variant,Lab Services,Per Unit,$202.40 ,OP,202.4,202.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81295,Msh2 gene full seq,Lab Services,Per Unit,$381.70 ,OP,381.7,381.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81296,Msh2 gene known variants,Lab Services,Per Unit,$337.73 ,OP,337.73,337.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81297,Msh2 gene dup/delete variant,Lab Services,Per Unit,$213.30 ,OP,213.3,213.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81298,Msh6 gene full seq,Lab Services,Per Unit,$641.85 ,OP,641.85,641.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81299,Msh6 gene known variants,Lab Services,Per Unit,$308.00 ,OP,308,308,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81300,Msh6 gene dup/delete variant,Lab Services,Per Unit,$238.00 ,OP,238,238,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81301,Microsatellite instability,Lab Services,Per Unit,$348.56 ,OP,348.56,348.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81302,Mecp2 gene full seq,Lab Services,Per Unit,$527.87 ,OP,527.87,527.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81303,Mecp2 gene known variant,Lab Services,Per Unit,$120.00 ,OP,120,120,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81304,Mecp2 gene dup/delet variant,Lab Services,Per Unit,$150.00 ,OP,150,150,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81305,Myd88 gene p.leu265pro vrnt,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81306,Nudt15 gene common variants,Lab Services,Per Unit,$291.36 ,OP,291.36,291.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81307,Palb2 gene full gene seq,Lab Services,Per Unit,$676.50 ,OP,676.5,676.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81308,Palb2 gene known famil vrnt,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81309,Pik3ca gene trgt seq alys,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81310,Npm1 gene,Lab Services,Per Unit,$246.52 ,OP,246.52,246.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81311,Nras gene variants exon 2&3,Lab Services,Per Unit,$295.79 ,OP,295.79,295.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81312,Pabpn1 gene detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81313,Pca3/klk3 antigen,Lab Services,Per Unit,$255.05 ,OP,255.05,255.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81314,Pdgfra gene,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81315,Pml/raralpha com breakpoints,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81316,Pml/raralpha 1 breakpoint,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81317,Pms2 gene full seq analysis,Lab Services,Per Unit,$676.50 ,OP,676.5,676.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81318,Pms2 known familial variants,Lab Services,Per Unit,$331.00 ,OP,331,331,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81319,Pms2 gene dup/delet variants,Lab Services,Per Unit,$203.50 ,OP,203.5,203.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81320,Plcg2 gene common variants,Lab Services,Per Unit,$291.36 ,OP,291.36,291.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81321,Pten gene full sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81322,Pten gene known fam variant,Lab Services,Per Unit,$46.60 ,OP,46.6,46.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81323,Pten gene dup/delet variant,Lab Services,Per Unit,$300.00 ,OP,300,300,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81324,Pmp22 gene dup/delet,Lab Services,Per Unit,$758.36 ,OP,758.36,758.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81325,Pmp22 gene full sequence,Lab Services,Per Unit,$769.58 ,OP,769.58,769.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81326,Pmp22 gene known fam variant,Lab Services,Per Unit,$46.60 ,OP,46.6,46.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81327,Sept9 gen prmtr mthyltn alys,Lab Services,Per Unit,$192.00 ,OP,192,192,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81328,Slco1b1 gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81329,Smn1 gene dos/deletion alys,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81330,Smpd1 gene common variants,Lab Services,Per Unit,$47.00 ,OP,47,47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81331,Snrpn/ube3a gene,Lab Services,Per Unit,$51.07 ,OP,51.07,51.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81332,Serpina1 gene,Lab Services,Per Unit,$43.65 ,OP,43.65,43.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81333,Tgfbi gene common variants,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81334,Runx1 gene targeted seq alys,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81335,Tpmt gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81336,Smn1 gene full gene sequence,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81337,Smn1 gen nown famil seq vrnt,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81338,Mpl gene common variants,Lab Services,Per Unit,$150.33 ,OP,150.33,150.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81339,Mpl gene seq alys exon 10,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81340,Trb@ gene rearrange amplify,Lab Services,Per Unit,$208.92 ,OP,208.92,208.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81341,Trb@ gene rearrange dirprobe,Lab Services,Per Unit,$49.59 ,OP,49.59,49.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81342,Trg gene rearrangement anal,Lab Services,Per Unit,$201.50 ,OP,201.5,201.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81343,Ppp2r2b gen detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81344,Tbp gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81345,Tert gene targeted seq alys,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81346,Tyms gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81347,Sf3b1 gene common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81348,Srsf2 gene common variants,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81350,Ugt1a1 gene common variants,Lab Services,Per Unit,$234.00 ,OP,234,234,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81351,Tp53 gene full gene sequence,Lab Services,Per Unit,$641.85 ,OP,641.85,641.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81352,Tp53 gene trgt sequence alys,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81353,Tp53 gene known famil vrnt,Lab Services,Per Unit,$308.00 ,OP,308,308,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81355,Vkorc1 gene,Lab Services,Per Unit,$88.20 ,OP,88.2,88.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81357,U2af1 gene common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81360,Zrsr2 gene common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81361,Hbb gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81362,Hbb gene known fam variant,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81363,Hbb gene dup/del variants,Lab Services,Per Unit,$202.40 ,OP,202.4,202.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81364,Hbb full gene sequence,Lab Services,Per Unit,$324.58 ,OP,324.58,324.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81370,Hla i & ii typing lr,Lab Services,Per Unit,$402.12 ,OP,402.12,402.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81371,Hla i & ii type verify lr,Lab Services,Per Unit,$404.52 ,OP,404.52,404.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81372,Hla i typing complete lr,Lab Services,Per Unit,$403.59 ,OP,403.59,403.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81373,Hla i typing 1 locus lr,Lab Services,Per Unit,$127.43 ,OP,127.43,127.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81374,Hla i typing 1 antigen lr,Lab Services,Per Unit,$74.33 ,OP,74.33,74.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81375,Hla ii typing ag equiv lr,Lab Services,Per Unit,$220.74 ,OP,220.74,220.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81376,Hla ii typing 1 locus lr,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81377,Hla ii type 1 ag equiv lr,Lab Services,Per Unit,$94.74 ,OP,94.74,94.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81378,Hla i & ii typing hr,Lab Services,Per Unit,$345.57 ,OP,345.57,345.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81379,Hla i typing complete hr,Lab Services,Per Unit,$335.38 ,OP,335.38,335.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81380,Hla i typing 1 locus hr,Lab Services,Per Unit,$177.25 ,OP,177.25,177.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81381,Hla i typing 1 allele hr,Lab Services,Per Unit,$169.90 ,OP,169.9,169.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81382,Hla ii typing 1 loc hr,Lab Services,Per Unit,$123.68 ,OP,123.68,123.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81383,Hla ii typing 1 allele hr,Lab Services,Per Unit,$109.13 ,OP,109.13,109.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81400,Mopath procedure level 1,Lab Services,Per Unit,$63.96 ,OP,63.96,63.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81401,Mopath procedure level 2,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81402,Mopath procedure level 3,Lab Services,Per Unit,$150.33 ,OP,150.33,150.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81403,Mopath procedure level 4,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81404,Mopath procedure level 5,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81405,Mopath procedure level 6,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81406,Mopath procedure level 7,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81407,Mopath procedure level 8,Lab Services,Per Unit,$846.27 ,OP,846.27,846.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81408,Mopath procedure level 9,Lab Services,Per Unit,"$2,000.00 ",OP,"2,000.00","2,000.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81410,Aortic dysfunction/dilation,Lab Services,Per Unit,$504.00 ,OP,504,504,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81411,Aortic dysfunction/dilation,Lab Services,Per Unit,"$1,350.19 ",OP,"1,350.19","1,350.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81412,Ashkenazi jewish assoc dis,Lab Services,Per Unit,"$2,448.56 ",OP,"2,448.56","2,448.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81413,Car ion chnnlpath inc 10 gns,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81414,Car ion chnnlpath inc 2 gns,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81415,Exome sequence analysis,Lab Services,Per Unit,"$4,780.00 ",OP,"4,780.00","4,780.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81416,Exome sequence analysis,Lab Services,Per Unit,"$12,000.00 ",OP,"12,000.00","12,000.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81417,Exome re-evaluation,Lab Services,Per Unit,$320.00 ,OP,320,320,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81419,Epilepsy gen seq alys panel,Lab Services,Per Unit,"$2,448.56 ",OP,"2,448.56","2,448.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81420,Fetal chrmoml aneuploidy,Lab Services,Per Unit,$759.05 ,OP,759.05,759.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81422,Fetal chrmoml microdeltj,Lab Services,Per Unit,$759.05 ,OP,759.05,759.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81425,Genome sequence analysis,Lab Services,Per Unit,"$5,031.20 ",OP,"5,031.20","5,031.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81426,Genome sequence analysis,Lab Services,Per Unit,"$2,709.95 ",OP,"2,709.95","2,709.95",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81427,Genome re-evaluation,Lab Services,Per Unit,"$2,337.65 ",OP,"2,337.65","2,337.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81430,Hearing loss sequence analys,Lab Services,Per Unit,"$1,625.00 ",OP,"1,625.00","1,625.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81431,Hearing loss dup/del analys,Lab Services,Per Unit,$679.57 ,OP,679.57,679.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81432,Hrdtry brst ca-rlatd dsordrs,Lab Services,Per Unit,$679.05 ,OP,679.05,679.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81433,Hrdtry brst ca-rlatd dsordrs,Lab Services,Per Unit,$438.93 ,OP,438.93,438.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81434,Hereditary retinal disorders,Lab Services,Per Unit,$597.91 ,OP,597.91,597.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81435,Hereditary colon ca dsordrs,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81436,Hereditary colon ca dsordrs,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81437,Heredtry nurondcrn tum dsrdr,Lab Services,Per Unit,$438.93 ,OP,438.93,438.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81438,Heredtry nurondcrn tum dsrdr,Lab Services,Per Unit,$438.93 ,OP,438.93,438.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81439,Hrdtry cardmypy gene panel,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81440,Mitochondrial gene,Lab Services,Per Unit,"$3,324.00 ",OP,"3,324.00","3,324.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81442,Noonan spectrum disorders,Lab Services,Per Unit,"$2,143.60 ",OP,"2,143.60","2,143.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81443,Genetic tstg severe inh cond,Lab Services,Per Unit,"$2,448.56 ",OP,"2,448.56","2,448.56",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81445,Targeted genomic seq analys,Lab Services,Per Unit,$597.91 ,OP,597.91,597.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81448,Hrdtry perph neurphy panel,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81450,Targeted genomic seq analys,Lab Services,Per Unit,$759.53 ,OP,759.53,759.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81455,Targeted genomic seq analys,Lab Services,Per Unit,"$2,919.60 ",OP,"2,919.60","2,919.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81460,Whole mitochondrial genome,Lab Services,Per Unit,"$1,287.00 ",OP,"1,287.00","1,287.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81465,Whole mitochondrial genome,Lab Services,Per Unit,$936.00 ,OP,936,936,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81470,X-linked intellectual dblt,Lab Services,Per Unit,$914.00 ,OP,914,914,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81471,X-linked intellectual dblt,Lab Services,Per Unit,$914.00 ,OP,914,914,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81490,Autoimmune rheumatoid arthr,Lab Services,Per Unit,$840.65 ,OP,840.65,840.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81493,Cor artery disease mrna,Lab Services,Per Unit,"$1,050.00 ",OP,"1,050.00","1,050.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81500,Onco (ovar) two proteins,Lab Services,Per Unit,$260.50 ,OP,260.5,260.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81503,Onco (ovar) five proteins,Lab Services,Per Unit,$897.00 ,OP,897,897,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81504,Oncology tissue of origin,Lab Services,Per Unit,$520.00 ,OP,520,520,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81506,Endo assay seven anal,Lab Services,Per Unit,$68.92 ,OP,68.92,68.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81507,Fetal aneuploidy trisom risk,Lab Services,Per Unit,$795.00 ,OP,795,795,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81508,Ftl cgen abnor two proteins,Lab Services,Per Unit,$54.30 ,OP,54.3,54.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81509,Ftl cgen abnor 3 proteins,Lab Services,Per Unit,"$1,487.37 ",OP,"1,487.37","1,487.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81510,Ftl cgen abnor three anal,Lab Services,Per Unit,$55.54 ,OP,55.54,55.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81511,Ftl cgen abnor four anal,Lab Services,Per Unit,$153.50 ,OP,153.5,153.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81512,Ftl cgen abnor five anal,Lab Services,Per Unit,$69.52 ,OP,69.52,69.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81513,Nfct ds bv rna vag flu alg,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81514,Nfct ds bv&vaginitis dna alg,Lab Services,Per Unit,$262.99 ,OP,262.99,262.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81518,Onc brst mrna 11 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81519,Oncology breast mrna,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81520,Onc breast mrna 58 genes,Lab Services,Per Unit,"$2,510.21 ",OP,"2,510.21","2,510.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81521,Onc breast mrna 70 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81522,Onc breast mrna 12 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81525,Oncology colon mrna,Lab Services,Per Unit,"$3,116.00 ",OP,"3,116.00","3,116.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81528,Oncology colorectal scr,Lab Services,Per Unit,$508.87 ,OP,508.87,508.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81529,Onc cutan mlnma mrna 31 gene,Lab Services,Per Unit,"$7,193.00 ",OP,"7,193.00","7,193.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81535,Oncology gynecologic,Lab Services,Per Unit,$579.46 ,OP,579.46,579.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81536,Oncology gynecologic,Lab Services,Per Unit,$177.56 ,OP,177.56,177.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81538,Oncology lung,Lab Services,Per Unit,"$2,871.00 ",OP,"2,871.00","2,871.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81539,Oncology prostate prob score,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81540,Oncology tum unknown origin,Lab Services,Per Unit,"$3,750.00 ",OP,"3,750.00","3,750.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81541,Onc prostate mrna 46 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81542,Onc prostate mrna 22 cnt gen,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81546,Onc thyr mrna 10-196 gen alg,Lab Services,Per Unit,"$3,600.00 ",OP,"3,600.00","3,600.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81551,Onc prostate 3 genes,Lab Services,Per Unit,"$2,030.00 ",OP,"2,030.00","2,030.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81552,Onc uveal mlnma mrna 15 gene,Lab Services,Per Unit,"$7,776.00 ",OP,"7,776.00","7,776.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81554,Pulm ds ipf mrna 190 gen alg,Lab Services,Per Unit,"$5,500.00 ",OP,"5,500.00","5,500.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81595,Cardiology hrt trnspl mrna,Lab Services,Per Unit,"$3,240.00 ",OP,"3,240.00","3,240.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,81596,Nfct ds chrnc hcv 6 assays,Lab Services,Per Unit,$72.19 ,OP,72.19,72.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82009,Test for acetone/ketones,Lab Services,Per Unit,$4.52 ,OP,4.52,39.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82010,Acetone assay,Lab Services,Per Unit,$8.17 ,OP,8.17,8.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82013,Acetylcholinesterase assay,Lab Services,Per Unit,$12.29 ,OP,12.29,12.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82016,Acylcarnitines qual,Lab Services,Per Unit,$16.49 ,OP,16.49,16.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82017,Acylcarnitines quant,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82024,Assay of acth,Lab Services,Per Unit,$38.62 ,OP,38.62,38.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82030,Assay of adp & amp,Lab Services,Per Unit,$25.80 ,OP,25.8,25.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82040,Assay of serum albumin,Lab Services,Per Unit,$4.95 ,OP,4.95,47.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82042,Other source albumin quan ea,Lab Services,Per Unit,$7.78 ,OP,7.78,37.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82043,Ur albumin quantitative,Lab Services,Per Unit,$5.78 ,OP,5.78,56.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82044,Ur albumin semiquantitative,Lab Services,Per Unit,$6.23 ,OP,6.23,6.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82045,Albumin ischemia modified,Lab Services,Per Unit,$33.94 ,OP,33.94,33.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82075,Assay of breath ethanol,Lab Services,Per Unit,$30.00 ,OP,30,59.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82077,Assay spec xcp ur&breath ia,Lab Services,Per Unit,$17.27 ,OP,17.27,17.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82085,Assay of aldolase,Lab Services,Per Unit,$9.71 ,OP,9.71,127.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82088,Assay of aldosterone,Lab Services,Per Unit,$40.75 ,OP,40.75,40.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82103,Alpha-1-antitrypsin total,Lab Services,Per Unit,$13.44 ,OP,13.44,76.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82104,Alpha-1-antitrypsin pheno,Lab Services,Per Unit,$14.46 ,OP,14.46,14.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82105,Alpha-fetoprotein serum,Lab Services,Per Unit,$16.77 ,OP,16.77,96.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82106,Alpha-fetoprotein amniotic,Lab Services,Per Unit,$17.00 ,OP,17,17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82107,Alpha-fetoprotein l3,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82108,Assay of aluminum,Lab Services,Per Unit,$25.48 ,OP,25.48,25.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82120,Amines vaginal fluid qual,Lab Services,Per Unit,$5.99 ,OP,5.99,5.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82127,Amino acid single qual,Lab Services,Per Unit,$14.18 ,OP,14.18,14.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82128,Amino acids mult qual,Lab Services,Per Unit,$13.87 ,OP,13.87,13.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82131,Amino acids single quant,Lab Services,Per Unit,$22.98 ,OP,22.98,213.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82135,Assay aminolevulinic acid,Lab Services,Per Unit,$16.45 ,OP,16.45,16.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82136,Amino acids quant 2-5,Lab Services,Per Unit,$19.61 ,OP,19.61,19.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82139,Amino acids quan 6 or more,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82140,Assay of ammonia,Lab Services,Per Unit,$14.57 ,OP,14.57,149.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82143,Amniotic fluid scan,Lab Services,Per Unit,$9.35 ,OP,9.35,9.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82150,Assay of amylase,Lab Services,Per Unit,$6.48 ,OP,6.48,69.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82154,Androstanediol glucuronide,Lab Services,Per Unit,$28.83 ,OP,28.83,28.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82157,Assay of androstenedione,Lab Services,Per Unit,$29.28 ,OP,29.28,29.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82160,Assay of androsterone,Lab Services,Per Unit,$25.55 ,OP,25.55,25.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82163,Assay of angiotensin ii,Lab Services,Per Unit,$20.52 ,OP,20.52,20.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82164,Angiotensin i enzyme test,Lab Services,Per Unit,$14.60 ,OP,14.6,14.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82172,Assay of apolipoprotein,Lab Services,Per Unit,$21.09 ,OP,21.09,65.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82175,Assay of arsenic,Lab Services,Per Unit,$18.97 ,OP,18.97,18.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82180,Assay of ascorbic acid,Lab Services,Per Unit,$9.89 ,OP,9.89,9.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82190,Atomic absorption,Lab Services,Per Unit,$15.90 ,OP,15.9,15.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82232,Assay of beta-2 protein,Lab Services,Per Unit,$16.18 ,OP,16.18,16.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82239,Bile acids total,Lab Services,Per Unit,$17.12 ,OP,17.12,17.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82240,Bile acids cholylglycine,Lab Services,Per Unit,$26.58 ,OP,26.58,26.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82247,Bilirubin total,Lab Services,Per Unit,$5.02 ,OP,5.02,42.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82248,Bilirubin direct,Lab Services,Per Unit,$5.02 ,OP,5.02,29.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82252,Fecal bilirubin test,Lab Services,Per Unit,$4.56 ,OP,4.56,4.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82261,Assay of biotinidase,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82270,Occult blood feces,Lab Services,Per Unit,$4.38 ,OP,4.38,26.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82271,Occult blood other sources,Lab Services,Per Unit,$5.32 ,OP,5.32,5.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82272,Occult bld feces 1-3 tests,Lab Services,Per Unit,$4.23 ,OP,4.23,4.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82274,Assay test for blood fecal,Lab Services,Per Unit,$15.92 ,OP,15.92,15.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82286,Assay of bradykinin,Lab Services,Per Unit,$5.16 ,OP,5.16,5.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82300,Assay of cadmium,Lab Services,Per Unit,$23.64 ,OP,23.64,23.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82306,Vitamin d 25 hydroxy,Lab Services,Per Unit,$29.60 ,OP,29.6,29.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82308,Assay of calcitonin,Lab Services,Per Unit,$26.79 ,OP,26.79,26.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82310,Assay of calcium,Lab Services,Per Unit,$5.16 ,OP,5.16,46.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82330,Assay of calcium,Lab Services,Per Unit,$13.68 ,OP,13.68,145.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82331,Calcium infusion test,Lab Services,Per Unit,$13.34 ,OP,13.34,13.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82340,Assay of calcium in urine,Lab Services,Per Unit,$6.03 ,OP,6.03,61.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82355,Calculus analysis qual,Lab Services,Per Unit,$11.58 ,OP,11.58,137.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82360,Calculus assay quant,Lab Services,Per Unit,$12.87 ,OP,12.87,96.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82365,Calculus spectroscopy,Lab Services,Per Unit,$12.90 ,OP,12.9,67.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82370,X-ray assay calculus,Lab Services,Per Unit,$12.52 ,OP,12.52,12.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82373,Assay c-d transfer measure,Lab Services,Per Unit,$18.06 ,OP,18.06,18.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82374,Assay blood carbon dioxide,Lab Services,Per Unit,$4.88 ,OP,4.88,4.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82375,Assay carboxyhb quant,Lab Services,Per Unit,$12.32 ,OP,12.32,55.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82376,Assay carboxyhb qual,Lab Services,Per Unit,$14.07 ,OP,14.07,14.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82378,Carcinoembryonic antigen,Lab Services,Per Unit,$18.96 ,OP,18.96,146,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82379,Assay of carnitine,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82380,Assay of carotene,Lab Services,Per Unit,$9.22 ,OP,9.22,9.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82382,Assay urine catecholamines,Lab Services,Per Unit,$27.30 ,OP,27.3,27.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82383,Assay blood catecholamines,Lab Services,Per Unit,$29.08 ,OP,29.08,29.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82384,Assay three catecholamines,Lab Services,Per Unit,$25.25 ,OP,25.25,115.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82387,Assay of cathepsin-d,Lab Services,Per Unit,$18.06 ,OP,18.06,18.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82390,Assay of ceruloplasmin,Lab Services,Per Unit,$10.74 ,OP,10.74,63.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82397,Chemiluminescent assay,Lab Services,Per Unit,$14.12 ,OP,14.12,14.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82415,Assay of chloramphenicol,Lab Services,Per Unit,$12.67 ,OP,12.67,12.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82435,Assay of blood chloride,Lab Services,Per Unit,$4.60 ,OP,4.6,11.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82436,Assay of urine chloride,Lab Services,Per Unit,$5.75 ,OP,5.75,5.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82438,Assay other fluid chlorides,Lab Services,Per Unit,$5.00 ,OP,5,5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82441,Test for chlorohydrocarbons,Lab Services,Per Unit,$6.01 ,OP,6.01,6.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82465,Assay bld/serum cholesterol,Lab Services,Per Unit,$4.35 ,OP,4.35,40.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82480,Assay serum cholinesterase,Lab Services,Per Unit,$7.87 ,OP,7.87,85.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82482,Assay rbc cholinesterase,Lab Services,Per Unit,$9.81 ,OP,9.81,9.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82485,Assay chondroitin sulfate,Lab Services,Per Unit,$20.65 ,OP,20.65,20.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82495,Assay of chromium,Lab Services,Per Unit,$20.28 ,OP,20.28,20.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82507,Assay of citrate,Lab Services,Per Unit,$27.80 ,OP,27.8,27.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82523,Collagen crosslinks,Lab Services,Per Unit,$18.68 ,OP,18.68,18.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82525,Assay of copper,Lab Services,Per Unit,$12.41 ,OP,12.41,12.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82528,Assay of corticosterone,Lab Services,Per Unit,$22.52 ,OP,22.52,22.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82530,Cortisol free,Lab Services,Per Unit,$16.71 ,OP,16.71,16.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82533,Total cortisol,Lab Services,Per Unit,$16.30 ,OP,16.3,154.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82540,Assay of creatine,Lab Services,Per Unit,$4.64 ,OP,4.64,4.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82542,Col chromotography qual/quan,Lab Services,Per Unit,$24.09 ,OP,24.09,24.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82550,Assay of ck (cpk),Lab Services,Per Unit,$6.51 ,OP,6.51,50.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82552,Assay of cpk in blood,Lab Services,Per Unit,$13.39 ,OP,13.39,79.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82553,Creatine mb fraction,Lab Services,Per Unit,$11.55 ,OP,11.55,77.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82554,Creatine isoforms,Lab Services,Per Unit,$11.87 ,OP,11.87,11.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82565,Assay of creatinine,Lab Services,Per Unit,$5.12 ,OP,5.12,39.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82570,Assay of urine creatinine,Lab Services,Per Unit,$5.18 ,OP,5.18,31.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82575,Creatinine clearance test,Lab Services,Per Unit,$9.46 ,OP,9.46,104.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82585,Assay of cryofibrinogen,Lab Services,Per Unit,$14.14 ,OP,14.14,14.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82595,Assay of cryoglobulin,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82600,Assay of cyanide,Lab Services,Per Unit,$19.40 ,OP,19.4,19.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82607,Vitamin b-12,Lab Services,Per Unit,$15.08 ,OP,15.08,93.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82608,B-12 binding capacity,Lab Services,Per Unit,$14.32 ,OP,14.32,14.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82610,Cystatin c,Lab Services,Per Unit,$18.52 ,OP,18.52,18.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82615,Test for urine cystines,Lab Services,Per Unit,$9.55 ,OP,9.55,9.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82626,Dehydroepiandrosterone,Lab Services,Per Unit,$25.27 ,OP,25.27,25.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82627,Dehydroepiandrosterone,Lab Services,Per Unit,$22.23 ,OP,22.23,150.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82633,Desoxycorticosterone,Lab Services,Per Unit,$30.98 ,OP,30.98,30.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82634,Deoxycortisol,Lab Services,Per Unit,$29.28 ,OP,29.28,29.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82638,Assay of dibucaine number,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82642,Dihydrotestosterone,Lab Services,Per Unit,$29.28 ,OP,29.28,29.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82652,Vit d 1 25-dihydroxy,Lab Services,Per Unit,$38.50 ,OP,38.5,314.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82656,Pancreatic elastase fecal,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82657,Enzyme cell activity,Lab Services,Per Unit,$22.17 ,OP,22.17,22.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82658,Enzyme cell activity ra,Lab Services,Per Unit,$44.03 ,OP,44.03,44.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82664,Electrophoretic test,Lab Services,Per Unit,$61.50 ,OP,61.5,61.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82668,Assay of erythropoietin,Lab Services,Per Unit,$18.79 ,OP,18.79,18.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82670,Assay of total estradiol,Lab Services,Per Unit,$27.94 ,OP,27.94,182.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82671,Assay of estrogens,Lab Services,Per Unit,$32.30 ,OP,32.3,32.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82672,Assay of estrogen,Lab Services,Per Unit,$21.70 ,OP,21.7,122.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82677,Assay of estriol,Lab Services,Per Unit,$24.18 ,OP,24.18,89.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82679,Assay of estrone,Lab Services,Per Unit,$24.95 ,OP,24.95,24.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82681,Assay dir meas fr estradiol,Lab Services,Per Unit,$27.94 ,OP,27.94,27.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82693,Assay of ethylene glycol,Lab Services,Per Unit,$14.90 ,OP,14.9,14.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82696,Assay of etiocholanolone,Lab Services,Per Unit,$26.24 ,OP,26.24,26.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82705,Fats/lipids feces qual,Lab Services,Per Unit,$5.10 ,OP,5.1,5.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82710,Fats/lipids feces quant,Lab Services,Per Unit,$16.80 ,OP,16.8,16.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82715,Assay of fecal fat,Lab Services,Per Unit,$22.97 ,OP,22.97,22.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82725,Assay of blood fatty acids,Lab Services,Per Unit,$18.77 ,OP,18.77,18.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82726,Long chain fatty acids,Lab Services,Per Unit,$19.75 ,OP,19.75,19.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82728,Assay of ferritin,Lab Services,Per Unit,$13.63 ,OP,13.63,97.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82731,Assay of fetal fibronectin,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82735,Assay of fluoride,Lab Services,Per Unit,$18.54 ,OP,18.54,18.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82746,Assay of folic acid serum,Lab Services,Per Unit,$14.70 ,OP,14.7,76.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82747,Assay of folic acid rbc,Lab Services,Per Unit,$17.65 ,OP,17.65,188.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82757,Assay of semen fructose,Lab Services,Per Unit,$17.34 ,OP,17.34,17.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82759,Assay of rbc galactokinase,Lab Services,Per Unit,$21.48 ,OP,21.48,21.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82760,Assay of galactose,Lab Services,Per Unit,$11.20 ,OP,11.2,11.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82775,Assay galactose transferase,Lab Services,Per Unit,$21.07 ,OP,21.07,21.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82776,Galactose transferase test,Lab Services,Per Unit,$11.74 ,OP,11.74,11.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82777,Galectin-3,Lab Services,Per Unit,$44.25 ,OP,44.25,44.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82784,Assay iga/igd/igg/igm each,Lab Services,Per Unit,$9.30 ,OP,9.3,81.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82785,Assay of ige,Lab Services,Per Unit,$16.46 ,OP,16.46,94.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82787,Igg 1 2 3 or 4 each,Lab Services,Per Unit,$8.02 ,OP,8.02,8.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82800,Blood ph,Lab Services,Per Unit,$11.00 ,OP,11,11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82803,Blood gases any combination,Lab Services,Per Unit,$26.07 ,OP,26.07,109.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82805,Blood gases w/o2 saturation,Lab Services,Per Unit,$78.77 ,OP,78.77,177.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82810,Blood gases o2 sat only,Lab Services,Per Unit,$9.77 ,OP,9.77,14.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82820,Hemoglobin-oxygen affinity,Lab Services,Per Unit,$13.34 ,OP,13.34,13.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82930,Gastric analy w/ph ea spec,Lab Services,Per Unit,$6.71 ,OP,6.71,6.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82938,Gastrin test,Lab Services,Per Unit,$17.69 ,OP,17.69,17.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82941,Assay of gastrin,Lab Services,Per Unit,$17.63 ,OP,17.63,17.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82943,Assay of glucagon,Lab Services,Per Unit,$14.29 ,OP,14.29,14.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82945,Glucose other fluid,Lab Services,Per Unit,$3.93 ,OP,3.93,66.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82946,Glucagon tolerance test,Lab Services,Per Unit,$17.77 ,OP,17.77,17.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82947,Assay glucose blood quant,Lab Services,Per Unit,$3.93 ,OP,3.93,34.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82948,Reagent strip/blood glucose,Lab Services,Per Unit,$5.04 ,OP,5.04,18.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82950,Glucose test,Lab Services,Per Unit,$4.75 ,OP,4.75,49.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82951,Glucose tolerance test (gtt),Lab Services,Per Unit,$12.87 ,OP,12.87,102.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82952,Gtt-added samples,Lab Services,Per Unit,$3.92 ,OP,3.92,46.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82955,Assay of g6pd enzyme,Lab Services,Per Unit,$9.70 ,OP,9.7,9.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82960,Test for g6pd enzyme,Lab Services,Per Unit,$6.05 ,OP,6.05,6.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82962,Glucose blood test,Lab Services,Per Unit,$3.28 ,OP,3.28,15.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82963,Assay of glucosidase,Lab Services,Per Unit,$21.48 ,OP,21.48,21.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82965,Assay of gdh enzyme,Lab Services,Per Unit,$13.15 ,OP,13.15,13.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82977,Assay of ggt,Lab Services,Per Unit,$7.20 ,OP,7.2,64.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82978,Assay of glutathione,Lab Services,Per Unit,$15.45 ,OP,15.45,15.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82979,Assay rbc glutathione,Lab Services,Per Unit,$9.44 ,OP,9.44,9.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,82985,Assay of glycated protein,Lab Services,Per Unit,$16.76 ,OP,16.76,16.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83001,Assay of gonadotropin (fsh),Lab Services,Per Unit,$18.58 ,OP,18.58,108.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83002,Assay of gonadotropin (lh),Lab Services,Per Unit,$18.52 ,OP,18.52,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83003,Assay growth hormone (hgh),Lab Services,Per Unit,$16.67 ,OP,16.67,16.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83006,Growth stimulation gene 2,Lab Services,Per Unit,$75.60 ,OP,75.6,75.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83009,H pylori (c-13) blood,Lab Services,Per Unit,$67.36 ,OP,67.36,67.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83010,Assay of haptoglobin quant,Lab Services,Per Unit,$12.58 ,OP,12.58,12.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83012,Assay of haptoglobins,Lab Services,Per Unit,$26.89 ,OP,26.89,26.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83013,H pylori (c-13) breath,Lab Services,Per Unit,$67.36 ,OP,67.36,67.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83014,H pylori drug admin,Lab Services,Per Unit,$7.86 ,OP,7.86,7.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83015,Heavy metal qual any anal,Lab Services,Per Unit,$20.94 ,OP,20.94,20.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83018,Heavy metal quant each nes,Lab Services,Per Unit,$21.96 ,OP,21.96,21.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83020,Hemoglobin electrophoresis,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83021,Hemoglobin chromotography,Lab Services,Per Unit,$18.06 ,OP,18.06,18.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83026,Hemoglobin copper sulfate,Lab Services,Per Unit,$4.01 ,OP,4.01,4.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83030,Fetal hemoglobin chemical,Lab Services,Per Unit,$10.74 ,OP,10.74,10.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83033,Fetal hemoglobin assay qual,Lab Services,Per Unit,$8.00 ,OP,8,8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83036,Glycosylated hemoglobin test,Lab Services,Per Unit,$9.71 ,OP,9.71,66.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83037,Glycosylated hb home device,Lab Services,Per Unit,$9.71 ,OP,9.71,9.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83045,Blood methemoglobin test,Lab Services,Per Unit,$6.49 ,OP,6.49,6.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83050,Blood methemoglobin assay,Lab Services,Per Unit,$8.20 ,OP,8.2,30.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83051,Assay of plasma hemoglobin,Lab Services,Per Unit,$7.31 ,OP,7.31,7.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83060,Blood sulfhemoglobin assay,Lab Services,Per Unit,$8.80 ,OP,8.8,8.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83065,Assay of hemoglobin heat,Lab Services,Per Unit,$9.00 ,OP,9,9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83068,Hemoglobin stability screen,Lab Services,Per Unit,$9.47 ,OP,9.47,9.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83069,Assay of urine hemoglobin,Lab Services,Per Unit,$3.95 ,OP,3.95,3.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83070,Assay of hemosiderin qual,Lab Services,Per Unit,$4.75 ,OP,4.75,4.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83080,Assay of b hexosaminidase,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83088,Assay of histamine,Lab Services,Per Unit,$29.53 ,OP,29.53,29.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83090,Assay of homocystine,Lab Services,Per Unit,$17.92 ,OP,17.92,139.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83150,Assay of homovanillic acid,Lab Services,Per Unit,$22.41 ,OP,22.41,22.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83491,Assay of corticosteroids 17,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83497,Assay of 5-hiaa,Lab Services,Per Unit,$12.90 ,OP,12.9,12.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83498,Assay of progesterone 17-d,Lab Services,Per Unit,$27.17 ,OP,27.17,27.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83500,Assay free hydroxyproline,Lab Services,Per Unit,$22.65 ,OP,22.65,22.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83505,Assay total hydroxyproline,Lab Services,Per Unit,$24.30 ,OP,24.3,24.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83516,Immunoassay nonantibody,Lab Services,Per Unit,$11.53 ,OP,11.53,130.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83518,Immunoassay dipstick,Lab Services,Per Unit,$9.64 ,OP,9.64,9.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83519,Ria nonantibody,Lab Services,Per Unit,$18.40 ,OP,18.4,18.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83520,Immunoassay quant nos nonab,Lab Services,Per Unit,$17.27 ,OP,17.27,118.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83525,Assay of insulin,Lab Services,Per Unit,$11.43 ,OP,11.43,67.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83527,Assay of insulin,Lab Services,Per Unit,$12.95 ,OP,12.95,12.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83528,Assay of intrinsic factor,Lab Services,Per Unit,$19.82 ,OP,19.82,19.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83540,Assay of iron,Lab Services,Per Unit,$6.47 ,OP,6.47,52.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83550,Iron binding test,Lab Services,Per Unit,$8.74 ,OP,8.74,63.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83570,Assay of idh enzyme,Lab Services,Per Unit,$8.85 ,OP,8.85,8.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83582,Assay of ketogenic steroids,Lab Services,Per Unit,$15.47 ,OP,15.47,15.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83586,Assay 17- ketosteroids,Lab Services,Per Unit,$12.80 ,OP,12.8,12.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83593,Fractionation ketosteroids,Lab Services,Per Unit,$28.50 ,OP,28.5,28.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83605,Assay of lactic acid,Lab Services,Per Unit,$11.57 ,OP,11.57,11.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83615,Lactate (ld) (ldh) enzyme,Lab Services,Per Unit,$6.04 ,OP,6.04,38.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83625,Assay of ldh enzymes,Lab Services,Per Unit,$12.79 ,OP,12.79,12.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83630,Lactoferrin fecal (qual),Lab Services,Per Unit,$19.70 ,OP,19.7,19.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83631,Lactoferrin fecal (quant),Lab Services,Per Unit,$19.63 ,OP,19.63,19.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83632,Placental lactogen,Lab Services,Per Unit,$20.22 ,OP,20.22,20.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83633,Test urine for lactose,Lab Services,Per Unit,$11.25 ,OP,11.25,11.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83655,Assay of lead,Lab Services,Per Unit,$12.11 ,OP,12.11,51.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83661,L/s ratio fetal lung,Lab Services,Per Unit,$21.99 ,OP,21.99,21.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83662,Foam stability fetal lung,Lab Services,Per Unit,$18.91 ,OP,18.91,18.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83663,Fluoro polarize fetal lung,Lab Services,Per Unit,$18.91 ,OP,18.91,18.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83664,Lamellar bdy fetal lung,Lab Services,Per Unit,$19.32 ,OP,19.32,19.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83670,Assay of lap enzyme,Lab Services,Per Unit,$9.81 ,OP,9.81,9.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83690,Assay of lipase,Lab Services,Per Unit,$6.89 ,OP,6.89,62.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83695,Assay of lipoprotein(a),Lab Services,Per Unit,$14.32 ,OP,14.32,14.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83698,Assay lipoprotein pla2,Lab Services,Per Unit,$46.31 ,OP,46.31,46.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83700,Lipopro bld electrophoretic,Lab Services,Per Unit,$11.26 ,OP,11.26,11.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83701,Lipoprotein bld hr fraction,Lab Services,Per Unit,$33.86 ,OP,33.86,33.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83704,Lipoprotein bld quan part,Lab Services,Per Unit,$34.19 ,OP,34.19,34.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83718,Assay of lipoprotein,Lab Services,Per Unit,$8.19 ,OP,8.19,8.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83719,Assay of blood lipoprotein,Lab Services,Per Unit,$12.75 ,OP,12.75,12.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83721,Assay of blood lipoprotein,Lab Services,Per Unit,$10.50 ,OP,10.5,31.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83722,Lipoprtn dir meas sd ldl chl,Lab Services,Per Unit,$34.19 ,OP,34.19,34.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83727,Assay of lrh hormone,Lab Services,Per Unit,$17.19 ,OP,17.19,17.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83735,Assay of magnesium,Lab Services,Per Unit,$6.70 ,OP,6.7,49.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83775,Assay malate dehydrogenase,Lab Services,Per Unit,$7.37 ,OP,7.37,7.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83785,Assay of manganese,Lab Services,Per Unit,$26.65 ,OP,26.65,26.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83789,Mass spectrometry qual/quan,Lab Services,Per Unit,$24.11 ,OP,24.11,24.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83825,Assay of mercury,Lab Services,Per Unit,$16.26 ,OP,16.26,16.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83835,Assay of metanephrines,Lab Services,Per Unit,$16.94 ,OP,16.94,16.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83857,Assay of methemalbumin,Lab Services,Per Unit,$10.74 ,OP,10.74,10.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83861,Microfluid analy tears,Lab Services,Per Unit,$22.48 ,OP,22.48,22.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83864,Mucopolysaccharides,Lab Services,Per Unit,$28.50 ,OP,28.5,28.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83872,Assay synovial fluid mucin,Lab Services,Per Unit,$5.86 ,OP,5.86,5.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83873,Assay of csf protein,Lab Services,Per Unit,$17.20 ,OP,17.2,17.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83874,Assay of myoglobin,Lab Services,Per Unit,$12.92 ,OP,12.92,88.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83876,Assay myeloperoxidase,Lab Services,Per Unit,$50.86 ,OP,50.86,50.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83880,Assay of natriuretic peptide,Lab Services,Per Unit,$39.26 ,OP,39.26,117.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83883,Assay nephelometry not spec,Lab Services,Per Unit,$13.60 ,OP,13.6,13.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83885,Assay of nickel,Lab Services,Per Unit,$24.51 ,OP,24.51,24.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83915,Assay of nucleotidase,Lab Services,Per Unit,$11.15 ,OP,11.15,11.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83916,Oligoclonal bands,Lab Services,Per Unit,$27.39 ,OP,27.39,27.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83918,Organic acids total quant,Lab Services,Per Unit,$23.60 ,OP,23.6,23.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83919,Organic acids qual each,Lab Services,Per Unit,$16.45 ,OP,16.45,16.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83921,Organic acid single quant,Lab Services,Per Unit,$21.21 ,OP,21.21,145.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83930,Assay of blood osmolality,Lab Services,Per Unit,$6.61 ,OP,6.61,6.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83935,Assay of urine osmolality,Lab Services,Per Unit,$6.82 ,OP,6.82,6.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83937,Assay of osteocalcin,Lab Services,Per Unit,$29.85 ,OP,29.85,29.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83945,Assay of oxalate,Lab Services,Per Unit,$14.45 ,OP,14.45,14.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83950,Oncoprotein her-2/neu,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83951,Oncoprotein dcp,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83970,Assay of parathormone,Lab Services,Per Unit,$41.28 ,OP,41.28,150.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83986,Assay ph body fluid nos,Lab Services,Per Unit,$3.58 ,OP,3.58,42.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83987,Exhaled breath condensate,Lab Services,Per Unit,$3.58 ,OP,3.58,3.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,83993,Assay for calprotectin fecal,Lab Services,Per Unit,$19.63 ,OP,19.63,19.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84030,Assay of blood pku,Lab Services,Per Unit,$5.50 ,OP,5.5,5.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84035,Assay of phenylketones,Lab Services,Per Unit,$3.98 ,OP,3.98,3.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84060,Assay acid phosphatase,Lab Services,Per Unit,$7.64 ,OP,7.64,7.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84066,Assay prostate phosphatase,Lab Services,Per Unit,$9.66 ,OP,9.66,52.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84075,Assay alkaline phosphatase,Lab Services,Per Unit,$5.18 ,OP,5.18,49.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84078,Assay alkaline phosphatase,Lab Services,Per Unit,$8.26 ,OP,8.26,8.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84080,Assay alkaline phosphatases,Lab Services,Per Unit,$14.78 ,OP,14.78,14.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84081,Assay phosphatidylglycerol,Lab Services,Per Unit,$16.52 ,OP,16.52,16.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84085,Assay of rbc pg6d enzyme,Lab Services,Per Unit,$9.44 ,OP,9.44,9.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84087,Assay phosphohexose enzymes,Lab Services,Per Unit,$10.73 ,OP,10.73,10.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84100,Assay of phosphorus,Lab Services,Per Unit,$4.74 ,OP,4.74,30.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84105,Assay of urine phosphorus,Lab Services,Per Unit,$5.78 ,OP,5.78,5.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84106,Test for porphobilinogen,Lab Services,Per Unit,$5.82 ,OP,5.82,5.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84110,Assay of porphobilinogen,Lab Services,Per Unit,$8.44 ,OP,8.44,8.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84112,Eval amniotic fluid protein,Lab Services,Per Unit,$98.11 ,OP,98.11,98.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84119,Test urine for porphyrins,Lab Services,Per Unit,$13.36 ,OP,13.36,13.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84120,Assay of urine porphyrins,Lab Services,Per Unit,$14.71 ,OP,14.71,14.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84126,Assay of feces porphyrins,Lab Services,Per Unit,$39.11 ,OP,39.11,39.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84132,Assay of serum potassium,Lab Services,Per Unit,$4.76 ,OP,4.76,26.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84133,Assay of urine potassium,Lab Services,Per Unit,$4.73 ,OP,4.73,4.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84134,Assay of prealbumin,Lab Services,Per Unit,$14.59 ,OP,14.59,134.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84135,Assay of pregnanediol,Lab Services,Per Unit,$21.27 ,OP,21.27,21.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84138,Assay of pregnanetriol,Lab Services,Per Unit,$21.05 ,OP,21.05,21.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84140,Assay of pregnenolone,Lab Services,Per Unit,$20.67 ,OP,20.67,20.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84143,Assay of 17-hydroxypregneno,Lab Services,Per Unit,$22.81 ,OP,22.81,22.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84144,Assay of progesterone,Lab Services,Per Unit,$20.86 ,OP,20.86,106.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84145,Procalcitonin (pct),Lab Services,Per Unit,$27.22 ,OP,27.22,27.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84146,Assay of prolactin,Lab Services,Per Unit,$19.38 ,OP,19.38,102.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84150,Assay of prostaglandin,Lab Services,Per Unit,$41.77 ,OP,41.77,41.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84152,Assay of psa complexed,Lab Services,Per Unit,$18.39 ,OP,18.39,18.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84153,Assay of psa total,Lab Services,Per Unit,$18.39 ,OP,18.39,85.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84154,Assay of psa free,Lab Services,Per Unit,$18.39 ,OP,18.39,137.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84155,Assay of protein serum,Lab Services,Per Unit,$3.67 ,OP,3.67,57.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84156,Assay of protein urine,Lab Services,Per Unit,$3.67 ,OP,3.67,61.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84157,Assay of protein other,Lab Services,Per Unit,$4.00 ,OP,4,58.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84160,Assay of protein any source,Lab Services,Per Unit,$5.61 ,OP,5.61,5.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84163,Pappa serum,Lab Services,Per Unit,$15.05 ,OP,15.05,15.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84165,Protein e-phoresis serum,Lab Services,Per Unit,$10.74 ,OP,10.74,98.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84166,Protein e-phoresis/urine/csf,Lab Services,Per Unit,$17.83 ,OP,17.83,17.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84181,Western blot test,Lab Services,Per Unit,$17.03 ,OP,17.03,17.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84182,Protein western blot test,Lab Services,Per Unit,$29.21 ,OP,29.21,29.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84202,Assay rbc protoporphyrin,Lab Services,Per Unit,$14.35 ,OP,14.35,14.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84203,Test rbc protoporphyrin,Lab Services,Per Unit,$9.74 ,OP,9.74,9.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84206,Assay of proinsulin,Lab Services,Per Unit,$26.69 ,OP,26.69,26.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84207,Assay of vitamin b-6,Lab Services,Per Unit,$28.10 ,OP,28.1,28.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84210,Assay of pyruvate,Lab Services,Per Unit,$14.48 ,OP,14.48,14.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84220,Assay of pyruvate kinase,Lab Services,Per Unit,$9.44 ,OP,9.44,9.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84228,Assay of quinine,Lab Services,Per Unit,$11.63 ,OP,11.63,11.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84233,Assay of estrogen,Lab Services,Per Unit,$87.88 ,OP,87.88,87.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84234,Assay of progesterone,Lab Services,Per Unit,$64.88 ,OP,64.88,64.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84235,Assay of endocrine hormone,Lab Services,Per Unit,$71.23 ,OP,71.23,71.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84238,Assay nonendocrine receptor,Lab Services,Per Unit,$36.57 ,OP,36.57,36.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84244,Assay of renin,Lab Services,Per Unit,$21.99 ,OP,21.99,21.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84252,Assay of vitamin b-2,Lab Services,Per Unit,$20.24 ,OP,20.24,20.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84255,Assay of selenium,Lab Services,Per Unit,$25.53 ,OP,25.53,25.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84260,Assay of serotonin,Lab Services,Per Unit,$30.98 ,OP,30.98,30.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84270,Assay of sex hormone globul,Lab Services,Per Unit,$21.73 ,OP,21.73,21.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84275,Assay of sialic acid,Lab Services,Per Unit,$13.44 ,OP,13.44,13.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84285,Assay of silica,Lab Services,Per Unit,$25.21 ,OP,25.21,25.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84295,Assay of serum sodium,Lab Services,Per Unit,$4.81 ,OP,4.81,27.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84300,Assay of urine sodium,Lab Services,Per Unit,$5.06 ,OP,5.06,5.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84302,Assay of sweat sodium,Lab Services,Per Unit,$4.86 ,OP,4.86,4.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84305,Assay of somatomedin,Lab Services,Per Unit,$21.26 ,OP,21.26,21.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84307,Assay of somatostatin,Lab Services,Per Unit,$18.28 ,OP,18.28,18.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84311,Spectrophotometry,Lab Services,Per Unit,$8.10 ,OP,8.1,8.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84315,Body fluid specific gravity,Lab Services,Per Unit,$3.28 ,OP,3.28,3.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84375,Chromatogram assay sugars,Lab Services,Per Unit,$39.00 ,OP,39,39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84376,Sugars single qual,Lab Services,Per Unit,$5.50 ,OP,5.5,5.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84377,Sugars multiple qual,Lab Services,Per Unit,$5.50 ,OP,5.5,5.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84378,Sugars single quant,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84379,Sugars multiple quant,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84392,Assay of urine sulfate,Lab Services,Per Unit,$5.49 ,OP,5.49,5.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84402,Assay of free testosterone,Lab Services,Per Unit,$25.47 ,OP,25.47,124.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84403,Assay of total testosterone,Lab Services,Per Unit,$25.81 ,OP,25.81,89.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84410,Testosterone bioavailable,Lab Services,Per Unit,$51.28 ,OP,51.28,51.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84425,Assay of vitamin b-1,Lab Services,Per Unit,$21.23 ,OP,21.23,100.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84430,Assay of thiocyanate,Lab Services,Per Unit,$11.63 ,OP,11.63,11.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84431,Thromboxane urine,Lab Services,Per Unit,$35.11 ,OP,35.11,35.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84432,Assay of thyroglobulin,Lab Services,Per Unit,$16.06 ,OP,16.06,16.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84436,Assay of total thyroxine,Lab Services,Per Unit,$6.87 ,OP,6.87,68.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84437,Assay of neonatal thyroxine,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84439,Assay of free thyroxine,Lab Services,Per Unit,$9.02 ,OP,9.02,89.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84442,Assay of thyroid activity,Lab Services,Per Unit,$14.78 ,OP,14.78,14.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84443,Assay thyroid stim hormone,Lab Services,Per Unit,$16.80 ,OP,16.8,88.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84445,Assay of tsi globulin,Lab Services,Per Unit,$50.86 ,OP,50.86,50.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84446,Assay of vitamin e,Lab Services,Per Unit,$14.18 ,OP,14.18,14.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84449,Assay of transcortin,Lab Services,Per Unit,$18.00 ,OP,18,18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84450,Transferase (ast) (sgot),Lab Services,Per Unit,$5.18 ,OP,5.18,43.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84460,Alanine amino (alt) (sgpt),Lab Services,Per Unit,$5.30 ,OP,5.3,53.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84466,Assay of transferrin,Lab Services,Per Unit,$12.76 ,OP,12.76,137.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84478,Assay of triglycerides,Lab Services,Per Unit,$5.74 ,OP,5.74,47.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84479,Assay of thyroid (t3 or t4),Lab Services,Per Unit,$6.47 ,OP,6.47,51.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84480,Assay triiodothyronine (t3),Lab Services,Per Unit,$14.18 ,OP,14.18,70.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84481,Free assay (ft-3),Lab Services,Per Unit,$16.94 ,OP,16.94,203.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84482,T3 reverse,Lab Services,Per Unit,$15.76 ,OP,15.76,15.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84484,Assay of troponin quant,Lab Services,Per Unit,$12.47 ,OP,12.47,101.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84485,Assay duodenal fluid trypsin,Lab Services,Per Unit,$7.20 ,OP,7.2,7.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84488,Test feces for trypsin,Lab Services,Per Unit,$7.30 ,OP,7.3,7.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84490,Assay of feces for trypsin,Lab Services,Per Unit,$9.93 ,OP,9.93,9.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84510,Assay of tyrosine,Lab Services,Per Unit,$10.63 ,OP,10.63,10.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84512,Assay of troponin qual,Lab Services,Per Unit,$10.09 ,OP,10.09,18.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84520,Assay of urea nitrogen,Lab Services,Per Unit,$3.95 ,OP,3.95,35.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84525,Urea nitrogen semi-quant,Lab Services,Per Unit,$5.13 ,OP,5.13,5.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84540,Assay of urine/urea-n,Lab Services,Per Unit,$5.56 ,OP,5.56,5.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84545,Urea-n clearance test,Lab Services,Per Unit,$7.20 ,OP,7.2,7.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84550,Assay of blood/uric acid,Lab Services,Per Unit,$4.52 ,OP,4.52,40.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84560,Assay of urine/uric acid,Lab Services,Per Unit,$5.08 ,OP,5.08,5.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84577,Assay of feces/urobilinogen,Lab Services,Per Unit,$16.80 ,OP,16.8,16.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84578,Test urine urobilinogen,Lab Services,Per Unit,$4.47 ,OP,4.47,4.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84580,Assay of urine urobilinogen,Lab Services,Per Unit,$9.55 ,OP,9.55,9.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84583,Assay of urine urobilinogen,Lab Services,Per Unit,$6.05 ,OP,6.05,6.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84585,Assay of urine vma,Lab Services,Per Unit,$15.50 ,OP,15.5,15.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84586,Assay of vip,Lab Services,Per Unit,$35.33 ,OP,35.33,35.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84588,Assay of vasopressin,Lab Services,Per Unit,$33.94 ,OP,33.94,33.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84590,Assay of vitamin a,Lab Services,Per Unit,$11.61 ,OP,11.61,11.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84591,Assay of nos vitamin,Lab Services,Per Unit,$17.06 ,OP,17.06,17.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84597,Assay of vitamin k,Lab Services,Per Unit,$13.72 ,OP,13.72,13.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84600,Assay of volatiles,Lab Services,Per Unit,$17.11 ,OP,17.11,17.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84620,Xylose tolerance test,Lab Services,Per Unit,$12.91 ,OP,12.91,12.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84630,Assay of zinc,Lab Services,Per Unit,$11.39 ,OP,11.39,11.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84681,Assay of c-peptide,Lab Services,Per Unit,$20.81 ,OP,20.81,20.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84702,Chorionic gonadotropin test,Lab Services,Per Unit,$15.05 ,OP,15.05,119.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84703,Chorionic gonadotropin assay,Lab Services,Per Unit,$7.52 ,OP,7.52,74.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84704,Hcg free betachain test,Lab Services,Per Unit,$15.29 ,OP,15.29,15.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,84830,Ovulation tests,Lab Services,Per Unit,$12.70 ,OP,12.7,12.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85002,Bleeding time test,Lab Services,Per Unit,$4.82 ,OP,4.82,57.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85004,Automated diff wbc count,Lab Services,Per Unit,$6.47 ,OP,6.47,23.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85007,Bl smear w/diff wbc count,Lab Services,Per Unit,$3.80 ,OP,3.8,25.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85008,Bl smear w/o diff wbc count,Lab Services,Per Unit,$3.43 ,OP,3.43,7.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85009,Manual diff wbc count b-coat,Lab Services,Per Unit,$5.07 ,OP,5.07,5.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85013,Spun microhematocrit,Lab Services,Per Unit,$7.00 ,OP,7,7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85014,Hematocrit,Lab Services,Per Unit,$2.37 ,OP,2.37,24.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85018,Hemoglobin,Lab Services,Per Unit,$2.37 ,OP,2.37,24.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85025,Complete cbc w/auto diff wbc,Lab Services,Per Unit,$7.77 ,OP,7.77,56.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85027,Complete cbc automated,Lab Services,Per Unit,$6.47 ,OP,6.47,51.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85032,Manual cell count each,Lab Services,Per Unit,$4.31 ,OP,4.31,4.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85041,Automated rbc count,Lab Services,Per Unit,$3.02 ,OP,3.02,3.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85044,Manual reticulocyte count,Lab Services,Per Unit,$4.31 ,OP,4.31,52.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85045,Automated reticulocyte count,Lab Services,Per Unit,$3.99 ,OP,3.99,44.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85046,Reticyte/hgb concentrate,Lab Services,Per Unit,$5.57 ,OP,5.57,5.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85048,Automated leukocyte count,Lab Services,Per Unit,$2.54 ,OP,2.54,41.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85049,Automated platelet count,Lab Services,Per Unit,$4.48 ,OP,4.48,35.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85055,Reticulated platelet assay,Lab Services,Per Unit,$35.74 ,OP,35.74,35.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85097,Bone marrow interpretation,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85130,Chromogenic substrate assay,Lab Services,Per Unit,$11.89 ,OP,11.89,11.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85170,Blood clot retraction,Lab Services,Per Unit,$16.30 ,OP,16.3,16.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85175,Blood clot lysis time,Lab Services,Per Unit,$20.37 ,OP,20.37,20.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85210,Clot factor ii prothrom spec,Lab Services,Per Unit,$12.98 ,OP,12.98,12.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85220,Blooc clot factor v test,Lab Services,Per Unit,$17.65 ,OP,17.65,17.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85230,Clot factor vii proconvertin,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85240,Clot factor viii ahg 1 stage,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85244,Clot factor viii reltd antgn,Lab Services,Per Unit,$20.42 ,OP,20.42,20.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85245,Clot factor viii vw ristoctn,Lab Services,Per Unit,$22.94 ,OP,22.94,22.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85246,Clot factor viii vw antigen,Lab Services,Per Unit,$22.94 ,OP,22.94,22.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85247,Clot factor viii multimetric,Lab Services,Per Unit,$22.94 ,OP,22.94,22.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85250,Clot factor ix ptc/chrstmas,Lab Services,Per Unit,$19.04 ,OP,19.04,19.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85260,Clot factor x stuart-power,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85270,Clot factor xi pta,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85280,Clot factor xii hageman,Lab Services,Per Unit,$19.35 ,OP,19.35,19.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85290,Clot factor xiii fibrin stab,Lab Services,Per Unit,$16.34 ,OP,16.34,16.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85291,Clot factor xiii fibrin scrn,Lab Services,Per Unit,$9.11 ,OP,9.11,9.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85292,Clot factor fletcher fact,Lab Services,Per Unit,$18.93 ,OP,18.93,18.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85293,Clot factor wght kininogen,Lab Services,Per Unit,$18.93 ,OP,18.93,18.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85300,Antithrombin iii activity,Lab Services,Per Unit,$11.85 ,OP,11.85,11.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85301,Antithrombin iii antigen,Lab Services,Per Unit,$10.81 ,OP,10.81,10.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85302,Clot inhibit prot c antigen,Lab Services,Per Unit,$12.01 ,OP,12.01,12.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85303,Clot inhibit prot c activity,Lab Services,Per Unit,$13.84 ,OP,13.84,13.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85305,Clot inhibit prot s total,Lab Services,Per Unit,$11.61 ,OP,11.61,11.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85306,Clot inhibit prot s free,Lab Services,Per Unit,$15.32 ,OP,15.32,15.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85307,Assay activated protein c,Lab Services,Per Unit,$15.32 ,OP,15.32,15.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85335,Factor inhibitor test,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85337,Thrombomodulin,Lab Services,Per Unit,$17.27 ,OP,17.27,17.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85345,Coagulation time lee & white,Lab Services,Per Unit,$4.69 ,OP,4.69,4.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85347,Coagulation time activated,Lab Services,Per Unit,$4.28 ,OP,4.28,4.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85348,Coagulation time otr method,Lab Services,Per Unit,$4.49 ,OP,4.49,4.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85360,Euglobulin lysis,Lab Services,Per Unit,$8.41 ,OP,8.41,8.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85362,Fibrin degradation products,Lab Services,Per Unit,$6.89 ,OP,6.89,6.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85366,Fibrinogen test,Lab Services,Per Unit,$80.46 ,OP,80.46,80.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85370,Fibrinogen test,Lab Services,Per Unit,$12.43 ,OP,12.43,108.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85378,Fibrin degrade semiquant,Lab Services,Per Unit,$9.72 ,OP,9.72,231.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85379,Fibrin degradation quant,Lab Services,Per Unit,$10.18 ,OP,10.18,89.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85380,Fibrin degradj d-dimer,Lab Services,Per Unit,$10.18 ,OP,10.18,91.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85384,Fibrinogen activity,Lab Services,Per Unit,$9.72 ,OP,9.72,93.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85385,Fibrinogen antigen,Lab Services,Per Unit,$14.46 ,OP,14.46,14.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85390,Fibrinolysins screen i&r,Lab Services,Per Unit,$15.48 ,OP,15.48,15.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85397,Clotting funct activity,Lab Services,Per Unit,$30.86 ,OP,30.86,30.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85400,Fibrinolytic plasmin,Lab Services,Per Unit,$7.71 ,OP,7.71,7.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85410,Fibrinolytic antiplasmin,Lab Services,Per Unit,$7.71 ,OP,7.71,7.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85415,Fibrinolytic plasminogen,Lab Services,Per Unit,$17.19 ,OP,17.19,17.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85420,Fibrinolytic plasminogen,Lab Services,Per Unit,$6.53 ,OP,6.53,6.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85421,Fibrinolytic plasminogen,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85441,Heinz bodies direct,Lab Services,Per Unit,$4.20 ,OP,4.2,4.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85445,Heinz bodies induced,Lab Services,Per Unit,$6.82 ,OP,6.82,6.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85460,Hemoglobin fetal,Lab Services,Per Unit,$7.73 ,OP,7.73,192.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85461,Hemoglobin fetal,Lab Services,Per Unit,$9.36 ,OP,9.36,47.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85475,Hemolysin acid,Lab Services,Per Unit,$8.87 ,OP,8.87,8.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85520,Heparin assay,Lab Services,Per Unit,$13.09 ,OP,13.09,13.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85525,Heparin neutralization,Lab Services,Per Unit,$11.84 ,OP,11.84,11.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85530,Heparin-protamine tolerance,Lab Services,Per Unit,$13.09 ,OP,13.09,13.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85536,Iron stain peripheral blood,Lab Services,Per Unit,$6.88 ,OP,6.88,6.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85540,Wbc alkaline phosphatase,Lab Services,Per Unit,$8.60 ,OP,8.6,8.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85547,Rbc mechanical fragility,Lab Services,Per Unit,$8.60 ,OP,8.6,8.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85549,Muramidase,Lab Services,Per Unit,$18.75 ,OP,18.75,18.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85555,Rbc osmotic fragility,Lab Services,Per Unit,$7.47 ,OP,7.47,7.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85557,Rbc osmotic fragility,Lab Services,Per Unit,$13.36 ,OP,13.36,13.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85576,Blood platelet aggregation,Lab Services,Per Unit,$24.91 ,OP,24.91,48.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85597,Phospholipid pltlt neutraliz,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85598,Hexagnal phosph pltlt neutrl,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85610,Prothrombin time,Lab Services,Per Unit,$4.29 ,OP,4.29,39.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85611,Prothrombin test,Lab Services,Per Unit,$3.94 ,OP,3.94,3.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85612,Viper venom prothrombin time,Lab Services,Per Unit,$17.49 ,OP,17.49,17.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85613,Russell viper venom diluted,Lab Services,Per Unit,$9.58 ,OP,9.58,75.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85635,Reptilase test,Lab Services,Per Unit,$9.85 ,OP,9.85,9.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85651,Rbc sed rate nonautomated,Lab Services,Per Unit,$4.27 ,OP,4.27,31.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85652,Rbc sed rate automated,Lab Services,Per Unit,$2.70 ,OP,2.7,32.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85660,Rbc sickle cell test,Lab Services,Per Unit,$5.51 ,OP,5.51,59.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85670,Thrombin time plasma,Lab Services,Per Unit,$5.77 ,OP,5.77,5.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85675,Thrombin time titer,Lab Services,Per Unit,$6.85 ,OP,6.85,6.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85705,Thromboplastin inhibition,Lab Services,Per Unit,$9.63 ,OP,9.63,9.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85730,Thromboplastin time partial,Lab Services,Per Unit,$6.01 ,OP,6.01,38.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85732,Thromboplastin time partial,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,85810,Blood viscosity examination,Lab Services,Per Unit,$11.67 ,OP,11.67,11.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86000,Agglutinins febrile antigen,Lab Services,Per Unit,$6.98 ,OP,6.98,6.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86001,Allergen specific igg,Lab Services,Per Unit,$7.82 ,OP,7.82,45.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86003,Allg spec ige crude xtrc ea,Lab Services,Per Unit,$5.22 ,OP,5.22,26.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86005,Allg spec ige multiallg scr,Lab Services,Per Unit,$7.97 ,OP,7.97,7.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86008,Allg spec ige recomb ea,Lab Services,Per Unit,$17.93 ,OP,17.93,17.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86021,Wbc antibody identification,Lab Services,Per Unit,$15.05 ,OP,15.05,15.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86022,Platelet antibodies,Lab Services,Per Unit,$18.37 ,OP,18.37,18.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86023,Immunoglobulin assay,Lab Services,Per Unit,$12.46 ,OP,12.46,12.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86038,Antinuclear antibodies,Lab Services,Per Unit,$12.09 ,OP,12.09,79.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86039,Antinuclear antibodies (ana),Lab Services,Per Unit,$11.16 ,OP,11.16,104.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86060,Antistreptolysin o titer,Lab Services,Per Unit,$7.30 ,OP,7.3,80.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86063,Antistreptolysin o screen,Lab Services,Per Unit,$5.77 ,OP,5.77,5.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86077,Phys blood bank serv xmatch,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86078,Phys blood bank serv reactj,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86079,Phys blood bank serv authrj,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86140,C-reactive protein,Lab Services,Per Unit,$5.18 ,OP,5.18,39.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86141,C-reactive protein hs,Lab Services,Per Unit,$12.95 ,OP,12.95,68.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86146,Beta-2 glycoprotein antibody,Lab Services,Per Unit,$25.45 ,OP,25.45,25.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86147,Cardiolipin antibody ea ig,Lab Services,Per Unit,$25.45 ,OP,25.45,53.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86148,Anti-phospholipid antibody,Lab Services,Per Unit,$16.07 ,OP,16.07,16.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86152,Cell enumeration & id,Lab Services,Per Unit,$250.78 ,OP,250.78,250.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86155,Chemotaxis assay,Lab Services,Per Unit,$15.99 ,OP,15.99,15.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86156,Cold agglutinin screen,Lab Services,Per Unit,$8.07 ,OP,8.07,8.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86157,Cold agglutinin titer,Lab Services,Per Unit,$8.06 ,OP,8.06,67.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86160,Complement antigen,Lab Services,Per Unit,$12.00 ,OP,12,88.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86161,Complement/function activity,Lab Services,Per Unit,$12.00 ,OP,12,12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86162,Complement total (ch50),Lab Services,Per Unit,$20.32 ,OP,20.32,63.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86171,Complement fixation each,Lab Services,Per Unit,$10.01 ,OP,10.01,10.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86200,Ccp antibody,Lab Services,Per Unit,$12.95 ,OP,12.95,12.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86215,Deoxyribonuclease antibody,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86225,Dna antibody native,Lab Services,Per Unit,$13.74 ,OP,13.74,174.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86226,Dna antibody single strand,Lab Services,Per Unit,$12.11 ,OP,12.11,12.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86235,Nuclear antigen antibody,Lab Services,Per Unit,$17.93 ,OP,17.93,103.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86255,Fluorescent antibody screen,Lab Services,Per Unit,$12.05 ,OP,12.05,75.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86256,Fluorescent antibody titer,Lab Services,Per Unit,$12.05 ,OP,12.05,88.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86277,Growth hormone antibody,Lab Services,Per Unit,$15.74 ,OP,15.74,15.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86280,Hemagglutination inhibition,Lab Services,Per Unit,$8.19 ,OP,8.19,8.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86294,Immunoassay tumor qual,Lab Services,Per Unit,$25.57 ,OP,25.57,25.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86300,Immunoassay tumor ca 15-3,Lab Services,Per Unit,$20.81 ,OP,20.81,144.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86301,Immunoassay tumor ca 19-9,Lab Services,Per Unit,$20.81 ,OP,20.81,130.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86304,Immunoassay tumor ca 125,Lab Services,Per Unit,$20.81 ,OP,20.81,147.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86305,Human epididymis protein 4,Lab Services,Per Unit,$20.81 ,OP,20.81,20.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86308,Heterophile antibody screen,Lab Services,Per Unit,$5.18 ,OP,5.18,45.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86309,Heterophile antibody titer,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86310,Heterophile antibody absrbj,Lab Services,Per Unit,$7.37 ,OP,7.37,7.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86316,Immunoassay tumor other,Lab Services,Per Unit,$20.81 ,OP,20.81,151.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86317,Immunoassay infectious agent,Lab Services,Per Unit,$14.99 ,OP,14.99,47.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86318,Ia infectious agent antibody,Lab Services,Per Unit,$18.09 ,OP,18.09,57.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86320,Serum immunoelectrophoresis,Lab Services,Per Unit,$29.92 ,OP,29.92,29.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86325,Other immunoelectrophoresis,Lab Services,Per Unit,$23.13 ,OP,23.13,23.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86327,Immunoelectrophoresis assay,Lab Services,Per Unit,$29.92 ,OP,29.92,29.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86328,Ia nfct ab sarscov2 covid19,Lab Services,Per Unit,$45.23 ,OP,45.23,45.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86329,Immunodiffusion nes,Lab Services,Per Unit,$14.05 ,OP,14.05,14.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86331,Immunodiffusion ouchterlony,Lab Services,Per Unit,$11.98 ,OP,11.98,49.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86332,Immune complex assay,Lab Services,Per Unit,$24.37 ,OP,24.37,24.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86334,Immunofix e-phoresis serum,Lab Services,Per Unit,$22.34 ,OP,22.34,242.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86335,Immunfix e-phorsis/urine/csf,Lab Services,Per Unit,$29.35 ,OP,29.35,29.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86336,Inhibin a,Lab Services,Per Unit,$15.59 ,OP,15.59,15.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86337,Insulin antibodies,Lab Services,Per Unit,$21.41 ,OP,21.41,21.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86340,Intrinsic factor antibody,Lab Services,Per Unit,$15.08 ,OP,15.08,15.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86341,Islet cell antibody,Lab Services,Per Unit,$23.57 ,OP,23.57,23.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86343,Leukocyte histamine release,Lab Services,Per Unit,$12.46 ,OP,12.46,12.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86344,Leukocyte phagocytosis,Lab Services,Per Unit,$10.39 ,OP,10.39,10.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86352,Cell function assay w/stim,Lab Services,Per Unit,$135.86 ,OP,135.86,135.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86353,Lymphocyte transformation,Lab Services,Per Unit,$49.03 ,OP,49.03,49.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86355,B cells total count,Lab Services,Per Unit,$37.73 ,OP,37.73,37.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86356,Mononuclear cell antigen,Lab Services,Per Unit,$26.78 ,OP,26.78,26.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86357,Nk cells total count,Lab Services,Per Unit,$37.73 ,OP,37.73,37.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86359,T cells total count,Lab Services,Per Unit,$37.73 ,OP,37.73,37.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86360,T cell absolute count/ratio,Lab Services,Per Unit,$46.98 ,OP,46.98,46.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86361,T cell absolute count,Lab Services,Per Unit,$26.78 ,OP,26.78,26.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86367,Stem cells total count,Lab Services,Per Unit,$77.78 ,OP,77.78,77.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86376,Microsomal antibody each,Lab Services,Per Unit,$14.55 ,OP,14.55,93.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86382,Neutralization test viral,Lab Services,Per Unit,$16.91 ,OP,16.91,16.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86384,Nitroblue tetrazolium dye,Lab Services,Per Unit,$13.61 ,OP,13.61,13.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86386,Nuclear matrix protein 22,Lab Services,Per Unit,$21.78 ,OP,21.78,21.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86403,Particle agglut antbdy scrn,Lab Services,Per Unit,$11.54 ,OP,11.54,103.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86406,Particle agglut antbdy titr,Lab Services,Per Unit,$10.64 ,OP,10.64,10.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86408,Neutrlzg antb sarscov2 scr,Lab Services,Per Unit,$42.13 ,OP,42.13,42.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86409,Neutrlzg antb sarscov2 titer,Lab Services,Per Unit,$79.61 ,OP,79.61,79.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86413,Sars-cov-2 antb quantitative,Lab Services,Per Unit,$51.43 ,OP,51.43,51.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86430,Rheumatoid factor test qual,Lab Services,Per Unit,$6.14 ,OP,6.14,40.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86431,Rheumatoid factor quant,Lab Services,Per Unit,$5.67 ,OP,5.67,72.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86480,Tb test cell immun measure,Lab Services,Per Unit,$61.98 ,OP,61.98,61.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86481,Tb ag response t-cell susp,Lab Services,Per Unit,$100.00 ,OP,100,100,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86485,Skin test candida,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86486,Skin test nos antigen,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86490,Coccidioidomycosis skin test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86510,Histoplasmosis skin test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86580,Tb intradermal test,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86590,Streptokinase antibody,Lab Services,Per Unit,$12.66 ,OP,12.66,12.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86592,Syphilis test non-trep qual,Lab Services,Per Unit,$4.27 ,OP,4.27,29.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86593,Syphilis test non-trep quant,Lab Services,Per Unit,$4.40 ,OP,4.4,4.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86602,Antinomyces antibody,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86603,Adenovirus antibody,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86606,Aspergillus antibody,Lab Services,Per Unit,$15.05 ,OP,15.05,15.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86609,Bacterium antibody,Lab Services,Per Unit,$12.88 ,OP,12.88,12.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86611,Bartonella antibody,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86612,Blastomyces antibody,Lab Services,Per Unit,$12.90 ,OP,12.9,12.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86615,Bordetella antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86617,Lyme disease antibody,Lab Services,Per Unit,$15.49 ,OP,15.49,87.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86618,Lyme disease antibody,Lab Services,Per Unit,$17.03 ,OP,17.03,146.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86619,Borrelia antibody,Lab Services,Per Unit,$13.38 ,OP,13.38,13.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86622,Brucella antibody,Lab Services,Per Unit,$8.93 ,OP,8.93,8.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86625,Campylobacter antibody,Lab Services,Per Unit,$13.12 ,OP,13.12,13.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86628,Candida antibody,Lab Services,Per Unit,$12.01 ,OP,12.01,12.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86631,Chlamydia antibody,Lab Services,Per Unit,$11.82 ,OP,11.82,11.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86632,Chlamydia igm antibody,Lab Services,Per Unit,$12.68 ,OP,12.68,12.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86635,Coccidioides antibody,Lab Services,Per Unit,$11.47 ,OP,11.47,11.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86638,Q fever antibody,Lab Services,Per Unit,$12.12 ,OP,12.12,12.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86641,Cryptococcus antibody,Lab Services,Per Unit,$14.41 ,OP,14.41,14.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86644,Cmv antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,74.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86645,Cmv antibody igm,Lab Services,Per Unit,$16.85 ,OP,16.85,74.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86648,Diphtheria antibody,Lab Services,Per Unit,$15.21 ,OP,15.21,15.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86651,Encephalitis californ antbdy,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86652,Encephaltis east eqne anbdy,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86653,Encephaltis st louis antbody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86654,Encephaltis west eqne antbdy,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86658,Enterovirus antibody,Lab Services,Per Unit,$13.03 ,OP,13.03,13.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86663,Epstein-barr antibody,Lab Services,Per Unit,$13.12 ,OP,13.12,57.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86664,Epstein-barr nuclear antigen,Lab Services,Per Unit,$15.29 ,OP,15.29,93.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86665,Epstein-barr capsid vca,Lab Services,Per Unit,$18.14 ,OP,18.14,60.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86666,Ehrlichia antibody,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86668,Francisella tularensis,Lab Services,Per Unit,$14.16 ,OP,14.16,14.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86671,Fungus nes antibody,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86674,Giardia lamblia antibody,Lab Services,Per Unit,$14.72 ,OP,14.72,14.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86677,Helicobacter pylori antibody,Lab Services,Per Unit,$16.85 ,OP,16.85,103.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86682,Helminth antibody,Lab Services,Per Unit,$13.01 ,OP,13.01,13.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86684,Hemophilus influenza antibdy,Lab Services,Per Unit,$15.84 ,OP,15.84,15.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86687,Htlv-i antibody,Lab Services,Per Unit,$9.09 ,OP,9.09,9.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86688,Htlv-ii antibody,Lab Services,Per Unit,$14.00 ,OP,14,14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86689,Htlv/hiv confirmj antibody,Lab Services,Per Unit,$19.35 ,OP,19.35,19.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86692,Hepatitis delta agent antbdy,Lab Services,Per Unit,$17.16 ,OP,17.16,17.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86694,Herpes simplex nes antbdy,Lab Services,Per Unit,$14.39 ,OP,14.39,14.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86695,Herpes simplex type 1 test,Lab Services,Per Unit,$13.19 ,OP,13.19,73.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86696,Herpes simplex type 2 test,Lab Services,Per Unit,$19.35 ,OP,19.35,53.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86698,Histoplasma antibody,Lab Services,Per Unit,$13.79 ,OP,13.79,13.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86701,Hiv-1antibody,Lab Services,Per Unit,$8.89 ,OP,8.89,52.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86702,Hiv-2 antibody,Lab Services,Per Unit,$13.52 ,OP,13.52,13.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86703,Hiv-1/hiv-2 1 result antbdy,Lab Services,Per Unit,$13.71 ,OP,13.71,96.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86704,Hep b core antibody total,Lab Services,Per Unit,$12.05 ,OP,12.05,152.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86705,Hep b core antibody igm,Lab Services,Per Unit,$11.77 ,OP,11.77,11.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86706,Hep b surface antibody,Lab Services,Per Unit,$10.74 ,OP,10.74,88.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86707,Hepatitis be antibody,Lab Services,Per Unit,$11.57 ,OP,11.57,11.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86708,Hepatitis a antibody,Lab Services,Per Unit,$12.39 ,OP,12.39,115.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86709,Hepatitis a igm antibody,Lab Services,Per Unit,$11.26 ,OP,11.26,153.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86710,Influenza virus antibody,Lab Services,Per Unit,$13.55 ,OP,13.55,13.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86711,John cunningham antibody,Lab Services,Per Unit,$16.89 ,OP,16.89,16.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86713,Legionella antibody,Lab Services,Per Unit,$15.30 ,OP,15.3,15.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86717,Leishmania antibody,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86720,Leptospira antibody,Lab Services,Per Unit,$16.20 ,OP,16.2,16.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86723,Listeria monocytogenes,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86727,Lymph choriomeningitis ab,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86732,Mucormycosis antibody,Lab Services,Per Unit,$15.00 ,OP,15,15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86735,Mumps antibody,Lab Services,Per Unit,$13.05 ,OP,13.05,13.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86738,Mycoplasma antibody,Lab Services,Per Unit,$13.24 ,OP,13.24,13.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86741,Neisseria meningitidis,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86744,Nocardia antibody,Lab Services,Per Unit,$15.99 ,OP,15.99,15.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86747,Parvovirus antibody,Lab Services,Per Unit,$15.03 ,OP,15.03,76.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86750,Malaria antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86753,Protozoa antibody nos,Lab Services,Per Unit,$12.39 ,OP,12.39,12.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86756,Respiratory virus antibody,Lab Services,Per Unit,$15.89 ,OP,15.89,253.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86757,Rickettsia antibody,Lab Services,Per Unit,$19.35 ,OP,19.35,19.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86759,Rotavirus antibody,Lab Services,Per Unit,$18.23 ,OP,18.23,18.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86762,Rubella antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,82.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86765,Rubeola antibody,Lab Services,Per Unit,$12.88 ,OP,12.88,12.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86768,Salmonella antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86769,Sars-cov-2 covid-19 antibody,Lab Services,Per Unit,$42.13 ,OP,42.13,42.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86771,Shigella antibody,Lab Services,Per Unit,$24.48 ,OP,24.48,24.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86774,Tetanus antibody,Lab Services,Per Unit,$14.80 ,OP,14.8,14.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86777,Toxoplasma antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,27.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86778,Toxoplasma antibody igm,Lab Services,Per Unit,$14.41 ,OP,14.41,14.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86780,Treponema pallidum,Lab Services,Per Unit,$13.24 ,OP,13.24,13.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86784,Trichinella antibody,Lab Services,Per Unit,$12.56 ,OP,12.56,12.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86787,Varicella-zoster antibody,Lab Services,Per Unit,$12.88 ,OP,12.88,162.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86788,West nile virus ab igm,Lab Services,Per Unit,$16.85 ,OP,16.85,16.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86789,West nile virus antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,14.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86790,Virus antibody nos,Lab Services,Per Unit,$12.88 ,OP,12.88,12.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86793,Yersinia antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86794,Zika virus igm antibody,Lab Services,Per Unit,$16.85 ,OP,16.85,16.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86800,Thyroglobulin antibody,Lab Services,Per Unit,$15.91 ,OP,15.91,65.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86803,Hepatitis c ab test,Lab Services,Per Unit,$14.27 ,OP,14.27,83.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86804,Hep c ab test confirm,Lab Services,Per Unit,$15.49 ,OP,15.49,15.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86805,Lymphocytotoxicity assay,Lab Services,Per Unit,$189.51 ,OP,189.51,189.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86806,Lymphocytotoxicity assay,Lab Services,Per Unit,$47.59 ,OP,47.59,47.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86807,Cytotoxic antibody screening,Lab Services,Per Unit,$78.65 ,OP,78.65,78.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86808,Cytotoxic antibody screening,Lab Services,Per Unit,$29.68 ,OP,29.68,29.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86812,Hla typing a b or c,Lab Services,Per Unit,$25.81 ,OP,25.81,70.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86813,Hla typing a b or c,Lab Services,Per Unit,$58.00 ,OP,58,58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86816,Hla typing dr/dq,Lab Services,Per Unit,$30.17 ,OP,30.17,30.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86817,Hla typing dr/dq,Lab Services,Per Unit,$106.14 ,OP,106.14,106.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86821,Lymphocyte culture mixed,Lab Services,Per Unit,$36.56 ,OP,36.56,36.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86825,Hla x-math non-cytotoxic,Lab Services,Per Unit,$109.49 ,OP,109.49,109.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86826,Hla x-match noncytotoxc addl,Lab Services,Per Unit,$36.53 ,OP,36.53,36.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86828,Hla class i&ii antibody qual,Lab Services,Per Unit,$64.19 ,OP,64.19,64.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86829,Hla class i/ii antibody qual,Lab Services,Per Unit,$64.19 ,OP,64.19,64.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86830,Hla class i phenotype qual,Lab Services,Per Unit,$95.52 ,OP,95.52,95.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86831,Hla class ii phenotype qual,Lab Services,Per Unit,$81.88 ,OP,81.88,81.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86832,Hla class i high defin qual,Lab Services,Per Unit,$323.75 ,OP,323.75,323.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86833,Hla class ii high defin qual,Lab Services,Per Unit,$325.80 ,OP,325.8,325.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86834,Hla class i semiquant panel,Lab Services,Per Unit,$357.56 ,OP,357.56,357.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86835,Hla class ii semiquant panel,Lab Services,Per Unit,$322.96 ,OP,322.96,322.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86850,Rbc antibody screen,APC 5671,RVU Per Case,$48.22 ,OP,48.22,56.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86860,Rbc antibody elution,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86870,Rbc antibody identification,APC 5673,RVU Per Case,$282.25 ,OP,282.25,297.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86880,Coombs test direct,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86885,Coombs test indirect qual,APC 5672,RVU Per Case,$144.55 ,OP,90,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86886,Coombs test indirect titer,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86890,Autologous blood process,APC 5672,RVU Per Case,$144.55 ,OP,144.55,254.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86891,Autologous blood op salvage,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86900,Blood typing serologic abo,APC 5734,RVU Per Case,$108.49 ,OP,23.28,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86901,Blood typing serologic rh(d),APC 5732,RVU Per Case,$32.79 ,OP,25.24,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86902,Blood type antigen donor ea,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86904,Blood typing patient serum,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86905,Blood typing rbc antigens,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86906,Bld typing serologic rh phnt,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86920,Compatibility test spin,APC 5672,RVU Per Case,$144.55 ,OP,44.61,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86921,Compatibility test incubate,APC 5672,RVU Per Case,$144.55 ,OP,40.26,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86922,Compatibility test antiglob,APC 5672,RVU Per Case,$144.55 ,OP,55.93,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86923,Compatibility test electric,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86927,Plasma fresh frozen,APC 5672,RVU Per Unit,$144.55 ,OP,50.47,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86930,Frozen blood prep,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86931,Frozen blood thaw,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86932,Frozen blood freeze/thaw,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86940,Hemolysins/agglutinins auto,Lab Services,Per Unit,$8.77 ,OP,8.77,8.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86941,Hemolysins/agglutinins,Lab Services,Per Unit,$12.11 ,OP,12.11,45.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86945,Blood product/irradiation,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86950,Leukacyte transfusion,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86960,Vol reduction of blood/prod,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86965,Pooling blood platelets,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86970,Rbc pretx incubatj w/chemicl,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86971,Rbc pretx incubatj w/enzymes,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86972,Rbc pretx incubatj w/density,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86975,Rbc serum pretx incubj drugs,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86976,Rbc serum pretx id dilution,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86977,Rbc serum pretx incubj/inhib,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86978,Rbc pretreatment serum,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86985,Split blood or products,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,86999,Transfusion procedure,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87003,Small animal inoculation,Lab Services,Per Unit,$16.84 ,OP,16.84,16.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87015,Specimen infect agnt concntj,Lab Services,Per Unit,$6.68 ,OP,6.68,6.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87040,Blood culture for bacteria,Lab Services,Per Unit,$10.32 ,OP,10.32,75.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87045,Feces culture aerobic bact,Lab Services,Per Unit,$9.44 ,OP,9.44,78.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87046,Stool cultr aerobic bact ea,Lab Services,Per Unit,$9.44 ,OP,9.44,30.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87070,Culture othr specimn aerobic,Lab Services,Per Unit,$8.62 ,OP,8.62,74.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87071,Culture aerobic quant other,Lab Services,Per Unit,$9.89 ,OP,9.89,84.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87073,Culture bacteria anaerobic,Lab Services,Per Unit,$9.66 ,OP,9.66,9.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87075,Cultr bacteria except blood,Lab Services,Per Unit,$9.47 ,OP,9.47,109.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87076,Culture anaerobe ident each,Lab Services,Per Unit,$8.08 ,OP,8.08,34.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87077,Culture aerobic identify,Lab Services,Per Unit,$8.08 ,OP,8.08,60.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87081,Culture screen only,Lab Services,Per Unit,$6.63 ,OP,6.63,79.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87084,Culture of specimen by kit,Lab Services,Per Unit,$27.07 ,OP,27.07,27.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87086,Urine culture/colony count,Lab Services,Per Unit,$8.07 ,OP,8.07,64.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87088,Urine bacteria culture,Lab Services,Per Unit,$8.09 ,OP,8.09,52.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87101,Skin fungi culture,Lab Services,Per Unit,$7.71 ,OP,7.71,7.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87102,Fungus isolation culture,Lab Services,Per Unit,$8.41 ,OP,8.41,127.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87103,Blood fungus culture,Lab Services,Per Unit,$20.46 ,OP,20.46,20.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87106,Fungi identification yeast,Lab Services,Per Unit,$10.32 ,OP,10.32,10.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87107,Fungi identification mold,Lab Services,Per Unit,$10.32 ,OP,10.32,10.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87109,Mycoplasma,Lab Services,Per Unit,$15.39 ,OP,15.39,15.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87110,Chlamydia culture,Lab Services,Per Unit,$19.60 ,OP,19.6,66.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87116,Mycobacteria culture,Lab Services,Per Unit,$10.80 ,OP,10.8,168.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87118,Mycobacteric identification,Lab Services,Per Unit,$14.61 ,OP,14.61,14.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87140,Culture type immunofluoresc,Lab Services,Per Unit,$5.57 ,OP,5.57,5.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87143,Culture typing glc/hplc,Lab Services,Per Unit,$12.52 ,OP,12.52,12.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87147,Culture type immunologic,Lab Services,Per Unit,$5.18 ,OP,5.18,55.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87149,Dna/rna direct probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87150,Dna/rna amplified probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87152,Culture type pulse field gel,Lab Services,Per Unit,$7.74 ,OP,7.74,7.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87153,Dna/rna sequencing,Lab Services,Per Unit,$115.36 ,OP,115.36,115.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87158,Culture typing added method,Lab Services,Per Unit,$7.74 ,OP,7.74,7.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87164,Dark field examination,Lab Services,Per Unit,$10.74 ,OP,10.74,10.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87166,Dark field examination,Lab Services,Per Unit,$11.30 ,OP,11.3,11.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87168,Macroscopic exam arthropod,Lab Services,Per Unit,$4.27 ,OP,4.27,4.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87169,Macroscopic exam parasite,Lab Services,Per Unit,$4.31 ,OP,4.31,4.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87172,Pinworm exam,Lab Services,Per Unit,$4.27 ,OP,4.27,4.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87176,Tissue homogenization cultr,Lab Services,Per Unit,$5.88 ,OP,5.88,5.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87177,Ova and parasites smears,Lab Services,Per Unit,$8.90 ,OP,8.9,68.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87181,Microbe susceptible diffuse,Lab Services,Per Unit,$4.75 ,OP,4.75,15.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87184,Microbe susceptible disk,Lab Services,Per Unit,$7.48 ,OP,7.48,43.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87185,Microbe susceptible enzyme,Lab Services,Per Unit,$4.75 ,OP,4.75,4.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87186,Microbe susceptible mic,Lab Services,Per Unit,$8.65 ,OP,8.65,46.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87187,Microbe susceptible mlc,Lab Services,Per Unit,$40.17 ,OP,40.17,40.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87188,Microbe suscept macrobroth,Lab Services,Per Unit,$6.64 ,OP,6.64,6.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87190,Microbe suscept mycobacteri,Lab Services,Per Unit,$7.31 ,OP,7.31,7.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87197,Bactericidal level serum,Lab Services,Per Unit,$15.02 ,OP,15.02,15.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87205,Smear gram stain,Lab Services,Per Unit,$4.27 ,OP,4.27,26.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87206,Smear fluorescent/acid stai,Lab Services,Per Unit,$5.39 ,OP,5.39,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87207,Smear special stain,Lab Services,Per Unit,$5.99 ,OP,5.99,5.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87209,Smear complex stain,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87210,Smear wet mount saline/ink,Lab Services,Per Unit,$5.82 ,OP,5.82,45.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87220,Tissue exam for fungi,Lab Services,Per Unit,$4.27 ,OP,4.27,93.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87230,Assay toxin or antitoxin,Lab Services,Per Unit,$19.74 ,OP,19.74,185.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87250,Virus inoculate eggs/animal,Lab Services,Per Unit,$19.56 ,OP,19.56,19.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87252,Virus inoculation tissue,Lab Services,Per Unit,$26.07 ,OP,26.07,157.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87253,Virus inoculate tissue addl,Lab Services,Per Unit,$20.20 ,OP,20.2,20.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87254,Virus inoculation shell via,Lab Services,Per Unit,$19.56 ,OP,19.56,19.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87255,Genet virus isolate hsv,Lab Services,Per Unit,$33.86 ,OP,33.86,33.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87260,Adenovirus ag if,Lab Services,Per Unit,$14.43 ,OP,14.43,14.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87265,Pertussis ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87267,Enterovirus antibody dfa,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87269,Giardia ag if,Lab Services,Per Unit,$13.61 ,OP,13.61,13.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87270,Chlamydia trachomatis ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,49.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87271,Cytomegalovirus dfa,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87272,Cryptosporidium ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87273,Herpes simplex 2 ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87274,Herpes simplex 1 ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87275,Influenza b ag if,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87276,Influenza a ag if,Lab Services,Per Unit,$16.07 ,OP,16.07,36.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87278,Legion pneumophilia ag if,Lab Services,Per Unit,$15.60 ,OP,15.6,15.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87279,Parainfluenza ag if,Lab Services,Per Unit,$16.43 ,OP,16.43,16.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87280,Respiratory syncytial ag if,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87281,Pneumocystis carinii ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87283,Rubeola ag if,Lab Services,Per Unit,$60.80 ,OP,60.8,60.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87285,Treponema pallidum ag if,Lab Services,Per Unit,$12.18 ,OP,12.18,12.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87290,Varicella zoster ag if,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87299,Antibody detection nos if,Lab Services,Per Unit,$16.10 ,OP,16.1,16.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87300,Ag detection polyval if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87301,Adenovirus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87305,Aspergillus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87320,Chylmd trach ag ia,Lab Services,Per Unit,$15.00 ,OP,15,40.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87324,Clostridium ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,104.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87327,Cryptococcus neoform ag ia,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87328,Cryptosporidium ag ia,Lab Services,Per Unit,$13.82 ,OP,13.82,51.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87329,Giardia ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,32.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87332,Cytomegalovirus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87335,E coli 0157 ag ia,Lab Services,Per Unit,$12.66 ,OP,12.66,12.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87336,Entamoeb hist dispr ag ia,Lab Services,Per Unit,$16.00 ,OP,16,38.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87337,Entamoeb hist group ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,37.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87338,Hpylori stool ag ia,Lab Services,Per Unit,$14.38 ,OP,14.38,14.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87339,H pylori ag ia,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87340,Hepatitis b surface ag ia,Lab Services,Per Unit,$10.33 ,OP,10.33,74.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87341,Hepatitis b surface ag ia,Lab Services,Per Unit,$10.33 ,OP,10.33,10.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87350,Hepatitis be ag ia,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87380,Hepatitis delta agent ag ia,Lab Services,Per Unit,$18.36 ,OP,18.36,18.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87385,Histoplasma capsul ag ia,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87389,Hiv-1 ag w/hiv-1&2 ab ag ia,Lab Services,Per Unit,$24.08 ,OP,24.08,24.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87390,Hiv-1 ag ia,Lab Services,Per Unit,$24.06 ,OP,24.06,58.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87391,Hiv-2 ag ia,Lab Services,Per Unit,$21.90 ,OP,21.9,21.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87400,Influenza a/b each ag ia,Lab Services,Per Unit,$14.13 ,OP,14.13,68.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87420,Resp syncytial virus ag ia,Lab Services,Per Unit,$13.91 ,OP,13.91,109.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87425,Rotavirus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,132.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87426,Sarscov coronavirus ag ia,Lab Services,Per Unit,$35.33 ,OP,35.33,35.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87427,Shiga-like toxin ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,111.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87428,Sarscov & inf vir a&b ag ia,Lab Services,Per Unit,$63.59 ,OP,63.59,63.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87430,Strep a ag ia,Lab Services,Per Unit,$16.81 ,OP,16.81,39.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87449,Nos each organism ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,41.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87451,Polyvalent mult org ea ag ia,Lab Services,Per Unit,$10.51 ,OP,10.51,10.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87471,Bartonella dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87472,Bartonella dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87475,Lyme dis dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87476,Lyme dis dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87480,Candida dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87481,Candida dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87482,Candida dna quant,Lab Services,Per Unit,$55.74 ,OP,55.74,55.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87483,Cns dna amp probe type 12-25,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87485,Chylmd pneum dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87486,Chylmd pneum dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87487,Chylmd pneum dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87490,Chylmd trach dna dir probe,Lab Services,Per Unit,$22.75 ,OP,22.75,105.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87491,Chylmd trach dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,56.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87492,Chylmd trach dna quant,Lab Services,Per Unit,$53.47 ,OP,53.47,53.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87493,C diff amplified probe,Lab Services,Per Unit,$37.27 ,OP,37.27,37.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87495,Cytomeg dna dir probe,Lab Services,Per Unit,$30.03 ,OP,30.03,30.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87496,Cytomeg dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87497,Cytomeg dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87498,Enterovirus probe&revrs trns,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87500,Vanomycin dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87501,Influenza dna amp prob 1+,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87502,Influenza dna amp probe,Lab Services,Per Unit,$95.80 ,OP,95.8,95.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87503,Influenza dna amp prob addl,Lab Services,Per Unit,$29.22 ,OP,29.22,29.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87505,Nfct agent detection gi,Lab Services,Per Unit,$128.29 ,OP,128.29,128.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87506,Iadna-dna/rna probe tq 6-11,Lab Services,Per Unit,$262.99 ,OP,262.99,262.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87507,Iadna-dna/rna probe tq 12-25,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87510,Gardner vag dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87511,Gardner vag dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87512,Gardner vag dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87516,Hepatitis b dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87517,Hepatitis b dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87520,Hepatitis c rna dir probe,Lab Services,Per Unit,$31.22 ,OP,31.22,31.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87521,Hepatitis c probe&rvrs trnsc,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87522,Hepatitis c revrs trnscrpj,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87525,Hepatitis g dna dir probe,Lab Services,Per Unit,$29.80 ,OP,29.8,29.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87526,Hepatitis g dna amp probe,Lab Services,Per Unit,$39.26 ,OP,39.26,39.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87527,Hepatitis g dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87528,Hsv dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87529,Hsv dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87530,Hsv dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87531,Hhv-6 dna dir probe,Lab Services,Per Unit,$58.00 ,OP,58,58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87532,Hhv-6 dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87533,Hhv-6 dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87534,Hiv-1 dna dir probe,Lab Services,Per Unit,$21.92 ,OP,21.92,21.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87535,Hiv-1 probe&reverse trnscrpj,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87536,Hiv-1 quant&revrse trnscrpj,Lab Services,Per Unit,$85.10 ,OP,85.1,85.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87537,Hiv-2 dna dir probe,Lab Services,Per Unit,$21.92 ,OP,21.92,21.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87538,Hiv-2 probe&revrse trnscripj,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87539,Hiv-2 quant&revrse trnscripj,Lab Services,Per Unit,$58.62 ,OP,58.62,58.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87540,Legion pneumo dna dir prob,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87541,Legion pneumo dna amp prob,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87542,Legion pneumo dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87550,Mycobacteria dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87551,Mycobacteria dna amp probe,Lab Services,Per Unit,$48.24 ,OP,48.24,48.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87552,Mycobacteria dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87555,M.tuberculo dna dir probe,Lab Services,Per Unit,$26.88 ,OP,26.88,26.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87556,M.tuberculo dna amp probe,Lab Services,Per Unit,$41.68 ,OP,41.68,41.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87557,M.tuberculo dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87560,M.avium-intra dna dir prob,Lab Services,Per Unit,$27.29 ,OP,27.29,27.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87561,M.avium-intra dna amp prob,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87562,M.avium-intra dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87563,M. genitalium amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87580,M.pneumon dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87581,M.pneumon dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87582,M.pneumon dna quant,Lab Services,Per Unit,$302.62 ,OP,302.62,302.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87590,N.gonorrhoeae dna dir prob,Lab Services,Per Unit,$26.88 ,OP,26.88,105.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87591,N.gonorrhoeae dna amp prob,Lab Services,Per Unit,$35.09 ,OP,35.09,56.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87592,N.gonorrhoeae dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87623,Hpv low-risk types,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87624,Hpv high-risk types,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87625,Hpv types 16 & 18 only,Lab Services,Per Unit,$40.55 ,OP,40.55,40.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87631,Resp virus 3-5 targets,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87632,Resp virus 6-11 targets,Lab Services,Per Unit,$218.06 ,OP,218.06,218.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87633,Resp virus 12-25 targets,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87634,Rsv dna/rna amp probe,Lab Services,Per Unit,$70.20 ,OP,70.2,70.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87635,Sars-cov-2 covid-19 amp prb,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87636,Sarscov2 & inf a&b amp prb,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87637,Sarscov2&inf a&b&rsv amp prb,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87640,Staph a dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87641,Mr-staph dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87650,Strep a dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87651,Strep a dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87652,Strep a dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87653,Strep b dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87660,Trichomonas vagin dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87661,Trichomonas vaginalis amplif,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87662,Zika virus dna/rna amp probe,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87797,Detect agent nos dna dir,Lab Services,Per Unit,$30.03 ,OP,30.03,30.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87798,Detect agent nos dna amp,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87799,Detect agent nos dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87800,Detect agnt mult dna direc,Lab Services,Per Unit,$43.67 ,OP,43.67,43.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87801,Detect agnt mult dna ampli,Lab Services,Per Unit,$70.20 ,OP,70.2,70.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87802,Strep b assay w/optic,Lab Services,Per Unit,$12.73 ,OP,12.73,12.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87803,Clostridium toxin a w/optic,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87804,Influenza assay w/optic,Lab Services,Per Unit,$16.55 ,OP,16.55,63.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87806,Hiv w/hiv1&2 antb w/optic,Lab Services,Per Unit,$32.77 ,OP,32.77,32.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87807,Rsv assay w/optic,Lab Services,Per Unit,$13.10 ,OP,13.1,13.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87808,Trichomonas assay w/optic,Lab Services,Per Unit,$15.29 ,OP,15.29,15.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87809,Adenovirus assay w/optic,Lab Services,Per Unit,$21.76 ,OP,21.76,21.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87810,Chylmd trach assay w/optic,Lab Services,Per Unit,$35.29 ,OP,35.29,35.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87811,Sars-cov-2 covid19 w/optic,Lab Services,Per Unit,$41.38 ,OP,41.38,41.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87850,N. gonorrhoeae assay w/optic,Lab Services,Per Unit,$24.56 ,OP,24.56,24.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87880,Strep a assay w/optic,Lab Services,Per Unit,$16.53 ,OP,16.53,45.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87899,Agent nos assay w/optic,Lab Services,Per Unit,$16.07 ,OP,16.07,27.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87900,Phenotype infect agent drug,Lab Services,Per Unit,$130.35 ,OP,130.35,130.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87901,Genotype dna hiv reverse t,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87902,Genotype dna/rna hep c,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87903,Phenotype dna hiv w/culture,Lab Services,Per Unit,$488.66 ,OP,488.66,488.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87904,Phenotype dna hiv w/clt add,Lab Services,Per Unit,$26.07 ,OP,26.07,26.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87905,Sialidase enzyme assay,Lab Services,Per Unit,$12.22 ,OP,12.22,12.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87906,Genotype dna/rna hiv,Lab Services,Per Unit,$128.73 ,OP,128.73,128.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87910,Genotype cytomegalovirus,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,87912,Genotype dna hepatitis b,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88104,Cytopath fl nongyn smears,APC 5732,RVU Per Case,$32.79 ,OP,32.79,74.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88106,Cytopath fl nongyn filter,APC 5731,RVU Per Case,$23.91 ,OP,23.91,62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88108,Cytopath concentrate tech,APC 5732,RVU Per Case,$32.79 ,OP,32.39,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88112,Cytopath cell enhance tech,APC 5671,RVU Per Case,$48.22 ,OP,48.22,52.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88120,Cytp urne 3-5 probes ea spec,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88121,Cytp urine 3-5 probes cmptr,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88125,Forensic cytopathology,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88130,Sex chromatin identification,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88140,Sex chromatin identification,Lab Services,Per Unit,$7.99 ,OP,7.99,7.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88142,Cytopath c/v thin layer,Lab Services,Per Unit,$20.26 ,OP,20.26,53.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88143,Cytopath c/v thin layer redo,Lab Services,Per Unit,$23.04 ,OP,23.04,23.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88147,Cytopath c/v automated,Lab Services,Per Unit,$50.56 ,OP,50.56,50.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88148,Cytopath c/v auto rescreen,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88150,Cytopath c/v manual,Lab Services,Per Unit,$15.15 ,OP,15.15,29.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88152,Cytopath c/v auto redo,Lab Services,Per Unit,$27.64 ,OP,27.64,27.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88153,Cytopath c/v redo,Lab Services,Per Unit,$24.03 ,OP,24.03,24.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88155,Cytopath c/v index add-on,Lab Services,Per Unit,$14.65 ,OP,14.65,14.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88160,Cytopath smear other source,APC 5731,RVU Per Case,$23.91 ,OP,23.91,44.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88161,Cytopath smear other source,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88162,Cytopath smear other source,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88164,Cytopath tbs c/v manual,Lab Services,Per Unit,$15.15 ,OP,15.15,37.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88165,Cytopath tbs c/v redo,Lab Services,Per Unit,$42.22 ,OP,42.22,42.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88166,Cytopath tbs c/v auto redo,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88167,Cytopath tbs c/v select,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88172,Cytp dx eval fna 1st ea site,APC 5672,RVU Per Case,$144.55 ,OP,144.55,185.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88173,Cytopath eval fna report,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88174,Cytopath c/v auto in fluid,Lab Services,Per Unit,$25.37 ,OP,25.37,25.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88175,Cytopath c/v auto fluid redo,Lab Services,Per Unit,$26.61 ,OP,26.61,67.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88182,Cell marker study,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88184,Flowcytometry/ tc 1 marker,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88199,Cytopathology procedure,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88230,Tissue culture lymphocyte,Lab Services,Per Unit,$116.49 ,OP,116.49,116.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88233,Tissue culture skin/biopsy,Lab Services,Per Unit,$140.73 ,OP,140.73,140.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88235,Tissue culture placenta,Lab Services,Per Unit,$150.30 ,OP,150.3,150.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88237,Tissue culture bone marrow,Lab Services,Per Unit,$143.75 ,OP,143.75,143.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88239,Tissue culture tumor,Lab Services,Per Unit,$147.52 ,OP,147.52,147.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88240,Cell cryopreserve/storage,Lab Services,Per Unit,$13.07 ,OP,13.07,13.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88241,Frozen cell preparation,Lab Services,Per Unit,$12.09 ,OP,12.09,12.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88245,Chromosome analysis 20-25,Lab Services,Per Unit,$173.17 ,OP,173.17,173.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88248,Chromosome analysis 50-100,Lab Services,Per Unit,$173.17 ,OP,173.17,173.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88249,Chromosome analysis 100,Lab Services,Per Unit,$173.17 ,OP,173.17,173.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88261,Chromosome analysis 5,Lab Services,Per Unit,$264.34 ,OP,264.34,264.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88262,Chromosome analysis 15-20,Lab Services,Per Unit,$125.49 ,OP,125.49,125.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88263,Chromosome analysis 45,Lab Services,Per Unit,$150.29 ,OP,150.29,150.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88264,Chromosome analysis 20-25,Lab Services,Per Unit,$144.61 ,OP,144.61,144.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88267,Chromosome analys placenta,Lab Services,Per Unit,$188.57 ,OP,188.57,188.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88269,Chromosome analys amniotic,Lab Services,Per Unit,$173.66 ,OP,173.66,173.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88271,Cytogenetics dna probe,Lab Services,Per Unit,$21.42 ,OP,21.42,21.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88272,Cytogenetics 3-5,Lab Services,Per Unit,$40.70 ,OP,40.7,40.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88273,Cytogenetics 10-30,Lab Services,Per Unit,$34.81 ,OP,34.81,34.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88274,Cytogenetics 25-99,Lab Services,Per Unit,$42.38 ,OP,42.38,42.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88275,Cytogenetics 100-300,Lab Services,Per Unit,$51.19 ,OP,51.19,51.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88280,Chromosome karyotype study,Lab Services,Per Unit,$33.47 ,OP,33.47,33.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88283,Chromosome banding study,Lab Services,Per Unit,$68.60 ,OP,68.6,68.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88285,Chromosome count additional,Lab Services,Per Unit,$26.91 ,OP,26.91,26.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88289,Chromosome study additional,Lab Services,Per Unit,$34.43 ,OP,34.43,34.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88299,Cytogenetic study,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88300,Surgical path gross,APC 5731,RVU Per Case,$23.91 ,OP,23.91,45.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88302,Tissue exam by pathologist,APC 5731,RVU Per Case,$23.91 ,OP,23.91,73.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88304,Tissue exam by pathologist,APC 5671,RVU Per Case,$48.22 ,OP,48.22,91.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88305,Tissue exam by pathologist,APC 5671,RVU Per Case,$48.22 ,OP,48.22,109.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88307,Tissue exam by pathologist,APC 5673,RVU Per Case,$282.25 ,OP,75.98,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88309,Tissue exam by pathologist,APC 5674,RVU Per Case,$635.86 ,OP,528.45,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88312,Special stains group 1,APC 5671,RVU Per Case,$48.22 ,OP,48.22,82.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88313,Special stains group 2,APC 5732,RVU Per Case,$32.79 ,OP,32.79,55.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88319,Enzyme histochemistry,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88321,Microslide consultation,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88323,Microslide consultation,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88325,Comprehensive review of data,APC 5672,RVU Per Case,$144.55 ,OP,141.52,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88329,Path consult introp,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88331,Path consult intraop 1 bloc,APC 5672,RVU Per Case,$144.55 ,OP,144.55,152.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88333,Intraop cyto path consult 1,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88342,Immunohisto antb 1st stain,APC 5672,RVU Per Case,$144.55 ,OP,144.55,156.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88344,Immunohisto antibody slide,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88346,Immunofluor antb 1st stain,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88348,Electron microscopy,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88355,Analysis skeletal muscle,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88356,Analysis nerve,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88358,Analysis tumor,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88360,Tumor immunohistochem/manual,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88361,Tumor immunohistochem/comput,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88362,Nerve teasing preparations,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88363,Xm archive tissue molec anal,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88365,Insitu hybridization (fish),APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88366,Insitu hybridization (fish),APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88367,Insitu hybridization auto,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88368,Insitu hybridization manual,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88374,M/phmtrc alys ishquant/semiq,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88377,M/phmtrc alys ishquant/semiq,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88399,Surgical pathology procedure,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88720,Bilirubin total transcut,Lab Services,Per Unit,$5.02 ,OP,5.02,5.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88738,Hgb quant transcutaneous,Lab Services,Per Unit,$5.02 ,OP,5.02,5.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88740,Transcutaneous carboxyhb,Lab Services,Per Unit,$9.37 ,OP,9.37,9.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,88741,Transcutaneous methb,Lab Services,Per Unit,$9.37 ,OP,9.37,9.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89049,Chct for mal hyperthermia,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89050,Body fluid cell count,Lab Services,Per Unit,$4.72 ,OP,4.72,80.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89051,Body fluid cell count,Lab Services,Per Unit,$5.60 ,OP,5.6,81.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89055,Leukocyte assessment fecal,Lab Services,Per Unit,$4.27 ,OP,4.27,48.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89060,Exam synovial fluid crystals,Lab Services,Per Unit,$7.33 ,OP,7.33,73.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89125,Specimen fat stain,Lab Services,Per Unit,$5.88 ,OP,5.88,5.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89160,Exam feces for meat fibers,Lab Services,Per Unit,$4.85 ,OP,4.85,36.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89190,Nasal smear for eosinophils,Lab Services,Per Unit,$5.79 ,OP,5.79,5.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89220,Sputum specimen collection,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89230,Collect sweat for test,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89240,Pathology lab procedure,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89250,Cultr oocyte/embryo <4 days,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89251,Cultr oocyte/embryo <4 days,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89253,Embryo hatching,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89254,Oocyte identification,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89255,Prepare embryo for transfer,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89257,Sperm identification,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89258,Cryopreservation embryo(s),APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89259,Cryopreservation sperm,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89260,Sperm isolation simple,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89261,Sperm isolation complex,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89264,Identify sperm tissue,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89268,Insemination of oocytes,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89272,Extended culture of oocytes,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89280,Assist oocyte fertilization,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89281,Assist oocyte fertilization,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89290,Biopsy oocyte polar body,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89291,Biopsy oocyte polar body,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89300,Semen analysis w/huhner,Lab Services,Per Unit,$9.84 ,OP,9.84,9.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89310,Semen analysis w/count,Lab Services,Per Unit,$8.61 ,OP,8.61,8.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89320,Semen anal vol/count/mot,Lab Services,Per Unit,$12.31 ,OP,12.31,207.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89321,Semen anal sperm detection,Lab Services,Per Unit,$12.05 ,OP,12.05,35.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89322,Semen anal strict criteria,Lab Services,Per Unit,$15.50 ,OP,15.5,15.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89325,Sperm antibody test,Lab Services,Per Unit,$10.67 ,OP,10.67,10.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89329,Sperm evaluation test,Lab Services,Per Unit,$19.59 ,OP,19.59,19.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89330,Evaluation cervical mucus,Lab Services,Per Unit,$10.38 ,OP,10.38,10.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89331,Retrograde ejaculation anal,Lab Services,Per Unit,$19.59 ,OP,19.59,19.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89335,Cryopreserve testicular tiss,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89337,Cryopreservation oocyte(s),APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89342,Storage/year embryo(s),APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89343,Storage/year sperm/semen,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89344,Storage/year reprod tissue,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89346,Storage/year oocyte(s),APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89352,Thawing cryopresrved embryo,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89353,Thawing cryopresrved sperm,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89354,Thaw cryoprsvrd reprod tiss,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89356,Thawing cryopresrved oocyte,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,89398,Unlisted reprod med lab proc,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90371,Hep b ig im,APC 1630,Per Unit,$130.31 ,OP,130.31,130.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90375,Rabies ig im/sc,APC 9133,Per Unit,$267.30 ,OP,267.3,267.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90376,Rabies ig heat treated,APC 9134,Per Unit,$287.38 ,OP,287.38,287.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90378,Rsv mab im 50mg,APC 9003,Per Unit,"$1,185.67 ",OP,"1,185.67","1,185.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90385,Rh ig minidose im,APC 9063,Per Unit,$151.41 ,OP,151.41,151.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90396,Varicella-zoster ig im,APC 9135,Per Unit,"$1,965.97 ",OP,"1,965.97","1,965.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90471,Immunization admin,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90473,Immune admin oral/nasal,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90630,Flu vacc iiv4 no preserv id,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90653,Iiv adjuvant vaccine im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90654,Flu vacc iiv3 no preserv id,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90655,Iiv3 vacc no prsv 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90656,Iiv3 vacc no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90657,Iiv3 vaccine splt 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90660,Laiv3 vaccine intranasal,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90661,Cciiv3 vac no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90662,Iiv no prsv increased ag im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90670,Pcv13 vaccine im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90672,Laiv4 vaccine intranasal,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90673,Riv3 vaccine no preserv im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90674,Cciiv4 vac no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90675,Rabies vaccine im,APC 9139,Per Unit,$327.53 ,OP,327.53,327.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90676,Rabies vaccine id,APC 9140,Per Unit,$189.63 ,OP,189.63,189.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90682,Riv4 vacc recombinant dna im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90685,Iiv4 vacc no prsv 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90686,Iiv4 vacc no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90687,Iiv4 vaccine splt 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90688,Iiv4 vaccine splt 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90689,Vacc iiv4 no prsrv 0.25ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90694,Vacc aiiv4 no prsrv 0.5ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90732,Ppsv23 vacc 2 yrs+ subq/im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90739,Hepb vacc 2 dose adult im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90740,Hepb vacc 3 dose immunsup im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90743,Hepb vacc 2 dose adolesc im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90744,Hepb vacc 3 dose ped/adol im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90746,Hepb vaccine 3 dose adult im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90747,Hepb vacc 4 dose immunsup im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90756,Cciiv4 vacc abx free im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90791,Psych diagnostic evaluation,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90792,Psych diag eval w/med srvcs,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90832,Psytx w pt 30 minutes,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90834,Psytx w pt 45 minutes,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90837,Psytx w pt 60 minutes,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90839,Psytx crisis initial 60 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90845,Psychoanalysis,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90846,Family psytx w/o pt 50 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90847,Family psytx w/pt 50 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90849,Multiple family group psytx,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90853,Group psychotherapy,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90865,Narcosynthesis,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90867,Tcranial magn stim tx plan,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90868,Tcranial magn stim tx deli,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90869,Tcran magn stim redetemine,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90870,Electroconvulsive therapy,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90880,Hypnotherapy,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90899,Psychiatric service/therapy,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90901,Biofeedback train any meth,Lab Services,Per Unit,$19.59 ,OP,19.59,19.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90912,Bfb training 1st 15 min,Lab Services,Per Unit,$43.33 ,OP,43.33,43.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90913,Bfb training ea addl 15 min,Lab Services,Per Unit,$24.51 ,OP,24.51,24.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90935,Hemodialysis one evaluation,APC 5401,RVU Per Unit,$634.11 ,OP,634.11,634.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,90945,Dialysis one evaluation,APC 5024,RVU Per Unit,$352.49 ,OP,352.49,352.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91010,Esophagus motility study,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91020,Gastric motility studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91022,Duodenal motility study,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91030,Acid perfusion of esophagus,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91034,Gastroesophageal reflux test,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91035,G-esoph reflx tst w/electrod,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91037,Esoph imped function test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91038,Esoph imped funct test > 1hr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91040,Esoph balloon distension tst,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91065,Breath hydrogen/methane test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91110,Gi tract capsule endoscopy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91111,Esophageal capsule endoscopy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91112,Gi wireless capsule measure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91117,Colon motility 6 hr study,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91120,Rectal sensation test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91122,Anal pressure record,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91132,Electrogastrography,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91133,Electrogastrography w/test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91200,Liver elastography,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91299,Gastroenterology procedure,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91300,Sarscov2 vac 30mcg/0.3ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91301,Sarscov2 vac 100mcg/0.5ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,91303,Sarscov2 vac ad26 .5ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92002,Eye exam new patient,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92004,Eye exam new patient,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92012,Eye exam establish patient,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92014,Eye exam&tx estab pt 1/>vst,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92018,New eye exam & treatment,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92019,Eye exam & treatment,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92020,Special eye evaluation,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92025,Corneal topography,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92060,Special eye evaluation,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92065,Orthoptic/pleoptic training,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92081,Visual field examination(s),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92082,Visual field examination(s),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92083,Visual field examination(s),APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92132,Cmptr ophth dx img ant segmt,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92133,Cmptr ophth img optic nerve,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92134,Cptr ophth dx img post segmt,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92136,Ophthalmic biometry,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92145,Corneal hysteresis deter,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92201,Opscpy extnd rta draw uni/bi,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92202,Opscpy extnd on/mac draw,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92227,Img rta detcj/mntr ds staff,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92228,Img rta detc/mntr ds phy/qhp,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92229,Img rta detc/mntr ds poc aly,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92230,Eye exam with photos,APC 5723,RVU Per Case,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92235,Fluorescein angrph uni/bi,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92240,Icg angiography uni/bi,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92242,Fluorescein icg angiography,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92250,Eye exam with photos,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92260,Ophthalmoscopy/dynamometry,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92265,Eye muscle evaluation,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92270,Electro-oculography,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92273,Full field erg w/i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92274,Multifocal erg w/i&r,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92283,Color vision examination,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92284,Dark adaptation eye exam,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92285,Eye photography,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92286,Internal eye photography,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92287,Internal eye photography,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92311,Contact lens fitting,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92312,Contact lens fitting,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92313,Contact lens fitting,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92315,Rx cntact lens aphakia 1 eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92316,Rx cntact lens aphakia 2 eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92317,Rx corneoscleral cntact lens,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92325,Modification of contact lens,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92326,Replacement of contact lens,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92352,Fit aphakia spectcl monofocl,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92353,Fit aphakia spectcl multifoc,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92354,Fit spectacles single system,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92355,Fit spectacles compound lens,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92358,Aphakia prosth service temp,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92371,Repair & adjust spectacles,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92499,Eye service or procedure,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92502,Ear and throat examination,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,438.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92507,Speech/hearing therapy,Lab Services,Per Unit,$75.75 ,OP,75.75,75.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92508,Speech/hearing therapy,Lab Services,Per Unit,$23.07 ,OP,23.07,23.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92511,Nasopharyngoscopy,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,159.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92512,Nasal function studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92516,Facial nerve function test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92517,Vemp test i&r cervical,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92518,Vemp test i&r ocular,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92519,Vemp tst i&r cervical&ocular,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92520,Laryngeal function studies,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92521,Evaluation of speech fluency,Lab Services,Per Unit,$132.47 ,OP,132.47,132.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92522,Evaluate speech production,Lab Services,Per Unit,$111.22 ,OP,111.22,111.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92523,Speech sound lang comprehen,Lab Services,Per Unit,$227.69 ,OP,227.69,227.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92524,Behavral qualit analys voice,Lab Services,Per Unit,$108.89 ,OP,108.89,108.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92526,Oral function therapy,Lab Services,Per Unit,$83.51 ,OP,83.51,83.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92537,Caloric vstblr test w/rec,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92538,Caloric vstblr test w/rec,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92540,Basic vestibular evaluation,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92541,Spontaneous nystagmus test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92542,Positional nystagmus test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92544,Optokinetic nystagmus test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92545,Oscillating tracking test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92546,Sinusoidal rotational test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92548,Cdp-sot 6 cond w/i&r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92549,Cdp-sot 6 cond w/i&r mct&adt,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92550,Tympanometry & reflex thresh,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92552,Pure tone audiometry air,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92553,Audiometry air & bone,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92555,Speech threshold audiometry,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92556,Speech audiometry complete,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92557,Comprehensive hearing test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92561,Bekesy audiometry diagnosis,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92562,Loudness balance test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92563,Tone decay hearing test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92564,Sisi hearing test,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92565,Stenger test pure tone,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92567,Tympanometry,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92568,Acoustic refl threshold tst,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92570,Acoustic immitance testing,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92571,Filtered speech hearing test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92572,Staggered spondaic word test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92575,Sensorineural acuity test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92576,Synthetic sentence test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92577,Stenger test speech,APC 5723,RVU Per Case,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92579,Visual audiometry (vra),APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92582,Conditioning play audiometry,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92583,Select picture audiometry,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92584,Electrocochleography,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92587,Evoked auditory test limited,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92588,Evoked auditory tst complete,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92596,Ear protector evaluation,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92597,Oral speech device eval,Lab Services,Per Unit,$70.53 ,OP,70.53,70.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92601,Cochlear implt f/up exam <7,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92602,Reprogram cochlear implt <7,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92603,Cochlear implt f/up exam 7/>,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92604,Reprogram cochlear implt 7/>,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92607,Ex for speech device rx 1hr,Lab Services,Per Unit,$122.72 ,OP,122.72,122.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92608,Ex for speech device rx addl,Lab Services,Per Unit,$49.31 ,OP,49.31,49.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92609,Use of speech device service,Lab Services,Per Unit,$102.45 ,OP,102.45,102.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92610,Evaluate swallowing function,Lab Services,Per Unit,$69.06 ,OP,69.06,69.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92611,Motion fluoroscopy/swallow,Lab Services,Per Unit,$90.57 ,OP,90.57,90.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92612,Endoscopy swallow (fees) vid,Lab Services,Per Unit,$65.56 ,OP,65.56,65.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92614,Laryngoscopic sensory vid,Lab Services,Per Unit,$64.93 ,OP,64.93,64.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92616,Fees w/laryngeal sense test,Lab Services,Per Unit,$97.82 ,OP,97.82,97.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92620,Auditory function 60 min,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92625,Tinnitus assessment,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92626,Eval aud funcj 1st hour,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92640,Aud brainstem implt programg,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92651,Aep hearing status deter i&r,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92652,Aep thrshld est mlt freq i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92653,Aep neurodiagnostic i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92700,Ent procedure/service,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92920,Prq cardiac angioplast 1 art,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92924,Prq card angio/athrect 1 art,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92928,Prq card stent w/angio 1 vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92933,Prq card stent/ath/angio,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92937,Prq revasc byp graft 1 vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92941,Prq card revasc mi 1 vsl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92943,Prq card revasc chronic 1vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92950,Heart/lung resuscitation cpr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92953,Temporary external pacing,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92960,Cardioversion electric ext,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92961,Cardioversion electric int,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92970,Cardioassist internal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92971,Cardioassist external,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92975,Dissolve clot heart vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92977,Dissolve clot heart vessel,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92986,Revision of aortic valve,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92987,Revision of mitral valve,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92990,Revision of pulmonary valve,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,92997,Pul art balloon repr percut,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93005,Electrocardiogram tracing,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93017,Cardiovascular stress test,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93024,Cardiac drug stress test,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93025,Microvolt t-wave assess,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93041,Rhythm ecg tracing,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93050,Art pressure waveform analys,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93225,Ecg monit/reprt up to 48 hrs,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93226,Ecg monit/reprt up to 48 hrs,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93229,Remote 30 day ecg tech supp,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93242,Ext ecg>48hr<7d recording,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93243,Ext ecg>48hr<7d scan a/r,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93246,Ext ecg>7d<15d recording,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93247,Ext ecg>7d<15d scan a/r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93260,Prgrmg dev eval impltbl sys,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93261,Interrogate subq defib,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93270,Remote 30 day ecg rev/report,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93271,Ecg/monitoring and analysis,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93278,Ecg/signal-averaged,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93279,Prgrmg dev eval pm/ldls pm,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93280,Pm device progr eval dual,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93281,Pm device progr eval multi,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93282,Prgrmg eval implantable dfb,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93283,Prgrmg eval implantable dfb,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93284,Prgrmg eval implantable dfb,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93285,Prgrmg dev eval scrms ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93288,Interrog evl pm/ldls pm ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93289,Interrog device eval heart,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93290,Interrog dev eval icpms ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93291,Interrog dev eval scrms ip,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93292,Wcd device interrogate,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93293,Pm phone r-strip device eval,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93296,Rem interrog evl pm/ids,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93303,Echo transthoracic,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93304,Echo transthoracic,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93306,Tte w/doppler complete,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93307,Tte w/o doppler complete,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93308,Tte f-up or lmtd,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93312,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93313,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93315,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93316,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93318,Echo transesophageal intraop,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93350,Stress tte only,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93351,Stress tte complete,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93451,Right heart cath,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93452,Left hrt cath w/ventrclgrphy,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93453,R&l hrt cath w/ventriclgrphy,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93454,Coronary artery angio s&i,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93455,Coronary art/grft angio s&i,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93456,R hrt coronary artery angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93457,R hrt art/grft angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93458,L hrt artery/ventricle angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93459,L hrt art/grft angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93460,R&l hrt art/ventricle angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93461,R&l hrt art/ventricle angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93503,Insert/place heart catheter,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93505,Biopsy of heart lining,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93530,Rt heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93531,R & l heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93532,R & l heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93533,R & l heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93580,Transcath closure of asd,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93581,Transcath closure of vsd,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93582,Perq transcath closure pda,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93583,Perq transcath septal reduxn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93590,Perq transcath cls mitral,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93591,Perq transcath cls aortic,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93600,Bundle of his recording,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93602,Intra-atrial recording,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93603,Right ventricular recording,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93610,Intra-atrial pacing,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93612,Intraventricular pacing,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93615,Esophageal recording,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93616,Esophageal recording,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93618,Heart rhythm pacing,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93619,Electrophysiology evaluation,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93620,Electrophysiology evaluation,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93624,Electrophysiologic study,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93642,Electrophysiology evaluation,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93650,Ablate heart dysrhythm focus,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93653,Ep & ablate supravent arrhyt,APC 5213,RVU Per Case,"$20,800.81 ",OP,"20,800.81","20,800.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93654,Ep & ablate ventric tachy,APC 5213,RVU Per Case,"$20,800.81 ",OP,"20,800.81","20,800.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93656,Tx atrial fib pulm vein isol,APC 5213,RVU Per Case,"$20,800.81 ",OP,"20,800.81","20,800.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93660,Tilt table evaluation,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93668,Peripheral vascular rehab,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93701,Bioimpedance cv analysis,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93702,Bis xtracell fluid analysis,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93724,Analyze pacemaker system,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93740,Temperature gradient studies,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93745,Set-up cardiovert-defibrill,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93750,Interrogation vad in person,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93786,Ambl bp mntr w/sw rec only,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93788,Ambl bp mntr w/sw a/r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93797,Cardiac rehab,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93798,Cardiac rehab/monitor,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93799,Cardiovascular procedure,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93880,Extracranial bilat study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93882,Extracranial uni/ltd study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93886,Intracranial complete study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93888,Intracranial limited study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93890,Tcd vasoreactivity study,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93892,Tcd emboli detect w/o inj,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93893,Tcd emboli detect w/inj,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93922,Upr/l xtremity art 2 levels,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93923,Upr/lxtr art stdy 3+ lvls,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93924,Lwr xtr vasc stdy bilat,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93925,Lower extremity study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93926,Lower extremity study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93930,Upper extremity study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93931,Upper extremity study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93970,Extremity study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93971,Extremity study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93975,Vascular study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93976,Vascular study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93978,Vascular study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93979,Vascular study,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93980,Penile vascular study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93981,Penile vascular study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93985,Dup-scan hemo compl bi std,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93986,Dup-scan hemo compl uni std,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93990,Doppler flow testing,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,93998,Noninvas vasc dx study proc,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94002,Vent mgmt inpat init day,APC 5801,RVU Per Unit,$470.26 ,OP,470.26,470.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94003,Vent mgmt inpat subq day,APC 5801,RVU Per Unit,$470.26 ,OP,470.26,470.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94010,Breathing capacity test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94011,Spirometry up to 2 yrs old,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94012,Spirmtry w/brnchdil inf-2 yr,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94013,Meas lung vol thru 2 yrs,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94014,Patient recorded spirometry,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94015,Patient recorded spirometry,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94016,Review patient spirometry,Lab Services,Per Unit,$24.70 ,OP,24.7,24.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94060,Evaluation of wheezing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94070,Evaluation of wheezing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94150,Vital capacity test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94200,Lung function test (mbc/mvv),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94375,Respiratory flow volume loop,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94450,Hypoxia response curve,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94452,Hast w/report,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94453,Hast w/oxygen titrate,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94610,Surfactant admin thru tube,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94617,Exercise tst brncspsm w/ecg,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94618,Pulmonary stress testing,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94619,Exercise tst brncspsm wo ecg,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94621,Cardiopulm exercise testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94640,Airway inhalation treatment,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94642,Aerosol inhalation treatment,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94644,Cbt 1st hour,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94660,Pos airway pressure cpap,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94662,Neg press ventilation cnp,APC 5801,RVU Per Unit,$470.26 ,OP,470.26,470.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94664,Evaluate pt use of inhaler,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94667,Chest wall manipulation,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94668,Chest wall manipulation,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94669,Mechanical chest wall oscill,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94680,Exhaled air analysis o2,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94681,Exhaled air analysis o2/co2,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94690,Exhaled air analysis,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94726,Pulm funct tst plethysmograp,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94727,Pulm function test by gas,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94728,Airwy resist by oscillometry,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94762,Measure blood oxygen level,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94772,Breath recording infant,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94775,Ped home apnea rec hk-up,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94776,Ped home apnea rec downld,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94780,Cars/bd tst inft-12mo 60 min,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,94799,Pulmonary service/procedure,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95004,Percut allergy skin tests,APC 5724,RVU Per Case,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95012,Exhaled nitric oxide meas,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95017,Perq & icut allg test venoms,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95018,Perq&ic allg test drugs/biol,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95024,Icut allergy test drug/bug,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95027,Icut allergy titrate-airborn,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95028,Icut allergy test-delayed,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95044,Allergy patch tests,APC 5724,RVU Per Case,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95052,Photo patch test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95056,Photosensitivity tests,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95060,Eye allergy tests,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95065,Nose allergy test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95070,Bronchial allergy tests,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95076,Ingest challenge ini 120 min,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95115,Immunotherapy one injection,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95117,Immunotherapy injections,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95144,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95145,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95146,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95147,Antigen therapy services,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95148,Antigen therapy services,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95149,Antigen therapy services,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95165,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95170,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95180,Rapid desensitization,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95199,Allergy immunology services,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95249,Cont gluc mntr pt prov eqp,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95250,Cont gluc mntr phys/qhp eqp,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95700,Eeg cont rec w/vid eeg tech,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95705,Eeg w/o vid 2-12 hr unmntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95706,Eeg wo vid 2-12hr intmt mntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95707,Eeg w/o vid 2-12hr cont mntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95708,Eeg wo vid ea 12-26hr unmntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95709,Eeg w/o vid ea 12-26hr intmt,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95710,Eeg w/o vid ea 12-26hr cont,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95711,Veeg 2-12 hr unmonitored,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95712,Veeg 2-12 hr intmt mntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95713,Veeg 2-12 hr cont mntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95714,Veeg ea 12-26 hr unmntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95715,Veeg ea 12-26hr intmt mntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95716,Veeg ea 12-26hr cont mntr,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95782,Polysom <6 yrs 4/> paramtrs,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95783,Polysom <6 yrs cpap/bilvl,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95800,Slp stdy unattended,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95801,Slp stdy unatnd w/anal,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95803,Actigraphy testing,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95805,Multiple sleep latency test,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95806,Sleep study unatt&resp efft,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95807,Sleep study attended,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95808,Polysom any age 1-3> param,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95810,Polysom 6/> yrs 4/> param,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95811,Polysom 6/>yrs cpap 4/> parm,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95812,Eeg 41-60 minutes,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95813,Eeg extnd mntr 61-119 min,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95816,Eeg awake and drowsy,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95819,Eeg awake and asleep,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95822,Eeg coma or sleep only,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95824,Eeg cerebral death only,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95836,Ecog impltd brn npgt <30 d,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95851,Range of motion measurements,Lab Services,Per Unit,$7.59 ,OP,7.59,7.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95852,Range of motion measurements,Lab Services,Per Unit,$5.52 ,OP,5.52,5.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95857,Cholinesterase challenge,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95860,Muscle test one limb,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95861,Muscle test 2 limbs,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95863,Muscle test 3 limbs,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95864,Muscle test 4 limbs,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95865,Muscle test larynx,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95866,Muscle test hemidiaphragm,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95867,Muscle test cran nerv unilat,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95868,Muscle test cran nerve bilat,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95869,Muscle test thor paraspinal,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95870,Muscle test nonparaspinal,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95872,Muscle test one fiber,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95875,Limb exercise test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95905,Motor &/ sens nrve cndj test,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95907,Nvr cndj tst 1-2 studies,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95908,Nrv cndj tst 3-4 studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95909,Nrv cndj tst 5-6 studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95910,Nrv cndj test 7-8 studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95911,Nrv cndj test 9-10 studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95912,Nrv cndj test 11-12 studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95913,Nrv cndj test 13/> studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95921,Autonomic nrv parasym inervj,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95922,Autonomic nrv adrenrg inervj,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95923,Autonomic nrv syst funj test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95924,Ans parasymp & symp w/tilt,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95925,Somatosensory testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95926,Somatosensory testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95927,Somatosensory testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95928,C motor evoked uppr limbs,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95929,C motor evoked lwr limbs,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95930,Visual ep test cns w/i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95933,Blink reflex test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95937,Neuromuscular junction test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95938,Somatosensory testing,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95939,C motor evoked upr&lwr limbs,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95943,Parasymp&symp hrt rate test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95954,Eeg monitoring/giving drugs,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95958,Eeg monitoring/function test,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95961,Electrode stimulation brain,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95965,Meg spontaneous,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95966,Meg evoked single,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95970,Alys npgt w/o prgrmg,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95971,Alys smpl sp/pn npgt w/prgrm,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95972,Alys cplx sp/pn npgt w/prgrm,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95976,Alys smpl cn npgt prgrmg,APC 5741,RVU Per Unit,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95977,Alys cplx cn npgt prgrmg,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95981,Io anal gast n-stim subsq,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95982,Io ga n-stim subsq w/reprog,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95983,Alys brn npgt prgrmg 15 min,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95990,Spin/brain pump refil & main,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95991,Spin/brain pump refil & main,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95992,Canalith repositioning proc,Lab Services,Per Unit,$36.73 ,OP,36.73,36.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,95999,Neurological procedure,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96000,Motion analysis video/3d,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96001,Motion test w/ft press meas,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96002,Dynamic surface emg,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96003,Dynamic fine wire emg,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96105,Assessment of aphasia,Lab Services,Per Unit,$98.92 ,OP,98.92,98.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96112,Devel tst phys/qhp 1st hr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96116,Nubhvl xm phys/qhp 1st hr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96125,Cognitive test by hc pro,Lab Services,Per Unit,$103.76 ,OP,103.76,103.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96127,Brief emotional/behav assmt,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96130,Psycl tst eval phys/qhp 1st,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96132,Nrpsyc tst eval phys/qhp 1st,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96136,Psycl/nrpsyc tst phy/qhp 1st,APC 5734,RVU Per Unit,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96138,Psycl/nrpsyc tech 1st,APC 5735,RVU Per Unit,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96146,Psycl/nrpsyc tst auto result,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96156,Hlth bhv assmt/reassessment,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96158,Hlth bhv ivntj indiv 1st 30,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96160,Pt-focused hlth risk assmt,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96161,Caregiver health risk assmt,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96164,Hlth bhv ivntj grp 1st 30,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96167,Hlth bhv ivntj fam 1st 30,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96360,Hydration iv infusion init,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96361,Hydrate iv infusion add-on,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96365,Ther/proph/diag iv inf init,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96366,Ther/proph/diag iv inf addon,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96367,Tx/proph/dg addl seq iv inf,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96369,Sc ther infusion up to 1 hr,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96370,Sc ther infusion addl hr,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96371,Sc ther infusion reset pump,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96372,Ther/proph/diag inj sc/im,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96373,Ther/proph/diag inj ia,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96374,Ther/proph/diag inj iv push,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96375,Tx/pro/dx inj new drug addon,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96377,Applicaton on-body injector,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96379,Ther/prop/diag inj/inf proc,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96401,Chemo anti-neopl sq/im,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96402,Chemo hormon antineopl sq/im,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96405,Chemo intralesional up to 7,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96406,Chemo intralesional over 7,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96409,Chemo iv push sngl drug,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96411,Chemo iv push addl drug,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96413,Chemo iv infusion 1 hr,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96415,Chemo iv infusion addl hr,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96416,Chemo prolong infuse w/pump,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96417,Chemo iv infus each addl seq,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96420,Chemo ia push tecnique,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96422,Chemo ia infusion up to 1 hr,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96423,Chemo ia infuse each addl hr,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96425,Chemotherapy infusion method,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96440,Chemotherapy intracavitary,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96446,Chemotx admn prtl cavity,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96450,Chemotherapy into cns,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96521,Refill/maint portable pump,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96522,Refill/maint pump/resvr syst,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96523,Irrig drug delivery device,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96542,Chemotherapy injection,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96549,Chemotherapy unspecified,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96567,Pdt dstr prmlg les skn,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96573,Pdt dstr prmlg les phys/qhp,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96574,Dbrdmt prmlg les w/pdt,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96900,Ultraviolet light therapy,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96910,Photochemotherapy with uv-b,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96912,Photochemotherapy with uv-a,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96913,Photochemotherapy uv-a or b,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96920,Laser tx skin < 250 sq cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96921,Laser tx skin 250-500 sq cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96922,Laser tx skin >500 sq cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,96999,Dermatological procedure,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97012,Mechanical traction therapy,Lab Services,Per Unit,$14.55 ,OP,14.55,41.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97016,Vasopneumatic device therapy,Lab Services,Per Unit,$11.78 ,OP,11.78,22.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97018,Paraffin bath therapy,Lab Services,Per Unit,$5.69 ,OP,5.69,52.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97022,Whirlpool therapy,Lab Services,Per Unit,$17.16 ,OP,17.16,40.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97024,Diathermy eg microwave,Lab Services,Per Unit,$6.96 ,OP,6.96,6.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97026,Infrared therapy,Lab Services,Per Unit,$6.32 ,OP,6.32,65.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97028,Ultraviolet therapy,Lab Services,Per Unit,$7.98 ,OP,7.98,7.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97032,Electrical stimulation,Lab Services,Per Unit,$14.55 ,OP,14.55,54.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97033,Electric current therapy,Lab Services,Per Unit,$19.67 ,OP,19.67,53.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97034,Contrast bath therapy,Lab Services,Per Unit,$14.42 ,OP,14.42,14.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97035,Ultrasound therapy,Lab Services,Per Unit,$14.10 ,OP,14.1,47.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97036,Hydrotherapy,Lab Services,Per Unit,$33.09 ,OP,33.09,33.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97110,Therapeutic exercises,Lab Services,Per Unit,$29.26 ,OP,29.26,61.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97112,Neuromuscular reeducation,Lab Services,Per Unit,$33.86 ,OP,33.86,40.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97113,Aquatic therapy/exercises,Lab Services,Per Unit,$36.67 ,OP,36.67,84.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97116,Gait training therapy,Lab Services,Per Unit,$29.26 ,OP,29.26,41.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97124,Massage therapy,Lab Services,Per Unit,$28.22 ,OP,28.22,79.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97129,Ther ivntj 1st 15 min,Lab Services,Per Unit,$23.04 ,OP,23.04,23.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97130,Ther ivntj ea addl 15 min,Lab Services,Per Unit,$22.35 ,OP,22.35,22.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97140,Manual therapy 1/> regions,Lab Services,Per Unit,$26.97 ,OP,26.97,56.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97150,Group therapeutic procedures,Lab Services,Per Unit,$17.53 ,OP,17.53,49.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97151,Bhv id assmt by phys/qhp,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97152,Bhv id suprt assmt by 1 tech,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97153,Adaptive behavior tx by tech,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97154,Grp adapt bhv tx by tech,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97155,Adapt behavior tx phys/qhp,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97156,Fam adapt bhv tx gdn phy/qhp,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97157,Mult fam adapt bhv tx gdn,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97158,Grp adapt bhv tx by phy/qhp,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97161,Pt eval low complex 20 min,Lab Services,Per Unit,$98.12 ,OP,98.12,98.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97162,Pt eval mod complex 30 min,Lab Services,Per Unit,$98.12 ,OP,98.12,98.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97163,Pt eval high complex 45 min,Lab Services,Per Unit,$98.12 ,OP,98.12,98.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97164,Pt re-eval est plan care,Lab Services,Per Unit,$66.97 ,OP,66.97,66.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97165,Ot eval low complex 30 min,Lab Services,Per Unit,$95.26 ,OP,95.26,95.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97166,Ot eval mod complex 45 min,Lab Services,Per Unit,$95.26 ,OP,95.26,95.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97167,Ot eval high complex 60 min,Lab Services,Per Unit,$95.26 ,OP,95.26,95.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97168,Ot re-eval est plan care,Lab Services,Per Unit,$64.11 ,OP,64.11,64.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97530,Therapeutic activities,Lab Services,Per Unit,$37.50 ,OP,37.5,56.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97533,Sensory integration,Lab Services,Per Unit,$57.03 ,OP,57.03,178.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97535,Self care mngment training,Lab Services,Per Unit,$32.44 ,OP,32.44,43.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97537,Community/work reintegration,Lab Services,Per Unit,$31.26 ,OP,31.26,31.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97542,Wheelchair mngment training,Lab Services,Per Unit,$31.58 ,OP,31.58,46.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97597,Rmvl devital tis 20 cm/<,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97602,Wound(s) care non-selective,APC 5051,RVU Per Case,$173.99 ,OP,68.84,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97605,Neg press wound tx <=50 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97606,Neg press wound tx >50 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97607,Neg press wnd tx <=50 sq cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97608,Neg press wound tx >50 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97610,Low frequency non-thermal us,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97750,Physical performance test,Lab Services,Per Unit,$33.07 ,OP,33.07,79.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97755,Assistive technology assess,Lab Services,Per Unit,$37.42 ,OP,37.42,37.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97760,Orthotic mgmt&traing 1st enc,Lab Services,Per Unit,$47.55 ,OP,47.55,47.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97761,Prosthetic traing 1st enc,Lab Services,Per Unit,$40.55 ,OP,40.55,40.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97763,Orthc/prostc mgmt sbsq enc,Lab Services,Per Unit,$51.94 ,OP,51.94,51.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97802,Medical nutrition indiv in,Lab Services,Per Unit,$36.18 ,OP,36.18,36.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97803,Med nutrition indiv subseq,Lab Services,Per Unit,$31.17 ,OP,31.17,31.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97804,Medical nutrition group,Lab Services,Per Unit,$16.45 ,OP,16.45,16.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97810,Acupunct w/o stimul 15 min,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,97813,Acupunct w/stimul 15 min,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98925,Osteopath manj 1-2 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98926,Osteopath manj 3-4 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98927,Osteopath manj 5-6 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98928,Osteopath manj 7-8 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98929,Osteopath manj 9-10 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98940,Chiropract manj 1-2 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98941,Chiropract manj 3-4 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98942,Chiropractic manj 5 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98966,Hc pro phone call 5-10 min,Lab Services,Per Unit,$12.73 ,OP,12.73,12.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98967,Hc pro phone call 11-20 min,Lab Services,Per Unit,$25.14 ,OP,25.14,25.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98968,Hc pro phone call 21-30 min,Lab Services,Per Unit,$37.46 ,OP,37.46,37.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98970,Qnhp ol dig assmt&mgmt 5-10,Lab Services,Per Unit,$11.36 ,OP,11.36,11.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98971,Qnhp ol dig assmt&mgmt 11-20,Lab Services,Per Unit,$20.31 ,OP,20.31,20.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,98972,Qnhp ol dig assmt&mgmt 21+,Lab Services,Per Unit,$32.41 ,OP,32.41,32.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99170,Anogenital exam child w imag,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,165.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99184,Hypothermia ill neonate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99190,Special pump services,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99191,Special pump services,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99192,Special pump services,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99195,Phlebotomy,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99281,Emergency dept visit,APC 5021,RVU Per Case,$70.35 ,OP,70.35,70.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99282,Emergency dept visit,APC 5022,RVU Per Case,$127.52 ,OP,127.52,127.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99283,Emergency dept visit,APC 5023,RVU Per Case,$224.44 ,OP,224.44,224.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99284,Emergency dept visit,APC 5024,RVU Per Case,$352.49 ,OP,352.49,352.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99285,Emergency dept visit,APC 5025,RVU Per Case,$505.98 ,OP,505.98,505.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99291,Critical care first hour,APC 5041,RVU Per Case,$671.26 ,OP,671.26,671.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99356,Prolng svc i/p/obs 1st hour,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99357,Prolng svc i/p/obs ea addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99406,Behav chng smoking 3-10 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99407,Behav chng smoking > 10 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99453,Rem mntr physiol param setup,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99454,Rem mntr physiol param dev,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99460,Init nb em per day hosp,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99462,Sbsq nb em per day hosp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99463,Same day nb discharge,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99465,Nb resuscitation,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99468,Neonate crit care initial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99469,Neonate crit care subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99471,Ped critical care initial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99472,Ped critical care subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99473,Self-meas bp pt educaj/train,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99475,Ped crit care age 2-5 init,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99476,Ped crit care age 2-5 subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99477,Init day hosp neonate care,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99478,Ic lbw inf < 1500 gm subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99479,Ic lbw inf 1500-2500 g subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99480,Ic inf pbw 2501-5000 g subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99483,Assmt & care pln pt cog imp,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99484,Care mgmt svc bhvl hlth cond,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99487,Cplx chrnc care 1st 60 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99490,Chrnc care mgmt svc 1st 20,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99492,1st psyc collab care mgmt,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99493,Sbsq psyc collab care mgmt,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99495,Trans care mgmt 14 day disch,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99496,Trans care mgmt 7 day disch,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,99497,Advncd care plan 30 min,APC 5822,RVU Per Case,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0001A,Adm sarscov2 30mcg/0.3ml 1st,APC 9397,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0001U,Rbc dna hea 35 ag 11 bld grp,Lab Services,Per Unit,$720.00 ,OP,720,720,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0002A,Adm sarscov2 30mcg/0.3ml 2nd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0002M,Liver dis 10 assays w/ash,Lab Services,Per Unit,$503.40 ,OP,503.4,503.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0002U,Onc clrct 3 ur metab alg plp,Lab Services,Per Unit,$25.00 ,OP,25,25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0003A,Adm sarscov2 30mcg/0.3ml 3rd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0003M,Liver dis 10 assays w/nash,Lab Services,Per Unit,$503.40 ,OP,503.4,503.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0003U,Onc ovar 5 prtn ser alg scor,Lab Services,Per Unit,$950.00 ,OP,950,950,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0004M,Scoliosis dna alys,Lab Services,Per Unit,$79.00 ,OP,79,79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0005U,Onco prst8 3 gene ur alg,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0006M,Onc hep gene risk classifier,Lab Services,Per Unit,$150.00 ,OP,150,150,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0007M,Onc gastro 51 gene nomogram,Lab Services,Per Unit,$375.00 ,OP,375,375,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0007U,Rx test prsmv ur w/def conf,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0008U,Hpylori detcj abx rstnc dna,Lab Services,Per Unit,$597.91 ,OP,597.91,597.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0009U,Onc brst ca erbb2 amp/nonamp,Lab Services,Per Unit,$107.00 ,OP,107,107,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0010U,Nfct ds strn typ whl gen seq,Lab Services,Per Unit,$427.26 ,OP,427.26,427.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0011A,Adm sarscov2 100mcg/0.5ml1st,APC 9397,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0011M,Onc prst8 ca mrna 12 gen alg,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0011U,Rx mntr lc-ms/ms oral fluid,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0012A,Adm sarscov2 100mcg/0.5ml2nd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0012M,Onc mrna 5 gen rsk urthl ca,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0012U,Germln do gene reargmt detcj,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0013A,Adm sarscov2 100mcg/0.5ml3rd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0013M,Onc mrna 5 gen recr urthl ca,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0013U,Onc sld org neo gene reargmt,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0014M,Liver ds alys 3 bmrk srm alg,Lab Services,Per Unit,$176.19 ,OP,176.19,176.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0014U,Hem hmtlmf neo gene reargmt,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0016U,Onc hmtlmf neo rna bcr/abl1,Lab Services,Per Unit,$163.96 ,OP,163.96,163.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0017U,Onc hmtlmf neo jak2 mut dna,Lab Services,Per Unit,$91.66 ,OP,91.66,91.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0018U,Onc thyr 10 microrna seq alg,Lab Services,Per Unit,"$3,002.09 ",OP,"3,002.09","3,002.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0019U,Onc rna tiss predict alg,Lab Services,Per Unit,"$3,675.00 ",OP,"3,675.00","3,675.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0021U,Onc prst8 detcj 8 autoantb,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0022U,Trgt gen seq dna&rna 23 gene,Lab Services,Per Unit,"$1,950.00 ",OP,"1,950.00","1,950.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0023U,Onc aml dna detcj/nondetcj,Lab Services,Per Unit,$248.51 ,OP,248.51,248.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0024U,Glyca nuc mr spectrsc quan,Lab Services,Per Unit,$34.19 ,OP,34.19,34.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0025U,Tenofovir liq chrom ur quan,Lab Services,Per Unit,$85.77 ,OP,85.77,85.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0026U,Onc thyr dna&mrna 112 genes,Lab Services,Per Unit,"$3,600.00 ",OP,"3,600.00","3,600.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0027U,Jak2 gene trgt seq alys,Lab Services,Per Unit,$121.91 ,OP,121.91,121.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0029U,Rx metab advrs trgt seq alys,Lab Services,Per Unit,$742.27 ,OP,742.27,742.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0030U,Rx metab warf trgt seq alys,Lab Services,Per Unit,$134.13 ,OP,134.13,134.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0031A,Adm sarscov2 vac ad26 .5ml,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0031U,Cyp1a2 gene,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0032U,Comt gene,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0033U,Htr2a htr2c genes,Lab Services,Per Unit,$349.62 ,OP,349.62,349.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0034U,Tpmt nudt15 genes,Lab Services,Per Unit,$466.17 ,OP,466.17,466.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0035U,Neuro csf prion prtn qual,Lab Services,Per Unit,$540.99 ,OP,540.99,540.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0036U,Xome tum & nml spec seq alys,Lab Services,Per Unit,"$4,780.00 ",OP,"4,780.00","4,780.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0037U,Trgt gen seq dna 324 genes,Lab Services,Per Unit,"$3,500.00 ",OP,"3,500.00","3,500.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0038U,Vitamin d srm microsamp quan,Lab Services,Per Unit,$29.60 ,OP,29.6,29.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0039U,Dna antb 2strand hi avidity,Lab Services,Per Unit,$13.74 ,OP,13.74,13.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0040U,Bcr/abl1 gene major bp quan,Lab Services,Per Unit,$409.90 ,OP,409.9,409.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0041U,B brgdrferi antb 5 prtn igm,Lab Services,Per Unit,$17.21 ,OP,17.21,17.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0042U,B brgdrferi antb 12 prtn igg,Lab Services,Per Unit,$17.21 ,OP,17.21,17.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0043U,Tbrf b grp antb 4 prtn igm,Lab Services,Per Unit,$14.86 ,OP,14.86,14.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0044U,Tbrf b grp antb 4 prtn igg,Lab Services,Per Unit,$14.86 ,OP,14.86,14.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0045U,Onc brst dux carc is 12 gene,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0046U,Flt3 gene itd variants quan,Lab Services,Per Unit,$407.43 ,OP,407.43,407.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0047U,Onc prst8 mrna 17 gene alg,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0048U,Onc sld org neo dna 468 gene,Lab Services,Per Unit,"$2,919.60 ",OP,"2,919.60","2,919.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0049U,Npm1 gene analysis quan,Lab Services,Per Unit,$407.43 ,OP,407.43,407.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0050U,Trgt gen seq dna 194 genes,Lab Services,Per Unit,"$2,916.60 ",OP,"2,916.60","2,916.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0051U,Rx mntr lc-ms/ms ur 31 pnl,Lab Services,Per Unit,$193.71 ,OP,193.71,193.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0052U,Lpoprtn bld w/5 maj classes,Lab Services,Per Unit,$33.86 ,OP,33.86,33.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0053U,Onc prst8 ca fish alys 4 gen,Lab Services,Per Unit,"$2,030.00 ",OP,"2,030.00","2,030.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0054U,Rx mntr 14+ drugs & sbsts,Lab Services,Per Unit,$148.96 ,OP,148.96,148.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0055U,Card hrt trnspl 96 dna seq,Lab Services,Per Unit,"$3,240.00 ",OP,"3,240.00","3,240.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0056U,Hem aml dna gene reargmt,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0058U,Onc merkel cll carc srm quan,Lab Services,Per Unit,$322.96 ,OP,322.96,322.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0059U,Onc merkel cll carc srm +/-,Lab Services,Per Unit,$322.96 ,OP,322.96,322.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0060U,Twn zyg gen seq alys chrms2,Lab Services,Per Unit,$759.05 ,OP,759.05,759.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0061U,Tc meas 5 bmrk sfdi m-s alys,Lab Services,Per Unit,$25.10 ,OP,25.1,25.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0062U,Ai sle igg&igm alys 80 bmrk,Lab Services,Per Unit,$380.72 ,OP,380.72,380.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0063U,Neuro autism 32 amines alg,Lab Services,Per Unit,$750.00 ,OP,750,750,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0064U,Antb tp total&rpr ia qual,Lab Services,Per Unit,$31.33 ,OP,31.33,31.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0065U,Syfls tst nontreponemal antb,Lab Services,Per Unit,$18.09 ,OP,18.09,18.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0066U,Pamg-1 ia cervico-vag fluid,Lab Services,Per Unit,$15.29 ,OP,15.29,15.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0067U,Onc brst imhchem prfl 4 bmrk,Lab Services,Per Unit,"$1,897.00 ",OP,"1,897.00","1,897.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0068U,Candida species pnl amp prb,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0069U,Onc clrct microrna mir-31-3p,Lab Services,Per Unit,$380.00 ,OP,380,380,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0070U,Cyp2d6 gen com&slct rar vrnt,Lab Services,Per Unit,$676.37 ,OP,676.37,676.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0071T,Us leiomyomata ablate <200,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0071U,Cyp2d6 full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0072T,Us leiomyomata ablate >200,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0072U,Cyp2d6 gen cyp2d6-2d7 hybrid,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0073U,Cyp2d6 gen cyp2d7-2d6 hybrid,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0074U,Cyp2d6 nonduplicated gene,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0075T,Perq stent/chest vert art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0075U,Cyp2d6 5' gene dup/mlt,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0076T,S&i stent/chest vert art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0076U,Cyp2d6 3' gene dup/mlt,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0077U,Ig paraprotein qual bld/ur,Lab Services,Per Unit,$43.43 ,OP,43.43,43.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0078U,Pain mgt opi use gnotyp pnl,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0080U,Onc lng 5 clin rsk factr alg,Lab Services,Per Unit,"$3,520.00 ",OP,"3,520.00","3,520.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0082U,Rx test def 90+ rx/sbsts ur,Lab Services,Per Unit,$246.92 ,OP,246.92,246.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0083U,Onc rspse chemo cntrst tomog,Lab Services,Per Unit,$167.35 ,OP,167.35,167.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0084U,Rbc dna gnotyp 10 bld groups,Lab Services,Per Unit,$720.00 ,OP,720,720,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0086U,Nfct ds bact&fng org id 6+,Lab Services,Per Unit,$200.00 ,OP,200,200,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0087U,Crd hrt trnspl mrna 1283 gen,Lab Services,Per Unit,"$3,159.42 ",OP,"3,159.42","3,159.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0088U,Trnsplj kdn algrft rej 1494,Lab Services,Per Unit,"$3,159.42 ",OP,"3,159.42","3,159.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0089U,Onc mlnma prame & linc00518,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0090U,Onc cutan mlnma mrna 23 gene,Lab Services,Per Unit,"$1,755.00 ",OP,"1,755.00","1,755.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0092U,Onc lng 3 prtn bmrk plsm alg,Lab Services,Per Unit,"$2,488.00 ",OP,"2,488.00","2,488.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0093U,Rx mntr 65 com drugs urine,Lab Services,Per Unit,$62.14 ,OP,62.14,62.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0094U,Genome rapid sequence alys,Lab Services,Per Unit,"$7,582.20 ",OP,"7,582.20","7,582.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0095U,Inflm ee elisa alys alg,Lab Services,Per Unit,$771.98 ,OP,771.98,771.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0096U,Hpv hi risk types male urine,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0097U,Gi pathogen 22 targets,Lab Services,Per Unit,$363.04 ,OP,363.04,363.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0101T,Extracorp shockwv tx hi enrg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0102T,Extracorp shockwv tx anesth,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0105U,Neph ckd mult eclia tum nec,Lab Services,Per Unit,$950.00 ,OP,950,950,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0106T,Touch quant sensory test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0106U,Gstr emptg 7 timed brth spec,Lab Services,Per Unit,$874.49 ,OP,874.49,874.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0107T,Vibrate quant sensory test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0107U,C diff tox ag detcj ia stool,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0108T,Cool quant sensory test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0108U,Gi barrett esoph 9 prtn bmrk,Lab Services,Per Unit,"$2,513.25 ",OP,"2,513.25","2,513.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0109T,Heat quant sensory test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0109U,Id aspergillus dna 4 species,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0110T,Nos quant sensory test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0110U,Rx mntr 1+oral onc rx&sbsts,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0111U,Onc colon ca kras&nras alys,Lab Services,Per Unit,$682.29 ,OP,682.29,682.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0112U,Iadi 16s&18s rrna genes,Lab Services,Per Unit,$356.13 ,OP,356.13,356.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0113U,Onc prst8 pca3&tmprss2-erg,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0114U,Gi barretts esoph vim&ccna1,Lab Services,Per Unit,"$1,938.01 ",OP,"1,938.01","1,938.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0115U,Respir iadna 18 viral&2 bact,Lab Services,Per Unit,$275.35 ,OP,275.35,275.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0116U,Rx mntr nzm ia 35+oral flu,Lab Services,Per Unit,$246.92 ,OP,246.92,246.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0117U,Pain mgmt 11 endogenous anal,Lab Services,Per Unit,$840.65 ,OP,840.65,840.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0118U,Trnsplj don-drv cll-fr dna,Lab Services,Per Unit,"$2,753.25 ",OP,"2,753.25","2,753.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0119U,Crd ceramides liq chrom plsm,Lab Services,Per Unit,$83.76 ,OP,83.76,83.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0120U,Onc b cll lymphm mrna 58 gen,Lab Services,Per Unit,"$2,510.21 ",OP,"2,510.21","2,510.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0121U,Sc dis vcam-1 whole blood,Lab Services,Per Unit,$509.20 ,OP,509.2,509.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0122U,Sc dis p-selectin whl blood,Lab Services,Per Unit,$526.23 ,OP,526.23,526.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0123U,Mchnl fragility rbc prflg,Lab Services,Per Unit,$357.63 ,OP,357.63,357.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0130U,Hered colon ca do mrna pnl,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0131U,Hered brst ca rltd do pnl 13,Lab Services,Per Unit,$710.00 ,OP,710,710,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0132U,Hered ova ca rltd do pnl 17,Lab Services,Per Unit,$741.64 ,OP,741.64,741.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0133U,Hered prst8 ca rltd do 11,Lab Services,Per Unit,$690.29 ,OP,690.29,690.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0134U,Hered pan ca mrna pnl 18 gen,Lab Services,Per Unit,$748.39 ,OP,748.39,748.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0135U,Hered gyn ca mrna pnl 12 gen,Lab Services,Per Unit,$700.56 ,OP,700.56,700.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0136U,Atm mrna seq alys,Lab Services,Per Unit,$407.43 ,OP,407.43,407.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0137U,Palb2 mrna seq alys,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0138U,Brca1 brca2 mrna seq alys,Lab Services,Per Unit,$468.33 ,OP,468.33,468.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0145U,Drug assay 65+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0146U,Drug assay 80+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0147U,Drug assay 85+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0148U,Drug assay 100+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0149U,Drug assay 60+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0150U,Drug assay 120+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0154U,Onc urthl ca rna fgfr3 gene,Lab Services,Per Unit,$482.14 ,OP,482.14,482.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0155U,Onc brst ca dna pik3ca gene,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0166U,Liver ds 10 biochem asy srm,Lab Services,Per Unit,$503.40 ,OP,503.4,503.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0167U,Chornc gonadotropin hcg ia,Lab Services,Per Unit,$7.52 ,OP,7.52,7.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0169U,Nudt15&tpmt gene com vrnt,Lab Services,Per Unit,$466.17 ,OP,466.17,466.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0170U,Neuro asd rna next gen seq,Lab Services,Per Unit,"$1,755.00 ",OP,"1,755.00","1,755.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0172U,Onc sld tum alys brca1 brca2,Lab Services,Per Unit,"$3,030.00 ",OP,"3,030.00","3,030.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0176U,Cdtb&vinculin igg antb ia,Lab Services,Per Unit,$64.19 ,OP,64.19,64.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0177U,Onc brst ca dna pik3ca 11,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0181U,Co gnotyp aqp1 exon 1,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0182U,Crom gnotyp cd55 exons 1-10,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0183U,Di gnotyp slc4a1 exon 19,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0184T,Exc rectal tumor endoscopic,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0184U,Do gnotyp art4 exon 2,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0185U,Fut1 gnotyp fut1 exon 4,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0186U,Fut2 gnotyp fut2 exon 2,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0187U,Fy gnotyp ackr1 exons 1-2,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0188U,Ge gnotyp gypc exons 1-4,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0189U,Gypa gnotyp ntrns 1 5 exon 2,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0190U,Gypb gnotyp ntrns 1 5 seux 3,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0191T,Insert ant segment drain int,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0191U,In gnotyp cd44 exons 2 3 6,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0192U,Jk gnotyp slc14a1 exon 9,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0193U,Jr gnotyp abcg2 exons 2-26,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0194U,Kel gnotyp kel exon 8,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0195U,Klf1 targeted sequencing,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0196U,Lu gnotyp bcam exon 3,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0197U,Lw gnotyp icam4 exon 1,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0198T,Ocular blood flow measure,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0198U,Rhd&rhce gntyp rhd1-10&rhce5,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0199U,Sc gnotyp ermap exons 4 12,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0200T,Perq sacral augmt unilat inj,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0200U,Xk gnotyp xk exons 1-3,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0201T,Perq sacral augmt bilat inj,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0201U,Yt gnotyp ache exon 2,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0202T,Post vert arthrplst 1 lumbar,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0202U,Nfct ds 22 trgt sars-cov-2,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0203U,Ai ibd mrna xprsn prfl 17,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0204U,Onc thyr mrna xprsn alys 593,Lab Services,Per Unit,"$2,919.60 ",OP,"2,919.60","2,919.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0205U,Oph amd alys 3 gene variants,Lab Services,Per Unit,$47.00 ,OP,47,47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0207T,Clear eyelid gland w/heat,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0208T,Audiometry air only,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0209T,Audiometry air & bone,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0210T,Speech audiometry threshold,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0210U,Syphilis tst antb ia quan,Lab Services,Per Unit,$18.63 ,OP,18.63,18.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0211T,Speech audiom thresh & recog,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0212T,Compre audiometry evaluation,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0213T,Njx paravert w/us cer/thor,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0216T,Njx paravert w/us lumb/sac,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0218U,Neuro musc dys dmd seq alys,Lab Services,Per Unit,"$2,279.00 ",OP,"2,279.00","2,279.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0219T,Plmt post facet implt cerv,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0220T,Plmt post facet implt thor,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0221T,Plmt post facet implt lumb,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0224U,Antibody sars-cov-2 titer(s),Lab Services,Per Unit,$42.13 ,OP,42.13,42.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0226U,Svnt sarscov2 elisa plsm srm,Lab Services,Per Unit,$42.28 ,OP,42.28,42.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0232T,Njx platelet plasma,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0234T,Trluml perip athrc renal art,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0235T,Trluml perip athrc visceral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0236T,Trluml perip athrc abd aorta,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0237T,Trluml perip athrc brchiocph,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0238T,Trluml perip athrc iliac art,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0239U,Trgt gen seq alys pnl 311+,Lab Services,Per Unit,"$3,500.00 ",OP,"3,500.00","3,500.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0240U,Nfct ds vir resp rna 3 trgt,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0241U,Nfct ds vir resp rna 4 trgt,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0242U,Trgt gen seq alys pnl 55-74,Lab Services,Per Unit,"$5,000.00 ",OP,"5,000.00","5,000.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0253T,Insert aqueous drain device,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0263T,Im b1 mrw cel ther cmpl,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0264T,Im b1 mrw cel ther xcl hrvst,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0265T,Im b1 mrw cel ther hrvst onl,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0266T,Implt/rpl crtd sns dev total,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0267T,Implt/rpl crtd sns dev lead,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0268T,Implt/rpl crtd sns dev gen,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0269T,Rev/remvl crtd sns dev total,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0270T,Rev/remvl crtd sns dev lead,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0271T,Rev/remvl crtd sns dev gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0272T,Interrogate crtd sns dev,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0273T,Interrogate crtd sns w/pgrmg,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0274T,Perq lamot/lam crv/thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0275T,Perq lamot/lam lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0278T,Tempr,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0308T,Insj ocular telescope prosth,APC 5495,RVU Per Case,"$20,124.53 ",OP,"20,124.53","20,124.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0312T,Laps impltj nstim vagus,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0313T,Laps rmvl nstim array vagus,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0314T,Laps rmvl vgl arry&pls gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0315T,Rmvl vagus nerve pls gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0316T,Replc vagus nerve pls gen,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0317T,Elec alys vagus nrv pls gen,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0330T,Tear film img uni/bi w/i&r,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0331T,Heart symp image plnr,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0332T,Heart symp image plnr spect,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0335T,Insj sinus tarsi implant,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0338T,Trnscth renal symp denrv unl,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0339T,Trnscth renal symp denrv bil,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0342T,Thxp apheresis w/hdl delip,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0345T,Transcath mtral vlve repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0347T,Ins bone device for rsa,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0348T,Rsa spine exam,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0349T,Rsa upper extr exam,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0350T,Rsa lower extr exam,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0355T,Gi tract capsule endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0356T,Insrt drug device for iop,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0358T,Bia whole body,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0362T,Bhv id suprt assmt ea 15 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0373T,Adapt bhv tx ea 15 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0379T,Vis field assmnt tech suppt,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0394T,Hdr elctrnc skn surf brchytx,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0395T,Hdr elctr ntrst/ntrcv brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0398T,Mrgfus strtctc les abltj,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0402T,Colgn cross-link crn med sep,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0404T,Trnscrv uterin fibroid abltj,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","6,584.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0408T,Insj/rplc cardiac modulj sys,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0409T,Insj/rplc car modulj pls gn,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0410T,Insj/rplc car modulj atr elt,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0411T,Insj/rplc car modulj vnt elt,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0412T,Rmvl cardiac modulj pls gen,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0413T,Rmvl car modulj tranvns elt,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0414T,Rmvl & rpl car modulj pls gn,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0415T,Repos car modulj tranvns elt,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0416T,Reloc skin pocket pls gen,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0417T,Prgrmg eval cardiac modulj,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0418T,Interro eval cardiac modulj,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0419T,Dstrj neurofibroma xtnsv,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0420T,Dstrj neurofibroma xtnsv,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0421T,Waterjet prostate abltj cmpl,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,002.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0422T,Tactile breast img uni/bi,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0424T,Insj/rplc nstim apnea compl,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0425T,Insj/rplc nstim apnea sen ld,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0426T,Insj/rplc nstim apnea stm ld,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0427T,Insj/rplc nstim apnea pls gn,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0428T,Rmvl nstim apnea pls gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0429T,Rmvl nstim apnea sen ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0430T,Rmvl nstim apnea stimj ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0431T,Rmvl/rplc nstim apnea pls gn,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0432T,Repos nstim apnea stimj ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0433T,Repos nstim apnea sensing ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0434T,Interro eval npgs apnea,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0435T,Prgrmg eval npgs apnea 1 ses,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0436T,Prgrmg eval npgs apnea study,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0440T,Abltj perc uxtr/perph nrv,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0441T,Abltj perc lxtr/perph nrv,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0442T,Abltj perc plex/trncl nrv,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0446T,Insj impltbl glucose sensor,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0447T,Rmvl impltbl glucose sensor,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0448T,Remvl insj impltbl gluc sens,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0449T,Insj aqueous drain dev 1st,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0451T,Insj/rplcmt aortic ventr sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0452T,Insj/rplcmt dev vasc seal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0453T,Insj/rplcmt mech-elec ntrfce,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0454T,Insj/rplcmt subq electrode,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0455T,Remvl aortic ventr cmpl sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0456T,Remvl aortic dev vasc seal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0457T,Remvl mech-elec skin ntrfce,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0458T,Remvl subq electrode,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0459T,Relocaj rplcmt aortic ventr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0460T,Repos aortic ventr dev eltrd,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0461T,Repos aortic contrpulsj dev,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0462T,Prgrmg eval aortic ventr sys,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0463T,Interrog aortic ventr sys,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0464T,Visual ep test for glaucoma,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0465T,Supchrdl njx rx w/o supply,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0467T,Revj/rplmnt ch respir eltrd,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0468T,Rmvl ch wal respir eltrd/ra,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0472T,Prgrmg io rta eltrd ra,APC 5743,RVU Per Case,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0473T,Reprgrmg io rta eltrd ra,APC 5742,RVU Per Case,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0476T,Rec ftl car sgl elec tr data,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0477T,Rec ftl car sgl xrtj alys,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0479T,Fxjl abl lsr 1st 100 sq cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0481T,Njx autol wbc concentrate,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0483T,Tmvi percutaneous approach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0484T,Tmvi transthoracic exposure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0485T,Oct mid ear i&r unilateral,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0486T,Oct mid ear i&r bilateral,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0487T,Trvg biomchn mapg w/reprt,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0491T,Abl lsr opn wnd 1st 20 sqcm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0494T,Prep & cannulj cdvr don lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0495T,Mntr cdvr don lng 1st 2 hrs,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0496T,Mntr cdvr don lng ea addl hr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0497T,Xtrnl pt act ecg in-off conn,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0499T,Cysto f/urtl strix/stenosis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0503T,Cor ffr alys gnrj ffr mdl,APC 1511,RVU Per Unit,$921.12 ,OP,921.12,921.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0505T,Ev fempop artl revsc,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0506T,Mac pgmt opt dns meas hfp,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0507T,Near ifr 2img mibmn glnd i&r,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0508T,Pls echo us b1 dns meas tib,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0509T,Pattern erg w/i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0510T,Rmvl sinus tarsi implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0511T,Rmvl&rinsj sinus tarsi implt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0512T,Esw integ wnd hlg 1st wnd,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0515T,Insj wcs lv compl sys,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0516T,Insj wcs lv eltrd only,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0517T,Insj wcs lv pg compnt,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0518T,Rmvl pg compnt wcs,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0519T,Rmvl & rplcmt pg compnt wcs,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0520T,Rmvl&rplcmt pg wcs new eltrd,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0521T,Interrog dev eval wcs ip,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0522T,Prgrmg dev eval wcs ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0524T,Ev cath dir chem abltj w/img,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0525T,Insj/rplcmt compl iims,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","10,078.61",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0526T,Insj/rplcmt iims eltrd only,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0527T,Insj/rplcmt iims implt mntr,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0528T,Prgrmg dev eval iims ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0529T,Interrog dev eval iims ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0530T,Removal complete iims,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0531T,Removal iims electrode only,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0532T,Removal iims implt mntr only,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0534T,Cont rec mvmt do setup&train,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0535T,Cont rec mvmt do reprt cnfig,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0540T,Car-t cll admn autologous,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0541T,Myocardial imaging mcg,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0543T,Ta mv rpr w/artif chord tend,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0544T,Tcat mv annulus rcnstj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0545T,Tcat tv annulus rcnstj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0548T,Tprnl balo cntnc dev bi,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","11,132.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0549T,Tprnl balo cntnc dev uni,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0550T,Tprnl balo cntnc dev rmvl ea,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0551T,Tprnl balo cntnc dev adjmt,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0555T,B1 str&fx rsk transmis data,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0556T,B1 str & fx rsk assessment,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0558T,Ct scan f/biomchn ct alys,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0559T,Antmc mdl 3d print 1st cmpnt,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0561T,Antmc guide 3d print 1st gd,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0563T,Evac meibomian glnd heat bi,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0564T,Onc chemo rx cytotox csc 14,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0565T,Autol cell implt adps hrvg,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0566T,Autol cell implt adps njx,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0569T,Ttvr perq appr 1st prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0570T,Ttvr perq ea addl prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0571T,Insj/rplcmt icds ss eltrd,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0572T,Insertion ss dfb electrode,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0573T,Removal ss dfb electrode,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0574T,Repos prev ss impl dfb eltrd,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0575T,Prgrmg dev eval icds ss ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0576T,Interrog dev eval icds ss ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0577T,Ephys eval icds ss,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0579T,Rem interrog dev icds tech,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0580T,Rmvl ss impl dfb pg only,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0583T,Tmpst auto tube dlvr sys,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0584T,Perq islet cell transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0585T,Laps islet cell transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0586T,Open islet cell transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0587T,Perq impltj/rplcmt isdns ptn,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","5,970.22",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0588T,Revision/removal isdns ptn,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0589T,Elec alys smpl prgrmg iins,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0590T,Elec alys cplx prgrmg iins,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0594T,Osteot hum xtrnl lngth dev,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0596T,Temp fml iu vlv-pmp 1st insj,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0597T,Temp fml iu valve-pmp rplcmt,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0598T,Ncntc r-t fluor wnd img 1st,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0600T,Ire abltj 1+tum organ perq,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0601T,Ire abltj 1+tumors open,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0604T,Rem oct rta dev setup&educaj,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0605T,Rem oct rta techl sprt min 8,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0607T,Rem mntr pulm flu mntr setup,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0608T,Rem mntr pulm flu mntr alys,APC 5741,RVU Per Unit,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0609T,Mrs disc pain acquisj data,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0611T,Mrs disc pain alg alys data,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0614T,Rmvl&rplcmt ss impl dfb pg,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0615T,Eye mvmt alys w/o calbrj i&r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0616T,Insertion of iris prosthesis,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0617T,Insj iris prosth w/rmvl&insj,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0618T,Insj iris prosth sec io lens,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0619T,Cysto w/prst8 commissurotomy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0620T,Evasc ven artlz tibl/prnl vn,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0627T,Perq njx algc fluor lmbr 1st,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0629T,Perq njx algc ct lmbr 1st,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0631T,Tc vis lit hyperspectral img,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0632T,Perq tcat us abltj nrv p-art,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0633T,Ct breast w/3d uni c-,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0634T,Ct breast w/3d uni c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0635T,Ct breast w/3d uni c-/c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0636T,Ct breast w/3d bi c-,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0637T,Ct breast w/3d bi c+,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,0638T,Ct breast w/3d bi c-/c+,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0425,Ground mileage,Therapy,Per Unit,$7.47 ,OP,7.47,7.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0426,Als 1,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0427,Als1-emergency,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0428,Bls,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0429,Bls-emergency,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0430,Fixed wing air transport,Therapy,Per Case,"$3,147.91 ",OP,"3,147.91","3,147.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0431,Rotary wing air transport,Therapy,Per Case,"$3,659.92 ",OP,"3,659.92","3,659.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0432,Pi volunteer ambulance co,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0433,Als 2,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0434,Specialty care transport,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0435,Fixed wing air mileage,Therapy,Per Unit,$8.93 ,OP,8.93,8.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A0436,Rotary wing air mileage,Therapy,Per Unit,$23.83 ,OP,23.83,23.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A4563,Vag inser rectal control sys,Durable Medical Equipment,Per Unit,"$1,372.71 ",OP,"1,372.71","1,372.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9513,Lutetium lu 177 dotatat ther,APC 9067,Per Unit,$274.33 ,OP,274.33,274.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9517,I131 iodide cap- rx,APC 1064,Per Unit,$20.12 ,OP,20.12,20.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9527,Iodine i-125 sodium iodide,APC 2632,Per Unit,$30.66 ,OP,30.66,30.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9530,I131 iodide sol- rx,APC 1150,Per Unit,$13.34 ,OP,13.34,13.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9543,Y90 ibritumomab- rx,APC 1643,Per Unit,"$59,793.85 ",OP,"59,793.85","59,793.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9563,P32 na phosphate,APC 1675,Per Unit,$458.34 ,OP,458.34,458.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9590,Iodine i-131 iobenguane 1mci,APC 9339,Per Unit,$320.12 ,OP,320.12,320.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9591,Fluoroestradiol f 18,APC 9370,Per Unit,$644.83 ,OP,644.83,644.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9592,Copper cu 64 dotatate diag,APC 9383,Per Unit,$918.21 ,OP,918.21,918.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9600,Sr89 strontium,APC 0701,Per Unit,"$3,975.00 ",OP,"3,975.00","3,975.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9604,Sm 153 lexidronam,APC 1295,Per Unit,"$17,259.85 ",OP,"17,259.85","17,259.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,A9606,Radium ra223 dichloride ther,APC 1745,Per Unit,$145.65 ,OP,145.65,145.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1052,Hemostatic agent- gi- topic,APC 2031,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1062,Intravertebral fx aug impl,APC 2032,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1716,Brachytx- non-str- gold-198,APC 2645,Per Unit,$330.76 ,OP,330.76,330.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1717,Brachytx- non-str-hdr ir-192,APC 2646,Per Unit,$383.90 ,OP,383.9,383.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1719,Brachytx- ns- non-hdrir-192,APC 2647,Per Unit,$323.97 ,OP,323.97,323.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1734,Orth/devic/drug bn/bn-tis/bn,APC 2026,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1748,Endoscope- single- ugi,APC 2029,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1823,Gen- neuro- trans sen/stim,APC 2993,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1824,Generator- ccm- implant,APC 2024,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1825,Gen- neuro- carot sinus baro,APC 2030,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1839,Iris prosthesis,APC 2028,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C1982,Cath- pressure-valve-occlu,APC 2025,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2596,Probe- robotic- water-jet,APC 2027,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2616,Brachytx- non-str-yttrium-90,APC 2616,Per Unit,"$19,955.81 ",OP,"19,955.81","19,955.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2634,Brachytx- non-str- ha- i-125,APC 2634,Per Unit,$169.87 ,OP,169.87,169.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2635,Brachytx- non-str- ha- p-103,APC 2635,Per Unit,$52.25 ,OP,52.25,52.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2636,Brachy linear- non-str-p-103,APC 2636,Per Unit,$36.02 ,OP,36.02,36.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2638,Brachytx- stranded- i-125,APC 2638,Per Unit,$42.90 ,OP,42.9,42.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2639,Brachytx- non-stranded-i-125,APC 2639,Per Unit,$39.11 ,OP,39.11,39.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2640,Brachytx- stranded- p-103,APC 2640,Per Unit,$100.65 ,OP,100.65,100.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2641,Brachytx- non-stranded-p-103,APC 2641,Per Unit,$79.72 ,OP,79.72,79.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2642,Brachytx- stranded- c-131,APC 2642,Per Unit,$82.43 ,OP,82.43,82.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2643,Brachytx- non-stranded-c-131,APC 2643,Per Unit,$92.16 ,OP,92.16,92.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2645,Brachytx planar- p-103,APC 2648,Per Unit,$5.38 ,OP,5.38,5.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2698,Brachytx- stranded- nos,APC 2698,Per Unit,$42.90 ,OP,42.9,42.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C2699,Brachytx- non-stranded- nos,APC 2699,Per Unit,$36.02 ,OP,36.02,36.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C5271,Low cost skin substitute app,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C5273,Low cost skin substitute app,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C5275,Low cost skin substitute app,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C5277,Low cost skin substitute app,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8900,Mra w/cont- abd,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8901,Mra w/o cont- abd,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8902,Mra w/o fol w/cont- abd,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8903,Mri w/cont- breast- uni,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8905,Mri w/o fol w/cont- brst- un,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8906,Mri w/cont- breast- bi,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8908,Mri w/o fol w/cont- breast-,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8909,Mra w/cont- chest,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8910,Mra w/o cont- chest,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8911,Mra w/o fol w/cont- chest,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8912,Mra w/cont- lwr ext,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8913,Mra w/o cont- lwr ext,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8914,Mra w/o fol w/cont- lwr ext,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8918,Mra w/cont- pelvis,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8919,Mra w/o cont- pelvis,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8920,Mra w/o fol w/cont- pelvis,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8921,Tte w or w/o fol w/cont- com,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8922,Tte w or w/o fol w/cont- f/u,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8923,2d tte w or w/o fol w/con-co,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8924,2d tte w or w/o fol w/con-fu,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8925,2d tee w or w/o fol w/con-in,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8926,Tee w or w/o fol w/cont-cong,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8927,Tee w or w/o fol w/cont- mon,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8928,Tte w or w/o fol w/con-stres,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8929,Tte w or wo fol wcon-doppler,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8930,Tte w or w/o contr- cont ecg,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8931,Mra- w/dye- spinal canal,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8932,Mra- w/o dye- spinal canal,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8933,Mra- w/o&w/dye- spinal canal,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8934,Mra- w/dye- upper extremity,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8935,Mra- w/o dye- upper extr,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8936,Mra- w/o&w/dye- upper extr,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C8957,Prolonged iv inf- req pump,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9046,Cocaine hcl nasal solution,APC 9307,Per Unit,$1.33 ,OP,1.33,1.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9047,Injection- caplacizumab-yhdp,APC 9199,Per Unit,$691.29 ,OP,691.29,691.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9067,Gallium ga-68 dotatoc,APC 9323,Per Unit,$8.64 ,OP,8.64,8.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9248,Inj- clevidipine butyrate,APC 9087,Per Unit,$2.91 ,OP,2.91,2.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9250,Artiss fibrin sealant,APC 1848,Per Unit,$156.84 ,OP,156.84,156.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9257,Bevacizumab injection,APC 1281,Per Unit,$1.76 ,OP,1.76,1.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9460,Injection- cangrelor,APC 9460,Per Unit,$16.32 ,OP,16.32,16.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9462,Injection- delafloxacin,APC 9462,Per Unit,$0.37 ,OP,0.37,0.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9482,Sotalol hydrochloride iv,APC 9482,Per Unit,$17.58 ,OP,17.58,17.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9488,Conivaptan hcl,APC 9488,Per Unit,$43.94 ,OP,43.94,43.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9600,Perc drug-el cor stent sing,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9602,Perc d-e cor stent ather s,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9604,Perc d-e cor revasc t cabg s,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9606,Perc d-e cor revasc w ami s,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9607,Perc d-e cor revasc chro sin,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9725,Place endorectal app,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9727,Insert palate implants,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9728,Place device/marker- non pro,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9733,Non-ophthalmic fva,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9734,U/s trtmt- not leiomyomata,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9739,Cystoscopy prostatic imp 1-3,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9740,Cysto impl 4 or more,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,002.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9752,Intraosseous des lumb/sacrum,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9757,Spine/lumbar disk surgery,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9761,Cysto- litho- vacuum kidney,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9762,Cardiac mri seg dys strain,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9763,Cardiac mri seg dys stress,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9764,Revasc intravasc lithotripsy,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9765,Revasc intra lithotrip-stent,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9766,Revasc intra lithotrip-ather,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9767,Revasc lithotrip-stent-ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9769,Cysto w/temp pros implant,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9771,Nsl/sins cryo post nasal tis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9772,Revasc lithotrip tibi/perone,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9773,Revasc lithotr-stent tib/per,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9774,Revasc lithotr-ather tib/per,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9775,Revasc lith-sten-ath tib/per,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,C9803,Hopd covid-19 spec collect,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0150,Comprehensve oral evaluation,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0240,Intraoral occlusal film,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0250,Extraoral 2d project image,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0251,Extraoral posterior image,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0270,Dental bitewing single image,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0272,Dental bitewings two images,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0274,Bitewings four images,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0277,Vert bitewings 7 to 8 images,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0460,Pulp vitality test,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D0600,Non-ionizing diag proc,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1510,Space maintainer fxd unilat,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1516,Fixed bilat space maint- max,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1517,Fixed bilat space maint- man,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1520,Remove unilat space maintain,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1526,Remove bilat space main- max,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1527,Remove bilat space main- man,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1551,Recement space maint - max,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1552,Recement space maint - man,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1553,Recement unilat space maint,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D1575,Dist space maint- fixed unil,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D2999,Dental unspec restorative pr,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D3460,Endodontic endosseous implan,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D3999,Endodontic procedure,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4260,Osseous surgery 4 or more,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4263,Bone replce graft first site,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4264,Bone replce graft each add,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4268,Surgical revision procedure,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4270,Pedicle soft tissue graft pr,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4273,Auto tissue graft 1st tooth,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4355,Full mouth debridement,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D4381,Localized delivery antimicro,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D5911,Facial moulage sectional,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D5912,Facial moulage complete,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D5983,Radiation applicator,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D5984,Radiation shield,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D5985,Radiation cone locator,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D5987,Commissure splint,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D6920,Dental connector bar,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7111,Extraction coronal remnants,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7140,Extraction erupted tooth/exr,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7210,Rem imp tooth w mucoper flp,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7220,Impact tooth remov soft tiss,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7230,Impact tooth remov part bony,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7240,Impact tooth remov comp bony,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7241,Impact tooth rem bony w/comp,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7250,Tooth root removal,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7260,Oral antral fistula closure,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7261,Primary closure sinus perf,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7291,Transseptal fiberotomy,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D7940,Reshaping bone orthognathic,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D9930,Treatment of complications,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D9944,Occ guard- hard- full arch,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D9945,Occ guard- soft- full arch,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D9946,Occ guard- hard- part arch,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D9950,Occlusion analysis,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D9951,Limited occlusal adjustment,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,D9952,Complete occlusal adjustment,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0008,Admin influenza virus vac,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0009,Admin pneumococcal vaccine,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0010,Admin hepatitis b vaccine,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0027,Semen analysis,Lab Services,Per Unit,$6.50 ,OP,6.5,6.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0101,Ca screen-pelvic/breast exam,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0103,Psa screening,Lab Services,Per Unit,$19.31 ,OP,19.31,19.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0104,Ca screen-flexi sigmoidscope,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0105,Colorectal scrn- hi risk ind,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0106,Colon ca screen-barium enema,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0108,Diab manage trn per indiv,Lab Services,Per Unit,$54.47 ,OP,54.47,54.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0109,Diab manage trn ind/group,Lab Services,Per Unit,$15.18 ,OP,15.18,15.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0117,Glaucoma scrn hgh risk direc,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0118,Glaucoma scrn hgh risk direc,APC 5732,RVU Per Unit,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0120,Colon ca scrn- barium enema,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0121,Colon ca scrn not hi rsk ind,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0123,Screen cerv/vag thin layer,Lab Services,Per Unit,$20.26 ,OP,20.26,20.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0127,Trim nail(s),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0129,Partial hosp prog service,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0130,Single energy x-ray study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0143,Scr c/v cyto-thinlayer-rescr,Lab Services,Per Unit,$27.05 ,OP,27.05,27.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0144,Scr c/v cyto-thinlayer-rescr,Lab Services,Per Unit,$43.97 ,OP,43.97,43.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0145,Scr c/v cyto-thinlayer-rescr,Lab Services,Per Unit,$26.49 ,OP,26.49,26.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0147,Scr c/v cyto- automated sys,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0148,Scr c/v cyto- autosys- rescr,Lab Services,Per Unit,$31.94 ,OP,31.94,31.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0166,Extrnl counterpulse- per tx,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0175,Opps service-sched team conf,APC 5024,RVU Per Unit,$352.49 ,OP,352.49,352.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0176,Opps/php-activity therapy,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0186,Dstry eye lesn-fdr vssl tech,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,488.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0235,Pet not otherwise specified,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0237,Therapeutic procd strg endur,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0238,Oth resp proc- indiv,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0239,Oth resp proc- group,APC 5732,RVU Per Unit,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0245,Initial foot exam pt lops,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0246,Followup eval of foot pt lop,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0247,Routine footcare pt w lops,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0248,Demonstrate use home inr mon,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0249,Provide inr test mater/equip,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0257,Unsched dialysis esrd pt hos,APC 5401,RVU Per Unit,$634.11 ,OP,634.11,634.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0260,Inj for sacroiliac jt anesth,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0270,Mnt subs tx for change dx,Lab Services,Per Unit,$26.49 ,OP,26.49,26.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0271,Group mnt 2 or more 30 mins,Lab Services,Per Unit,$13.98 ,OP,13.98,13.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0276,Pild/placebo control clin tr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0277,Hbot- full body chamber- 30m,APC 5061,RVU Per Unit,$115.59 ,OP,115.59,115.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0279,Tomosynthesis- mammo,Lab Services,Per Unit,$23.23 ,OP,23.23,23.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0281,Elec stim unattend for press,Lab Services,Per Unit,$12.74 ,OP,12.74,12.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0283,Elec stim other than wound,Lab Services,Per Unit,$12.74 ,OP,12.74,12.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0293,Non-cov surg proc-clin trial,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0294,Non-cov proc- clinical trial,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0296,Visit to determ ldct elig,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0302,Pre-op service lvrs complete,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0303,Pre-op service lvrs 10-15dos,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0304,Pre-op service lvrs 1-9 dos,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0305,Post op service lvrs min 6,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0306,Cbc/diffwbc w/o platelet,Lab Services,Per Unit,$7.77 ,OP,7.77,7.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0307,Cbc without platelet,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0328,Fecal blood scrn immunoassay,Lab Services,Per Unit,$18.05 ,OP,18.05,18.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0329,Electromagntic tx for ulcers,Lab Services,Per Unit,$10.46 ,OP,10.46,10.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0341,Percutaneous islet celltrans,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0342,Laparoscopy islet cell trans,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0343,Laparotomy islet cell transp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0379,Direct refer hospital observ,APC 5025,RVU Per Case,$505.98 ,OP,505.98,505.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0380,Lev 1 hosp type b ed visit,APC 5031,RVU Per Case,$68.36 ,OP,68.36,68.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0381,Lev 2 hosp type b ed visit,APC 5032,RVU Per Case,$92.46 ,OP,92.46,92.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0382,Lev 3 hosp type b ed visit,APC 5033,RVU Per Case,$175.37 ,OP,175.37,175.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0383,Lev 4 hosp type b ed visit,APC 5034,RVU Per Case,$221.52 ,OP,221.52,221.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0384,Lev 5 hosp type b ed visit,APC 5035,RVU Per Case,$308.54 ,OP,308.54,308.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0390,Trauma respons w/hosp criti,APC 5045,RVU Per Unit,$913.52 ,OP,913.52,913.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0396,Alcohol/subs interv 15-30mn,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0397,Alcohol/subs interv >30 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0398,Home sleep test/type 2 porta,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0399,Home sleep test/type 3 porta,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0400,Home sleep test/type 4 porta,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0402,Initial preventive exam,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0404,Ekg tracing for initial prev,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0410,Grp psych partial hosp 45-50,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0411,Inter active grp psych parti,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0412,Open tx iliac spine uni/bil,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0413,Pelvic ring fracture uni/bil,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0414,Pelvic ring fx treat int fix,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0415,Open tx post pelvic fxcture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0416,Prostate biopsy- any mthd,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0420,Ed svc ckd ind per session,Lab Services,Per Unit,$111.79 ,OP,111.79,111.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0421,Ed svc ckd grp per session,Lab Services,Per Unit,$26.73 ,OP,26.73,26.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0422,Intens cardiac rehab w/exerc,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0423,Intens cardiac rehab no exer,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0424,Pulmonary rehab w exer,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0429,Dermal filler injection(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0432,Eia hiv-1/hiv-2 screen,Lab Services,Per Unit,$19.57 ,OP,19.57,19.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0433,Elisa hiv-1/hiv-2 screen,Lab Services,Per Unit,$18.29 ,OP,18.29,18.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0435,Oral hiv-1/hiv-2 screen,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0438,Ppps- initial visit,Lab Services,Per Unit,$163.74 ,OP,163.74,163.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0439,Ppps- subseq visit,Lab Services,Per Unit,$129.00 ,OP,129,129,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0442,Annual alcohol screen 15 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0443,Brief alcohol misuse counsel,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0444,Depression screen annual,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0445,High inten beh couns std 30m,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0446,Intens behave ther cardio dx,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0447,Behavior counsel obesity 15m,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0451,Devlopment test interpt&rep,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0455,Fecal microbiota prep instil,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0460,Autologous prp for ulcers,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0463,Hospital outpt clinic visit,APC 5012,RVU Per Case,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0471,Ven blood coll snf/hha,Lab Services,Per Unit,$5.00 ,OP,5,5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0472,Hep c screen high risk/other,Lab Services,Per Unit,$46.35 ,OP,46.35,46.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0473,Group behave couns 2-10,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0475,Hiv combination assay,Lab Services,Per Unit,$24.08 ,OP,24.08,24.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0476,Hpv combo assay ca screen,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0480,Drug test def 1-7 classes,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0481,Drug test def 8-14 classes,Lab Services,Per Unit,$156.59 ,OP,156.59,156.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0482,Drug test def 15-21 classes,Lab Services,Per Unit,$198.74 ,OP,198.74,198.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0483,Drug test def 22+ classes,Lab Services,Per Unit,$246.92 ,OP,246.92,246.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0498,Chemo extend iv infus w/pump,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0499,Hepb screen high risk indiv,Lab Services,Per Unit,$28.27 ,OP,28.27,28.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0516,Insert drug del implant- >=4,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0517,Remove drug implant,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0518,Remove w insert drug implant,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G0659,Drug test def simple all cl,Lab Services,Per Unit,$62.14 ,OP,62.14,62.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2000,Blinded conv. tx mdd clin tr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2011,Alcohol/sub misuse assess,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2065,Clin mang h risk dx 30,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2066,Inter devc remote 30d,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2082,Visit esketamine 56m or less,APC 1508,RVU Per Unit,$630.39 ,OP,630.39,630.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2083,Visit esketamine- > 56m,APC 1511,RVU Per Unit,$921.12 ,OP,921.12,921.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2086,Off base opioid tx 70min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2087,Off base opioid tx- 60 m,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2170,Avf by tissue w thermal e,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2171,Avf use magnetic/art/ven,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2214,Init/sub psych care m 1st 30,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2250,Remot img sub by pt- non e/m,Lab Services,Per Unit,$9.24 ,OP,9.24,9.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2251,Brief chkin- 5-10- non-e/m,Lab Services,Per Unit,$13.05 ,OP,13.05,13.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,G2252,Brief chkin by md/qhp- 11-20,Lab Services,Per Unit,$25.14 ,OP,25.14,25.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0121,Inj.- omadacycline- 1 mg,APC 9311,Per Unit,$3.30 ,OP,3.3,3.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0129,Abatacept injection,APC 9230,Per Unit,$45.27 ,OP,45.27,45.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0135,Adalimumab injection,APC 1083,Per Unit,"$1,581.57 ",OP,"1,581.57","1,581.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0178,Aflibercept injection,APC 1420,Per Unit,$917.94 ,OP,917.94,917.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0179,Inj- brolucizumab-dbll- 1 mg,APC 9340,Per Unit,$312.01 ,OP,312.01,312.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0180,Agalsidase beta injection,APC 9208,Per Unit,$198.14 ,OP,198.14,198.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0185,Inj.- aprepitant- 1 mg,APC 9463,Per Unit,$1.69 ,OP,1.69,1.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0202,Injection- alemtuzumab,APC 1809,Per Unit,"$2,086.32 ",OP,"2,086.32","2,086.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0207,Amifostine,APC 7000,Per Unit,"$1,135.69 ",OP,"1,135.69","1,135.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0220,Alglucosidase alfa injection,APC 9234,Per Unit,$117.07 ,OP,117.07,117.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0221,Lumizyme injection,APC 1413,Per Unit,$180.35 ,OP,180.35,180.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0222,Inj.- patisiran- 0.1 mg,APC 9180,Per Unit,$97.75 ,OP,97.75,97.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0223,Inj givosiran 0.5 mg,APC 9343,Per Unit,$106.76 ,OP,106.76,106.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0256,Alpha 1 proteinase inhibitor,APC 0901,Per Unit,$4.54 ,OP,4.54,4.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0257,Glassia injection,APC 1415,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0287,Amphotericin b lipid complex,APC 9024,Per Unit,$9.50 ,OP,9.5,9.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0289,Amphotericin b liposome inj,APC 0736,Per Unit,$28.75 ,OP,28.75,28.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0291,Inj.- plazomicin- 5 mg,APC 9183,Per Unit,$3.05 ,OP,3.05,3.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0300,Amobarbital 125 mg inj,APC 1341,Per Unit,$125.22 ,OP,125.22,125.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0390,Chloroquine injection,APC 9352,Per Unit,$165.22 ,OP,165.22,165.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0401,Inj aripiprazole ext rel 1mg,APC 1468,Per Unit,$6.01 ,OP,6.01,6.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0475,Baclofen 10 mg injection,APC 9032,Per Unit,$177.43 ,OP,177.43,177.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0480,Basiliximab,APC 1683,Per Unit,"$4,013.08 ",OP,"4,013.08","4,013.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0485,Belatacept injection,APC 9286,Per Unit,$3.80 ,OP,3.8,3.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0490,Belimumab injection,APC 1353,Per Unit,$47.57 ,OP,47.57,47.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0517,Inj.- benralizumab- 1 mg,APC 9466,Per Unit,$170.80 ,OP,170.8,170.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0558,Peng benzathine/procaine inj,APC 9088,Per Unit,$11.79 ,OP,11.79,11.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0561,Penicillin g benzathine inj,APC 1829,Per Unit,$14.95 ,OP,14.95,14.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0565,Inj- bezlotoxumab- 10 mg,APC 9490,Per Unit,$39.77 ,OP,39.77,39.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0570,Buprenorphine implant 74.2mg,APC 9058,Per Unit,"$1,311.75 ",OP,"1,311.75","1,311.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0584,Injection- burosumab-twza 1m,APC 9187,Per Unit,$369.11 ,OP,369.11,369.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0585,Injection-onabotulinumtoxina,APC 0902,Per Unit,$6.09 ,OP,6.09,6.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0586,Abobotulinumtoxina,APC 1289,Per Unit,$8.41 ,OP,8.41,8.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0587,Inj- rimabotulinumtoxinb,APC 9018,Per Unit,$12.05 ,OP,12.05,12.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0588,Incobotulinumtoxin a,APC 9278,Per Unit,$5.05 ,OP,5.05,5.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0594,Busulfan injection,APC 1178,Per Unit,$1.71 ,OP,1.71,1.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0596,Injection- ruconest,APC 9445,Per Unit,$29.97 ,OP,29.97,29.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0597,C-1 esterase- berinert,APC 9269,Per Unit,$57.39 ,OP,57.39,57.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0598,C-1 esterase- cinryze,APC 9251,Per Unit,$58.93 ,OP,58.93,58.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0599,Inj.- haegarda 10 units,APC 9015,Per Unit,$10.25 ,OP,10.25,10.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0600,Edetate calcium disodium inj,APC 1274,Per Unit,"$5,708.59 ",OP,"5,708.59","5,708.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0630,Calcitonin salmon injection,APC 1433,Per Unit,"$3,100.79 ",OP,"3,100.79","3,100.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0638,Canakinumab injection,APC 1311,Per Unit,$115.61 ,OP,115.61,115.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0641,Inj levoleucovorin nos 0.5mg,APC 1236,Per Unit,$0.09 ,OP,0.09,0.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0642,Injection- khapzory- 0.5 mg,APC 9334,Per Unit,$1.86 ,OP,1.86,1.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0691,Inj lefamulin 1 mg,APC 9332,Per Unit,$0.72 ,OP,0.72,0.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0695,Inj ceftolozane tazobactam,APC 9452,Per Unit,$6.64 ,OP,6.64,6.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0712,Ceftaroline fosamil inj,APC 1824,Per Unit,$3.51 ,OP,3.51,3.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0714,Ceftazidime and avibactam,APC 1825,Per Unit,$92.39 ,OP,92.39,92.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0716,Centruroides immune f(ab),APC 1431,Per Unit,"$5,190.15 ",OP,"5,190.15","5,190.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0717,Certolizumab pegol inj 1mg,APC 1474,Per Unit,$6.27 ,OP,6.27,6.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0740,Cidofovir injection,APC 9033,Per Unit,$563.76 ,OP,563.76,563.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0742,Inj imip 4 cilas 4 releb 2mg,APC 9362,Per Unit,$2.32 ,OP,2.32,2.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0745,Inj codeine phosphate /30 mg,APC 9393,Per Unit,$135.64 ,OP,135.64,135.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0775,Collagenase- clost hist inj,APC 1340,Per Unit,$56.66 ,OP,56.66,56.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0791,Inj crizanlizumab-tmca 5mg,APC 9359,Per Unit,$123.29 ,OP,123.29,123.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0795,Corticorelin ovine triflutal,APC 1684,Per Unit,$9.67 ,OP,9.67,9.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0840,Crotalidae poly immune fab,APC 9274,Per Unit,"$2,743.36 ",OP,"2,743.36","2,743.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0841,Inj crotalidae im f(ab)2 eq,APC 9188,Per Unit,"$1,189.81 ",OP,"1,189.81","1,189.81",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0850,Cytomegalovirus imm iv /vial,APC 0903,Per Unit,"$1,538.70 ",OP,"1,538.70","1,538.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0875,Injection- dalbavancin,APC 1823,Per Unit,$15.89 ,OP,15.89,15.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0881,Darbepoetin alfa- non-esrd,APC 1685,Per Unit,$3.15 ,OP,3.15,3.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0882,Darbepoetin alfa- esrd use,APC 1482,Per Unit,$3.15 ,OP,3.15,3.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0883,Argatroban nonesrd use 1mg,APC 1859,Per Unit,$1.20 ,OP,1.2,1.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0884,Argatroban esrd dialysis 1mg,APC 9065,Per Unit,$1.20 ,OP,1.2,1.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0885,Epoetin alfa- non-esrd,APC 1686,Per Unit,$8.15 ,OP,8.15,8.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0888,Epoetin beta non esrd,APC 9077,Per Unit,$1.51 ,OP,1.51,1.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0894,Decitabine injection,APC 9231,Per Unit,$3.45 ,OP,3.45,3.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0896,Inj luspatercept-aamt 0.25mg,APC 9347,Per Unit,$36.85 ,OP,36.85,36.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J0897,Denosumab injection,APC 9272,Per Unit,$21.19 ,OP,21.19,21.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1095,Injection- dexamethasone 9%,APC 9172,Per Unit,$1.04 ,OP,1.04,1.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1096,Dexametha opth insert 0.1 mg,APC 9308,Per Unit,$133.30 ,OP,133.3,133.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1162,Digoxin immune fab (ovine),APC 1687,Per Unit,"$4,128.19 ",OP,"4,128.19","4,128.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1190,Dexrazoxane hcl injection,APC 0726,Per Unit,$192.33 ,OP,192.33,192.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1201,Inj. cetirizine hcl 0.5mg,APC 9361,Per Unit,$15.38 ,OP,15.38,15.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1212,Dimethyl sulfoxide 50% 50 ml,APC 1832,Per Unit,$637.11 ,OP,637.11,637.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1290,Ecallantide injection,APC 9263,Per Unit,$503.88 ,OP,503.88,503.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1300,Eculizumab injection,APC 9236,Per Unit,$229.23 ,OP,229.23,229.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1301,Injection- edaravone- 1 mg,APC 9493,Per Unit,$20.51 ,OP,20.51,20.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1303,Inj.- ravulizumab-cwvz 10 mg,APC 9312,Per Unit,$224.68 ,OP,224.68,224.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1322,Elosulfase alfa- injection,APC 1480,Per Unit,$250.33 ,OP,250.33,250.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1364,Erythro lactobionate /500 mg,APC 1669,Per Unit,$77.75 ,OP,77.75,77.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1410,Inj estrogen conjugate 25 mg,APC 9038,Per Unit,$341.46 ,OP,341.46,341.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1427,Inj. viltolarsen,APC 9386,Per Unit,$59.05 ,OP,59.05,59.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1429,Inj golodirsen 10 mg,APC 9356,Per Unit,$166.21 ,OP,166.21,166.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1430,Ethanolamine oleate 100 mg,APC 1688,Per Unit,$444.10 ,OP,444.1,444.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1437,Inj. fe derisomaltose 10 mg,APC 9388,Per Unit,$24.87 ,OP,24.87,24.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1438,Etanercept injection,APC 1608,Per Unit,$790.78 ,OP,790.78,790.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1439,Inj ferric carboxymaltos 1mg,APC 9441,Per Unit,$1.12 ,OP,1.12,1.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1442,Inj filgrastim excl biosimil,APC 1469,Per Unit,$0.97 ,OP,0.97,0.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1447,Inj tbo filgrastim 1 microg,APC 1748,Per Unit,$0.46 ,OP,0.46,0.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1451,Fomepizole- 15 mg,APC 1689,Per Unit,$5.98 ,OP,5.98,5.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1453,Fosaprepitant injection,APC 9242,Per Unit,$0.24 ,OP,0.24,0.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1454,Inj fosnetupitant- palonoset,APC 9099,Per Unit,$571.22 ,OP,571.22,571.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1455,Foscarnet sodium injection,APC 1849,Per Unit,$72.86 ,OP,72.86,72.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1458,Galsulfase injection,APC 9224,Per Unit,$411.92 ,OP,411.92,411.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1459,Inj ivig privigen 500 mg,APC 1214,Per Unit,$44.48 ,OP,44.48,44.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1460,Gamma globulin 1 cc inj,APC 1850,Per Unit,$44.13 ,OP,44.13,44.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1554,Inj. asceniv,APC 9392,Per Unit,$481.77 ,OP,481.77,481.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1555,Inj cuvitru- 100 mg,APC 9034,Per Unit,$14.50 ,OP,14.5,14.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1556,Inj- imm glob bivigam- 500mg,APC 9130,Per Unit,$70.49 ,OP,70.49,70.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1557,Gammaplex injection,APC 9270,Per Unit,$48.53 ,OP,48.53,48.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1558,Inj. xembify- 100 mg,APC 9372,Per Unit,$13.61 ,OP,13.61,13.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1559,Hizentra injection,APC 1312,Per Unit,$11.58 ,OP,11.58,11.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1560,Gamma globulin > 10 cc inj,APC 1851,Per Unit,$441.31 ,OP,441.31,441.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1561,Gamunex-c/gammaked,APC 0948,Per Unit,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1566,Immune globulin- powder,APC 2731,Per Unit,$65.49 ,OP,65.49,65.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1568,Octagam injection,APC 0943,Per Unit,$41.63 ,OP,41.63,41.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1569,Gammagard liquid injection,APC 0944,Per Unit,$44.49 ,OP,44.49,44.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1571,Hepagam b im injection,APC 0946,Per Unit,$70.94 ,OP,70.94,70.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1572,Flebogamma injection,APC 0947,Per Unit,$36.80 ,OP,36.8,36.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1573,Hepagam b intravenous- inj,APC 1138,Per Unit,$71.24 ,OP,71.24,71.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1575,Hyqvia 100mg immuneglobulin,APC 1826,Per Unit,$15.16 ,OP,15.16,15.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1595,Injection glatiramer acetate,APC 1015,Per Unit,$141.29 ,OP,141.29,141.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1602,Golimumab for iv use 1mg,APC 1475,Per Unit,$16.82 ,OP,16.82,16.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1610,Glucagon hydrochloride/1 mg,APC 9042,Per Unit,$171.74 ,OP,171.74,171.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1628,Inj.- guselkumab- 1 mg,APC 9029,Per Unit,$82.56 ,OP,82.56,82.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1632,Inj.- brexanolone- 1 mg,APC 9333,Per Unit,$74.65 ,OP,74.65,74.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1640,Hemin- 1 mg,APC 1690,Per Unit,$26.64 ,OP,26.64,26.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1670,Tetanus immune globulin inj,APC 1670,Per Unit,$441.70 ,OP,441.7,441.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1726,Makena- 10 mg,APC 9074,Per Unit,$16.82 ,OP,16.82,16.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1729,Inj hydroxyprogst capoat nos,APC 9318,Per Unit,$21.54 ,OP,21.54,21.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1738,Inj. meloxicam 1 mg,APC 9371,Per Unit,$3.18 ,OP,3.18,3.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1740,Ibandronate sodium injection,APC 9229,Per Unit,$37.09 ,OP,37.09,37.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1742,Ibutilide fumarate injection,APC 9044,Per Unit,$205.06 ,OP,205.06,205.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1744,Icatibant injection,APC 1443,Per Unit,$204.96 ,OP,204.96,204.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1745,Infliximab not biosimil 10mg,APC 7043,Per Unit,$39.53 ,OP,39.53,39.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1746,Inj.- ibalizumab-uiyk- 10 mg,APC 9189,Per Unit,$66.39 ,OP,66.39,66.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1750,Inj iron dextran,APC 1237,Per Unit,$15.84 ,OP,15.84,15.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1786,Imuglucerase injection,APC 1327,Per Unit,$44.05 ,OP,44.05,44.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1823,Inj. inebilizumab-cdon- 1 mg,APC 9394,Per Unit,$458.21 ,OP,458.21,458.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1826,Interferon beta-1a inj,APC 1852,Per Unit,"$2,293.85 ",OP,"2,293.85","2,293.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1830,Interferon beta-1b / .25 mg,APC 0910,Per Unit,$406.24 ,OP,406.24,406.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1833,Injection- isavuconazonium,APC 9456,Per Unit,$0.83 ,OP,0.83,0.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1930,Lanreotide injection,APC 9237,Per Unit,$67.64 ,OP,67.64,67.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1931,Laronidase injection,APC 9209,Per Unit,$34.75 ,OP,34.75,34.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1943,Inj.- aristada initio- 1 mg,APC 9179,Per Unit,$3.05 ,OP,3.05,3.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1944,Aripirazole lauroxil 1 mg,APC 9470,Per Unit,$2.99 ,OP,2.99,2.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J1950,Leuprolide acetate /3.75 mg,APC 0800,Per Unit,"$1,406.37 ",OP,"1,406.37","1,406.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2182,Injection- mepolizumab- 1mg,APC 9473,Per Unit,$28.29 ,OP,28.29,28.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2186,Inj.- meropenem- vaborbactam,APC 9178,Per Unit,$1.76 ,OP,1.76,1.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2248,Micafungin sodium injection,APC 9227,Per Unit,$0.97 ,OP,0.97,0.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2265,Minocycline hydrochloride,APC 1853,Per Unit,$2.00 ,OP,2,2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2278,Ziconotide injection,APC 1694,Per Unit,$8.69 ,OP,8.69,8.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2315,Naltrexone- depot form,APC 0759,Per Unit,$3.53 ,OP,3.53,3.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2323,Natalizumab injection,APC 9126,Per Unit,$23.24 ,OP,23.24,23.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2326,Inj- nusinersen- 0.1mg,APC 9489,Per Unit,"$1,122.13 ",OP,"1,122.13","1,122.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2350,Injection- ocrelizumab- 1 mg,APC 9494,Per Unit,$58.29 ,OP,58.29,58.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2353,Octreotide injection- depot,APC 1207,Per Unit,$205.37 ,OP,205.37,205.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2357,Omalizumab injection,APC 9300,Per Unit,$37.67 ,OP,37.67,37.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2358,Olanzapine long-acting inj,APC 1331,Per Unit,$2.91 ,OP,2.91,2.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2407,Injection- oritavancin,APC 1660,Per Unit,$23.63 ,OP,23.63,23.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2425,Palifermin injection,APC 1696,Per Unit,$23.93 ,OP,23.93,23.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2426,Paliperidone palmitate inj,APC 9255,Per Unit,$12.66 ,OP,12.66,12.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2502,Inj- pasireotide long acting,APC 9454,Per Unit,$359.03 ,OP,359.03,359.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2504,Pegademase bovine- 25 iu,APC 1739,Per Unit,$4.06 ,OP,4.06,4.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2505,Injection- pegfilgrastim 6mg,APC 9119,Per Unit,"$2,221.63 ",OP,"2,221.63","2,221.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2507,Pegloticase injection,APC 9281,Per Unit,"$2,960.91 ",OP,"2,960.91","2,960.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2515,Pentobarbital sodium inj,APC 1854,Per Unit,$26.41 ,OP,26.41,26.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2547,Injection- peramivir,APC 9451,Per Unit,$1.68 ,OP,1.68,1.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2560,Phenobarbital sodium inj,APC 9069,Per Unit,$40.22 ,OP,40.22,40.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2562,Plerixafor injection,APC 9252,Per Unit,$382.85 ,OP,382.85,382.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2597,Inj desmopressin acetate,APC 1440,Per Unit,$9.40 ,OP,9.4,9.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2724,Protein c concentrate,APC 1139,Per Unit,$15.13 ,OP,15.13,15.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2760,Phentolaine mesylate inj,APC 1458,Per Unit,$416.00 ,OP,416,416,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2770,Quinupristin/dalfopristin,APC 2770,Per Unit,$444.67 ,OP,444.67,444.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2778,Ranibizumab injection,APC 9233,Per Unit,$318.47 ,OP,318.47,318.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2783,Rasburicase,APC 0738,Per Unit,$315.06 ,OP,315.06,315.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2786,Injection- reslizumab- 1mg,APC 9481,Per Unit,$10.11 ,OP,10.11,10.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2792,Rho(d) immune globulin h- sd,APC 1609,Per Unit,$31.42 ,OP,31.42,31.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2794,Inj risperdal consta- 0.5 mg,APC 9125,Per Unit,$11.04 ,OP,11.04,11.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2796,Romiplostim injection,APC 9245,Per Unit,$83.47 ,OP,83.47,83.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2798,Inj.- perseris- 0.5 mg,APC 9181,Per Unit,$10.69 ,OP,10.69,10.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2820,Sargramostim injection,APC 0731,Per Unit,$51.55 ,OP,51.55,51.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2840,Inj sebelipase alfa 1 mg,APC 9478,Per Unit,$539.91 ,OP,539.91,539.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2850,Inj secretin synthetic human,APC 1700,Per Unit,$34.78 ,OP,34.78,34.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2860,Injection- siltuximab,APC 9455,Per Unit,$124.09 ,OP,124.09,124.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2941,Somatropin injection,APC 9319,Per Unit,$36.54 ,OP,36.54,36.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2993,Reteplase injection,APC 9005,Per Unit,"$2,506.51 ",OP,"2,506.51","2,506.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J2997,Alteplase recombinant,APC 7048,Per Unit,$87.75 ,OP,87.75,87.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3031,Inj.- fremanezumab-vfrm 1 mg,APC 9197,Per Unit,$2.34 ,OP,2.34,2.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3032,Inj. eptinezumab-jjmr 1 mg,APC 9357,Per Unit,$15.64 ,OP,15.64,15.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3060,Inj- taliglucerase alfa 10 u,APC 9294,Per Unit,$41.32 ,OP,41.32,41.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3090,Inj tedizolid phosphate,APC 1662,Per Unit,$1.60 ,OP,1.6,1.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3095,Telavancin injection,APC 9258,Per Unit,$6.16 ,OP,6.16,6.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3101,Tenecteplase injection,APC 9002,Per Unit,$134.74 ,OP,134.74,134.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3111,Inj. romosozumab-aqqg 1 mg,APC 9327,Per Unit,$9.34 ,OP,9.34,9.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3145,Testosterone undecanoate 1mg,APC 9078,Per Unit,$1.63 ,OP,1.63,1.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3240,Thyrotropin injection,APC 9108,Per Unit,"$1,837.25 ",OP,"1,837.25","1,837.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3241,Inj. teprotumumab-trbw 10 mg,APC 9355,Per Unit,$315.88 ,OP,315.88,315.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3243,Tigecycline injection,APC 9228,Per Unit,$1.12 ,OP,1.12,1.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3245,Inj.- tildrakizumab- 1 mg,APC 9306,Per Unit,$134.08 ,OP,134.08,134.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3246,Tirofiban hcl,APC 7041,Per Unit,$3.83 ,OP,3.83,3.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3262,Tocilizumab injection,APC 9264,Per Unit,$5.55 ,OP,5.55,5.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3285,Treprostinil injection,APC 1701,Per Unit,$59.68 ,OP,59.68,59.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3304,Inj triamcinolone ace xr 1mg,APC 9469,Per Unit,$17.75 ,OP,17.75,17.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3315,Triptorelin pamoate,APC 9122,Per Unit,$379.90 ,OP,379.9,379.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3316,Inj.- triptorelin xr 3.75 mg,APC 9016,Per Unit,"$3,120.11 ",OP,"3,120.11","3,120.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3357,Ustekinumab sub cu inj- 1 mg,APC 9261,Per Unit,$176.65 ,OP,176.65,176.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3358,Ustekinumab- iv inject- 1 mg,APC 9487,Per Unit,$11.68 ,OP,11.68,11.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3380,Injection- vedolizumab,APC 1489,Per Unit,$21.28 ,OP,21.28,21.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3385,Velaglucerase alfa,APC 9271,Per Unit,$359.29 ,OP,359.29,359.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3396,Verteporfin injection,APC 1203,Per Unit,$11.25 ,OP,11.25,11.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J3398,Inj luxturna 1 billion vec g,APC 9070,Per Unit,"$2,953.71 ",OP,"2,953.71","2,953.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7168,Prothrombin complex kcentra,APC 9132,Per Unit,$1.99 ,OP,1.99,1.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7169,Inj andexxa- 10 mg,APC 9198,Per Unit,$289.93 ,OP,289.93,289.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7170,Inj.- emicizumab-kxwh 0.5 mg,APC 9257,Per Unit,$48.88 ,OP,48.88,48.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7175,Inj- factor x- (human)- 1iu,APC 1857,Per Unit,$8.20 ,OP,8.2,8.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7178,Inj human fibrinogen con nos,APC 1478,Per Unit,$1.30 ,OP,1.3,1.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7179,Vonvendi inj 1 iu vwf:rco,APC 9059,Per Unit,$1.85 ,OP,1.85,1.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7180,Factor xiii anti-hem factor,APC 1416,Per Unit,$9.14 ,OP,9.14,9.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7181,Factor xiii recomb a-subunit,APC 1746,Per Unit,$15.87 ,OP,15.87,15.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7182,Factor viii recomb novoeight,APC 1856,Per Unit,$1.51 ,OP,1.51,1.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7183,Wilate injection,APC 1352,Per Unit,$1.16 ,OP,1.16,1.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7185,Xyntha inj,APC 1268,Per Unit,$1.33 ,OP,1.33,1.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7186,Antihemophilic viii/vwf comp,APC 1213,Per Unit,$1.14 ,OP,1.14,1.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7187,Humate-p- inj,APC 1704,Per Unit,$1.26 ,OP,1.26,1.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7188,Factor viii recomb obizur,APC 1827,Per Unit,$3.19 ,OP,3.19,3.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7189,Factor viia recomb novoseven,APC 1705,Per Unit,$2.33 ,OP,2.33,2.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7190,Factor viii,APC 0925,Per Unit,$1.12 ,OP,1.12,1.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7192,Factor viii recombinant nos,APC 0927,Per Unit,$1.43 ,OP,1.43,1.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7193,Factor ix non-recombinant,APC 0931,Per Unit,$1.17 ,OP,1.17,1.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7194,Factor ix complex,APC 0928,Per Unit,$1.54 ,OP,1.54,1.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7195,Factor ix recombinant nos,APC 0932,Per Unit,$1.61 ,OP,1.61,1.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7197,Antithrombin iii injection,APC 1263,Per Unit,$3.20 ,OP,3.2,3.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7198,Anti-inhibitor,APC 0929,Per Unit,$2.21 ,OP,2.21,2.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7200,Factor ix recombinan rixubis,APC 1467,Per Unit,$1.54 ,OP,1.54,1.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7201,Factor ix alprolix recomb,APC 1486,Per Unit,$3.28 ,OP,3.28,3.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7202,Factor ix idelvion inj,APC 9171,Per Unit,$4.59 ,OP,4.59,4.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7203,Factor ix recomb gly rebinyn,APC 9468,Per Unit,$4.23 ,OP,4.23,4.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7204,Inj recombin esperoct per iu,APC 9354,Per Unit,$2.23 ,OP,2.23,2.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7205,Factor viii fc fusion recomb,APC 1656,Per Unit,$2.15 ,OP,2.15,2.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7207,Factor viii pegylated recomb,APC 1844,Per Unit,$1.92 ,OP,1.92,1.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7208,Inj. jivi 1 iu,APC 9299,Per Unit,$2.10 ,OP,2.1,2.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7209,Factor viii nuwiq recomb 1iu,APC 1846,Per Unit,$1.24 ,OP,1.24,1.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7210,Inj- afstyla- 1 i.u.,APC 9043,Per Unit,$1.36 ,OP,1.36,1.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7211,Inj- kovaltry- 1 i.u.,APC 9075,Per Unit,$1.24 ,OP,1.24,1.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7212,Factor viia recomb sevenfact,APC 9395,Per Unit,$2.27 ,OP,2.27,2.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7308,Aminolevulinic acid hcl top,APC 7308,Per Unit,$392.48 ,OP,392.48,392.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7311,Inj.- retisert- 0.01 mg,APC 9225,Per Unit,$339.00 ,OP,339,339,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7312,Dexamethasone intra implant,APC 9256,Per Unit,$199.69 ,OP,199.69,199.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7313,Inj.- iluvien- 0.01 mg,APC 9450,Per Unit,$490.95 ,OP,490.95,490.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7314,Inj.- yutiq- 0.01 mg,APC 9328,Per Unit,$513.16 ,OP,513.16,513.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7316,Inj- ocriplasmin- 0.125 mg,APC 9298,Per Unit,"$1,046.93 ",OP,"1,046.93","1,046.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7318,Inj- durolane 1 mg,APC 9174,Per Unit,$17.23 ,OP,17.23,17.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7320,Genvisc 850- inj- 1mg,APC 9079,Per Unit,$16.92 ,OP,16.92,16.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7322,Hymovis injection 1 mg,APC 9471,Per Unit,$31.67 ,OP,31.67,31.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7323,Euflexxa inj per dose,APC 0875,Per Unit,$138.82 ,OP,138.82,138.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7324,Orthovisc inj per dose,APC 0877,Per Unit,$148.74 ,OP,148.74,148.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7325,Synvisc or synvisc-one,APC 0874,Per Unit,$11.24 ,OP,11.24,11.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7326,Gel-one,APC 1417,Per Unit,"$1,219.00 ",OP,"1,219.00","1,219.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7327,Monovisc inj per dose,APC 1747,Per Unit,$762.80 ,OP,762.8,762.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7328,Gelsyn-3 injection 0.1 mg,APC 1862,Per Unit,$2.18 ,OP,2.18,2.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7329,Inj- trivisc 1 mg,APC 9196,Per Unit,$19.12 ,OP,19.12,19.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7331,Synojoynt- inj.- 1 mg,APC 9337,Per Unit,$18.02 ,OP,18.02,18.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7336,Capsaicin 8% patch,APC 9071,Per Unit,$3.23 ,OP,3.23,3.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7340,Carbidopa levodopa ent 100ml,APC 9320,Per Unit,$211.70 ,OP,211.7,211.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7342,Ciprofloxacin otic susp 6 mg,APC 9479,Per Unit,$29.98 ,OP,29.98,29.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7345,Aminolevulinic acid- 10% gel,APC 9301,Per Unit,$1.59 ,OP,1.59,1.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7351,Inj bimatoprost itc imp1mcg,APC 9351,Per Unit,$205.63 ,OP,205.63,205.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7352,Afamelanotide implant- 1 mg,APC 9396,Per Unit,"$3,218.90 ",OP,"3,218.90","3,218.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7402,Mometasone sinus sinuva,APC 9346,Per Unit,$10.56 ,OP,10.56,10.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7501,Azathioprine parenteral,APC 0887,Per Unit,$245.02 ,OP,245.02,245.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7504,Lymphocyte immune globulin,APC 0890,Per Unit,"$2,355.53 ",OP,"2,355.53","2,355.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7511,Antithymocyte globuln rabbit,APC 9104,Per Unit,$837.42 ,OP,837.42,837.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J7525,Tacrolimus injection,APC 9006,Per Unit,$219.33 ,OP,219.33,219.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J8560,Etoposide oral 50 mg,APC 0802,Per Unit,$75.63 ,OP,75.63,75.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J8655,Oral netupitant- palonosetro,APC 9448,Per Unit,$315.59 ,OP,315.59,315.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J8670,Rolapitant- oral- 1mg,APC 1761,Per Unit,$1.75 ,OP,1.75,1.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9015,Aldesleukin injection,APC 0807,Per Unit,"$3,795.26 ",OP,"3,795.26","3,795.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9017,Arsenic trioxide injection,APC 9012,Per Unit,$13.11 ,OP,13.11,13.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9019,Erwinaze injection,APC 9289,Per Unit,$427.27 ,OP,427.27,427.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9022,Inj- atezolizumab-10 mg,APC 9483,Per Unit,$79.75 ,OP,79.75,79.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9023,Injection- avelumab- 10 mg,APC 9491,Per Unit,$86.19 ,OP,86.19,86.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9025,Azacitidine injection,APC 1709,Per Unit,$0.93 ,OP,0.93,0.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9027,Clofarabine injection,APC 1710,Per Unit,$53.15 ,OP,53.15,53.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9032,Injection- belinostat- 10mg,APC 1658,Per Unit,$42.77 ,OP,42.77,42.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9033,Inj.- treanda 1 mg,APC 9243,Per Unit,$22.01 ,OP,22.01,22.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9034,Inj.- bendeka 1 mg,APC 1861,Per Unit,$19.65 ,OP,19.65,19.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9035,Bevacizumab injection,APC 9214,Per Unit,$70.41 ,OP,70.41,70.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9036,Inj. belrapzo/bendamustine,APC 9313,Per Unit,$21.47 ,OP,21.47,21.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9037,Inj belantamab mafodont blmf,APC 9384,Per Unit,$42.78 ,OP,42.78,42.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9039,Injection- blinatumomab,APC 9449,Per Unit,$123.88 ,OP,123.88,123.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9041,Inj.- velcade 0.1 mg,APC 9207,Per Unit,$45.16 ,OP,45.16,45.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9042,Brentuximab vedotin inj,APC 9287,Per Unit,$189.34 ,OP,189.34,189.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9043,Cabazitaxel injection,APC 9276,Per Unit,$189.00 ,OP,189,189,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9044,Inj- bortezomib- nos- 0.1 mg,APC 9192,Per Unit,$18.31 ,OP,18.31,18.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9047,Injection- carfilzomib- 1 mg,APC 9295,Per Unit,$41.10 ,OP,41.1,41.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9050,Carmustine injection,APC 0812,Per Unit,"$1,234.46 ",OP,"1,234.46","1,234.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9055,Cetuximab injection,APC 9215,Per Unit,$66.71 ,OP,66.71,66.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9057,Inj.- copanlisib- 1 mg,APC 9030,Per Unit,$80.96 ,OP,80.96,80.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9065,Inj cladribine per 1 mg,APC 0858,Per Unit,$18.02 ,OP,18.02,18.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9070,Cyclophosphamide 100 mg inj,APC 1408,Per Unit,$29.15 ,OP,29.15,29.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9119,Inj.- cemiplimab-rwlc- 1 mg,APC 9304,Per Unit,$27.54 ,OP,27.54,27.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9120,Dactinomycin injection,APC 0752,Per Unit,$890.64 ,OP,890.64,890.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9144,Daratumumab- hyaluronidase,APC 9378,Per Unit,$45.10 ,OP,45.1,45.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9145,Injection- daratumumab 10 mg,APC 9476,Per Unit,$57.55 ,OP,57.55,57.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9150,Daunorubicin injection,APC 0820,Per Unit,$40.36 ,OP,40.36,40.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9153,Inj daunorubicin- cytarabine,APC 9302,Per Unit,$202.60 ,OP,202.6,202.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9155,Degarelix injection,APC 1296,Per Unit,$4.12 ,OP,4.12,4.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9173,Inj.- durvalumab- 10 mg,APC 9492,Per Unit,$76.86 ,OP,76.86,76.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9176,Injection- elotuzumab- 1mg,APC 9477,Per Unit,$6.77 ,OP,6.77,6.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9177,Inj enfort vedo-ejfv 0.25mg,APC 9364,Per Unit,$30.17 ,OP,30.17,30.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9179,Eribulin mesylate injection,APC 1426,Per Unit,$123.93 ,OP,123.93,123.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9198,Inj. infugem- 100 mg,APC 9387,Per Unit,$34.00 ,OP,34,34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9202,Goserelin acetate implant,APC 0810,Per Unit,$525.21 ,OP,525.21,525.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9203,Gemtuzumab ozogamicin 0.1 mg,APC 9495,Per Unit,$207.99 ,OP,207.99,207.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9204,Inj mogamulizumab-kpkc- 1 mg,APC 9182,Per Unit,$210.05 ,OP,210.05,210.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9205,Inj irinotecan liposome 1 mg,APC 9474,Per Unit,$57.20 ,OP,57.2,57.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9207,Ixabepilone injection,APC 9240,Per Unit,$112.12 ,OP,112.12,112.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9210,Inj.- emapalumab-lzsg- 1 mg,APC 9310,Per Unit,$376.03 ,OP,376.03,376.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9214,Interferon alfa-2b inj,APC 0836,Per Unit,$33.24 ,OP,33.24,33.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9217,Leuprolide acetate suspnsion,APC 9217,Per Unit,$139.09 ,OP,139.09,139.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9223,Inj. lurbinectedin- 0.1 mg,APC 9389,Per Unit,$174.03 ,OP,174.03,174.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9225,Vantas implant,APC 1711,Per Unit,"$5,166.29 ",OP,"5,166.29","5,166.29",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9226,Supprelin la implant,APC 1142,Per Unit,"$43,467.03 ",OP,"43,467.03","43,467.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9227,Inj. isatuximab-irfc 10 mg,APC 9377,Per Unit,$67.60 ,OP,67.6,67.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9228,Ipilimumab injection,APC 9284,Per Unit,$158.65 ,OP,158.65,158.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9229,Inj inotuzumab ozogam 0.1 mg,APC 9028,Per Unit,"$2,371.62 ",OP,"2,371.62","2,371.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9230,Mechlorethamine hcl inj,APC 0751,Per Unit,$11.74 ,OP,11.74,11.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9245,Inj melpha hydroch nos 50 mg,APC 0840,Per Unit,$208.41 ,OP,208.41,208.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9246,Inj.- evomela- 1 mg,APC 9375,Per Unit,$18.20 ,OP,18.2,18.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9261,Nelarabine injection,APC 0825,Per Unit,$155.90 ,OP,155.9,155.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9262,Inj- omacetaxine mep- 0.01mg,APC 9297,Per Unit,$3.30 ,OP,3.3,3.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9264,Paclitaxel protein bound,APC 1712,Per Unit,$14.08 ,OP,14.08,14.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9266,Pegaspargase injection,APC 0843,Per Unit,"$21,561.05 ",OP,"21,561.05","21,561.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9268,Pentostatin injection,APC 0844,Per Unit,"$1,880.67 ",OP,"1,880.67","1,880.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9269,Inj. tagraxofusp-erzs 10 mcg,APC 9309,Per Unit,$290.37 ,OP,290.37,290.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9270,Plicamycin (mithramycin) inj,APC 9093,Per Unit,$115.40 ,OP,115.4,115.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9271,Inj pembrolizumab,APC 1490,Per Unit,$52.75 ,OP,52.75,52.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9280,Mitomycin injection,APC 1232,Per Unit,$38.63 ,OP,38.63,38.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9281,Mitomycin instillation,APC 9374,Per Unit,$281.88 ,OP,281.88,281.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9285,Inj- olaratumab- 10 mg,APC 9485,Per Unit,$52.07 ,OP,52.07,52.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9293,Mitoxantrone hydrochl / 5 mg,APC 0864,Per Unit,$26.29 ,OP,26.29,26.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9295,Injection- necitumumab- 1 mg,APC 9475,Per Unit,$5.74 ,OP,5.74,5.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9299,Injection- nivolumab,APC 9453,Per Unit,$28.86 ,OP,28.86,28.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9301,Obinutuzumab inj,APC 1476,Per Unit,$64.54 ,OP,64.54,64.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9302,Ofatumumab injection,APC 9260,Per Unit,$63.96 ,OP,63.96,63.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9303,Panitumumab injection,APC 9235,Per Unit,$130.38 ,OP,130.38,130.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9305,Inj. pemetrexed nos 10mg,APC 9213,Per Unit,$74.93 ,OP,74.93,74.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9306,Injection- pertuzumab- 1 mg,APC 1471,Per Unit,$13.56 ,OP,13.56,13.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9307,Pralatrexate injection,APC 9259,Per Unit,$314.84 ,OP,314.84,314.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9308,Injection- ramucirumab,APC 1488,Per Unit,$62.69 ,OP,62.69,62.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9309,Inj- polatuzumab vedotin 1mg,APC 9331,Per Unit,$113.57 ,OP,113.57,113.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9311,Inj rituximab- hyaluronidase,APC 9467,Per Unit,$37.94 ,OP,37.94,37.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9312,Inj.- rituximab- 10 mg,APC 9186,Per Unit,$86.94 ,OP,86.94,86.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9313,Inj.- lumoxiti- 0.01 mg,APC 9305,Per Unit,$23.39 ,OP,23.39,23.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9316,Pertuzu- trastuzu- 10 mg,APC 9390,Per Unit,$72.15 ,OP,72.15,72.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9317,Sacituzumab govitecan-hziy,APC 9376,Per Unit,$30.35 ,OP,30.35,30.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9320,Streptozocin injection,APC 0850,Per Unit,$348.51 ,OP,348.51,348.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9325,Inj talimogene laherparepvec,APC 9472,Per Unit,$57.26 ,OP,57.26,57.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9328,Temozolomide injection,APC 9253,Per Unit,$10.41 ,OP,10.41,10.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9330,Temsirolimus injection,APC 1168,Per Unit,$38.25 ,OP,38.25,38.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9340,Thiotepa injection,APC 0851,Per Unit,$305.84 ,OP,305.84,305.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9349,Inj.- tafasitamab-cxix,APC 9385,Per Unit,$12.62 ,OP,12.62,12.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9352,Injection trabectedin 0.1mg,APC 9480,Per Unit,$325.03 ,OP,325.03,325.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9353,Inj. margetuximab-cmkb- 5 mg,APC 9418,Per Unit,$42.99 ,OP,42.99,42.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9354,Inj- ado-trastuzumab emt 1mg,APC 9131,Per Unit,$34.18 ,OP,34.18,34.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9355,Inj trastuzumab excl biosimi,APC 1613,Per Unit,$89.81 ,OP,89.81,89.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9356,Inj. herceptin hylecta- 10mg,APC 9314,Per Unit,$71.85 ,OP,71.85,71.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9357,Valrubicin injection,APC 1235,Per Unit,"$1,425.37 ",OP,"1,425.37","1,425.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9358,Inj fam-trastu deru-nxki 1mg,APC 9353,Per Unit,$24.27 ,OP,24.27,24.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9371,Inj- vincristine sul lip 1mg,APC 1466,Per Unit,"$3,370.23 ",OP,"3,370.23","3,370.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9395,Injection- fulvestrant,APC 9120,Per Unit,$15.98 ,OP,15.98,15.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9400,Inj- ziv-aflibercept- 1mg,APC 9296,Per Unit,$8.42 ,OP,8.42,8.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,J9600,Porfimer sodium injection,APC 0856,Per Unit,"$21,856.35 ",OP,"21,856.35","21,856.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,K0672,Removable soft interface le,Durable Medical Equipment,Per Unit,$85.14 ,OP,85.14,85.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0112,Cranial cervical orthosis,Durable Medical Equipment,Per Unit,"$1,404.96 ",OP,"1,404.96","1,404.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0113,Cranial cervical torticollis,Durable Medical Equipment,Per Unit,$286.27 ,OP,286.27,286.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0120,Cerv flex n/adj foam pre ots,Durable Medical Equipment,Per Unit,$26.55 ,OP,26.55,26.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0130,Flex thermoplastic collar mo,Durable Medical Equipment,Per Unit,$153.23 ,OP,153.23,153.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0140,Cervical semi-rigid adjustab,Durable Medical Equipment,Per Unit,$60.09 ,OP,60.09,60.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0150,Cerv semi-rig adj molded chn,Durable Medical Equipment,Per Unit,$107.45 ,OP,107.45,107.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0160,Cerv sr wire occ/man pre ots,Durable Medical Equipment,Per Unit,$156.89 ,OP,156.89,156.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0170,Cervical collar molded to pt,Durable Medical Equipment,Per Unit,$807.10 ,OP,807.1,807.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0172,Cerv col sr foam 2pc pre ots,Durable Medical Equipment,Per Unit,$142.17 ,OP,142.17,142.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0174,Cerv sr 2pc thor ext pre ots,Durable Medical Equipment,Per Unit,$279.55 ,OP,279.55,279.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0180,Cer post col occ/man sup adj,Durable Medical Equipment,Per Unit,$452.88 ,OP,452.88,452.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0190,Cerv collar supp adj cerv ba,Durable Medical Equipment,Per Unit,$534.12 ,OP,534.12,534.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0200,Cerv col supp adj bar & thor,Durable Medical Equipment,Per Unit,$619.54 ,OP,619.54,619.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0220,Thor rib belt custom fabrica,Durable Medical Equipment,Per Unit,$129.68 ,OP,129.68,129.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0450,Tlso flex trunk/thor pre ots,Durable Medical Equipment,Per Unit,$150.15 ,OP,150.15,150.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0454,Tlso trnk sj-t9 pre cst,Durable Medical Equipment,Per Unit,$348.14 ,OP,348.14,348.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0455,Tlso flex trnk sj-t9 pre ots,Durable Medical Equipment,Per Unit,$301.39 ,OP,301.39,301.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0456,Tlso flex trnk sj-ss pre cst,Durable Medical Equipment,Per Unit,$998.38 ,OP,998.38,998.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0457,Tlso flex trnk sj-ss pre ots,Durable Medical Equipment,Per Unit,$864.31 ,OP,864.31,864.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0458,Tlso 2mod symphis-xipho pre,Durable Medical Equipment,Per Unit,$895.27 ,OP,895.27,895.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0460,Tlso 2 shl symphys-stern cst,Durable Medical Equipment,Per Unit,"$1,007.68 ",OP,"1,007.68","1,007.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0462,Tlso 3mod sacro-scap pre,Durable Medical Equipment,Per Unit,"$1,253.37 ",OP,"1,253.37","1,253.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0464,Tlso 4mod sacro-scap pre,Durable Medical Equipment,Per Unit,"$1,492.13 ",OP,"1,492.13","1,492.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0466,Tlso r fram soft ant pre cst,Durable Medical Equipment,Per Unit,$380.86 ,OP,380.86,380.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0467,Tlso r fram soft pre ots,Durable Medical Equipment,Per Unit,$333.22 ,OP,333.22,333.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0468,Tlso rig fram pelvic pre cst,Durable Medical Equipment,Per Unit,$477.29 ,OP,477.29,477.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0469,Tlso rig fram pelvic pre ots,Durable Medical Equipment,Per Unit,$420.59 ,OP,420.59,420.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0470,Tlso rigid frame pre subclav,Durable Medical Equipment,Per Unit,$660.47 ,OP,660.47,660.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0472,Tlso rigid frame hyperex pre,Durable Medical Equipment,Per Unit,$406.41 ,OP,406.41,406.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0480,Tlso rigid plastic custom fa,Durable Medical Equipment,Per Unit,"$1,516.23 ",OP,"1,516.23","1,516.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0482,Tlso rigid lined custom fab,Durable Medical Equipment,Per Unit,"$1,693.64 ",OP,"1,693.64","1,693.64",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0484,Tlso rigid plastic cust fab,Durable Medical Equipment,Per Unit,"$1,829.06 ",OP,"1,829.06","1,829.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0486,Tlso rigidlined cust fab two,Durable Medical Equipment,Per Unit,"$2,054.11 ",OP,"2,054.11","2,054.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0488,Tlso rigid lined pre one pie,Durable Medical Equipment,Per Unit,"$1,007.68 ",OP,"1,007.68","1,007.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0490,Tlso rigid plastic pre one,Durable Medical Equipment,Per Unit,$283.96 ,OP,283.96,283.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0491,Tlso 2 piece rigid shell,Durable Medical Equipment,Per Unit,$770.93 ,OP,770.93,770.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0492,Tlso 3 piece rigid shell,Durable Medical Equipment,Per Unit,$502.01 ,OP,502.01,502.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0621,Sio flex pelvic/sacr pre ots,Durable Medical Equipment,Per Unit,$79.44 ,OP,79.44,79.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0622,Sio flex pelvisacral custom,Durable Medical Equipment,Per Unit,$268.31 ,OP,268.31,268.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0623,Sio rig pnl pelv/sac pre ots,Durable Medical Equipment,Per Unit,$153.64 ,OP,153.64,153.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0625,Lo flex l1-below l5 pre ots,Durable Medical Equipment,Per Unit,$47.88 ,OP,47.88,47.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0626,Lo sag rig pnl stays pre cst,Durable Medical Equipment,Per Unit,$78.25 ,OP,78.25,78.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0627,Lo sag ri an/pos pnl pre cst,Durable Medical Equipment,Per Unit,$412.59 ,OP,412.59,412.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0628,Lso flex no ri stays pre ots,Durable Medical Equipment,Per Unit,$72.90 ,OP,72.9,72.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0630,Lso r post pnl sj-t9 pre cst,Durable Medical Equipment,Per Unit,$162.59 ,OP,162.59,162.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0631,Lso sag r an/pos pnl pre cst,Durable Medical Equipment,Per Unit,"$1,030.49 ",OP,"1,030.49","1,030.49",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0633,Lso sc r pos/lat pnl pre cst,Durable Medical Equipment,Per Unit,$287.85 ,OP,287.85,287.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0635,Lso sagit rigid panel prefab,Durable Medical Equipment,Per Unit,"$1,003.05 ",OP,"1,003.05","1,003.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0636,Lso sagittal rigid panel cus,Durable Medical Equipment,Per Unit,"$1,360.98 ",OP,"1,360.98","1,360.98",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0637,Lso sc r ant/pos pnl pre cst,Durable Medical Equipment,Per Unit,"$1,300.47 ",OP,"1,300.47","1,300.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0638,Lso sag-coronal panel custom,Durable Medical Equipment,Per Unit,"$1,323.97 ",OP,"1,323.97","1,323.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0639,Lso s/c shell/panel prefab,Durable Medical Equipment,Per Unit,"$1,300.47 ",OP,"1,300.47","1,300.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0640,Lso s/c shell/panel custom,Durable Medical Equipment,Per Unit,"$1,050.39 ",OP,"1,050.39","1,050.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0641,Lo rig pos pnl l1-l5 pre ots,Durable Medical Equipment,Per Unit,$67.74 ,OP,67.74,67.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0642,Lo sag ri an/pos pnl pre ots,Durable Medical Equipment,Per Unit,$357.24 ,OP,357.24,357.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0643,Lso sag ctr rigi pos pre ots,Durable Medical Equipment,Per Unit,$140.76 ,OP,140.76,140.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0648,Lso sag r an/pos pnl pre ots,Durable Medical Equipment,Per Unit,$892.19 ,OP,892.19,892.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0649,Lso sc r pos/lat pnl pre ots,Durable Medical Equipment,Per Unit,$249.22 ,OP,249.22,249.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0650,Lso sc r ant/pos pnl pre ots,Durable Medical Equipment,Per Unit,"$1,086.39 ",OP,"1,086.39","1,086.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0651,Lso sag-co shell pnl pre ots,Durable Medical Equipment,Per Unit,"$1,086.39 ",OP,"1,086.39","1,086.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0700,Ctlso a-p-l control molded,Durable Medical Equipment,Per Unit,"$1,998.37 ",OP,"1,998.37","1,998.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0710,Ctlso a-p-l control w/ inter,Durable Medical Equipment,Per Unit,"$2,196.75 ",OP,"2,196.75","2,196.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0810,Halo cervical into jckt vest,Durable Medical Equipment,Per Unit,"$2,683.14 ",OP,"2,683.14","2,683.14",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0820,Halo cervical into body jack,Durable Medical Equipment,Per Unit,"$2,110.65 ",OP,"2,110.65","2,110.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0830,Halo cerv into milwaukee typ,Durable Medical Equipment,Per Unit,"$3,229.60 ",OP,"3,229.60","3,229.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0859,Mri compatible system,Durable Medical Equipment,Per Unit,"$1,143.45 ",OP,"1,143.45","1,143.45",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0861,Halo repl liner/interface,Durable Medical Equipment,Per Unit,$216.37 ,OP,216.37,216.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0970,Tlso corset front,Durable Medical Equipment,Per Unit,$107.27 ,OP,107.27,107.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0972,Lso corset front,Durable Medical Equipment,Per Unit,$97.64 ,OP,97.64,97.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0974,Tlso full corset,Durable Medical Equipment,Per Unit,$175.42 ,OP,175.42,175.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0976,Lso full corset,Durable Medical Equipment,Per Unit,$150.09 ,OP,150.09,150.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0978,Axillary crutch extension,Durable Medical Equipment,Per Unit,$188.90 ,OP,188.9,188.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0980,Peroneal straps pair pre ots,Durable Medical Equipment,Per Unit,$17.15 ,OP,17.15,17.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0982,Stocking sup grips 4 pre ots,Durable Medical Equipment,Per Unit,$15.70 ,OP,15.7,15.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L0984,Protect body sock ea pre ots,Durable Medical Equipment,Per Unit,$67.93 ,OP,67.93,67.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1000,Ctlso milwauke initial model,Durable Medical Equipment,Per Unit,"$2,035.53 ",OP,"2,035.53","2,035.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1005,Tension based scoliosis orth,Durable Medical Equipment,Per Unit,"$3,212.88 ",OP,"3,212.88","3,212.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1010,Ctlso axilla sling,Durable Medical Equipment,Per Unit,$83.99 ,OP,83.99,83.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1020,Kyphosis pad,Durable Medical Equipment,Per Unit,$108.17 ,OP,108.17,108.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1025,Kyphosis pad floating,Durable Medical Equipment,Per Unit,$156.06 ,OP,156.06,156.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1030,Lumbar bolster pad,Durable Medical Equipment,Per Unit,$78.60 ,OP,78.6,78.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1040,Lumbar or lumbar rib pad,Durable Medical Equipment,Per Unit,$89.00 ,OP,89,89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1050,Sternal pad,Durable Medical Equipment,Per Unit,$100.72 ,OP,100.72,100.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1060,Thoracic pad,Durable Medical Equipment,Per Unit,$108.72 ,OP,108.72,108.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1070,Trapezius sling,Durable Medical Equipment,Per Unit,$112.62 ,OP,112.62,112.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1080,Outrigger,Durable Medical Equipment,Per Unit,$52.52 ,OP,52.52,52.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1085,Outrigger bil w/ vert extens,Durable Medical Equipment,Per Unit,$175.83 ,OP,175.83,175.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1090,Lumbar sling,Durable Medical Equipment,Per Unit,$101.01 ,OP,101.01,101.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1100,Ring flange plastic/leather,Durable Medical Equipment,Per Unit,$190.64 ,OP,190.64,190.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1110,Ring flange plas/leather mol,Durable Medical Equipment,Per Unit,$319.63 ,OP,319.63,319.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1120,Covers for upright each,Durable Medical Equipment,Per Unit,$38.18 ,OP,38.18,38.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1200,Furnsh initial orthosis only,Durable Medical Equipment,Per Unit,"$1,796.37 ",OP,"1,796.37","1,796.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1210,Lateral thoracic extension,Durable Medical Equipment,Per Unit,$245.60 ,OP,245.6,245.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1220,Anterior thoracic extension,Durable Medical Equipment,Per Unit,$239.05 ,OP,239.05,239.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1230,Milwaukee type superstructur,Durable Medical Equipment,Per Unit,$669.67 ,OP,669.67,669.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1240,Lumbar derotation pad,Durable Medical Equipment,Per Unit,$91.29 ,OP,91.29,91.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1250,Anterior asis pad,Durable Medical Equipment,Per Unit,$79.39 ,OP,79.39,79.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1260,Anterior thoracic derotation,Durable Medical Equipment,Per Unit,$94.68 ,OP,94.68,94.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1270,Abdominal pad,Durable Medical Equipment,Per Unit,$83.20 ,OP,83.2,83.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1280,Rib gusset (elastic) each,Durable Medical Equipment,Per Unit,$87.71 ,OP,87.71,87.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1290,Lateral trochanteric pad,Durable Medical Equipment,Per Unit,$78.00 ,OP,78,78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1300,Body jacket mold to patient,Durable Medical Equipment,Per Unit,"$1,730.06 ",OP,"1,730.06","1,730.06",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1310,Post-operative body jacket,Durable Medical Equipment,Per Unit,"$1,802.00 ",OP,"1,802.00","1,802.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1600,Ho flex frejka w/cov pre cst,Durable Medical Equipment,Per Unit,$129.35 ,OP,129.35,129.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1610,Ho frejka cov only pre cst,Durable Medical Equipment,Per Unit,$54.94 ,OP,54.94,54.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1620,Ho flex pavlik harns pre cst,Durable Medical Equipment,Per Unit,$157.73 ,OP,157.73,157.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1630,Abduct control hip semi-flex,Durable Medical Equipment,Per Unit,$212.06 ,OP,212.06,212.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1640,Pelv band/spread bar thigh c,Durable Medical Equipment,Per Unit,$475.20 ,OP,475.2,475.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1650,Ho abduction hip adjustable,Durable Medical Equipment,Per Unit,$247.55 ,OP,247.55,247.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1652,Ho bi thighcuffs w sprdr bar,Durable Medical Equipment,Per Unit,$357.83 ,OP,357.83,357.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1660,Ho abduction static plastic,Durable Medical Equipment,Per Unit,$181.40 ,OP,181.4,181.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1680,Pelvic & hip control thigh c,Durable Medical Equipment,Per Unit,"$1,143.62 ",OP,"1,143.62","1,143.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1685,Post-op hip abduct custom fa,Durable Medical Equipment,Per Unit,"$1,116.47 ",OP,"1,116.47","1,116.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1686,Ho post-op hip abduction,Durable Medical Equipment,Per Unit,$940.60 ,OP,940.6,940.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1690,Combination bilateral ho,Durable Medical Equipment,Per Unit,"$1,941.15 ",OP,"1,941.15","1,941.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1700,Leg perthes orth toronto typ,Durable Medical Equipment,Per Unit,"$1,561.78 ",OP,"1,561.78","1,561.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1710,Legg perthes orth newington,Durable Medical Equipment,Per Unit,"$1,988.75 ",OP,"1,988.75","1,988.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1720,Legg perthes orthosis trilat,Durable Medical Equipment,Per Unit,"$1,480.82 ",OP,"1,480.82","1,480.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1730,Legg perthes orth scottish r,Durable Medical Equipment,Per Unit,"$1,250.14 ",OP,"1,250.14","1,250.14",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1755,Legg perthes patten bottom t,Durable Medical Equipment,Per Unit,"$1,797.35 ",OP,"1,797.35","1,797.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1810,Ko elastic with joints,Durable Medical Equipment,Per Unit,$103.34 ,OP,103.34,103.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1812,Ko elastic w/joints pre ots,Durable Medical Equipment,Per Unit,$92.18 ,OP,92.18,92.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1820,Ko elas w/ condyle pads & jo,Durable Medical Equipment,Per Unit,$142.66 ,OP,142.66,142.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1830,Ko immob canvas long pre ots,Durable Medical Equipment,Per Unit,$78.26 ,OP,78.26,78.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1831,Knee orth pos locking joint,Durable Medical Equipment,Per Unit,$295.44 ,OP,295.44,295.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1832,Ko adj jnt pos r sup pre cst,Durable Medical Equipment,Per Unit,$691.44 ,OP,691.44,691.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1833,Ko adj jnt pos r sup pre ots,Durable Medical Equipment,Per Unit,$608.67 ,OP,608.67,608.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1834,Ko w/0 joint rigid molded to,Durable Medical Equipment,Per Unit,$728.61 ,OP,728.61,728.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1836,Ko rigid w/o joints pre ots,Durable Medical Equipment,Per Unit,$118.58 ,OP,118.58,118.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1840,Ko derot ant cruciate custom,Durable Medical Equipment,Per Unit,$944.00 ,OP,944,944,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1843,Ko single upright pre cst,Durable Medical Equipment,Per Unit,$900.70 ,OP,900.7,900.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1844,Ko w/adj jt rot cntrl molded,Durable Medical Equipment,Per Unit,"$1,528.66 ",OP,"1,528.66","1,528.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1845,Ko double upright pre cst,Durable Medical Equipment,Per Unit,$840.88 ,OP,840.88,840.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1846,Ko w adj flex/ext rotat mold,Durable Medical Equipment,Per Unit,"$1,174.51 ",OP,"1,174.51","1,174.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1847,Ko dbl upright w/air pre cst,Durable Medical Equipment,Per Unit,$577.37 ,OP,577.37,577.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1848,Ko dbl upright w/air pre ots,Durable Medical Equipment,Per Unit,$577.37 ,OP,577.37,577.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1850,Ko swedish type pre ots,Durable Medical Equipment,Per Unit,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1851,Ko single upright prefab ots,Durable Medical Equipment,Per Unit,$797.42 ,OP,797.42,797.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1852,Ko double upright prefab ots,Durable Medical Equipment,Per Unit,$751.54 ,OP,751.54,751.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1860,Ko supracondylar socket mold,Durable Medical Equipment,Per Unit,"$1,251.75 ",OP,"1,251.75","1,251.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1900,Afo sprng wir drsflx calf bd,Durable Medical Equipment,Per Unit,$286.39 ,OP,286.39,286.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1902,Afo ankle gauntlet pre ots,Durable Medical Equipment,Per Unit,$74.93 ,OP,74.93,74.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1904,Afo molded ankle gauntlet,Durable Medical Equipment,Per Unit,$453.09 ,OP,453.09,453.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1906,Afo multilig ank sup pre ots,Durable Medical Equipment,Per Unit,$112.88 ,OP,112.88,112.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1907,Afo supramalleolar custom,Durable Medical Equipment,Per Unit,$564.86 ,OP,564.86,564.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1910,Afo sing bar clasp attach sh,Durable Medical Equipment,Per Unit,$281.51 ,OP,281.51,281.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1920,Afo sing upright w/ adjust s,Durable Medical Equipment,Per Unit,$412.37 ,OP,412.37,412.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1930,Afo plastic,Durable Medical Equipment,Per Unit,$252.89 ,OP,252.89,252.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1932,Afo rig ant tib prefab tcf/=,Durable Medical Equipment,Per Unit,$895.75 ,OP,895.75,895.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1940,Afo molded to patient plasti,Durable Medical Equipment,Per Unit,$488.84 ,OP,488.84,488.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1945,Afo molded plas rig ant tib,Durable Medical Equipment,Per Unit,"$1,126.77 ",OP,"1,126.77","1,126.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1950,Afo spiral molded to pt plas,Durable Medical Equipment,Per Unit,$772.00 ,OP,772,772,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1951,Afo spiral prefabricated,Durable Medical Equipment,Per Unit,$843.02 ,OP,843.02,843.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1960,Afo pos solid ank plastic mo,Durable Medical Equipment,Per Unit,$622.25 ,OP,622.25,622.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1970,Afo plastic molded w/ankle j,Durable Medical Equipment,Per Unit,$694.78 ,OP,694.78,694.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1971,Afo w/ankle joint- prefab,Durable Medical Equipment,Per Unit,$470.55 ,OP,470.55,470.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1980,Afo sing solid stirrup calf,Durable Medical Equipment,Per Unit,$405.31 ,OP,405.31,405.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L1990,Afo doub solid stirrup calf,Durable Medical Equipment,Per Unit,$469.10 ,OP,469.1,469.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2000,Kafo sing fre stirr thi/calf,Durable Medical Equipment,Per Unit,"$1,122.95 ",OP,"1,122.95","1,122.95",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2005,Kafo sng/dbl mechanical act,Durable Medical Equipment,Per Unit,"$4,113.39 ",OP,"4,113.39","4,113.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2010,Kafo sng solid stirrup w/o j,Durable Medical Equipment,Per Unit,$875.89 ,OP,875.89,875.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2020,Kafo dbl solid stirrup band/,Durable Medical Equipment,Per Unit,"$1,106.22 ",OP,"1,106.22","1,106.22",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2030,Kafo dbl solid stirrup w/o j,Durable Medical Equipment,Per Unit,"$1,087.33 ",OP,"1,087.33","1,087.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2034,Kafo pla sin up w/wo k/a cus,Durable Medical Equipment,Per Unit,"$2,039.24 ",OP,"2,039.24","2,039.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2035,Kafo plastic pediatric size,Durable Medical Equipment,Per Unit,$173.91 ,OP,173.91,173.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2036,Kafo plas doub free knee mol,Durable Medical Equipment,Per Unit,"$1,861.04 ",OP,"1,861.04","1,861.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2037,Kafo plas sing free knee mol,Durable Medical Equipment,Per Unit,"$1,664.67 ",OP,"1,664.67","1,664.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2038,Kafo w/o joint multi-axis an,Durable Medical Equipment,Per Unit,"$1,341.97 ",OP,"1,341.97","1,341.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2040,Hkafo torsion bil rot straps,Durable Medical Equipment,Per Unit,$203.08 ,OP,203.08,203.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2050,Hkafo torsion cable hip pelv,Durable Medical Equipment,Per Unit,$489.17 ,OP,489.17,489.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2060,Hkafo torsion ball bearing j,Durable Medical Equipment,Per Unit,$611.86 ,OP,611.86,611.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2070,Hkafo torsion unilat rot str,Durable Medical Equipment,Per Unit,$155.80 ,OP,155.8,155.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2080,Hkafo unilat torsion cable,Durable Medical Equipment,Per Unit,$374.61 ,OP,374.61,374.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2090,Hkafo unilat torsion ball br,Durable Medical Equipment,Per Unit,$499.12 ,OP,499.12,499.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2106,Afo tib fx cast plaster mold,Durable Medical Equipment,Per Unit,$791.23 ,OP,791.23,791.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2108,Afo tib fx cast molded to pt,Durable Medical Equipment,Per Unit,"$1,154.03 ",OP,"1,154.03","1,154.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2112,Afo tibial fracture soft,Durable Medical Equipment,Per Unit,$506.43 ,OP,506.43,506.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2114,Afo tib fx semi-rigid,Durable Medical Equipment,Per Unit,$634.33 ,OP,634.33,634.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2116,Afo tibial fracture rigid,Durable Medical Equipment,Per Unit,$773.69 ,OP,773.69,773.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2126,Kafo fem fx cast thermoplas,Durable Medical Equipment,Per Unit,"$1,281.77 ",OP,"1,281.77","1,281.77",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2128,Kafo fem fx cast molded to p,Durable Medical Equipment,Per Unit,"$1,609.47 ",OP,"1,609.47","1,609.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2132,Kafo femoral fx cast soft,Durable Medical Equipment,Per Unit,$976.92 ,OP,976.92,976.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2134,Kafo fem fx cast semi-rigid,Durable Medical Equipment,Per Unit,"$1,156.80 ",OP,"1,156.80","1,156.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2136,Kafo femoral fx cast rigid,Durable Medical Equipment,Per Unit,"$1,265.95 ",OP,"1,265.95","1,265.95",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2180,Plas shoe insert w ank joint,Durable Medical Equipment,Per Unit,$133.08 ,OP,133.08,133.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2182,Drop lock knee,Durable Medical Equipment,Per Unit,$114.71 ,OP,114.71,114.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2184,Limited motion knee joint,Durable Medical Equipment,Per Unit,$116.27 ,OP,116.27,116.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2186,Adj motion knee jnt lerman t,Durable Medical Equipment,Per Unit,$154.63 ,OP,154.63,154.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2188,Quadrilateral brim,Durable Medical Equipment,Per Unit,$281.10 ,OP,281.1,281.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2190,Waist belt,Durable Medical Equipment,Per Unit,$85.62 ,OP,85.62,85.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2192,Pelvic band & belt thigh fla,Durable Medical Equipment,Per Unit,$334.67 ,OP,334.67,334.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2200,Limited ankle motion ea jnt,Durable Medical Equipment,Per Unit,$50.44 ,OP,50.44,50.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2210,Dorsiflexion assist each joi,Durable Medical Equipment,Per Unit,$63.09 ,OP,63.09,63.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2220,Dorsi & plantar flex ass/res,Durable Medical Equipment,Per Unit,$81.22 ,OP,81.22,81.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2230,Split flat caliper stirr & p,Durable Medical Equipment,Per Unit,$96.02 ,OP,96.02,96.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2232,Rocker bottom- contact afo,Durable Medical Equipment,Per Unit,$97.51 ,OP,97.51,97.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2240,Round caliper and plate atta,Durable Medical Equipment,Per Unit,$95.58 ,OP,95.58,95.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2250,Foot plate molded stirrup at,Durable Medical Equipment,Per Unit,$335.30 ,OP,335.3,335.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2260,Reinforced solid stirrup,Durable Medical Equipment,Per Unit,$188.16 ,OP,188.16,188.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2265,Long tongue stirrup,Durable Medical Equipment,Per Unit,$134.94 ,OP,134.94,134.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2270,Varus/valgus strap padded/li,Durable Medical Equipment,Per Unit,$61.87 ,OP,61.87,61.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2275,Plastic mod low ext pad/line,Durable Medical Equipment,Per Unit,$130.85 ,OP,130.85,130.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2280,Molded inner boot,Durable Medical Equipment,Per Unit,$566.69 ,OP,566.69,566.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2300,Abduction bar jointed adjust,Durable Medical Equipment,Per Unit,$252.72 ,OP,252.72,252.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2310,Abduction bar-straight,Durable Medical Equipment,Per Unit,$115.47 ,OP,115.47,115.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2320,Non-molded lacer,Durable Medical Equipment,Per Unit,$193.64 ,OP,193.64,193.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2330,Lacer molded to patient mode,Durable Medical Equipment,Per Unit,$368.55 ,OP,368.55,368.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2335,Anterior swing band,Durable Medical Equipment,Per Unit,$282.18 ,OP,282.18,282.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2340,Pre-tibial shell molded to p,Durable Medical Equipment,Per Unit,$419.50 ,OP,419.5,419.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2350,Prosthetic type socket molde,Durable Medical Equipment,Per Unit,$836.35 ,OP,836.35,836.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2360,Extended steel shank,Durable Medical Equipment,Per Unit,$51.76 ,OP,51.76,51.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2370,Patten bottom,Durable Medical Equipment,Per Unit,$321.26 ,OP,321.26,321.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2375,Torsion ank & half solid sti,Durable Medical Equipment,Per Unit,$123.52 ,OP,123.52,123.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2380,Torsion straight knee joint,Durable Medical Equipment,Per Unit,$129.54 ,OP,129.54,129.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2385,Straight knee joint heavy du,Durable Medical Equipment,Per Unit,$147.50 ,OP,147.5,147.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2387,Add le poly knee custom kafo,Durable Medical Equipment,Per Unit,$191.63 ,OP,191.63,191.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2390,Offset knee joint each,Durable Medical Equipment,Per Unit,$102.75 ,OP,102.75,102.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2395,Offset knee joint heavy duty,Durable Medical Equipment,Per Unit,$146.86 ,OP,146.86,146.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2397,Suspension sleeve lower ext,Durable Medical Equipment,Per Unit,$122.52 ,OP,122.52,122.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2405,Knee joint drop lock ea jnt,Durable Medical Equipment,Per Unit,$87.52 ,OP,87.52,87.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2415,Knee joint cam lock each joi,Durable Medical Equipment,Per Unit,$121.95 ,OP,121.95,121.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2425,Knee disc/dial lock/adj flex,Durable Medical Equipment,Per Unit,$143.90 ,OP,143.9,143.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2430,Knee jnt ratchet lock ea jnt,Durable Medical Equipment,Per Unit,$143.90 ,OP,143.9,143.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2492,Knee lift loop drop lock rin,Durable Medical Equipment,Per Unit,$117.74 ,OP,117.74,117.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2500,Thi/glut/ischia wgt bearing,Durable Medical Equipment,Per Unit,$314.13 ,OP,314.13,314.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2510,Th/wght bear quad-lat brim m,Durable Medical Equipment,Per Unit,$809.60 ,OP,809.6,809.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2520,Th/wght bear quad-lat brim c,Durable Medical Equipment,Per Unit,$539.56 ,OP,539.56,539.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2525,Th/wght bear nar m-l brim mo,Durable Medical Equipment,Per Unit,"$1,144.16 ",OP,"1,144.16","1,144.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2526,Th/wght bear nar m-l brim cu,Durable Medical Equipment,Per Unit,$642.90 ,OP,642.9,642.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2530,Thigh/wght bear lacer non-mo,Durable Medical Equipment,Per Unit,$240.74 ,OP,240.74,240.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2540,Thigh/wght bear lacer molded,Durable Medical Equipment,Per Unit,$455.54 ,OP,455.54,455.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2550,Thigh/wght bear high roll cu,Durable Medical Equipment,Per Unit,$341.55 ,OP,341.55,341.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2570,Hip clevis type 2 posit jnt,Durable Medical Equipment,Per Unit,$447.07 ,OP,447.07,447.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2580,Pelvic control pelvic sling,Durable Medical Equipment,Per Unit,$435.62 ,OP,435.62,435.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2600,Hip clevis/thrust bearing fr,Durable Medical Equipment,Per Unit,$214.10 ,OP,214.1,214.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2610,Hip clevis/thrust bearing lo,Durable Medical Equipment,Per Unit,$236.58 ,OP,236.58,236.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2620,Pelvic control hip heavy dut,Durable Medical Equipment,Per Unit,$250.96 ,OP,250.96,250.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2622,Hip joint adjustable flexion,Durable Medical Equipment,Per Unit,$319.42 ,OP,319.42,319.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2624,Hip adj flex ext abduct cont,Durable Medical Equipment,Per Unit,$391.68 ,OP,391.68,391.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2627,Plastic mold recipro hip & c,Durable Medical Equipment,Per Unit,"$2,145.41 ",OP,"2,145.41","2,145.41",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2628,Metal frame recipro hip & ca,Durable Medical Equipment,Per Unit,"$1,572.54 ",OP,"1,572.54","1,572.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2630,Pelvic control band & belt u,Durable Medical Equipment,Per Unit,$232.43 ,OP,232.43,232.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2640,Pelvic control band & belt b,Durable Medical Equipment,Per Unit,$315.42 ,OP,315.42,315.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2650,Pelv & thor control gluteal,Durable Medical Equipment,Per Unit,$138.91 ,OP,138.91,138.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2660,Thoracic control thoracic ba,Durable Medical Equipment,Per Unit,$179.86 ,OP,179.86,179.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2670,Thorac cont paraspinal uprig,Durable Medical Equipment,Per Unit,$160.11 ,OP,160.11,160.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2680,Thorac cont lat support upri,Durable Medical Equipment,Per Unit,$146.88 ,OP,146.88,146.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2750,Plating chrome/nickel pr bar,Durable Medical Equipment,Per Unit,$78.45 ,OP,78.45,78.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2755,Carbon graphite lamination,Durable Medical Equipment,Per Unit,$131.16 ,OP,131.16,131.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2760,Extension per extension per,Durable Medical Equipment,Per Unit,$57.03 ,OP,57.03,57.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2768,Ortho sidebar disconnect,Durable Medical Equipment,Per Unit,$130.78 ,OP,130.78,130.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2780,Non-corrosive finish,Durable Medical Equipment,Per Unit,$63.53 ,OP,63.53,63.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2785,Drop lock retainer each,Durable Medical Equipment,Per Unit,$29.75 ,OP,29.75,29.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2795,Knee control full kneecap,Durable Medical Equipment,Per Unit,$82.32 ,OP,82.32,82.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2800,Knee cap medial or lateral p,Durable Medical Equipment,Per Unit,$101.09 ,OP,101.09,101.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2810,Knee control condylar pad,Durable Medical Equipment,Per Unit,$81.98 ,OP,81.98,81.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2820,Soft interface below knee se,Durable Medical Equipment,Per Unit,$81.51 ,OP,81.51,81.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2830,Soft interface above knee se,Durable Medical Equipment,Per Unit,$88.18 ,OP,88.18,88.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2840,Tibial length sock fx or equ,Durable Medical Equipment,Per Unit,$43.30 ,OP,43.3,43.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L2850,Femoral lgth sock fx or equa,Durable Medical Equipment,Per Unit,$60.72 ,OP,60.72,60.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3000,Ft insert ucb berkeley shell,Durable Medical Equipment,Per Unit,$315.34 ,OP,315.34,315.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3001,Foot insert remov molded spe,Durable Medical Equipment,Per Unit,$132.78 ,OP,132.78,132.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3002,Foot insert plastazote or eq,Durable Medical Equipment,Per Unit,$162.12 ,OP,162.12,162.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3003,Foot insert silicone gel eac,Durable Medical Equipment,Per Unit,$174.89 ,OP,174.89,174.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3010,Foot longitudinal arch suppo,Durable Medical Equipment,Per Unit,$174.89 ,OP,174.89,174.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3020,Foot longitud/metatarsal sup,Durable Medical Equipment,Per Unit,$199.16 ,OP,199.16,199.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3030,Foot arch support remov prem,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3031,Foot lamin/prepreg composite,Durable Medical Equipment,Per Unit,$122.94 ,OP,122.94,122.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3040,Ft arch suprt premold longit,Durable Medical Equipment,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3050,Foot arch supp premold metat,Durable Medical Equipment,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3060,Foot arch supp longitud/meta,Durable Medical Equipment,Per Unit,$74.04 ,OP,74.04,74.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3070,Arch suprt att to sho longit,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3080,Arch supp att to shoe metata,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3090,Arch supp att to shoe long/m,Durable Medical Equipment,Per Unit,$40.86 ,OP,40.86,40.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3100,Hallus-valgus nt dyn pre ots,Durable Medical Equipment,Per Unit,$43.43 ,OP,43.43,43.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3140,Abduction rotation bar shoe,Durable Medical Equipment,Per Unit,$89.37 ,OP,89.37,89.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3150,Abduct rotation bar w/o shoe,Durable Medical Equipment,Per Unit,$81.72 ,OP,81.72,81.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3170,Foot plas heel stabi pre ots,Durable Medical Equipment,Per Unit,$51.06 ,OP,51.06,51.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3224,Woman's shoe oxford brace,Durable Medical Equipment,Per Unit,$67.83 ,OP,67.83,67.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3225,Man's shoe oxford brace,Durable Medical Equipment,Per Unit,$74.09 ,OP,74.09,74.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3300,Sho lift taper to metatarsal,Durable Medical Equipment,Per Unit,$52.35 ,OP,52.35,52.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3310,Shoe lift elev heel/sole neo,Durable Medical Equipment,Per Unit,$81.72 ,OP,81.72,81.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3330,Lifts elevation metal extens,Durable Medical Equipment,Per Unit,$568.10 ,OP,568.1,568.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3332,Shoe lifts tapered to one-ha,Durable Medical Equipment,Per Unit,$74.04 ,OP,74.04,74.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3334,Shoe lifts elevation heel /i,Durable Medical Equipment,Per Unit,$38.28 ,OP,38.28,38.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3340,Shoe wedge sach,Durable Medical Equipment,Per Unit,$85.56 ,OP,85.56,85.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3350,Shoe heel wedge,Durable Medical Equipment,Per Unit,$22.96 ,OP,22.96,22.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3360,Shoe sole wedge outside sole,Durable Medical Equipment,Per Unit,$35.74 ,OP,35.74,35.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3370,Shoe sole wedge between sole,Durable Medical Equipment,Per Unit,$49.79 ,OP,49.79,49.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3380,Shoe clubfoot wedge,Durable Medical Equipment,Per Unit,$49.79 ,OP,49.79,49.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3390,Shoe outflare wedge,Durable Medical Equipment,Per Unit,$49.79 ,OP,49.79,49.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3400,Shoe metatarsal bar wedge ro,Durable Medical Equipment,Per Unit,$40.86 ,OP,40.86,40.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3410,Shoe metatarsal bar between,Durable Medical Equipment,Per Unit,$93.19 ,OP,93.19,93.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3420,Full sole/heel wedge btween,Durable Medical Equipment,Per Unit,$54.90 ,OP,54.9,54.9,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3430,Sho heel count plast reinfor,Durable Medical Equipment,Per Unit,$160.86 ,OP,160.86,160.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3440,Heel leather reinforced,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3450,Shoe heel sach cushion type,Durable Medical Equipment,Per Unit,$105.93 ,OP,105.93,105.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3455,Shoe heel new leather standa,Durable Medical Equipment,Per Unit,$40.86 ,OP,40.86,40.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3460,Shoe heel new rubber standar,Durable Medical Equipment,Per Unit,$34.49 ,OP,34.49,34.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3465,Shoe heel thomas with wedge,Durable Medical Equipment,Per Unit,$58.76 ,OP,58.76,58.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3470,Shoe heel thomas extend to b,Durable Medical Equipment,Per Unit,$62.54 ,OP,62.54,62.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3480,Shoe heel pad & depress for,Durable Medical Equipment,Per Unit,$62.54 ,OP,62.54,62.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3500,Ortho shoe add leather insol,Durable Medical Equipment,Per Unit,$29.35 ,OP,29.35,29.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3510,Orthopedic shoe add rub insl,Durable Medical Equipment,Per Unit,$29.35 ,OP,29.35,29.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3520,O shoe add felt w leath insl,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3530,Ortho shoe add half sole,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3540,Ortho shoe add full sole,Durable Medical Equipment,Per Unit,$51.06 ,OP,51.06,51.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3550,O shoe add standard toe tap,Durable Medical Equipment,Per Unit,$8.97 ,OP,8.97,8.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3560,O shoe add horseshoe toe tap,Durable Medical Equipment,Per Unit,$22.96 ,OP,22.96,22.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3570,O shoe add instep extension,Durable Medical Equipment,Per Unit,$85.56 ,OP,85.56,85.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3580,O shoe add instep velcro clo,Durable Medical Equipment,Per Unit,$65.11 ,OP,65.11,65.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3590,O shoe convert to sof counte,Durable Medical Equipment,Per Unit,$53.63 ,OP,53.63,53.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3595,Ortho shoe add march bar,Durable Medical Equipment,Per Unit,$42.10 ,OP,42.1,42.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3600,Trans shoe calip plate exist,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3610,Trans shoe caliper plate new,Durable Medical Equipment,Per Unit,$100.86 ,OP,100.86,100.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3620,Trans shoe solid stirrup exi,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3630,Trans shoe solid stirrup new,Durable Medical Equipment,Per Unit,$100.86 ,OP,100.86,100.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3640,Shoe dennis browne splint bo,Durable Medical Equipment,Per Unit,$43.43 ,OP,43.43,43.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3650,So 8 abd restraint pre ots,Durable Medical Equipment,Per Unit,$65.83 ,OP,65.83,65.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3660,So 8 ab rstr can/web pre ots,Durable Medical Equipment,Per Unit,$94.40 ,OP,94.4,94.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3670,So acro/clav can web pre ots,Durable Medical Equipment,Per Unit,$103.86 ,OP,103.86,103.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3671,So cap design w/o jnts cf,Durable Medical Equipment,Per Unit,$823.17 ,OP,823.17,823.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3674,So airplane w/wo joint cf,Durable Medical Equipment,Per Unit,"$1,079.87 ",OP,"1,079.87","1,079.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3675,So vest canvas/web pre ots,Durable Medical Equipment,Per Unit,$160.35 ,OP,160.35,160.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3702,Eo w/o joints cf,Durable Medical Equipment,Per Unit,$263.81 ,OP,263.81,263.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3710,Eo elas w/metal jnts pre ots,Durable Medical Equipment,Per Unit,$130.45 ,OP,130.45,130.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3720,Forearm/arm cuffs free motio,Durable Medical Equipment,Per Unit,$624.22 ,OP,624.22,624.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3730,Forearm/arm cuffs ext/flex a,Durable Medical Equipment,Per Unit,$827.96 ,OP,827.96,827.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3740,Cuffs adj lock w/ active con,Durable Medical Equipment,Per Unit,$981.62 ,OP,981.62,981.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3760,Eo adj jt prefab custom fit,Durable Medical Equipment,Per Unit,$456.89 ,OP,456.89,456.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3761,Eo- adj lock joint prefab ot,Durable Medical Equipment,Per Unit,$456.89 ,OP,456.89,456.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3762,Eo rigid w/o joints pre ots,Durable Medical Equipment,Per Unit,$98.22 ,OP,98.22,98.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3763,Ewho rigid w/o jnts cf,Durable Medical Equipment,Per Unit,$683.66 ,OP,683.66,683.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3764,Ewho w/joint(s) cf,Durable Medical Equipment,Per Unit,$715.47 ,OP,715.47,715.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3765,Ewhfo rigid w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,171.43 ",OP,"1,171.43","1,171.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3766,Ewhfo w/joint(s) cf,Durable Medical Equipment,Per Unit,"$1,240.47 ",OP,"1,240.47","1,240.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3806,Whfo w/joint(s) custom fab,Durable Medical Equipment,Per Unit,$414.97 ,OP,414.97,414.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3807,Whfo w/o joints pre cst,Durable Medical Equipment,Per Unit,$228.43 ,OP,228.43,228.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3808,Whfo- rigid w/o joints,Durable Medical Equipment,Per Unit,$325.43 ,OP,325.43,325.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3809,Whfo w/o joints pre ots,Durable Medical Equipment,Per Unit,$228.43 ,OP,228.43,228.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3900,Hinge extension/flex wrist/f,Durable Medical Equipment,Per Unit,"$1,479.93 ",OP,"1,479.93","1,479.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3901,Hinge ext/flex wrist finger,Durable Medical Equipment,Per Unit,"$1,939.53 ",OP,"1,939.53","1,939.53",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3904,Whfo electric custom fitted,Durable Medical Equipment,Per Unit,"$3,083.64 ",OP,"3,083.64","3,083.64",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3905,Who w/nontorsion jnt(s) cf,Durable Medical Equipment,Per Unit,$905.97 ,OP,905.97,905.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3906,Who w/o joints cf,Durable Medical Equipment,Per Unit,$462.97 ,OP,462.97,462.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3908,Who cock-up nonmolde pre ots,Durable Medical Equipment,Per Unit,$66.98 ,OP,66.98,66.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3912,Hfo flexion glove pre ots,Durable Medical Equipment,Per Unit,$96.25 ,OP,96.25,96.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3913,Hfo w/o joints cf,Durable Medical Equipment,Per Unit,$247.41 ,OP,247.41,247.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3915,Who nontorsion jnts pre cst,Durable Medical Equipment,Per Unit,$485.63 ,OP,485.63,485.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3916,Who nontorsion jnts pre ots,Durable Medical Equipment,Per Unit,$485.63 ,OP,485.63,485.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3917,Metacarp fx orthosis pre cst,Durable Medical Equipment,Per Unit,$96.47 ,OP,96.47,96.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3918,Metacarp fx orthosis pre ots,Durable Medical Equipment,Per Unit,$96.47 ,OP,96.47,96.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3919,Ho w/o joints cf,Durable Medical Equipment,Per Unit,$247.41 ,OP,247.41,247.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3921,Hfo w/joint(s) cf,Durable Medical Equipment,Per Unit,$293.46 ,OP,293.46,293.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3923,Hfo without joints pre cst,Durable Medical Equipment,Per Unit,$88.25 ,OP,88.25,88.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3924,Hfo without joints pre ots,Durable Medical Equipment,Per Unit,$88.25 ,OP,88.25,88.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3925,Fo pip dip jnt/sprng pre ots,Durable Medical Equipment,Per Unit,$60.01 ,OP,60.01,60.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3927,Fo pip dip no jt spr pre ots,Durable Medical Equipment,Per Unit,$31.98 ,OP,31.98,31.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3929,Hfo nontorsion jnts pre cst,Durable Medical Equipment,Per Unit,$83.44 ,OP,83.44,83.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3930,Hfo nontorsion jnts pre ots,Durable Medical Equipment,Per Unit,$83.44 ,OP,83.44,83.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3931,Whfo nontorsion joint prefab,Durable Medical Equipment,Per Unit,$190.48 ,OP,190.48,190.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3933,Fo w/o joints cf,Durable Medical Equipment,Per Unit,$194.93 ,OP,194.93,194.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3935,Fo nontorsion joint cf,Durable Medical Equipment,Per Unit,$201.82 ,OP,201.82,201.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3960,Sewho airplan desig abdu pos,Durable Medical Equipment,Per Unit,$728.64 ,OP,728.64,728.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3961,Sewho cap design w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,534.92 ",OP,"1,534.92","1,534.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3962,Sewho erbs palsey design abd,Durable Medical Equipment,Per Unit,$659.00 ,OP,659,659,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3967,Sewho airplane w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,812.20 ",OP,"1,812.20","1,812.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3971,Sewho cap design w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,720.20 ",OP,"1,720.20","1,720.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3973,Sewho airplane w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,812.20 ",OP,"1,812.20","1,812.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3975,Sewhfo cap design w/o jnt cf,Durable Medical Equipment,Per Unit,"$1,534.92 ",OP,"1,534.92","1,534.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3976,Sewhfo airplane w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,534.92 ",OP,"1,534.92","1,534.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3977,Sewhfo cap desgn w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,720.20 ",OP,"1,720.20","1,720.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3978,Sewhfo airplane w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,812.20 ",OP,"1,812.20","1,812.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3980,Up ext fx orthos humeral nos,Durable Medical Equipment,Per Unit,$353.43 ,OP,353.43,353.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3981,Ue fx orth shoul cap forearm,Durable Medical Equipment,Per Unit,$919.57 ,OP,919.57,919.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3982,Upper ext fx orthosis rad/ul,Durable Medical Equipment,Per Unit,$358.87 ,OP,358.87,358.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3984,Upper ext fx orthosis wrist,Durable Medical Equipment,Per Unit,$316.13 ,OP,316.13,316.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L3995,Sock fracture or equal each,Durable Medical Equipment,Per Unit,$37.51 ,OP,37.51,37.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4000,Repl girdle milwaukee orth,Durable Medical Equipment,Per Unit,"$1,326.47 ",OP,"1,326.47","1,326.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4010,Replace trilateral socket br,Durable Medical Equipment,Per Unit,$806.25 ,OP,806.25,806.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4020,Replace quadlat socket brim,Durable Medical Equipment,Per Unit,$968.52 ,OP,968.52,968.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4030,Replace socket brim cust fit,Durable Medical Equipment,Per Unit,$615.47 ,OP,615.47,615.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4040,Replace molded thigh lacer,Durable Medical Equipment,Per Unit,$416.80 ,OP,416.8,416.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4045,Replace non-molded thigh lac,Durable Medical Equipment,Per Unit,$307.89 ,OP,307.89,307.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4050,Replace molded calf lacer,Durable Medical Equipment,Per Unit,$412.80 ,OP,412.8,412.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4055,Replace non-molded calf lace,Durable Medical Equipment,Per Unit,$250.92 ,OP,250.92,250.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4060,Replace high roll cuff,Durable Medical Equipment,Per Unit,$326.17 ,OP,326.17,326.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4070,Replace prox & dist upright,Durable Medical Equipment,Per Unit,$264.15 ,OP,264.15,264.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4080,Repl met band kafo-afo prox,Durable Medical Equipment,Per Unit,$99.72 ,OP,99.72,99.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4090,Repl met band kafo-afo calf/,Durable Medical Equipment,Per Unit,$84.84 ,OP,84.84,84.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4100,Repl leath cuff kafo prox th,Durable Medical Equipment,Per Unit,$101.94 ,OP,101.94,101.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4110,Repl leath cuff kafo-afo cal,Durable Medical Equipment,Per Unit,$79.60 ,OP,79.6,79.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4130,Replace pretibial shell,Durable Medical Equipment,Per Unit,$481.14 ,OP,481.14,481.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4350,Ankle control ortho pre ots,Durable Medical Equipment,Per Unit,$97.13 ,OP,97.13,97.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4360,Pneumat walking boot pre cst,Durable Medical Equipment,Per Unit,$259.89 ,OP,259.89,259.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4361,Pneuma/vac walk boot pre ots,Durable Medical Equipment,Per Unit,$259.89 ,OP,259.89,259.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4370,Pneum full leg splnt pre ots,Durable Medical Equipment,Per Unit,$236.26 ,OP,236.26,236.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4386,Non-pneum walk boot pre cst,Durable Medical Equipment,Per Unit,$159.16 ,OP,159.16,159.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4387,Non-pneum walk boot pre ots,Durable Medical Equipment,Per Unit,$159.16 ,OP,159.16,159.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4392,Replace afo soft interface,Durable Medical Equipment,Per Unit,$23.62 ,OP,23.62,23.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4394,Replace foot drop spint,Durable Medical Equipment,Per Unit,$17.23 ,OP,17.23,17.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4396,Static or dynami afo pre cst,Durable Medical Equipment,Per Unit,$168.46 ,OP,168.46,168.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4397,Static or dynami afo pre ots,Durable Medical Equipment,Per Unit,$168.46 ,OP,168.46,168.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4398,Foot drop splint pre ots,Durable Medical Equipment,Per Unit,$77.54 ,OP,77.54,77.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L4631,Afo- walk boot type- cus fab,Durable Medical Equipment,Per Unit,"$1,479.79 ",OP,"1,479.79","1,479.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5000,Sho insert w arch toe filler,Durable Medical Equipment,Per Unit,$576.42 ,OP,576.42,576.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5010,Mold socket ank hgt w/ toe f,Durable Medical Equipment,Per Unit,"$1,610.60 ",OP,"1,610.60","1,610.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5020,Tibial tubercle hgt w/ toe f,Durable Medical Equipment,Per Unit,"$2,523.29 ",OP,"2,523.29","2,523.29",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5050,Ank symes mold sckt sach ft,Durable Medical Equipment,Per Unit,"$2,755.91 ",OP,"2,755.91","2,755.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5060,Symes met fr leath socket ar,Durable Medical Equipment,Per Unit,"$3,397.24 ",OP,"3,397.24","3,397.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5100,Molded socket shin sach foot,Durable Medical Equipment,Per Unit,"$2,744.12 ",OP,"2,744.12","2,744.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5105,Plast socket jts/thgh lacer,Durable Medical Equipment,Per Unit,"$3,872.55 ",OP,"3,872.55","3,872.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5150,Mold sckt ext knee shin sach,Durable Medical Equipment,Per Unit,"$4,305.35 ",OP,"4,305.35","4,305.35",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5160,Mold socket bent knee shin s,Durable Medical Equipment,Per Unit,"$4,727.07 ",OP,"4,727.07","4,727.07",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5200,Kne sing axis fric shin sach,Durable Medical Equipment,Per Unit,"$3,656.04 ",OP,"3,656.04","3,656.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5210,No knee/ankle joints w/ ft b,Durable Medical Equipment,Per Unit,"$2,902.89 ",OP,"2,902.89","2,902.89",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5220,No knee joint with artic ali,Durable Medical Equipment,Per Unit,"$3,197.74 ",OP,"3,197.74","3,197.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5230,Fem focal defic constant fri,Durable Medical Equipment,Per Unit,"$4,796.11 ",OP,"4,796.11","4,796.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5250,Hip canad sing axi cons fric,Durable Medical Equipment,Per Unit,"$5,623.57 ",OP,"5,623.57","5,623.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5270,Tilt table locking hip sing,Durable Medical Equipment,Per Unit,"$6,265.76 ",OP,"6,265.76","6,265.76",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5280,Hemipelvect canad sing axis,Durable Medical Equipment,Per Unit,"$6,090.55 ",OP,"6,090.55","6,090.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5301,Bk mold socket sach ft endo,Durable Medical Equipment,Per Unit,"$2,694.66 ",OP,"2,694.66","2,694.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5312,Knee disart- sach ft- endo,Durable Medical Equipment,Per Unit,"$4,245.62 ",OP,"4,245.62","4,245.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5321,Ak open end sach,Durable Medical Equipment,Per Unit,"$3,593.24 ",OP,"3,593.24","3,593.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5331,Hip disart canadian sach ft,Durable Medical Equipment,Per Unit,"$5,262.80 ",OP,"5,262.80","5,262.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5341,Hemipelvectomy canadian sach,Durable Medical Equipment,Per Unit,"$5,594.28 ",OP,"5,594.28","5,594.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5400,Postop dress & 1 cast chg bk,Durable Medical Equipment,Per Unit,"$1,604.68 ",OP,"1,604.68","1,604.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5410,Postop dsg bk ea add cast ch,Durable Medical Equipment,Per Unit,$443.32 ,OP,443.32,443.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5420,Postop dsg & 1 cast chg ak/d,Durable Medical Equipment,Per Unit,"$2,026.64 ",OP,"2,026.64","2,026.64",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5430,Postop dsg ak ea add cast ch,Durable Medical Equipment,Per Unit,$550.12 ,OP,550.12,550.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5450,Postop app non-wgt bear dsg,Durable Medical Equipment,Per Unit,$475.67 ,OP,475.67,475.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5460,Postop app non-wgt bear dsg,Durable Medical Equipment,Per Unit,$623.89 ,OP,623.89,623.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5500,Init bk ptb plaster direct,Durable Medical Equipment,Per Unit,"$1,483.19 ",OP,"1,483.19","1,483.19",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5505,Init ak ischal plstr direct,Durable Medical Equipment,Per Unit,"$2,086.44 ",OP,"2,086.44","2,086.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5510,Prep bk ptb plaster molded,Durable Medical Equipment,Per Unit,"$1,771.18 ",OP,"1,771.18","1,771.18",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5520,Perp bk ptb thermopls direct,Durable Medical Equipment,Per Unit,"$1,587.65 ",OP,"1,587.65","1,587.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5530,Prep bk ptb thermopls molded,Durable Medical Equipment,Per Unit,"$2,087.07 ",OP,"2,087.07","2,087.07",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5535,Prep bk ptb open end socket,Durable Medical Equipment,Per Unit,"$1,945.59 ",OP,"1,945.59","1,945.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5540,Prep bk ptb laminated socket,Durable Medical Equipment,Per Unit,"$2,060.66 ",OP,"2,060.66","2,060.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5560,Prep ak ischial plast molded,Durable Medical Equipment,Per Unit,"$2,348.01 ",OP,"2,348.01","2,348.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5570,Prep ak ischial direct form,Durable Medical Equipment,Per Unit,"$2,278.83 ",OP,"2,278.83","2,278.83",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5580,Prep ak ischial thermo mold,Durable Medical Equipment,Per Unit,"$2,828.36 ",OP,"2,828.36","2,828.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5585,Prep ak ischial open end,Durable Medical Equipment,Per Unit,"$3,312.24 ",OP,"3,312.24","3,312.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5590,Prep ak ischial laminated,Durable Medical Equipment,Per Unit,"$2,948.85 ",OP,"2,948.85","2,948.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5595,Hip disartic sach thermopls,Durable Medical Equipment,Per Unit,"$4,608.29 ",OP,"4,608.29","4,608.29",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5600,Hip disart sach laminat mold,Durable Medical Equipment,Per Unit,"$5,244.91 ",OP,"5,244.91","5,244.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5610,Above knee hydracadence,Durable Medical Equipment,Per Unit,"$2,529.59 ",OP,"2,529.59","2,529.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5611,Ak 4 bar link w/fric swing,Durable Medical Equipment,Per Unit,"$1,611.13 ",OP,"1,611.13","1,611.13",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5613,Ak 4 bar ling w/hydraul swig,Durable Medical Equipment,Per Unit,"$2,450.64 ",OP,"2,450.64","2,450.64",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5614,4-bar link above knee w/swng,Durable Medical Equipment,Per Unit,"$1,697.23 ",OP,"1,697.23","1,697.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5616,Ak univ multiplex sys frict,Durable Medical Equipment,Per Unit,"$1,477.66 ",OP,"1,477.66","1,477.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5617,Ak/bk self-aligning unit ea,Durable Medical Equipment,Per Unit,$562.74 ,OP,562.74,562.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5618,Test socket symes,Durable Medical Equipment,Per Unit,$336.06 ,OP,336.06,336.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5620,Test socket below knee,Durable Medical Equipment,Per Unit,$298.16 ,OP,298.16,298.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5622,Test socket knee disarticula,Durable Medical Equipment,Per Unit,$401.70 ,OP,401.7,401.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5624,Test socket above knee,Durable Medical Equipment,Per Unit,$401.54 ,OP,401.54,401.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5626,Test socket hip disarticulat,Durable Medical Equipment,Per Unit,$635.70 ,OP,635.7,635.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5628,Test socket hemipelvectomy,Durable Medical Equipment,Per Unit,$643.74 ,OP,643.74,643.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5629,Below knee acrylic socket,Durable Medical Equipment,Per Unit,$317.79 ,OP,317.79,317.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5630,Syme typ expandabl wall sckt,Durable Medical Equipment,Per Unit,$552.17 ,OP,552.17,552.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5631,Ak/knee disartic acrylic soc,Durable Medical Equipment,Per Unit,$439.37 ,OP,439.37,439.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5632,Symes type ptb brim design s,Durable Medical Equipment,Per Unit,$270.81 ,OP,270.81,270.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5634,Symes type poster opening so,Durable Medical Equipment,Per Unit,$338.66 ,OP,338.66,338.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5636,Symes type medial opening so,Durable Medical Equipment,Per Unit,$258.86 ,OP,258.86,258.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5637,Below knee total contact,Durable Medical Equipment,Per Unit,$385.17 ,OP,385.17,385.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5638,Below knee leather socket,Durable Medical Equipment,Per Unit,$648.87 ,OP,648.87,648.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5639,Below knee wood socket,Durable Medical Equipment,Per Unit,"$1,121.15 ",OP,"1,121.15","1,121.15",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5640,Knee disarticulat leather so,Durable Medical Equipment,Per Unit,$736.94 ,OP,736.94,736.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5642,Above knee leather socket,Durable Medical Equipment,Per Unit,$683.11 ,OP,683.11,683.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5643,Hip flex inner socket ext fr,Durable Medical Equipment,Per Unit,"$2,014.84 ",OP,"2,014.84","2,014.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5644,Above knee wood socket,Durable Medical Equipment,Per Unit,$590.63 ,OP,590.63,590.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5645,Bk flex inner socket ext fra,Durable Medical Equipment,Per Unit,$979.82 ,OP,979.82,979.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5646,Below knee cushion socket,Durable Medical Equipment,Per Unit,$620.93 ,OP,620.93,620.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5647,Below knee suction socket,Durable Medical Equipment,Per Unit,$795.44 ,OP,795.44,795.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5648,Above knee cushion socket,Durable Medical Equipment,Per Unit,$733.68 ,OP,733.68,733.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5649,Isch containmt/narrow m-l so,Durable Medical Equipment,Per Unit,"$2,465.24 ",OP,"2,465.24","2,465.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5650,Tot contact ak/knee disart s,Durable Medical Equipment,Per Unit,$488.17 ,OP,488.17,488.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5651,Ak flex inner socket ext fra,Durable Medical Equipment,Per Unit,"$1,430.29 ",OP,"1,430.29","1,430.29",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5652,Suction susp ak/knee disart,Durable Medical Equipment,Per Unit,$435.97 ,OP,435.97,435.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5653,Knee disart expand wall sock,Durable Medical Equipment,Per Unit,$680.24 ,OP,680.24,680.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5654,Socket insert symes,Durable Medical Equipment,Per Unit,$394.33 ,OP,394.33,394.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5655,Socket insert below knee,Durable Medical Equipment,Per Unit,$284.71 ,OP,284.71,284.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5656,Socket insert knee articulat,Durable Medical Equipment,Per Unit,$432.53 ,OP,432.53,432.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5658,Socket insert above knee,Durable Medical Equipment,Per Unit,$456.55 ,OP,456.55,456.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5661,Multi-durometer symes,Durable Medical Equipment,Per Unit,$655.04 ,OP,655.04,655.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5665,Multi-durometer below knee,Durable Medical Equipment,Per Unit,$582.36 ,OP,582.36,582.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5666,Below knee cuff suspension,Durable Medical Equipment,Per Unit,$77.11 ,OP,77.11,77.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5668,Bk molded distal cushion,Durable Medical Equipment,Per Unit,$114.86 ,OP,114.86,114.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5670,Bk molded supracondylar susp,Durable Medical Equipment,Per Unit,$271.35 ,OP,271.35,271.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5671,Bk/ak locking mechanism,Durable Medical Equipment,Per Unit,$497.40 ,OP,497.4,497.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5672,Bk removable medial brim sus,Durable Medical Equipment,Per Unit,$359.07 ,OP,359.07,359.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5673,Socket insert w lock mech,Durable Medical Equipment,Per Unit,$790.52 ,OP,790.52,790.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5676,Bk knee joints single axis p,Durable Medical Equipment,Per Unit,$362.36 ,OP,362.36,362.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5677,Bk knee joints polycentric p,Durable Medical Equipment,Per Unit,$554.97 ,OP,554.97,554.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5678,Bk joint covers pair,Durable Medical Equipment,Per Unit,$39.70 ,OP,39.7,39.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5679,Socket insert w/o lock mech,Durable Medical Equipment,Per Unit,$658.75 ,OP,658.75,658.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5680,Bk thigh lacer non-molded,Durable Medical Equipment,Per Unit,$304.37 ,OP,304.37,304.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5681,Intl custm cong/latyp insert,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5682,Bk thigh lacer glut/ischia m,Durable Medical Equipment,Per Unit,$625.37 ,OP,625.37,625.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5683,Initial custom socket insert,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5684,Bk fork strap,Durable Medical Equipment,Per Unit,$48.13 ,OP,48.13,48.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5685,Below knee sus/seal sleeve,Durable Medical Equipment,Per Unit,$128.85 ,OP,128.85,128.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5686,Bk back check,Durable Medical Equipment,Per Unit,$57.89 ,OP,57.89,57.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5688,Bk waist belt webbing,Durable Medical Equipment,Per Unit,$61.48 ,OP,61.48,61.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5690,Bk waist belt padded and lin,Durable Medical Equipment,Per Unit,$125.50 ,OP,125.5,125.5,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5692,Ak pelvic control belt light,Durable Medical Equipment,Per Unit,$132.88 ,OP,132.88,132.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5694,Ak pelvic control belt pad/l,Durable Medical Equipment,Per Unit,$181.41 ,OP,181.41,181.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5695,Ak sleeve susp neoprene/equa,Durable Medical Equipment,Per Unit,$163.08 ,OP,163.08,163.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5696,Ak/knee disartic pelvic join,Durable Medical Equipment,Per Unit,$196.99 ,OP,196.99,196.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5697,Ak/knee disartic pelvic band,Durable Medical Equipment,Per Unit,$93.55 ,OP,93.55,93.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5698,Ak/knee disartic silesian ba,Durable Medical Equipment,Per Unit,$120.01 ,OP,120.01,120.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5699,Shoulder harness,Durable Medical Equipment,Per Unit,$205.11 ,OP,205.11,205.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5700,Replace socket below knee,Durable Medical Equipment,Per Unit,"$3,085.07 ",OP,"3,085.07","3,085.07",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5701,Replace socket above knee,Durable Medical Equipment,Per Unit,"$3,827.32 ",OP,"3,827.32","3,827.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5702,Replace socket hip,Durable Medical Equipment,Per Unit,"$4,823.75 ",OP,"4,823.75","4,823.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5703,Symes ankle w/o (sach) foot,Durable Medical Equipment,Per Unit,"$2,537.43 ",OP,"2,537.43","2,537.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5704,Custom shape cover bk,Durable Medical Equipment,Per Unit,$629.03 ,OP,629.03,629.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5705,Custom shape cover ak,Durable Medical Equipment,Per Unit,"$1,153.25 ",OP,"1,153.25","1,153.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5706,Custom shape cvr knee disart,Durable Medical Equipment,Per Unit,"$1,124.85 ",OP,"1,124.85","1,124.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5707,Custom shape cvr hip disart,Durable Medical Equipment,Per Unit,"$1,511.27 ",OP,"1,511.27","1,511.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5710,Kne-shin exo sng axi mnl loc,Durable Medical Equipment,Per Unit,$359.65 ,OP,359.65,359.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5711,Knee-shin exo mnl lock ultra,Durable Medical Equipment,Per Unit,$603.60 ,OP,603.6,603.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5712,Knee-shin exo frict swg & st,Durable Medical Equipment,Per Unit,$430.88 ,OP,430.88,430.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5714,Knee-shin exo variable frict,Durable Medical Equipment,Per Unit,$438.43 ,OP,438.43,438.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5716,Knee-shin exo mech stance ph,Durable Medical Equipment,Per Unit,$866.93 ,OP,866.93,866.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5718,Knee-shin exo frct swg & sta,Durable Medical Equipment,Per Unit,$927.01 ,OP,927.01,927.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5722,Knee-shin pneum swg frct exo,Durable Medical Equipment,Per Unit,"$1,127.32 ",OP,"1,127.32","1,127.32",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5724,Knee-shin exo fluid swing ph,Durable Medical Equipment,Per Unit,"$1,737.57 ",OP,"1,737.57","1,737.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5726,Knee-shin ext jnts fld swg e,Durable Medical Equipment,Per Unit,"$2,068.65 ",OP,"2,068.65","2,068.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5728,Knee-shin fluid swg & stance,Durable Medical Equipment,Per Unit,"$2,424.23 ",OP,"2,424.23","2,424.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5780,Knee-shin pneum/hydra pneum,Durable Medical Equipment,Per Unit,"$1,334.72 ",OP,"1,334.72","1,334.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5781,Lower limb pros vacuum pump,Durable Medical Equipment,Per Unit,"$4,024.33 ",OP,"4,024.33","4,024.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5782,Hd low limb pros vacuum pump,Durable Medical Equipment,Per Unit,"$4,242.55 ",OP,"4,242.55","4,242.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5785,Exoskeletal bk ultralt mater,Durable Medical Equipment,Per Unit,$519.54 ,OP,519.54,519.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5790,Exoskeletal ak ultra-light m,Durable Medical Equipment,Per Unit,$749.83 ,OP,749.83,749.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5795,Exoskel hip ultra-light mate,Durable Medical Equipment,Per Unit,"$1,073.66 ",OP,"1,073.66","1,073.66",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5810,Endoskel knee-shin mnl lock,Durable Medical Equipment,Per Unit,$572.04 ,OP,572.04,572.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5811,Endo knee-shin mnl lck ultra,Durable Medical Equipment,Per Unit,$789.42 ,OP,789.42,789.42,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5812,Endo knee-shin frct swg & st,Durable Medical Equipment,Per Unit,$594.07 ,OP,594.07,594.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5814,Endo knee-shin hydral swg ph,Durable Medical Equipment,Per Unit,"$3,735.37 ",OP,"3,735.37","3,735.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5816,Endo knee-shin polyc mch sta,Durable Medical Equipment,Per Unit,$850.43 ,OP,850.43,850.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5818,Endo knee-shin frct swg & st,Durable Medical Equipment,Per Unit,$960.30 ,OP,960.3,960.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5822,Endo knee-shin pneum swg frc,Durable Medical Equipment,Per Unit,"$1,761.65 ",OP,"1,761.65","1,761.65",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5824,Endo knee-shin fluid swing p,Durable Medical Equipment,Per Unit,"$1,665.27 ",OP,"1,665.27","1,665.27",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5826,Miniature knee joint,Durable Medical Equipment,Per Unit,"$3,140.97 ",OP,"3,140.97","3,140.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5828,Endo knee-shin fluid swg/sta,Durable Medical Equipment,Per Unit,"$2,963.78 ",OP,"2,963.78","2,963.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5830,Endo knee-shin pneum/swg pha,Durable Medical Equipment,Per Unit,"$1,998.37 ",OP,"1,998.37","1,998.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5840,Multi-axial knee/shin system,Durable Medical Equipment,Per Unit,"$3,922.28 ",OP,"3,922.28","3,922.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5845,Knee-shin sys stance flexion,Durable Medical Equipment,Per Unit,"$1,802.73 ",OP,"1,802.73","1,802.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5848,Knee-shin sys hydraul stance,Durable Medical Equipment,Per Unit,"$1,081.55 ",OP,"1,081.55","1,081.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5850,Endo ak/hip knee extens assi,Durable Medical Equipment,Per Unit,$127.92 ,OP,127.92,127.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5855,Mech hip extension assist,Durable Medical Equipment,Per Unit,$308.82 ,OP,308.82,308.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5856,Elec knee-shin swing/stance,Durable Medical Equipment,Per Unit,"$24,144.68 ",OP,"24,144.68","24,144.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5857,Elec knee-shin swing only,Durable Medical Equipment,Per Unit,"$8,567.44 ",OP,"8,567.44","8,567.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5858,Stance phase only,Durable Medical Equipment,Per Unit,"$18,692.70 ",OP,"18,692.70","18,692.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5859,Knee-shin pro flex/ext cont,Durable Medical Equipment,Per Unit,"$14,593.21 ",OP,"14,593.21","14,593.21",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5910,Endo below knee alignable sy,Durable Medical Equipment,Per Unit,$362.17 ,OP,362.17,362.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5920,Endo ak/hip alignable system,Durable Medical Equipment,Per Unit,$530.58 ,OP,530.58,530.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5925,Above knee manual lock,Durable Medical Equipment,Per Unit,$336.00 ,OP,336,336,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5930,High activity knee frame,Durable Medical Equipment,Per Unit,"$3,385.39 ",OP,"3,385.39","3,385.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5940,Endo bk ultra-light material,Durable Medical Equipment,Per Unit,$501.60 ,OP,501.6,501.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5950,Endo ak ultra-light material,Durable Medical Equipment,Per Unit,$777.99 ,OP,777.99,777.99,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5960,Endo hip ultra-light materia,Durable Medical Equipment,Per Unit,"$1,163.29 ",OP,"1,163.29","1,163.29",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5961,Endo poly hip- pneu/hyd/rot,Durable Medical Equipment,Per Unit,"$4,800.88 ",OP,"4,800.88","4,800.88",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5962,Below knee flex cover system,Durable Medical Equipment,Per Unit,$587.78 ,OP,587.78,587.78,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5964,Above knee flex cover system,Durable Medical Equipment,Per Unit,"$1,127.47 ",OP,"1,127.47","1,127.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5966,Hip flexible cover system,Durable Medical Equipment,Per Unit,"$1,452.38 ",OP,"1,452.38","1,452.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5968,Multiaxial ankle w dorsiflex,Durable Medical Equipment,Per Unit,"$3,654.91 ",OP,"3,654.91","3,654.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5970,Foot external keel sach foot,Durable Medical Equipment,Per Unit,$218.47 ,OP,218.47,218.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5971,Sach foot- replacement,Durable Medical Equipment,Per Unit,$218.47 ,OP,218.47,218.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5972,Flexible keel foot,Durable Medical Equipment,Per Unit,$397.97 ,OP,397.97,397.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5973,Ank-foot sys dors-plant flex,Durable Medical Equipment,Per Unit,"$17,757.02 ",OP,"17,757.02","17,757.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5974,Foot single axis ankle/foot,Durable Medical Equipment,Per Unit,$233.03 ,OP,233.03,233.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5975,Combo ankle/foot prosthesis,Durable Medical Equipment,Per Unit,$466.28 ,OP,466.28,466.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5976,Energy storing foot,Durable Medical Equipment,Per Unit,$591.07 ,OP,591.07,591.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5978,Ft prosth multiaxial ankl/ft,Durable Medical Equipment,Per Unit,$313.20 ,OP,313.2,313.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5979,Multi-axial ankle/ft prosth,Durable Medical Equipment,Per Unit,"$2,507.69 ",OP,"2,507.69","2,507.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5980,Flex foot system,Durable Medical Equipment,Per Unit,"$3,820.69 ",OP,"3,820.69","3,820.69",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5981,Flex-walk sys low ext prosth,Durable Medical Equipment,Per Unit,"$3,431.91 ",OP,"3,431.91","3,431.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5982,Exoskeletal axial rotation u,Durable Medical Equipment,Per Unit,$644.71 ,OP,644.71,644.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5984,Endoskeletal axial rotation,Durable Medical Equipment,Per Unit,$646.71 ,OP,646.71,646.71,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5985,Lwr ext dynamic prosth pylon,Durable Medical Equipment,Per Unit,$284.02 ,OP,284.02,284.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5986,Multi-axial rotation unit,Durable Medical Equipment,Per Unit,$780.11 ,OP,780.11,780.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5987,Shank ft w vert load pylon,Durable Medical Equipment,Per Unit,"$7,235.38 ",OP,"7,235.38","7,235.38",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5988,Vertical shock reducing pylo,Durable Medical Equipment,Per Unit,"$2,009.25 ",OP,"2,009.25","2,009.25",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L5990,User adjustable heel height,Durable Medical Equipment,Per Unit,"$1,824.64 ",OP,"1,824.64","1,824.64",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6000,Part hand thumb rem,Durable Medical Equipment,Per Unit,"$1,771.55 ",OP,"1,771.55","1,771.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6010,Part hand little/ring,Durable Medical Equipment,Per Unit,"$1,971.44 ",OP,"1,971.44","1,971.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6020,Part hand no fingers,Durable Medical Equipment,Per Unit,"$1,838.05 ",OP,"1,838.05","1,838.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6026,Part hand myo exclu term dev,Durable Medical Equipment,Per Unit,"$4,375.03 ",OP,"4,375.03","4,375.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6050,Wrst mld sck flx hng tri pad,Durable Medical Equipment,Per Unit,"$2,500.12 ",OP,"2,500.12","2,500.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6055,Wrst mold sock w/exp interfa,Durable Medical Equipment,Per Unit,"$3,189.04 ",OP,"3,189.04","3,189.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6100,Elb mold sock flex hinge pad,Durable Medical Equipment,Per Unit,"$2,530.04 ",OP,"2,530.04","2,530.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6110,Elbow mold sock suspension t,Durable Medical Equipment,Per Unit,"$2,676.61 ",OP,"2,676.61","2,676.61",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6120,Elbow mold doub splt soc ste,Durable Medical Equipment,Per Unit,"$3,027.26 ",OP,"3,027.26","3,027.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6130,Elbow stump activated lock h,Durable Medical Equipment,Per Unit,"$3,193.82 ",OP,"3,193.82","3,193.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6200,Elbow mold outsid lock hinge,Durable Medical Equipment,Per Unit,"$3,290.01 ",OP,"3,290.01","3,290.01",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6205,Elbow molded w/ expand inter,Durable Medical Equipment,Per Unit,"$4,538.50 ",OP,"4,538.50","4,538.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6250,Elbow inter loc elbow forarm,Durable Medical Equipment,Per Unit,"$3,236.79 ",OP,"3,236.79","3,236.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6300,Shlder disart int lock elbow,Durable Medical Equipment,Per Unit,"$4,464.43 ",OP,"4,464.43","4,464.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6310,Shoulder passive restor comp,Durable Medical Equipment,Per Unit,"$4,046.04 ",OP,"4,046.04","4,046.04",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6320,Shoulder passive restor cap,Durable Medical Equipment,Per Unit,"$2,108.67 ",OP,"2,108.67","2,108.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6350,Thoracic intern lock elbow,Durable Medical Equipment,Per Unit,"$4,891.63 ",OP,"4,891.63","4,891.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6360,Thoracic passive restor comp,Durable Medical Equipment,Per Unit,"$4,246.80 ",OP,"4,246.80","4,246.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6370,Thoracic passive restor cap,Durable Medical Equipment,Per Unit,"$2,462.85 ",OP,"2,462.85","2,462.85",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6380,Postop dsg cast chg wrst/elb,Durable Medical Equipment,Per Unit,"$1,424.44 ",OP,"1,424.44","1,424.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6382,Postop dsg cast chg elb dis/,Durable Medical Equipment,Per Unit,"$1,695.74 ",OP,"1,695.74","1,695.74",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6384,Postop dsg cast chg shlder/t,Durable Medical Equipment,Per Unit,"$2,145.20 ",OP,"2,145.20","2,145.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6386,Postop ea cast chg & realign,Durable Medical Equipment,Per Unit,$470.24 ,OP,470.24,470.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6388,Postop applicat rigid dsg on,Durable Medical Equipment,Per Unit,$517.85 ,OP,517.85,517.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6400,Below elbow prosth tiss shap,Durable Medical Equipment,Per Unit,"$2,736.86 ",OP,"2,736.86","2,736.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6450,Elb disart prosth tiss shap,Durable Medical Equipment,Per Unit,"$3,576.94 ",OP,"3,576.94","3,576.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6500,Above elbow prosth tiss shap,Durable Medical Equipment,Per Unit,"$3,512.48 ",OP,"3,512.48","3,512.48",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6550,Shldr disar prosth tiss shap,Durable Medical Equipment,Per Unit,"$4,549.39 ",OP,"4,549.39","4,549.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6570,Scap thorac prosth tiss shap,Durable Medical Equipment,Per Unit,"$5,078.79 ",OP,"5,078.79","5,078.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6580,Wrist/elbow bowden cable mol,Durable Medical Equipment,Per Unit,"$2,030.62 ",OP,"2,030.62","2,030.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6582,Wrist/elbow bowden cbl dir f,Durable Medical Equipment,Per Unit,"$1,705.44 ",OP,"1,705.44","1,705.44",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6584,Elbow fair lead cable molded,Durable Medical Equipment,Per Unit,"$2,525.30 ",OP,"2,525.30","2,525.30",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6586,Elbow fair lead cable dir fo,Durable Medical Equipment,Per Unit,"$2,250.20 ",OP,"2,250.20","2,250.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6588,Shdr fair lead cable molded,Durable Medical Equipment,Per Unit,"$3,583.73 ",OP,"3,583.73","3,583.73",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6590,Shdr fair lead cable direct,Durable Medical Equipment,Per Unit,"$3,123.36 ",OP,"3,123.36","3,123.36",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6600,Polycentric hinge pair,Durable Medical Equipment,Per Unit,$228.13 ,OP,228.13,228.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6605,Single pivot hinge pair,Durable Medical Equipment,Per Unit,$234.81 ,OP,234.81,234.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6610,Flexible metal hinge pair,Durable Medical Equipment,Per Unit,$221.98 ,OP,221.98,221.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6611,Additional switch- ext power,Durable Medical Equipment,Per Unit,$414.10 ,OP,414.1,414.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6615,Disconnect locking wrist uni,Durable Medical Equipment,Per Unit,$215.48 ,OP,215.48,215.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6616,Disconnect insert locking wr,Durable Medical Equipment,Per Unit,$64.86 ,OP,64.86,64.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6620,Flexion/extension wrist unit,Durable Medical Equipment,Per Unit,$376.69 ,OP,376.69,376.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6621,Flex/ext wrist w/wo friction,Durable Medical Equipment,Per Unit,"$2,300.54 ",OP,"2,300.54","2,300.54",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6623,Spring-ass rot wrst w/ latch,Durable Medical Equipment,Per Unit,$717.59 ,OP,717.59,717.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6624,Flex/ext/rotation wrist unit,Durable Medical Equipment,Per Unit,"$3,787.86 ",OP,"3,787.86","3,787.86",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6625,Rotation wrst w/ cable lock,Durable Medical Equipment,Per Unit,$531.84 ,OP,531.84,531.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6628,Quick disconn hook adapter o,Durable Medical Equipment,Per Unit,$572.47 ,OP,572.47,572.47,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6629,Lamination collar w/ couplin,Durable Medical Equipment,Per Unit,$195.07 ,OP,195.07,195.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6630,Stainless steel any wrist,Durable Medical Equipment,Per Unit,$287.35 ,OP,287.35,287.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6632,Latex suspension sleeve each,Durable Medical Equipment,Per Unit,$64.97 ,OP,64.97,64.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6635,Lift assist for elbow,Durable Medical Equipment,Per Unit,$207.68 ,OP,207.68,207.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6637,Nudge control elbow lock,Durable Medical Equipment,Per Unit,$406.60 ,OP,406.6,406.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6638,Elec lock on manual pw elbow,Durable Medical Equipment,Per Unit,"$2,515.20 ",OP,"2,515.20","2,515.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6640,Shoulder abduction joint pai,Durable Medical Equipment,Per Unit,$338.63 ,OP,338.63,338.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6641,Excursion amplifier pulley t,Durable Medical Equipment,Per Unit,$197.18 ,OP,197.18,197.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6642,Excursion amplifier lever ty,Durable Medical Equipment,Per Unit,$289.92 ,OP,289.92,289.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6645,Shoulder flexion-abduction j,Durable Medical Equipment,Per Unit,$366.21 ,OP,366.21,366.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6646,Multipo locking shoulder jnt,Durable Medical Equipment,Per Unit,"$3,172.24 ",OP,"3,172.24","3,172.24",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6647,Shoulder lock actuator,Durable Medical Equipment,Per Unit,$522.26 ,OP,522.26,522.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6648,Ext pwrd shlder lock/unlock,Durable Medical Equipment,Per Unit,"$3,271.71 ",OP,"3,271.71","3,271.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6650,Shoulder universal joint,Durable Medical Equipment,Per Unit,$397.20 ,OP,397.2,397.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6655,Standard control cable extra,Durable Medical Equipment,Per Unit,$77.05 ,OP,77.05,77.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6660,Heavy duty control cable,Durable Medical Equipment,Per Unit,$103.11 ,OP,103.11,103.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6665,Teflon or equal cable lining,Durable Medical Equipment,Per Unit,$46.05 ,OP,46.05,46.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6670,Hook to hand cable adapter,Durable Medical Equipment,Per Unit,$47.96 ,OP,47.96,47.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6672,Harness chest/shlder saddle,Durable Medical Equipment,Per Unit,$220.08 ,OP,220.08,220.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6675,Harness figure of 8 sing con,Durable Medical Equipment,Per Unit,$120.09 ,OP,120.09,120.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6676,Harness figure of 8 dual con,Durable Medical Equipment,Per Unit,$125.64 ,OP,125.64,125.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6677,Ue triple control harness,Durable Medical Equipment,Per Unit,$298.35 ,OP,298.35,298.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6680,Test sock wrist disart/bel e,Durable Medical Equipment,Per Unit,$309.33 ,OP,309.33,309.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6682,Test sock elbw disart/above,Durable Medical Equipment,Per Unit,$342.01 ,OP,342.01,342.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6684,Test socket shldr disart/tho,Durable Medical Equipment,Per Unit,$464.75 ,OP,464.75,464.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6686,Suction socket,Durable Medical Equipment,Per Unit,$689.63 ,OP,689.63,689.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6687,Frame typ socket bel elbow/w,Durable Medical Equipment,Per Unit,$576.80 ,OP,576.8,576.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6688,Frame typ sock above elb/dis,Durable Medical Equipment,Per Unit,$638.36 ,OP,638.36,638.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6689,Frame typ socket shoulder di,Durable Medical Equipment,Per Unit,$760.81 ,OP,760.81,760.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6690,Frame typ sock interscap-tho,Durable Medical Equipment,Per Unit,$895.74 ,OP,895.74,895.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6691,Removable insert each,Durable Medical Equipment,Per Unit,$353.58 ,OP,353.58,353.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6692,Silicone gel insert or equal,Durable Medical Equipment,Per Unit,$643.25 ,OP,643.25,643.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6693,Lockingelbow forearm cntrbal,Durable Medical Equipment,Per Unit,"$2,855.43 ",OP,"2,855.43","2,855.43",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6694,Elbow socket ins use w/lock,Durable Medical Equipment,Per Unit,$790.52 ,OP,790.52,790.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6695,Elbow socket ins use w/o lck,Durable Medical Equipment,Per Unit,$658.75 ,OP,658.75,658.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6696,Cus elbo skt in for con/atyp,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6697,Cus elbo skt in not con/atyp,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6698,Below/above elbow lock mech,Durable Medical Equipment,Per Unit,$497.40 ,OP,497.4,497.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6703,Term dev- passive hand mitt,Durable Medical Equipment,Per Unit,$351.79 ,OP,351.79,351.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6704,Term dev- sport/rec/work att,Durable Medical Equipment,Per Unit,$679.06 ,OP,679.06,679.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6706,Term dev mech hook vol open,Durable Medical Equipment,Per Unit,$421.40 ,OP,421.4,421.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6707,Term dev mech hook vol close,Durable Medical Equipment,Per Unit,"$1,490.70 ",OP,"1,490.70","1,490.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6708,Term dev mech hand vol open,Durable Medical Equipment,Per Unit,$985.41 ,OP,985.41,985.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6709,Term dev mech hand vol close,Durable Medical Equipment,Per Unit,"$1,398.55 ",OP,"1,398.55","1,398.55",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6711,Ped term dev- hook- vol open,Durable Medical Equipment,Per Unit,$676.19 ,OP,676.19,676.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6712,Ped term dev- hook- vol clos,Durable Medical Equipment,Per Unit,"$1,245.05 ",OP,"1,245.05","1,245.05",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6713,Ped term dev- hand- vol open,Durable Medical Equipment,Per Unit,"$1,571.33 ",OP,"1,571.33","1,571.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6714,Ped term dev- hand- vol clos,Durable Medical Equipment,Per Unit,"$1,330.91 ",OP,"1,330.91","1,330.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6715,Term device- multi art digit,Durable Medical Equipment,Per Unit,"$3,175.42 ",OP,"3,175.42","3,175.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6721,Hook/hand- hvy dty- vol open,Durable Medical Equipment,Per Unit,"$2,365.59 ",OP,"2,365.59","2,365.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6722,Hook/hand- hvy dty- vol clos,Durable Medical Equipment,Per Unit,"$2,039.28 ",OP,"2,039.28","2,039.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6805,Term dev modifier wrist unit,Durable Medical Equipment,Per Unit,$385.75 ,OP,385.75,385.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6810,Term dev precision pinch dev,Durable Medical Equipment,Per Unit,$205.07 ,OP,205.07,205.07,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6880,Elec hand ind art digits,Durable Medical Equipment,Per Unit,"$24,030.68 ",OP,"24,030.68","24,030.68",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6881,Term dev auto grasp feature,Durable Medical Equipment,Per Unit,"$4,111.91 ",OP,"4,111.91","4,111.91",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6882,Microprocessor control uplmb,Durable Medical Equipment,Per Unit,"$3,119.08 ",OP,"3,119.08","3,119.08",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6883,Replc sockt below e/w disa,Durable Medical Equipment,Per Unit,"$1,997.96 ",OP,"1,997.96","1,997.96",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6884,Replc sockt above elbow disa,Durable Medical Equipment,Per Unit,"$2,733.67 ",OP,"2,733.67","2,733.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6885,Replc sockt shldr dis/interc,Durable Medical Equipment,Per Unit,"$4,246.80 ",OP,"4,246.80","4,246.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6890,Prefab glove for term device,Durable Medical Equipment,Per Unit,$200.88 ,OP,200.88,200.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6895,Custom glove for term device,Durable Medical Equipment,Per Unit,$671.68 ,OP,671.68,671.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6900,Hand restorat thumb/1 finger,Durable Medical Equipment,Per Unit,"$1,950.52 ",OP,"1,950.52","1,950.52",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6905,Hand restoration multiple fi,Durable Medical Equipment,Per Unit,"$1,930.47 ",OP,"1,930.47","1,930.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6910,Hand restoration no fingers,Durable Medical Equipment,Per Unit,"$1,897.78 ",OP,"1,897.78","1,897.78",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6915,Hand restoration replacmnt g,Durable Medical Equipment,Per Unit,$815.40 ,OP,815.4,815.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6920,Wrist disarticul switch ctrl,Durable Medical Equipment,Per Unit,"$8,425.39 ",OP,"8,425.39","8,425.39",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6925,Wrist disart myoelectronic c,Durable Medical Equipment,Per Unit,"$9,001.12 ",OP,"9,001.12","9,001.12",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6930,Below elbow switch control,Durable Medical Equipment,Per Unit,"$8,114.82 ",OP,"8,114.82","8,114.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6935,Below elbow myoelectronic ct,Durable Medical Equipment,Per Unit,"$8,958.82 ",OP,"8,958.82","8,958.82",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6940,Elbow disarticulation switch,Durable Medical Equipment,Per Unit,"$10,478.90 ",OP,"10,478.90","10,478.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6945,Elbow disart myoelectronic c,Durable Medical Equipment,Per Unit,"$11,690.57 ",OP,"11,690.57","11,690.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6950,Above elbow switch control,Durable Medical Equipment,Per Unit,"$10,459.47 ",OP,"10,459.47","10,459.47",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6955,Above elbow myoelectronic ct,Durable Medical Equipment,Per Unit,"$12,129.70 ",OP,"12,129.70","12,129.70",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6960,Shldr disartic switch contro,Durable Medical Equipment,Per Unit,"$12,759.97 ",OP,"12,759.97","12,759.97",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6965,Shldr disartic myoelectronic,Durable Medical Equipment,Per Unit,"$15,116.16 ",OP,"15,116.16","15,116.16",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6970,Interscapular-thor switch ct,Durable Medical Equipment,Per Unit,"$16,180.17 ",OP,"16,180.17","16,180.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L6975,Interscap-thor myoelectronic,Durable Medical Equipment,Per Unit,"$17,834.37 ",OP,"17,834.37","17,834.37",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7007,Adult electric hand,Durable Medical Equipment,Per Unit,"$3,673.63 ",OP,"3,673.63","3,673.63",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7008,Pediatric electric hand,Durable Medical Equipment,Per Unit,"$5,696.71 ",OP,"5,696.71","5,696.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7009,Adult electric hook,Durable Medical Equipment,Per Unit,"$3,758.57 ",OP,"3,758.57","3,758.57",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7040,Prehensile actuator,Durable Medical Equipment,Per Unit,"$3,059.23 ",OP,"3,059.23","3,059.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7045,Pediatric electric hook,Durable Medical Equipment,Per Unit,"$1,616.29 ",OP,"1,616.29","1,616.29",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7170,Electronic elbow hosmer swit,Durable Medical Equipment,Per Unit,"$6,050.00 ",OP,"6,050.00","6,050.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7180,Electronic elbow sequential,Durable Medical Equipment,Per Unit,"$39,141.46 ",OP,"39,141.46","39,141.46",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7181,Electronic elbo simultaneous,Durable Medical Equipment,Per Unit,"$40,299.84 ",OP,"40,299.84","40,299.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7185,Electron elbow adolescent sw,Durable Medical Equipment,Per Unit,"$6,360.51 ",OP,"6,360.51","6,360.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7186,Electron elbow child switch,Durable Medical Equipment,Per Unit,"$10,692.92 ",OP,"10,692.92","10,692.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7190,Elbow adolescent myoelectron,Durable Medical Equipment,Per Unit,"$8,439.80 ",OP,"8,439.80","8,439.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7191,Elbow child myoelectronic ct,Durable Medical Equipment,Per Unit,"$11,247.26 ",OP,"11,247.26","11,247.26",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7259,Electronic wrist rotator any,Durable Medical Equipment,Per Unit,"$4,121.94 ",OP,"4,121.94","4,121.94",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7360,Six volt bat otto bock/eq ea,Durable Medical Equipment,Per Unit,$266.08 ,OP,266.08,266.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7362,Battery chrgr six volt otto,Durable Medical Equipment,Per Unit,$290.68 ,OP,290.68,290.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7364,Twelve volt battery utah/equ,Durable Medical Equipment,Per Unit,$514.33 ,OP,514.33,514.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7366,Battery chrgr 12 volt utah/e,Durable Medical Equipment,Per Unit,$707.34 ,OP,707.34,707.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7367,Replacemnt lithium ionbatter,Durable Medical Equipment,Per Unit,$391.59 ,OP,391.59,391.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7368,Lithium ion battery charger,Durable Medical Equipment,Per Unit,$507.61 ,OP,507.61,507.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7400,Add ue prost be/wd- ultlite,Durable Medical Equipment,Per Unit,$308.25 ,OP,308.25,308.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7401,Add ue prost a/e ultlite mat,Durable Medical Equipment,Per Unit,$345.06 ,OP,345.06,345.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7402,Add ue prost s/d ultlite mat,Durable Medical Equipment,Per Unit,$372.68 ,OP,372.68,372.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7403,Add ue prost b/e acrylic,Durable Medical Equipment,Per Unit,$370.41 ,OP,370.41,370.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7404,Add ue prost a/e acrylic,Durable Medical Equipment,Per Unit,$559.06 ,OP,559.06,559.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7405,Add ue prost s/d acrylic,Durable Medical Equipment,Per Unit,$731.10 ,OP,731.1,731.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L7700,Pros soc insert gasket/seal,Durable Medical Equipment,Per Unit,$150.48 ,OP,150.48,150.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8000,Mastectomy bra,Durable Medical Equipment,Per Unit,$42.59 ,OP,42.59,42.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8001,Breast prosthesis bra & form,Durable Medical Equipment,Per Unit,$126.18 ,OP,126.18,126.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8002,Brst prsth bra & bilat form,Durable Medical Equipment,Per Unit,$165.94 ,OP,165.94,165.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8015,Ext breastprosthesis garment,Durable Medical Equipment,Per Unit,$60.29 ,OP,60.29,60.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8020,Mastectomy form,Durable Medical Equipment,Per Unit,$227.40 ,OP,227.4,227.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8030,Breast prosthes w/o adhesive,Durable Medical Equipment,Per Unit,$351.55 ,OP,351.55,351.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8031,Breast prosthesis w adhesive,Durable Medical Equipment,Per Unit,$351.55 ,OP,351.55,351.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8032,Reusable nipple prosthesis,Durable Medical Equipment,Per Unit,$39.39 ,OP,39.39,39.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8035,Custom breast prosthesis,Durable Medical Equipment,Per Unit,"$3,684.79 ",OP,"3,684.79","3,684.79",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8040,Nasal prosthesis,Durable Medical Equipment,Per Unit,"$2,493.50 ",OP,"2,493.50","2,493.50",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8041,Midfacial prosthesis,Durable Medical Equipment,Per Unit,"$3,005.20 ",OP,"3,005.20","3,005.20",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8042,Orbital prosthesis,Durable Medical Equipment,Per Unit,"$3,376.62 ",OP,"3,376.62","3,376.62",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8043,Upper facial prosthesis,Durable Medical Equipment,Per Unit,"$3,781.84 ",OP,"3,781.84","3,781.84",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8044,Hemi-facial prosthesis,Durable Medical Equipment,Per Unit,"$4,187.02 ",OP,"4,187.02","4,187.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8045,Auricular prosthesis,Durable Medical Equipment,Per Unit,"$3,278.72 ",OP,"3,278.72","3,278.72",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8046,Partial facial prosthesis,Durable Medical Equipment,Per Unit,"$2,701.33 ",OP,"2,701.33","2,701.33",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8047,Nasal septal prosthesis,Durable Medical Equipment,Per Unit,"$1,384.42 ",OP,"1,384.42","1,384.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8300,Truss single w/ standard pad,Durable Medical Equipment,Per Unit,$84.35 ,OP,84.35,84.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8310,Truss double w/ standard pad,Durable Medical Equipment,Per Unit,$149.44 ,OP,149.44,149.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8320,Truss addition to std pad wa,Durable Medical Equipment,Per Unit,$62.00 ,OP,62,62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8330,Truss add to std pad scrotal,Durable Medical Equipment,Per Unit,$49.37 ,OP,49.37,49.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8400,Sheath below knee,Durable Medical Equipment,Per Unit,$15.74 ,OP,15.74,15.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8410,Sheath above knee,Durable Medical Equipment,Per Unit,$20.72 ,OP,20.72,20.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8415,Sheath upper limb,Durable Medical Equipment,Per Unit,$21.44 ,OP,21.44,21.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8417,Pros sheath/sock w gel cushn,Durable Medical Equipment,Per Unit,$75.64 ,OP,75.64,75.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8420,Prosthetic sock multi ply bk,Durable Medical Equipment,Per Unit,$20.98 ,OP,20.98,20.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8430,Prosthetic sock multi ply ak,Durable Medical Equipment,Per Unit,$23.76 ,OP,23.76,23.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8435,Pros sock multi ply upper lm,Durable Medical Equipment,Per Unit,$22.58 ,OP,22.58,22.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8440,Shrinker below knee,Durable Medical Equipment,Per Unit,$46.88 ,OP,46.88,46.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8460,Shrinker above knee,Durable Medical Equipment,Per Unit,$66.65 ,OP,66.65,66.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8465,Shrinker upper limb,Durable Medical Equipment,Per Unit,$61.60 ,OP,61.6,61.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8470,Pros sock single ply bk,Durable Medical Equipment,Per Unit,$6.67 ,OP,6.67,6.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8480,Pros sock single ply ak,Durable Medical Equipment,Per Unit,$9.20 ,OP,9.2,9.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8485,Pros sock single ply upper l,Durable Medical Equipment,Per Unit,$12.39 ,OP,12.39,12.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8500,Artificial larynx,Durable Medical Equipment,Per Unit,$661.87 ,OP,661.87,661.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8501,Tracheostomy speaking valve,Durable Medical Equipment,Per Unit,$120.80 ,OP,120.8,120.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8507,Trach-esoph voice pros pt in,Durable Medical Equipment,Per Unit,$42.11 ,OP,42.11,42.11,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8509,Trach-esoph voice pros md in,Durable Medical Equipment,Per Unit,$109.85 ,OP,109.85,109.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8510,Voice amplifier,Durable Medical Equipment,Per Unit,$254.17 ,OP,254.17,254.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8511,Indwelling trach insert,Durable Medical Equipment,Per Unit,$73.14 ,OP,73.14,73.14,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8512,Gel cap for trach voice pros,Durable Medical Equipment,Per Unit,$2.19 ,OP,2.19,2.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8513,Trach pros cleaning device,Durable Medical Equipment,Per Unit,$5.22 ,OP,5.22,5.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8514,Repl trach puncture dilator,Durable Medical Equipment,Per Unit,$94.85 ,OP,94.85,94.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8515,Gel cap app device for trach,Durable Medical Equipment,Per Unit,$63.49 ,OP,63.49,63.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8615,Coch implant headset replace,Durable Medical Equipment,Per Unit,$453.62 ,OP,453.62,453.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8616,Coch implant microphone repl,Durable Medical Equipment,Per Unit,$105.64 ,OP,105.64,105.64,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8617,Coch implant trans coil repl,Durable Medical Equipment,Per Unit,$92.27 ,OP,92.27,92.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8618,Coch implant tran cable repl,Durable Medical Equipment,Per Unit,$26.38 ,OP,26.38,26.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8619,Coch imp ext proc/contr rplc,Durable Medical Equipment,Per Unit,"$8,454.02 ",OP,"8,454.02","8,454.02",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8621,Repl zinc air battery,Durable Medical Equipment,Per Unit,$0.62 ,OP,0.62,0.62,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8622,Repl alkaline battery,Durable Medical Equipment,Per Unit,$0.32 ,OP,0.32,0.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8623,Lith ion batt cid-non-earlvl,Durable Medical Equipment,Per Unit,$65.06 ,OP,65.06,65.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8624,Lith ion batt cid- ear level,Durable Medical Equipment,Per Unit,$162.20 ,OP,162.2,162.2,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8625,Charger coch impl/aoi battry,Durable Medical Equipment,Per Unit,$189.97 ,OP,189.97,189.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8627,Cid ext speech process repl,Durable Medical Equipment,Per Unit,"$7,175.59 ",OP,"7,175.59","7,175.59",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8628,Cid ext controller repl,Durable Medical Equipment,Per Unit,"$1,278.42 ",OP,"1,278.42","1,278.42",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8629,Cid transmit coil and cable,Durable Medical Equipment,Per Unit,$180.09 ,OP,180.09,180.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8681,Pt prgrm for implt neurostim,Durable Medical Equipment,Per Unit,"$1,147.11 ",OP,"1,147.11","1,147.11",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8683,Radiofq trsmtr for implt neu,Durable Medical Equipment,Per Unit,"$5,420.03 ",OP,"5,420.03","5,420.03",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8684,Radiof trsmtr implt scrl neu,Durable Medical Equipment,Per Unit,$850.48 ,OP,850.48,850.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8689,External recharg sys intern,Durable Medical Equipment,Per Unit,"$1,734.92 ",OP,"1,734.92","1,734.92",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8691,Aoi snd proc repl excl actua,Durable Medical Equipment,Per Unit,"$1,732.10 ",OP,"1,732.10","1,732.10",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8693,Aud osseo dev- abutment,Durable Medical Equipment,Per Unit,"$1,525.09 ",OP,"1,525.09","1,525.09",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8694,Aoi transducer/actuator repl,Durable Medical Equipment,Per Unit,$949.85 ,OP,949.85,949.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8695,External recharg sys extern,Durable Medical Equipment,Per Unit,$16.77 ,OP,16.77,16.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,L8696,Ext antenna phren nerve stim,Durable Medical Equipment,Per Unit,$217.98 ,OP,217.98,217.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,M0201,Covid-19 vaccine home admin,APC 1494,RVU Per Unit,$34.41 ,OP,34.41,34.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,M0243,Casirivi and imdevi inj,APC 1506,RVU Per Unit,$436.57 ,OP,436.57,436.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,M0244,Casirivi and imdevi inj hm,APC 1509,RVU Per Unit,$727.29 ,OP,727.29,727.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,M0245,Bamlan and etesev infusion,APC 1506,RVU Per Unit,$436.57 ,OP,436.57,436.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P2028,Cephalin floculation test,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P2029,Congo red blood test,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P2033,Blood thymol turbidity,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P2038,Blood mucoprotein,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P3000,Screen pap by tech w md supv,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9010,Whole blood for transfusion,APC 9510,Per Unit,$172.22 ,OP,172.22,172.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9011,Blood split unit,APC 9520,Per Unit,$169.28 ,OP,169.28,169.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9012,Cryoprecipitate each unit,APC 9511,Per Unit,$91.59 ,OP,91.59,91.59,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9016,Rbc leukocytes reduced,APC 9512,Per Unit,$216.23 ,OP,216.23,216.23,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9017,Plasma 1 donor frz w/in 8 hr,APC 9508,Per Unit,$94.81 ,OP,94.81,94.81,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9019,Platelets- each unit,APC 9515,Per Unit,$81.77 ,OP,81.77,81.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9020,Plaelet rich plasma unit,APC 9516,Per Unit,$229.41 ,OP,229.41,229.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9021,Red blood cells unit,APC 9517,Per Unit,$157.87 ,OP,157.87,157.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9022,Washed red blood cells unit,APC 9518,Per Unit,$435.72 ,OP,435.72,435.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9023,Frozen plasma- pooled- sd,APC 9509,Per Unit,$102.26 ,OP,102.26,102.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9031,Platelets leukocytes reduced,APC 9526,Per Unit,$171.96 ,OP,171.96,171.96,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9032,Platelets- irradiated,APC 9500,Per Unit,$162.52 ,OP,162.52,162.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9033,Platelets leukoreduced irrad,APC 9521,Per Unit,$244.54 ,OP,244.54,244.54,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9034,Platelets- pheresis,APC 9507,Per Unit,$371.63 ,OP,371.63,371.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9035,Platelet pheres leukoreduced,APC 9501,Per Unit,$558.38 ,OP,558.38,558.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9036,Platelet pheresis irradiated,APC 9502,Per Unit,$693.83 ,OP,693.83,693.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9037,Plate pheres leukoredu irrad,APC 9530,Per Unit,$708.10 ,OP,708.1,708.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9038,Rbc irradiated,APC 9505,Per Unit,$194.21 ,OP,194.21,194.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9039,Rbc deglycerolized,APC 9504,Per Unit,$500.86 ,OP,500.86,500.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9040,Rbc leukoreduced irradiated,APC 9522,Per Unit,$298.86 ,OP,298.86,298.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9041,Albumin (human)-5%- 50ml,APC 0961,Per Unit,$10.49 ,OP,10.49,10.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9043,Plasma protein fract-5%-50ml,APC 9514,Per Unit,$9.16 ,OP,9.16,9.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9044,Cryoprecipitatereducedplasma,APC 9523,Per Unit,$75.36 ,OP,75.36,75.36,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9045,Albumin (human)- 5%- 250 ml,APC 0963,Per Unit,$52.45 ,OP,52.45,52.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9046,Albumin (human)- 25%- 20 ml,APC 0964,Per Unit,$20.98 ,OP,20.98,20.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9047,Albumin (human)- 25%- 50ml,APC 0965,Per Unit,$52.45 ,OP,52.45,52.45,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9048,Plasmaprotein fract-5%-250ml,APC 9519,Per Unit,$183.92 ,OP,183.92,183.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9051,Blood- l/r- cmv-neg,APC 9524,Per Unit,$243.44 ,OP,243.44,243.44,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9052,Platelets- hla-m- l/r- unit,APC 9525,Per Unit,$923.57 ,OP,923.57,923.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9053,Plt- pher- l/r cmv-neg- irr,APC 9531,Per Unit,$513.08 ,OP,513.08,513.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9054,Blood- l/r- froz/degly/wash,APC 9527,Per Unit,$356.39 ,OP,356.39,356.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9055,Plt- aph/pher- l/r- cmv-neg,APC 9528,Per Unit,$550.63 ,OP,550.63,550.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9056,Blood- l/r- irradiated,APC 9529,Per Unit,$176.83 ,OP,176.83,176.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9057,Rbc- frz/deg/wsh- l/r- irrad,APC 9532,Per Unit,$298.91 ,OP,298.91,298.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9058,Rbc- l/r- cmv-neg- irrad,APC 9533,Per Unit,$279.73 ,OP,279.73,279.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9059,Plasma- frz between 8-24hour,APC 9513,Per Unit,$81.61 ,OP,81.61,81.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9060,Fr frz plasma donor retested,APC 9503,Per Unit,$74.65 ,OP,74.65,74.65,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9070,Pathogen reduced plasma pool,APC 9534,Per Unit,$60.91 ,OP,60.91,60.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9071,Pathogen reduced plasma sing,APC 9535,Per Unit,$140.88 ,OP,140.88,140.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9073,Platelets pheresis path redu,APC 9536,Per Unit,$669.72 ,OP,669.72,669.72,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9099,Blood component/product noc,APC 9537,Per Unit,$9.16 ,OP,9.16,9.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9100,Pathogen test for platelets,APC 5732,RVU Per Unit,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,P9612,Catheterize for urine spec,Lab Services,Per Unit,$3.00 ,OP,3,3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0035,Cardiokymography,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0091,Obtaining screen pap smear,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0111,Wet mounts/ w preparations,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0112,Potassium hydroxide preps,Lab Services,Per Unit,$5.83 ,OP,5.83,5.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0113,Pinworm examinations,Lab Services,Per Unit,$4.27 ,OP,4.27,4.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0114,Fern test,Lab Services,Per Unit,$9.74 ,OP,9.74,9.74,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0115,Post-coital mucous exam,Lab Services,Per Unit,$25.00 ,OP,25,25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0138,Ferumoxytol- non-esrd,APC 1297,Per Unit,$1.00 ,OP,1,1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0139,Ferumoxytol- esrd use,APC 1485,Per Unit,$1.00 ,OP,1,1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0243,Casirivimab and imdevimab,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0245,Bamlanivimab and etesevima,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0477,Pwr module pt cable lvad rpl,Durable Medical Equipment,Per Unit,$780.34 ,OP,780.34,780.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0478,Power adapter- combo vad,Durable Medical Equipment,Per Unit,$184.82 ,OP,184.82,184.82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0479,Power module combo vad- rep,Durable Medical Equipment,Per Unit,"$12,073.17 ",OP,"12,073.17","12,073.17",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0480,Driver pneumatic vad- rep,Durable Medical Equipment,Per Unit,"$90,585.51 ",OP,"90,585.51","90,585.51",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0481,Microprcsr cu elec vad- rep,Durable Medical Equipment,Per Unit,"$14,614.95 ",OP,"14,614.95","14,614.95",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0482,Microprcsr cu combo vad- rep,Durable Medical Equipment,Per Unit,"$4,577.67 ",OP,"4,577.67","4,577.67",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0483,Monitor elec vad- rep,Durable Medical Equipment,Per Unit,"$18,857.93 ",OP,"18,857.93","18,857.93",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0484,Monitor elec or comb vad rep,Durable Medical Equipment,Per Unit,"$3,662.14 ",OP,"3,662.14","3,662.14",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0485,Monitor cable elec vad- rep,Durable Medical Equipment,Per Unit,$353.60 ,OP,353.6,353.6,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0486,Mon cable elec/pneum vad rep,Durable Medical Equipment,Per Unit,$294.28 ,OP,294.28,294.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0487,Leads any type vad- rep only,Durable Medical Equipment,Per Unit,$343.31 ,OP,343.31,343.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0489,Pwr pck base combo vad- rep,Durable Medical Equipment,Per Unit,"$16,348.80 ",OP,"16,348.80","16,348.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0490,Emr pwr source elec vad- rep,Durable Medical Equipment,Per Unit,$707.17 ,OP,707.17,707.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0491,Emr pwr source combo vad rep,Durable Medical Equipment,Per Unit,"$1,111.75 ",OP,"1,111.75","1,111.75",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0492,Emr pwr cbl elec vad- rep,Durable Medical Equipment,Per Unit,$89.58 ,OP,89.58,89.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0493,Emr pwr cbl combo vad- rep,Durable Medical Equipment,Per Unit,$255.02 ,OP,255.02,255.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0494,Emr hd pmp elec/combo- rep,Durable Medical Equipment,Per Unit,$215.79 ,OP,215.79,215.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0495,Charger elec/combo vad- rep,Durable Medical Equipment,Per Unit,"$4,201.23 ",OP,"4,201.23","4,201.23",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0496,Battery elec/combo vad- rep,Durable Medical Equipment,Per Unit,"$1,507.90 ",OP,"1,507.90","1,507.90",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0497,Bat clps elec/comb vad- rep,Durable Medical Equipment,Per Unit,$470.84 ,OP,470.84,470.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0498,Holster elec/combo vad- rep,Durable Medical Equipment,Per Unit,$516.61 ,OP,516.61,516.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0499,Belt/vest elec/combo vad rep,Durable Medical Equipment,Per Unit,$167.86 ,OP,167.86,167.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0500,Filters elec/combo vad- rep,Durable Medical Equipment,Per Unit,$30.69 ,OP,30.69,30.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0501,Shwr cov elec/combo vad- rep,Durable Medical Equipment,Per Unit,$513.63 ,OP,513.63,513.63,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0502,Mobility cart pneum vad- rep,Durable Medical Equipment,Per Unit,$653.97 ,OP,653.97,653.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0503,Battery pneum vad replacemnt,Durable Medical Equipment,Per Unit,"$1,307.87 ",OP,"1,307.87","1,307.87",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0504,Pwr adpt pneum vad- rep veh,Durable Medical Equipment,Per Unit,$690.16 ,OP,690.16,690.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q0506,Lith-ion batt elec/pneum vad,Durable Medical Equipment,Per Unit,$859.04 ,OP,859.04,859.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2017,Teniposide- 50 mg,APC 7035,Per Unit,"$2,645.71 ",OP,"2,645.71","2,645.71",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2026,Radiesse injection,APC 9094,Per Unit,$257.37 ,OP,257.37,257.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2028,Inj- sculptra- 0.5mg,APC 9095,Per Unit,$2.49 ,OP,2.49,2.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2034,Agriflu vaccine,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2035,Afluria vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2036,Flulaval vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2037,Fluvirin vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2038,Fluzone vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2039,Influenza virus vaccine- nos,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2041,Axicabtagene ciloleucel car+,APC 9035,Per Unit,"$395,380.00 ",OP,"395,380.00","395,380.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2042,Tisagenlecleucel car-pos t,APC 9194,Per Unit,"$434,337.60 ",OP,"434,337.60","434,337.60",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2043,Sipuleucel-t auto cd54+,APC 9273,Per Unit,"$53,017.58 ",OP,"53,017.58","53,017.58",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2049,Imported lipodox inj,APC 1421,Per Unit,$311.04 ,OP,311.04,311.04,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2050,Doxorubicin inj 10mg,APC 7046,Per Unit,$234.03 ,OP,234.03,234.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q2053,Brexucabtagene car pos t,APC 9391,Per Unit,"$395,380.00 ",OP,"395,380.00","395,380.00",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q3027,Inj beta interferon im 1 mcg,APC 1472,Per Unit,$55.29 ,OP,55.29,55.29,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5101,Injection- zarxio,APC 1822,Per Unit,$0.32 ,OP,0.32,0.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5103,Injection- inflectra,APC 1847,Per Unit,$41.19 ,OP,41.19,41.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5104,Injection- renflexis,APC 9036,Per Unit,$38.79 ,OP,38.79,38.79,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5106,Inj retacrit non-esrd use,APC 9097,Per Unit,$8.66 ,OP,8.66,8.66,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5107,Inj mvasi 10 mg,APC 9329,Per Unit,$44.56 ,OP,44.56,44.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5108,Injection- fulphila,APC 9173,Per Unit,$211.19 ,OP,211.19,211.19,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5110,Nivestym,APC 9193,Per Unit,$0.33 ,OP,0.33,0.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5111,Injection- udenyca 0.5 mg,APC 9195,Per Unit,$222.38 ,OP,222.38,222.38,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5112,Inj ontruzant 10 mg,APC 9382,Per Unit,$66.55 ,OP,66.55,66.55,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5113,Inj herzuma 10 mg,APC 9349,Per Unit,$57.30 ,OP,57.3,57.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5114,Inj ogivri 10 mg,APC 9341,Per Unit,$59.91 ,OP,59.91,59.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5115,Inj truxima 10 mg,APC 9336,Per Unit,$60.58 ,OP,60.58,60.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5116,Inj.- trazimera- 10 mg,APC 9350,Per Unit,$59.93 ,OP,59.93,59.93,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5117,Inj.- kanjinti- 10 mg,APC 9330,Per Unit,$53.18 ,OP,53.18,53.18,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5118,Inj.- zirabev- 10 mg,APC 9348,Per Unit,$52.37 ,OP,52.37,52.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5119,Inj ruxience- 10 mg,APC 9367,Per Unit,$58.80 ,OP,58.8,58.8,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5120,Inj pegfilgrastim-bmez 0.5mg,APC 9345,Per Unit,$245.43 ,OP,245.43,245.43,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5121,Inj. avsola- 10 mg,APC 9381,Per Unit,$47.12 ,OP,47.12,47.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q5122,Inj- nyvepria,APC 9406,Per Unit,$284.69 ,OP,284.69,284.69,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q9968,Visualization adjunct,APC 1446,Per Unit,$6.73 ,OP,6.73,6.73,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q9969,Non-heu tc-99m add-on/dose,APC 1442,Per Unit,$10.00 ,OP,10,10,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q9991,Buprenorph xr 100 mg or less,APC 9073,Per Unit,"$1,796.80 ",OP,"1,796.80","1,796.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,Q9992,Buprenorphine xr over 100 mg,APC 9239,Per Unit,"$1,796.80 ",OP,"1,796.80","1,796.80",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,U0001,2019-ncov diagnostic p,Lab Services,Per Unit,$35.92 ,OP,35.92,35.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,U0002,Covid-19 lab test non-cdc,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,U0003,Cov-19 amp prb hgh thruput,Lab Services,Per Unit,$75.00 ,OP,75,75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,U0004,Cov-19 test non-cdc hgh thru,Lab Services,Per Unit,$75.00 ,OP,75,75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,U0005,Infec agen detec ampli probe,Lab Services,Per Unit,$25.00 ,OP,25,25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2020,Vision svcs frames purchases,Durable Medical Equipment,Per Unit,$75.22 ,OP,75.22,75.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2100,Lens spher single plano 4.00,Durable Medical Equipment,Per Unit,$46.49 ,OP,46.49,46.49,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2101,Single visn sphere 4.12-7.00,Durable Medical Equipment,Per Unit,$44.67 ,OP,44.67,44.67,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2102,Singl visn sphere 7.12-20.00,Durable Medical Equipment,Per Unit,$77.24 ,OP,77.24,77.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2103,Spherocylindr 4.00d/12-2.00d,Durable Medical Equipment,Per Unit,$39.13 ,OP,39.13,39.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2104,Spherocylindr 4.00d/2.12-4d,Durable Medical Equipment,Per Unit,$40.34 ,OP,40.34,40.34,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2105,Spherocylinder 4.00d/4.25-6d,Durable Medical Equipment,Per Unit,$47.98 ,OP,47.98,47.98,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2106,Spherocylinder 4.00d/>6.00d,Durable Medical Equipment,Per Unit,$53.15 ,OP,53.15,53.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2107,Spherocylinder 4.25d/12-2d,Durable Medical Equipment,Per Unit,$47.33 ,OP,47.33,47.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2108,Spherocylinder 4.25d/2.12-4d,Durable Medical Equipment,Per Unit,$47.46 ,OP,47.46,47.46,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2109,Spherocylinder 4.25d/4.25-6d,Durable Medical Equipment,Per Unit,$66.10 ,OP,66.1,66.1,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2110,Spherocylinder 4.25d/over 6d,Durable Medical Equipment,Per Unit,$53.39 ,OP,53.39,53.39,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2111,Spherocylindr 7.25d/.25-2.25,Durable Medical Equipment,Per Unit,$64.70 ,OP,64.7,64.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2112,Spherocylindr 7.25d/2.25-4d,Durable Medical Equipment,Per Unit,$73.09 ,OP,73.09,73.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2113,Spherocylindr 7.25d/4.25-6d,Durable Medical Equipment,Per Unit,$73.91 ,OP,73.91,73.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2114,Spherocylinder over 12.00d,Durable Medical Equipment,Per Unit,$87.57 ,OP,87.57,87.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2115,Lens lenticular bifocal,Durable Medical Equipment,Per Unit,$88.27 ,OP,88.27,88.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2118,Lens aniseikonic single,Durable Medical Equipment,Per Unit,$96.05 ,OP,96.05,96.05,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2121,Lenticular lens- single,Durable Medical Equipment,Per Unit,$86.61 ,OP,86.61,86.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2200,Lens spher bifoc plano 4.00d,Durable Medical Equipment,Per Unit,$52.35 ,OP,52.35,52.35,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2201,Lens sphere bifocal 4.12-7.0,Durable Medical Equipment,Per Unit,$56.09 ,OP,56.09,56.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2202,Lens sphere bifocal 7.12-20.,Durable Medical Equipment,Per Unit,$69.53 ,OP,69.53,69.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2203,Lens sphcyl bifocal 4.00d/.1,Durable Medical Equipment,Per Unit,$53.92 ,OP,53.92,53.92,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2204,Lens sphcy bifocal 4.00d/2.1,Durable Medical Equipment,Per Unit,$55.48 ,OP,55.48,55.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2205,Lens sphcy bifocal 4.00d/4.2,Durable Medical Equipment,Per Unit,$61.51 ,OP,61.51,61.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2206,Lens sphcy bifocal 4.00d/ove,Durable Medical Equipment,Per Unit,$72.21 ,OP,72.21,72.21,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2207,Lens sphcy bifocal 4.25-7d/.,Durable Medical Equipment,Per Unit,$61.03 ,OP,61.03,61.03,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2208,Lens sphcy bifocal 4.25-7/2.,Durable Medical Equipment,Per Unit,$59.97 ,OP,59.97,59.97,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2209,Lens sphcy bifocal 4.25-7/4.,Durable Medical Equipment,Per Unit,$70.40 ,OP,70.4,70.4,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2210,Lens sphcy bifocal 4.25-7/ov,Durable Medical Equipment,Per Unit,$75.86 ,OP,75.86,75.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2211,Lens sphcy bifo 7.25-12/.25-,Durable Medical Equipment,Per Unit,$73.85 ,OP,73.85,73.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2212,Lens sphcyl bifo 7.25-12/2.2,Durable Medical Equipment,Per Unit,$77.30 ,OP,77.3,77.3,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2213,Lens sphcyl bifo 7.25-12/4.2,Durable Medical Equipment,Per Unit,$81.28 ,OP,81.28,81.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2214,Lens sphcyl bifocal over 12.,Durable Medical Equipment,Per Unit,$84.95 ,OP,84.95,84.95,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2215,Lens lenticular bifocal,Durable Medical Equipment,Per Unit,$106.06 ,OP,106.06,106.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2218,Lens aniseikonic bifocal,Durable Medical Equipment,Per Unit,$108.09 ,OP,108.09,108.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2219,Lens bifocal seg width over,Durable Medical Equipment,Per Unit,$49.86 ,OP,49.86,49.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2220,Lens bifocal add over 3.25d,Durable Medical Equipment,Per Unit,$44.28 ,OP,44.28,44.28,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2221,Lenticular lens- bifocal,Durable Medical Equipment,Per Unit,$88.33 ,OP,88.33,88.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2300,Lens sphere trifocal 4.00d,Durable Medical Equipment,Per Unit,$71.57 ,OP,71.57,71.57,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2301,Lens sphere trifocal 4.12-7.,Durable Medical Equipment,Per Unit,$87.77 ,OP,87.77,87.77,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2302,Lens sphere trifocal 7.12-20,Durable Medical Equipment,Per Unit,$82.00 ,OP,82,82,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2303,Lens sphcy trifocal 4.0/.12-,Durable Medical Equipment,Per Unit,$68.89 ,OP,68.89,68.89,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2304,Lens sphcy trifocal 4.0/2.25,Durable Medical Equipment,Per Unit,$69.70 ,OP,69.7,69.7,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2305,Lens sphcy trifocal 4.0/4.25,Durable Medical Equipment,Per Unit,$77.86 ,OP,77.86,77.86,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2306,Lens sphcyl trifocal 4.00/>6,Durable Medical Equipment,Per Unit,$80.17 ,OP,80.17,80.17,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2307,Lens sphcy trifocal 4.25-7/.,Durable Medical Equipment,Per Unit,$76.33 ,OP,76.33,76.33,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2308,Lens sphc trifocal 4.25-7/2.,Durable Medical Equipment,Per Unit,$83.26 ,OP,83.26,83.26,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2309,Lens sphc trifocal 4.25-7/4.,Durable Medical Equipment,Per Unit,$87.13 ,OP,87.13,87.13,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2310,Lens sphc trifocal 4.25-7/>6,Durable Medical Equipment,Per Unit,$91.01 ,OP,91.01,91.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2311,Lens sphc trifo 7.25-12/.25-,Durable Medical Equipment,Per Unit,$105.08 ,OP,105.08,105.08,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2312,Lens sphc trifo 7.25-12/2.25,Durable Medical Equipment,Per Unit,$96.32 ,OP,96.32,96.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2313,Lens sphc trifo 7.25-12/4.25,Durable Medical Equipment,Per Unit,$105.15 ,OP,105.15,105.15,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2314,Lens sphcyl trifocal over 12,Durable Medical Equipment,Per Unit,$107.48 ,OP,107.48,107.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2315,Lens lenticular trifocal,Durable Medical Equipment,Per Unit,$119.32 ,OP,119.32,119.32,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2318,Lens aniseikonic trifocal,Durable Medical Equipment,Per Unit,$146.68 ,OP,146.68,146.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2319,Lens trifocal seg width > 28,Durable Medical Equipment,Per Unit,$66.22 ,OP,66.22,66.22,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2320,Lens trifocal add over 3.25d,Durable Medical Equipment,Per Unit,$69.85 ,OP,69.85,69.85,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2321,Lenticular lens- trifocal,Durable Medical Equipment,Per Unit,$117.61 ,OP,117.61,117.61,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2410,Lens variab asphericity sing,Durable Medical Equipment,Per Unit,$102.83 ,OP,102.83,102.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2430,Lens variable asphericity bi,Durable Medical Equipment,Per Unit,$108.84 ,OP,108.84,108.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2500,Contact lens pmma spherical,Durable Medical Equipment,Per Unit,$92.01 ,OP,92.01,92.01,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2501,Cntct lens pmma-toric/prism,Durable Medical Equipment,Per Unit,$130.56 ,OP,130.56,130.56,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2502,Contact lens pmma bifocal,Durable Medical Equipment,Per Unit,$176.91 ,OP,176.91,176.91,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2503,Cntct lens pmma color vision,Durable Medical Equipment,Per Unit,$170.87 ,OP,170.87,170.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2510,Cntct gas permeable sphericl,Durable Medical Equipment,Per Unit,$122.68 ,OP,122.68,122.68,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2511,Cntct toric prism ballast,Durable Medical Equipment,Per Unit,$181.84 ,OP,181.84,181.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2512,Cntct lens gas permbl bifocl,Durable Medical Equipment,Per Unit,$209.31 ,OP,209.31,209.31,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2513,Contact lens extended wear,Durable Medical Equipment,Per Unit,$210.87 ,OP,210.87,210.87,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2520,Contact lens hydrophilic,Durable Medical Equipment,Per Unit,$122.25 ,OP,122.25,122.25,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2521,Cntct lens hydrophilic toric,Durable Medical Equipment,Per Unit,$242.09 ,OP,242.09,242.09,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2522,Cntct lens hydrophil bifocl,Durable Medical Equipment,Per Unit,$177.16 ,OP,177.16,177.16,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2523,Cntct lens hydrophil extend,Durable Medical Equipment,Per Unit,$186.00 ,OP,186,186,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2530,Contact lens gas impermeable,Durable Medical Equipment,Per Unit,$297.37 ,OP,297.37,297.37,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2531,Contact lens gas permeable,Durable Medical Equipment,Per Unit,$544.58 ,OP,544.58,544.58,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2623,Plastic eye prosth custom,Durable Medical Equipment,Per Unit,$942.94 ,OP,942.94,942.94,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2624,Polishing artifical eye,Durable Medical Equipment,Per Unit,$60.88 ,OP,60.88,60.88,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2625,Enlargemnt of eye prosthesis,Durable Medical Equipment,Per Unit,$482.12 ,OP,482.12,482.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2626,Reduction of eye prosthesis,Durable Medical Equipment,Per Unit,$199.51 ,OP,199.51,199.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2627,Scleral cover shell,Durable Medical Equipment,Per Unit,"$1,430.28 ",OP,"1,430.28","1,430.28",,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2628,Fabrication & fitting,Durable Medical Equipment,Per Unit,$304.24 ,OP,304.24,304.24,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2700,Balance lens,Durable Medical Equipment,Per Unit,$44.84 ,OP,44.84,44.84,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2710,Glass/plastic slab off prism,Durable Medical Equipment,Per Unit,$73.51 ,OP,73.51,73.51,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2715,Prism lens/es,Durable Medical Equipment,Per Unit,$14.41 ,OP,14.41,14.41,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2718,Fresnell prism press-on lens,Durable Medical Equipment,Per Unit,$31.12 ,OP,31.12,31.12,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2730,Special base curve,Durable Medical Equipment,Per Unit,$26.06 ,OP,26.06,26.06,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2744,Tint photochromatic lens/es,Durable Medical Equipment,Per Unit,$17.83 ,OP,17.83,17.83,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2745,Tint- any color/solid/grad,Durable Medical Equipment,Per Unit,$10.27 ,OP,10.27,10.27,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2750,Anti-reflective coating,Durable Medical Equipment,Per Unit,$20.02 ,OP,20.02,20.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2755,Uv lens/es,Durable Medical Equipment,Per Unit,$16.76 ,OP,16.76,16.76,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2770,Occluder lens/es,Durable Medical Equipment,Per Unit,$19.52 ,OP,19.52,19.52,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2780,Oversize lens/es,Durable Medical Equipment,Per Unit,$12.53 ,OP,12.53,12.53,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2782,Lens- 1.54-1.65 p/1.60-1.79g,Durable Medical Equipment,Per Unit,$64.75 ,OP,64.75,64.75,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2783,Lens- >= 1.66 p/>=1.80 g,Durable Medical Equipment,Per Unit,$73.02 ,OP,73.02,73.02,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2784,Lens polycarb or equal,Durable Medical Equipment,Per Unit,$47.48 ,OP,47.48,47.48,,,,,,,,,,,,,
Health Alliance MCR ADV,CPT,V2785,Corneal tissue processing,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
Healthlink PPO,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,,Relative Weights,"$304,800.80 ",IP,"260,218.80","304,800.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,,Relative Weights,"$167,641.91 ",IP,"134,730.90","167,641.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,,Relative Weights,"$199,844.40 ",IP,"171,949.50","199,844.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,,Relative Weights,"$124,823.83 ",IP,"107,302.50","124,823.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,,Relative Weights,"$107,579.79 ",IP,"92,115.00","107,579.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,,Relative Weights,"$49,370.76 ",IP,"42,267.60","49,370.76",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-007,LUNG TRANSPLANT,,Relative Weights,"$121,796.36 ",IP,"104,220.00","121,796.36",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,,Relative Weights,"$57,106.22 ",IP,"48,899.70","57,106.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-010,PANCREAS TRANSPLANT,,Relative Weights,"$38,069.06 ",IP,"32,580.00","38,069.06",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,,Relative Weights,"$52,787.58 ",IP,"45,192.60","52,787.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,,Relative Weights,"$40,323.08 ",IP,"34,495.20","40,323.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,,Relative Weights,"$28,627.82 ",IP,"24,514.20","28,627.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$134,471.31 ",IP,"96,093.00","134,471.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,,Relative Weights,"$70,779.80 ",IP,"60,626.70","70,779.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,,Relative Weights,"$50,828.19 ",IP,"43,701.30","50,828.19",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,,Relative Weights,"$392,813.07 ",IP,"337,050.90","392,813.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,Relative Weights,"$70,103.17 ",IP,"60,117.30","70,103.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,,Relative Weights,"$108,598.41 ",IP,"93,033.00","108,598.41",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,,Relative Weights,"$79,255.03 ",IP,"67,891.50","79,255.03",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,,Relative Weights,"$51,137.57 ",IP,"43,585.20","51,137.57",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,,Relative Weights,"$59,584.38 ",IP,"51,047.10","59,584.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,,Relative Weights,"$41,381.70 ",IP,"35,451.00","41,381.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,,Relative Weights,"$47,266.16 ",IP,"40,476.60","47,266.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,,Relative Weights,"$32,179.33 ",IP,"27,558.00","32,179.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$26,431.67 ",IP,"22,628.70","26,431.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-028,SPINAL PROCEDURES WITH MCC,,Relative Weights,"$61,243.86 ",IP,"52,407.90","61,243.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,,Relative Weights,"$34,673.29 ",IP,"29,671.20","34,673.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$24,803.76 ",IP,"21,211.20","24,803.76",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,,Relative Weights,"$45,944.47 ",IP,"39,345.30","45,944.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,,Relative Weights,"$23,278.98 ",IP,"19,948.50","23,278.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$18,106.93 ",IP,"15,499.80","18,106.93",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,,Relative Weights,"$41,824.72 ",IP,"35,802.90","41,824.72",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,,Relative Weights,"$24,593.30 ",IP,"21,057.30","24,593.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$19,480.18 ",IP,"16,670.70","19,480.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,,Relative Weights,"$34,459.67 ",IP,"29,498.40","34,459.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,,Relative Weights,"$17,439.77 ",IP,"14,929.20","17,439.77",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$11,985.70 ",IP,"10,251.90","11,985.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,,Relative Weights,"$41,647.93 ",IP,"34,783.20","41,647.93",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,,Relative Weights,"$24,737.47 ",IP,"21,147.30","24,737.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$19,834.80 ",IP,"17,110.80","19,834.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,,Relative Weights,"$19,415.99 ",IP,"16,681.50","19,415.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,,Relative Weights,"$11,955.18 ",IP,"10,227.60","11,955.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,,Relative Weights,"$14,372.31 ",IP,"12,314.70","14,372.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,,Relative Weights,"$10,979.70 ",IP,"9,401.40","10,979.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,,Relative Weights,"$23,016.96 ",IP,"19,757.70","23,016.96",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,,Relative Weights,"$13,303.18 ",IP,"11,407.50","13,303.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,,Relative Weights,"$18,275.29 ",IP,"15,640.20","18,275.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,,Relative Weights,"$11,854.16 ",IP,"10,145.70","11,854.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,,Relative Weights,"$9,634.86 ",IP,"8,259.30","9,634.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,,Relative Weights,"$30,392.53 ",IP,"26,020.80","30,392.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,,Relative Weights,"$20,911.31 ",IP,"17,894.70","20,911.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,,Relative Weights,"$17,993.28 ",IP,"15,387.30","17,993.28",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,,Relative Weights,"$20,130.50 ",IP,"17,270.10","20,130.50",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,,Relative Weights,"$10,714.52 ",IP,"9,180.00","10,714.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,,Relative Weights,"$7,480.80 ",IP,"6,404.40","7,480.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,,Relative Weights,"$14,991.07 ",IP,"12,832.20","14,991.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,,Relative Weights,"$9,350.74 ",IP,"8,000.10","9,350.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,,Relative Weights,"$8,272.13 ",IP,"7,083.90","8,272.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,,Relative Weights,"$17,640.76 ",IP,"15,116.40","17,640.76",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,,Relative Weights,"$10,636.65 ",IP,"9,106.20","10,636.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,,Relative Weights,"$8,115.34 ",IP,"6,945.30","8,115.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,,Relative Weights,"$15,252.04 ",IP,"13,076.10","15,252.04",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,,Relative Weights,"$10,716.62 ",IP,"9,171.00","10,716.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,,Relative Weights,"$17,110.40 ",IP,"14,643.00","17,110.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,,Relative Weights,"$10,322.01 ",IP,"8,864.10","10,322.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,,Relative Weights,"$16,120.18 ",IP,"13,796.10","16,120.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,,Relative Weights,"$9,986.33 ",IP,"8,549.10","9,986.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,,Relative Weights,"$7,648.12 ",IP,"6,559.20","7,648.12",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,,Relative Weights,"$22,014.12 ",IP,"18,858.60","22,014.12",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,,Relative Weights,"$8,123.76 ",IP,"6,958.80","8,123.76",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,,Relative Weights,"$23,761.99 ",IP,"20,375.10","23,761.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,,Relative Weights,"$14,118.71 ",IP,"12,096.00","14,118.71",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,,Relative Weights,"$9,514.90 ",IP,"8,150.40","9,514.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,,Relative Weights,"$24,270.25 ",IP,"20,805.30","24,270.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,,Relative Weights,"$13,394.73 ",IP,"11,470.50","13,394.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,,Relative Weights,"$9,077.14 ",IP,"7,772.40","9,077.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-088,CONCUSSION WITH MCC,,Relative Weights,"$15,356.21 ",IP,"13,096.80","15,356.21",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-089,CONCUSSION WITH CC,,Relative Weights,"$11,167.01 ",IP,"9,571.50","11,167.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,,Relative Weights,"$8,995.06 ",IP,"7,691.40","8,995.06",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,,Relative Weights,"$17,351.37 ",IP,"14,857.20","17,351.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,,Relative Weights,"$10,376.73 ",IP,"8,900.10","10,376.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,,Relative Weights,"$8,221.62 ",IP,"7,039.80","8,221.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,,Relative Weights,"$38,231.11 ",IP,"32,741.10","38,231.11",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,,Relative Weights,"$26,391.68 ",IP,"22,565.70","26,391.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,,Relative Weights,"$24,534.37 ",IP,"20,994.30","24,534.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,,Relative Weights,"$39,488.61 ",IP,"33,843.60","39,488.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,,Relative Weights,"$22,213.00 ",IP,"19,012.50","22,213.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,,Relative Weights,"$14,703.79 ",IP,"12,617.10","14,703.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-100,SEIZURES WITH MCC,,Relative Weights,"$19,715.89 ",IP,"16,887.60","19,715.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-101,SEIZURES WITHOUT MCC,,Relative Weights,"$9,333.90 ",IP,"7,995.60","9,333.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-102,HEADACHES WITH MCC,,Relative Weights,"$12,119.34 ",IP,"10,377.90","12,119.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-103,HEADACHES WITHOUT MCC,,Relative Weights,"$8,715.15 ",IP,"7,465.50","8,715.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,,Relative Weights,"$23,064.31 ",IP,"19,749.60","23,064.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$15,211.00 ",IP,"13,028.40","15,211.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,,Relative Weights,"$15,293.08 ",IP,"13,109.40","15,293.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,,Relative Weights,"$19,753.78 ",IP,"16,944.30","19,753.78",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$10,932.34 ",IP,"9,370.80","10,932.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,,Relative Weights,"$12,508.69 ",IP,"10,715.40","12,508.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,,Relative Weights,"$6,774.71 ",IP,"5,809.50","6,774.71",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,,Relative Weights,"$8,053.25 ",IP,"6,901.20","8,053.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,,Relative Weights,"$14,719.57 ",IP,"12,618.00","14,719.57",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,,Relative Weights,"$8,790.91 ",IP,"7,533.00","8,790.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,,Relative Weights,"$22,525.53 ",IP,"19,291.50","22,525.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$13,211.63 ",IP,"11,299.50","13,211.63",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,,Relative Weights,"$15,454.08 ",IP,"13,587.30","15,454.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$8,871.94 ",IP,"7,708.50","8,871.94",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-139,SALIVARY GLAND PROCEDURES,,Relative Weights,"$12,909.62 ",IP,"11,106.90","12,909.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,Relative Weights,"$41,887.85 ",IP,"35,801.10","41,887.85",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,,Relative Weights,"$23,229.52 ",IP,"19,854.90","23,229.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$16,929.40 ",IP,"14,445.90","16,929.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,Relative Weights,"$31,188.07 ",IP,"26,818.20","31,188.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,,Relative Weights,"$18,420.51 ",IP,"15,853.50","18,420.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$12,769.66 ",IP,"11,021.40","12,769.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,,Relative Weights,"$21,394.31 ",IP,"18,369.90","21,394.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,,Relative Weights,"$13,691.48 ",IP,"11,709.90","13,691.48",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$8,274.23 ",IP,"7,083.00","8,274.23",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-149,DYSEQUILIBRIUM,,Relative Weights,"$7,739.67 ",IP,"6,633.00","7,739.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-150,EPISTAXIS WITH MCC,,Relative Weights,"$13,939.82 ",IP,"11,947.50","13,939.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-151,EPISTAXIS WITHOUT MCC,,Relative Weights,"$7,755.45 ",IP,"6,645.60","7,755.45",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,,Relative Weights,"$11,332.22 ",IP,"9,724.50","11,332.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,,Relative Weights,"$7,477.64 ",IP,"6,418.80","7,477.64",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,,Relative Weights,"$16,231.73 ",IP,"13,921.20","16,231.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,,Relative Weights,"$9,542.26 ",IP,"8,185.50","9,542.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$6,919.92 ",IP,"5,925.60","6,919.92",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,,Relative Weights,"$16,546.37 ",IP,"14,185.80","16,546.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,,Relative Weights,"$9,356.00 ",IP,"8,101.80","9,356.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,,Relative Weights,"$6,900.98 ",IP,"5,967.90","6,900.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,,Relative Weights,"$52,189.87 ",IP,"45,061.20","52,189.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,,Relative Weights,"$27,736.52 ",IP,"23,900.40","27,736.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$20,084.20 ",IP,"17,249.40","20,084.20",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,,Relative Weights,"$39,879.01 ",IP,"33,511.50","39,879.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,,Relative Weights,"$19,583.30 ",IP,"16,368.30","19,583.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,410.20 ",IP,"12,189.60","14,410.20",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,,Relative Weights,"$16,249.62 ",IP,"13,914.00","16,249.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,,Relative Weights,"$9,330.74 ",IP,"7,990.20","9,330.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,,Relative Weights,"$19,418.09 ",IP,"16,641.90","19,418.09",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,,Relative Weights,"$12,689.69 ",IP,"10,870.20","12,689.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,,Relative Weights,"$9,166.59 ",IP,"7,854.30","9,166.59",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,,Relative Weights,"$18,286.87 ",IP,"15,659.10","18,286.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,,Relative Weights,"$11,795.23 ",IP,"10,080.90","11,795.23",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,,Relative Weights,"$8,286.86 ",IP,"7,128.00","8,286.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,,Relative Weights,"$16,369.58 ",IP,"14,030.10","16,369.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,,Relative Weights,"$10,937.61 ",IP,"9,368.10","10,937.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,,Relative Weights,"$8,140.59 ",IP,"6,974.10","8,140.59",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-186,PLEURAL EFFUSION WITH MCC,,Relative Weights,"$16,239.09 ",IP,"13,894.20","16,239.09",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-187,PLEURAL EFFUSION WITH CC,,Relative Weights,"$10,861.84 ",IP,"9,296.10","10,861.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,,Relative Weights,"$7,661.80 ",IP,"6,565.50","7,661.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,,Relative Weights,"$12,888.57 ",IP,"11,034.90","12,888.57",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,,Relative Weights,"$11,826.80 ",IP,"10,125.90","11,826.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,,Relative Weights,"$9,292.86 ",IP,"7,958.70","9,292.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,,Relative Weights,"$7,312.43 ",IP,"6,260.40","7,312.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,,Relative Weights,"$13,792.50 ",IP,"11,808.00","13,792.50",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,,Relative Weights,"$9,081.35 ",IP,"7,775.10","9,081.35",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,,Relative Weights,"$6,997.80 ",IP,"5,992.20","6,997.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,,Relative Weights,"$18,268.98 ",IP,"15,647.40","18,268.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,,Relative Weights,"$10,581.93 ",IP,"9,063.00","10,581.93",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,,Relative Weights,"$7,811.22 ",IP,"6,690.60","7,811.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-199,PNEUMOTHORAX WITH MCC,,Relative Weights,"$18,810.91 ",IP,"16,110.00","18,810.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-200,PNEUMOTHORAX WITH CC,,Relative Weights,"$11,312.23 ",IP,"9,688.50","11,312.23",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,,Relative Weights,"$7,466.07 ",IP,"6,386.40","7,466.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,,Relative Weights,"$10,161.01 ",IP,"8,703.00","10,161.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,,Relative Weights,"$7,423.98 ",IP,"6,363.00","7,423.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,,Relative Weights,"$8,339.48 ",IP,"7,142.40","8,339.48",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,,Relative Weights,"$17,702.84 ",IP,"15,163.20","17,702.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,,Relative Weights,"$9,304.44 ",IP,"7,974.00","9,304.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,,Relative Weights,"$60,258.91 ",IP,"51,624.90","60,258.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,,Relative Weights,"$26,752.62 ",IP,"22,903.20","26,752.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,,Relative Weights,"$117,414.58 ",IP,"95,025.60","117,414.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,,Relative Weights,"$109,755.94 ",IP,"90,353.70","109,755.94",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,,Relative Weights,"$68,323.73 ",IP,"58,351.50","68,323.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,,Relative Weights,"$54,121.89 ",IP,"54,121.89","59,467.93",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,,Relative Weights,"$84,763.82 ",IP,"72,518.40","84,763.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,,Relative Weights,"$56,823.15 ",IP,"48,647.70","56,823.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,,Relative Weights,"$47,903.85 ",IP,"41,219.10","47,903.85",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,,Relative Weights,"$88,615.24 ",IP,"71,559.00","88,615.24",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,,Relative Weights,"$65,369.93 ",IP,"52,187.40","65,369.93",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,,Relative Weights,"$77,472.43 ",IP,"67,671.90","77,472.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,,Relative Weights,"$59,210.82 ",IP,"50,560.20","59,210.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,,Relative Weights,"$69,575.97 ",IP,"59,085.00","69,575.97",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,,Relative Weights,"$55,265.74 ",IP,"46,908.90","55,265.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,,Relative Weights,"$65,403.60 ",IP,"47,972.70","65,403.60",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,,Relative Weights,"$41,965.72 ",IP,"30,970.80","41,965.72",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,,Relative Weights,"$89,342.37 ",IP,"78,443.10","89,342.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,,Relative Weights,"$62,067.81 ",IP,"53,584.20","62,067.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,,Relative Weights,"$82,002.58 ",IP,"71,300.70","82,002.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,,Relative Weights,"$55,955.00 ",IP,"48,024.00","55,955.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,,Relative Weights,"$63,455.79 ",IP,"54,936.90","63,455.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,,Relative Weights,"$42,942.26 ",IP,"36,873.00","42,942.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,,Relative Weights,"$50,601.95 ",IP,"43,344.00","50,601.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,,Relative Weights,"$29,359.17 ",IP,"25,099.20","29,359.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,,Relative Weights,"$16,746.30 ",IP,"14,331.60","16,746.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,,Relative Weights,"$39,171.87 ",IP,"33,548.40","39,171.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,,Relative Weights,"$26,650.55 ",IP,"22,666.50","26,650.55",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,,Relative Weights,"$21,737.36 ",IP,"18,569.70","21,737.36",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-245,AICD GENERATOR PROCEDURES,,Relative Weights,"$56,971.52 ",IP,"48,760.20","56,971.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,,Relative Weights,"$32,891.74 ",IP,"28,118.70","32,891.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,,Relative Weights,"$20,921.83 ",IP,"17,758.80","20,921.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,,Relative Weights,"$33,398.95 ",IP,"28,459.80","33,398.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,,Relative Weights,"$19,775.87 ",IP,"16,863.30","19,775.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,,Relative Weights,"$26,547.42 ",IP,"22,696.20","26,547.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,,Relative Weights,"$17,466.08 ",IP,"14,925.60","17,466.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,,Relative Weights,"$34,943.73 ",IP,"29,931.30","34,943.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,,Relative Weights,"$27,924.89 ",IP,"23,882.40","27,924.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$19,041.37 ",IP,"16,343.10","19,041.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,,Relative Weights,"$26,759.99 ",IP,"22,817.70","26,759.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,,Relative Weights,"$17,290.34 ",IP,"14,797.80","17,290.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,,Relative Weights,"$12,217.20 ",IP,"10,486.80","12,217.20",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,,Relative Weights,"$33,687.28 ",IP,"28,512.90","33,687.28",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,,Relative Weights,"$22,310.86 ",IP,"18,802.80","22,310.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,,Relative Weights,"$37,716.54 ",IP,"32,105.70","37,716.54",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,,Relative Weights,"$20,954.45 ",IP,"17,945.10","20,954.45",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,,Relative Weights,"$17,974.34 ",IP,"15,355.80","17,974.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-263,VEIN LIGATION AND STRIPPING,,Relative Weights,"$24,258.67 ",IP,"20,818.80","24,258.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,,Relative Weights,"$34,176.60 ",IP,"29,282.40","34,176.60",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-265,AICD LEAD PROCEDURES,,Relative Weights,"$35,385.69 ",IP,"30,289.50","35,385.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,,Relative Weights,"$74,683.84 ",IP,"63,431.10","74,683.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,,Relative Weights,"$58,938.27 ",IP,"50,382.00","58,938.27",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,,Relative Weights,"$73,183.26 ",IP,"62,669.70","73,183.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,,Relative Weights,"$45,402.54 ",IP,"38,835.90","45,402.54",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,,Relative Weights,"$54,525.98 ",IP,"46,683.00","54,525.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,,Relative Weights,"$37,510.29 ",IP,"32,088.60","37,510.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$28,294.24 ",IP,"24,194.70","28,294.24",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,,Relative Weights,"$40,378.86 ",IP,"34,440.30","40,378.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,,Relative Weights,"$34,572.26 ",IP,"29,579.40","34,572.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,,Relative Weights,"$17,112.50 ",IP,"14,462.10","17,112.50",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,,Relative Weights,"$9,808.49 ",IP,"8,375.40","9,808.49",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,,Relative Weights,"$7,634.44 ",IP,"6,534.90","7,634.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,,Relative Weights,"$19,621.19 ",IP,"16,782.30","19,621.19",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,,Relative Weights,"$7,725.99 ",IP,"6,510.60","7,725.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,,Relative Weights,"$5,223.62 ",IP,"4,452.30","5,223.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,,Relative Weights,"$23,298.97 ",IP,"19,226.70","23,298.97",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,,Relative Weights,"$12,101.45 ",IP,"10,035.90","12,101.45",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,,Relative Weights,"$28,212.16 ",IP,"24,168.60","28,212.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,,Relative Weights,"$17,285.08 ",IP,"14,792.40","17,285.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,,Relative Weights,"$10,771.34 ",IP,"9,242.10","10,771.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,,Relative Weights,"$14,110.29 ",IP,"11,414.70","14,110.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,,Relative Weights,"$9,419.14 ",IP,"7,771.50","9,419.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,,Relative Weights,"$6,867.31 ",IP,"5,309.10","6,867.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,,Relative Weights,"$13,491.54 ",IP,"11,545.20","13,491.54",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,,Relative Weights,"$10,326.22 ",IP,"8,856.90","10,326.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,,Relative Weights,"$16,782.08 ",IP,"14,356.80","16,782.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,,Relative Weights,"$7,414.51 ",IP,"6,363.00","7,414.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,,Relative Weights,"$5,137.33 ",IP,"4,399.20","5,137.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,,Relative Weights,"$16,114.92 ",IP,"13,793.40","16,114.92",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,,Relative Weights,"$10,967.07 ",IP,"9,394.20","10,967.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,,Relative Weights,"$7,813.33 ",IP,"6,687.90","7,813.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,,Relative Weights,"$11,506.90 ",IP,"9,853.20","11,506.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,,Relative Weights,"$7,117.76 ",IP,"6,098.40","7,117.76",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-304,HYPERTENSION WITH MCC,,Relative Weights,"$11,529.00 ",IP,"9,873.00","11,529.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-305,HYPERTENSION WITHOUT MCC,,Relative Weights,"$7,771.24 ",IP,"6,659.10","7,771.24",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,,Relative Weights,"$15,823.44 ",IP,"13,566.60","15,823.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,,Relative Weights,"$9,138.17 ",IP,"7,833.60","9,138.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,,Relative Weights,"$12,620.23 ",IP,"10,808.10","12,620.23",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,,Relative Weights,"$7,885.94 ",IP,"6,754.50","7,885.94",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,,Relative Weights,"$5,876.04 ",IP,"5,032.80","5,876.04",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-311,ANGINA PECTORIS,,Relative Weights,"$7,334.53 ",IP,"6,286.50","7,334.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-312,SYNCOPE AND COLLAPSE,,Relative Weights,"$8,809.86 ",IP,"7,548.30","8,809.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-313,CHEST PAIN,,Relative Weights,"$7,584.98 ",IP,"6,492.60","7,584.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,,Relative Weights,"$21,923.62 ",IP,"18,762.30","21,923.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,,Relative Weights,"$10,262.03 ",IP,"8,760.60","10,262.03",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$7,886.99 ",IP,"6,510.60","7,886.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,,Relative Weights,"$45,415.16 ",IP,"38,861.10","45,415.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,,Relative Weights,"$25,715.06 ",IP,"21,650.40","25,715.06",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,,Relative Weights,"$56,589.54 ",IP,"47,846.70","56,589.54",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,,Relative Weights,"$27,460.82 ",IP,"23,082.30","27,460.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$17,526.06 ",IP,"15,002.10","17,526.06",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,,Relative Weights,"$51,039.71 ",IP,"43,975.80","51,039.71",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,,Relative Weights,"$26,717.90 ",IP,"22,943.70","26,717.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$17,995.38 ",IP,"15,394.50","17,995.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-332,RECTAL RESECTION WITH MCC,,Relative Weights,"$43,772.52 ",IP,"37,453.50","43,772.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-333,RECTAL RESECTION WITH CC,,Relative Weights,"$22,529.74 ",IP,"19,271.70","22,529.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,,Relative Weights,"$16,933.61 ",IP,"14,477.40","16,933.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,,Relative Weights,"$40,938.68 ",IP,"35,221.50","40,938.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,,Relative Weights,"$24,022.96 ",IP,"20,621.70","24,022.96",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,,Relative Weights,"$17,179.85 ",IP,"14,735.70","17,179.85",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,,Relative Weights,"$29,451.77 ",IP,"25,175.70","29,451.77",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,,Relative Weights,"$17,836.49 ",IP,"15,276.60","17,836.49",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,,Relative Weights,"$12,926.45 ",IP,"11,054.70","12,926.45",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,,Relative Weights,"$24,373.37 ",IP,"20,901.60","24,373.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,,Relative Weights,"$15,080.51 ",IP,"12,896.10","15,080.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,,Relative Weights,"$11,674.22 ",IP,"9,977.40","11,674.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,,Relative Weights,"$29,473.87 ",IP,"25,365.60","29,473.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,,Relative Weights,"$16,602.14 ",IP,"14,209.20","16,602.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$13,416.83 ",IP,"11,478.60","13,416.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,,Relative Weights,"$25,903.42 ",IP,"22,182.30","25,903.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,,Relative Weights,"$14,126.08 ",IP,"12,132.90","14,126.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$10,305.17 ",IP,"8,813.70","10,305.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,,Relative Weights,"$25,806.61 ",IP,"22,093.20","25,806.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,,Relative Weights,"$15,683.48 ",IP,"13,434.30","15,683.48",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$11,606.87 ",IP,"9,939.60","11,606.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,,Relative Weights,"$31,656.34 ",IP,"27,224.10","31,656.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,,Relative Weights,"$18,762.51 ",IP,"16,063.20","18,762.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,,Relative Weights,"$14,302.86 ",IP,"12,241.80","14,302.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,,Relative Weights,"$45,158.40 ",IP,"38,770.20","45,158.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,,Relative Weights,"$23,715.69 ",IP,"20,416.50","23,715.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,090.30 ",IP,"12,141.90","14,090.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,,Relative Weights,"$20,438.82 ",IP,"17,541.90","20,438.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,,Relative Weights,"$11,331.17 ",IP,"9,694.80","11,331.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,,Relative Weights,"$7,866.99 ",IP,"6,732.90","7,866.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,,Relative Weights,"$18,186.90 ",IP,"15,580.80","18,186.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,,Relative Weights,"$10,813.43 ",IP,"9,263.70","10,813.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,,Relative Weights,"$7,823.85 ",IP,"6,701.40","7,823.85",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,,Relative Weights,"$21,760.51 ",IP,"18,663.30","21,760.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,,Relative Weights,"$12,679.16 ",IP,"10,868.40","12,679.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$9,420.19 ",IP,"8,090.10","9,420.19",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,,Relative Weights,"$18,929.82 ",IP,"16,210.80","18,929.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,,Relative Weights,"$10,451.44 ",IP,"8,941.50","10,451.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,,Relative Weights,"$6,704.20 ",IP,"5,734.80","6,704.20",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,,Relative Weights,"$19,815.86 ",IP,"16,979.40","19,815.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,,Relative Weights,"$11,151.22 ",IP,"9,533.70","11,151.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,,Relative Weights,"$8,084.82 ",IP,"6,917.40","8,084.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,,Relative Weights,"$13,794.60 ",IP,"11,813.40","13,794.60",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,,Relative Weights,"$9,390.73 ",IP,"8,035.20","9,390.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,,Relative Weights,"$17,037.79 ",IP,"14,600.70","17,037.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,,Relative Weights,"$10,454.60 ",IP,"8,955.90","10,454.60",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,,Relative Weights,"$7,508.16 ",IP,"6,432.30","7,508.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,,Relative Weights,"$15,908.67 ",IP,"13,631.40","15,908.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,,Relative Weights,"$8,647.80 ",IP,"7,408.80","8,647.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,,Relative Weights,"$6,130.70 ",IP,"5,247.90","6,130.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,,Relative Weights,"$13,094.82 ",IP,"11,242.80","13,094.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,,Relative Weights,"$8,043.78 ",IP,"6,892.20","8,043.78",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,,Relative Weights,"$17,400.83 ",IP,"14,950.80","17,400.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,,Relative Weights,"$9,876.89 ",IP,"8,468.10","9,876.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$6,836.79 ",IP,"5,863.50","6,836.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,,Relative Weights,"$60,302.05 ",IP,"51,638.40","60,302.05",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,,Relative Weights,"$30,274.67 ",IP,"25,928.10","30,274.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$22,266.67 ",IP,"19,062.00","22,266.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,,Relative Weights,"$39,455.99 ",IP,"33,776.10","39,455.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,,Relative Weights,"$22,248.78 ",IP,"19,047.60","22,248.78",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,,Relative Weights,"$16,475.86 ",IP,"14,114.70","16,475.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,,Relative Weights,"$39,486.51 ",IP,"33,781.50","39,486.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,,Relative Weights,"$23,947.19 ",IP,"20,497.50","23,947.19",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,,Relative Weights,"$18,219.52 ",IP,"15,578.10","18,219.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,,Relative Weights,"$38,151.14 ",IP,"32,654.70","38,151.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,,Relative Weights,"$21,381.68 ",IP,"18,285.30","21,381.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,,Relative Weights,"$14,965.81 ",IP,"12,800.70","14,965.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,,Relative Weights,"$25,502.49 ",IP,"21,818.70","25,502.49",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,,Relative Weights,"$17,763.88 ",IP,"15,201.00","17,763.88",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,,Relative Weights,"$13,839.85 ",IP,"11,837.70","13,839.85",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,,Relative Weights,"$36,978.87 ",IP,"31,648.50","36,978.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,,Relative Weights,"$20,087.35 ",IP,"17,167.50","20,087.35",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$15,273.08 ",IP,"13,082.40","15,273.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,,Relative Weights,"$43,975.62 ",IP,"37,673.10","43,975.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,,Relative Weights,"$24,009.28 ",IP,"20,556.90","24,009.28",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$16,240.15 ",IP,"13,884.30","16,240.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,,Relative Weights,"$19,805.34 ",IP,"16,927.20","19,805.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,,Relative Weights,"$10,822.91 ",IP,"9,269.10","10,822.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,,Relative Weights,"$6,520.05 ",IP,"5,586.30","6,520.05",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,,Relative Weights,"$18,444.71 ",IP,"15,780.60","18,444.71",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,,Relative Weights,"$11,787.86 ",IP,"10,093.50","11,787.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,,Relative Weights,"$9,412.82 ",IP,"8,063.10","9,412.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,,Relative Weights,"$16,797.86 ",IP,"14,380.20","16,797.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,,Relative Weights,"$8,885.62 ",IP,"7,606.80","8,885.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$6,375.89 ",IP,"5,456.70","6,375.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,,Relative Weights,"$19,822.18 ",IP,"16,915.50","19,822.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,,Relative Weights,"$9,803.23 ",IP,"8,370.00","9,803.23",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,,Relative Weights,"$6,974.64 ",IP,"5,968.80","6,974.64",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,,Relative Weights,"$17,560.78 ",IP,"15,044.40","17,560.78",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,,Relative Weights,"$11,331.17 ",IP,"9,697.50","11,331.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,,Relative Weights,"$8,588.87 ",IP,"7,349.40","8,588.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,,Relative Weights,"$96,744.25 ",IP,"82,692.00","96,744.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,,Relative Weights,"$64,170.31 ",IP,"54,837.90","64,170.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,,Relative Weights,"$50,415.69 ",IP,"43,031.70","50,415.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,,Relative Weights,"$90,477.81 ",IP,"77,400.00","90,477.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,,Relative Weights,"$68,420.55 ",IP,"58,463.10","68,420.55",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,,Relative Weights,"$52,798.10 ",IP,"45,068.40","52,798.10",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,,Relative Weights,"$70,838.73 ",IP,"60,601.50","70,838.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,,Relative Weights,"$41,383.80 ",IP,"35,376.30","41,383.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,,Relative Weights,"$63,939.85 ",IP,"54,735.30","63,939.85",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,,Relative Weights,"$33,086.42 ",IP,"28,272.60","33,086.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,,Relative Weights,"$56,460.10 ",IP,"48,332.70","56,460.10",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,,Relative Weights,"$31,300.66 ",IP,"26,783.10","31,300.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,Relative Weights,"$19,400.20 ",IP,"16,596.90","19,400.20",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,,Relative Weights,"$56,245.44 ",IP,"48,111.30","56,245.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,,Relative Weights,"$37,632.35 ",IP,"32,197.50","37,632.35",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,,Relative Weights,"$29,506.49 ",IP,"25,221.60","29,506.49",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,,Relative Weights,"$32,457.14 ",IP,"27,773.10","32,457.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,,Relative Weights,"$19,992.65 ",IP,"17,102.70","19,992.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,,Relative Weights,"$52,791.79 ",IP,"45,177.30","52,791.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,,Relative Weights,"$32,128.82 ",IP,"27,483.30","32,128.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,,Relative Weights,"$26,730.52 ",IP,"22,851.00","26,730.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,,Relative Weights,"$42,858.07 ",IP,"36,684.90","42,858.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,,Relative Weights,"$23,083.25 ",IP,"19,766.70","23,083.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,Relative Weights,"$12,204.58 ",IP,"10,442.70","12,204.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,,Relative Weights,"$35,324.66 ",IP,"30,230.10","35,324.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,,Relative Weights,"$24,801.66 ",IP,"21,225.60","24,801.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,,Relative Weights,"$19,039.26 ",IP,"16,285.50","19,039.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,,Relative Weights,"$31,826.81 ",IP,"27,232.20","31,826.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,,Relative Weights,"$22,050.95 ",IP,"18,864.90","22,050.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,,Relative Weights,"$17,329.28 ",IP,"14,812.20","17,329.28",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,,Relative Weights,"$25,111.03 ",IP,"21,471.30","25,111.03",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,,Relative Weights,"$35,858.17 ",IP,"30,686.40","35,858.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,,Relative Weights,"$22,607.61 ",IP,"19,344.60","22,607.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,,Relative Weights,"$17,260.88 ",IP,"14,761.80","17,260.88",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,,Relative Weights,"$20,778.72 ",IP,"17,781.30","20,778.72",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,,Relative Weights,"$13,660.96 ",IP,"11,683.80","13,660.96",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,,Relative Weights,"$36,495.87 ",IP,"31,230.00","36,495.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,,Relative Weights,"$24,468.08 ",IP,"20,932.20","24,468.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,,Relative Weights,"$19,487.54 ",IP,"16,665.30","19,487.54",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,,Relative Weights,"$38,242.69 ",IP,"32,777.10","38,242.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,,Relative Weights,"$20,894.47 ",IP,"17,877.60","20,894.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,,Relative Weights,"$15,349.90 ",IP,"13,063.50","15,349.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,,Relative Weights,"$27,194.59 ",IP,"23,253.30","27,194.59",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,,Relative Weights,"$12,613.92 ",IP,"10,791.00","12,613.92",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,,Relative Weights,"$33,188.49 ",IP,"28,705.50","33,188.49",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,,Relative Weights,"$18,362.64 ",IP,"15,786.90","18,362.64",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,004.01 ",IP,"11,995.20","14,004.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-503,FOOT PROCEDURES WITH MCC,,Relative Weights,"$27,661.81 ",IP,"23,765.40","27,661.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-504,FOOT PROCEDURES WITH CC,,Relative Weights,"$18,666.75 ",IP,"15,975.00","18,666.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$18,666.75 ",IP,"15,975.00","18,666.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,,Relative Weights,"$15,528.79 ",IP,"13,352.40","15,528.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,,Relative Weights,"$21,280.66 ",IP,"18,548.10","21,280.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,879.52 ",IP,"12,687.30","14,879.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-509,ARTHROSCOPY,,Relative Weights,"$17,613.40 ",IP,"15,178.50","17,613.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,,Relative Weights,"$28,735.16 ",IP,"24,693.30","28,735.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,,Relative Weights,"$20,714.53 ",IP,"17,706.60","20,714.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$16,375.89 ",IP,"13,990.50","16,375.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,,Relative Weights,"$16,405.36 ",IP,"14,148.00","16,405.36",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$10,461.97 ",IP,"8,991.90","10,461.97",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,,Relative Weights,"$33,010.65 ",IP,"28,265.40","33,010.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,,Relative Weights,"$20,636.66 ",IP,"17,665.20","20,636.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,697.47 ",IP,"12,583.80","14,697.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,,Relative Weights,"$37,717.59 ",IP,"32,282.10","37,717.59",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,,Relative Weights,"$20,600.88 ",IP,"17,640.00","20,600.88",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,,Relative Weights,"$14,915.30 ",IP,"12,764.70","14,915.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,Relative Weights,"$32,236.16 ",IP,"27,595.80","32,236.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,Relative Weights,"$23,035.90 ",IP,"19,704.60","23,035.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,,Relative Weights,"$14,864.79 ",IP,"12,745.80","14,864.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,,Relative Weights,"$8,298.44 ",IP,"7,111.80","8,298.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,,Relative Weights,"$12,983.28 ",IP,"11,095.20","12,983.28",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,,Relative Weights,"$8,119.55 ",IP,"6,945.30","8,119.55",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,,Relative Weights,"$9,820.06 ",IP,"8,418.60","9,820.06",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,,Relative Weights,"$7,591.29 ",IP,"6,508.80","7,591.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-539,OSTEOMYELITIS WITH MCC,,Relative Weights,"$20,427.25 ",IP,"17,529.30","20,427.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-540,OSTEOMYELITIS WITH CC,,Relative Weights,"$13,630.44 ",IP,"11,714.40","13,630.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,,Relative Weights,"$8,845.63 ",IP,"7,588.80","8,845.63",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,,Relative Weights,"$18,997.17 ",IP,"16,282.80","18,997.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,,Relative Weights,"$10,978.65 ",IP,"9,406.80","10,978.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$8,167.95 ",IP,"6,999.30","8,167.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,,Relative Weights,"$26,302.24 ",IP,"22,527.90","26,302.24",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,,Relative Weights,"$12,697.05 ",IP,"10,872.00","12,697.05",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,Relative Weights,"$8,765.66 ",IP,"7,502.40","8,765.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,,Relative Weights,"$21,357.48 ",IP,"18,457.20","21,357.48",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,,Relative Weights,"$13,121.13 ",IP,"11,249.10","13,121.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,,Relative Weights,"$9,288.65 ",IP,"7,910.10","9,288.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,,Relative Weights,"$17,079.88 ",IP,"14,646.60","17,079.88",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,,Relative Weights,"$9,912.67 ",IP,"8,490.60","9,912.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,,Relative Weights,"$13,346.32 ",IP,"11,443.50","13,346.32",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,,Relative Weights,"$8,317.38 ",IP,"7,132.50","8,317.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,,Relative Weights,"$14,340.74 ",IP,"12,316.50","14,340.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,,Relative Weights,"$8,484.69 ",IP,"7,278.30","8,484.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,,Relative Weights,"$14,668.01 ",IP,"12,591.90","14,668.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,,Relative Weights,"$9,031.89 ",IP,"7,752.60","9,031.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,,Relative Weights,"$19,655.91 ",IP,"16,787.70","19,655.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,,Relative Weights,"$11,326.96 ",IP,"9,684.00","11,326.96",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,,Relative Weights,"$8,324.75 ",IP,"7,131.60","8,324.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,,Relative Weights,"$14,816.38 ",IP,"12,706.20","14,816.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,,Relative Weights,"$9,163.43 ",IP,"7,849.80","9,163.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,,Relative Weights,"$15,929.72 ",IP,"13,712.40","15,929.72",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,,Relative Weights,"$10,589.29 ",IP,"9,083.70","10,589.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$7,908.03 ",IP,"6,767.10","7,908.03",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,,Relative Weights,"$29,846.38 ",IP,"25,575.30","29,846.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,,Relative Weights,"$17,181.95 ",IP,"14,718.60","17,181.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,,Relative Weights,"$11,602.66 ",IP,"9,939.60","11,602.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,,Relative Weights,"$58,269.01 ",IP,"49,851.90","58,269.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,,Relative Weights,"$34,181.86 ",IP,"29,218.50","34,181.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,,Relative Weights,"$18,536.26 ",IP,"15,868.80","18,536.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,,Relative Weights,"$53,150.62 ",IP,"45,573.30","53,150.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,,Relative Weights,"$26,873.64 ",IP,"22,946.40","26,873.64",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,,Relative Weights,"$17,159.86 ",IP,"14,356.80","17,159.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,,Relative Weights,"$30,809.24 ",IP,"28,304.10","30,809.24",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,,Relative Weights,"$16,839.96 ",IP,"15,559.20","16,839.96",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$13,175.85 ",IP,"12,391.20","13,401.77",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,,Relative Weights,"$17,213.52 ",IP,"14,787.90","17,213.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$16,183.32 ",IP,"13,873.50","16,183.32",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,,Relative Weights,"$19,197.11 ",IP,"16,530.30","19,197.11",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$18,274.24 ",IP,"15,656.40","18,274.24",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-592,SKIN ULCERS WITH MCC,,Relative Weights,"$17,749.14 ",IP,"15,248.70","17,749.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-593,SKIN ULCERS WITH CC,,Relative Weights,"$11,962.55 ",IP,"10,265.40","11,962.55",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,,Relative Weights,"$8,615.18 ",IP,"7,344.00","8,615.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,,Relative Weights,"$21,173.33 ",IP,"18,148.50","21,173.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,,Relative Weights,"$10,409.35 ",IP,"8,952.30","10,409.35",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,,Relative Weights,"$17,222.99 ",IP,"14,796.00","17,222.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,,Relative Weights,"$11,693.16 ",IP,"10,016.10","11,693.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,,Relative Weights,"$7,063.04 ",IP,"6,042.60","7,063.04",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,,Relative Weights,"$10,477.75 ",IP,"8,972.10","10,477.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,,Relative Weights,"$7,235.61 ",IP,"6,181.20","7,235.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-602,CELLULITIS WITH MCC,,Relative Weights,"$15,117.34 ",IP,"13,050.00","15,117.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-603,CELLULITIS WITHOUT MCC,,Relative Weights,"$8,889.83 ",IP,"7,682.40","8,889.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,,Relative Weights,"$15,692.95 ",IP,"13,301.10","15,692.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,,Relative Weights,"$9,567.51 ",IP,"8,135.10","9,567.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,,Relative Weights,"$15,900.25 ",IP,"13,608.90","15,900.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,,Relative Weights,"$8,687.79 ",IP,"7,453.80","8,687.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,,Relative Weights,"$25,116.30 ",IP,"21,507.30","25,116.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$16,564.25 ",IP,"14,175.00","16,564.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,,Relative Weights,"$41,974.14 ",IP,"35,695.80","41,974.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,,Relative Weights,"$21,404.83 ",IP,"18,268.20","21,404.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,,Relative Weights,"$13,711.47 ",IP,"11,728.80","13,711.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,,Relative Weights,"$32,211.96 ",IP,"27,555.30","32,211.96",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,,Relative Weights,"$18,532.06 ",IP,"15,864.30","18,532.06",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,,Relative Weights,"$16,798.92 ",IP,"14,373.90","16,798.92",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,,Relative Weights,"$38,017.49 ",IP,"32,534.10","38,017.49",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,,Relative Weights,"$19,708.53 ",IP,"16,843.50","19,708.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,,Relative Weights,"$11,515.32 ",IP,"9,890.10","11,515.32",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,,Relative Weights,"$29,897.95 ",IP,"25,561.80","29,897.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,,Relative Weights,"$17,387.15 ",IP,"14,876.10","17,387.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$12,436.08 ",IP,"10,645.20","12,436.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,,Relative Weights,"$38,915.11 ",IP,"33,114.60","38,915.11",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,,Relative Weights,"$24,695.38 ",IP,"21,107.70","24,695.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,804.81 ",IP,"12,683.70","14,804.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-637,DIABETES WITH MCC,,Relative Weights,"$14,465.97 ",IP,"12,389.40","14,465.97",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-638,DIABETES WITH CC,,Relative Weights,"$9,253.93 ",IP,"7,914.60","9,253.93",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-639,DIABETES WITHOUT CC/MCC,,Relative Weights,"$6,411.66 ",IP,"5,486.40","6,411.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,,Relative Weights,"$12,920.14 ",IP,"11,077.20","12,920.14",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,,Relative Weights,"$7,923.82 ",IP,"6,787.80","7,923.82",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,,Relative Weights,"$13,548.36 ",IP,"11,608.20","13,548.36",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,,Relative Weights,"$17,502.91 ",IP,"15,009.30","17,502.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,,Relative Weights,"$10,715.57 ",IP,"9,178.20","10,715.57",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,,Relative Weights,"$8,079.56 ",IP,"6,917.40","8,079.56",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,Relative Weights,"$47,491.35 ",IP,"40,686.30","47,491.35",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,Relative Weights,"$38,867.75 ",IP,"33,285.60","38,867.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-652,KIDNEY TRANSPLANT,,Relative Weights,"$33,483.13 ",IP,"28,665.90","33,483.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,,Relative Weights,"$57,341.93 ",IP,"49,132.80","57,341.93",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,,Relative Weights,"$30,518.80 ",IP,"26,125.20","30,518.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$21,888.89 ",IP,"18,722.70","21,888.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,,Relative Weights,"$34,533.33 ",IP,"29,565.00","34,533.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,,Relative Weights,"$20,352.53 ",IP,"17,412.30","20,352.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,,Relative Weights,"$16,616.87 ",IP,"14,201.10","16,616.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,,Relative Weights,"$28,041.69 ",IP,"23,997.60","28,041.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,,Relative Weights,"$15,188.90 ",IP,"12,987.90","15,188.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,,Relative Weights,"$11,200.68 ",IP,"9,573.30","11,200.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,,Relative Weights,"$30,830.29 ",IP,"26,435.70","30,830.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,,Relative Weights,"$16,783.13 ",IP,"14,395.50","16,783.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$12,461.34 ",IP,"10,654.20","12,461.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-665,PROSTATECTOMY WITH MCC,,Relative Weights,"$31,955.19 ",IP,"27,375.30","31,955.19",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-666,PROSTATECTOMY WITH CC,,Relative Weights,"$18,250.04 ",IP,"15,657.30","18,250.04",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,,Relative Weights,"$10,469.33 ",IP,"8,977.50","10,469.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,,Relative Weights,"$28,991.92 ",IP,"25,256.70","28,991.92",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,,Relative Weights,"$16,120.18 ",IP,"14,071.50","16,120.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$10,275.71 ",IP,"8,806.50","10,275.71",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,,Relative Weights,"$18,696.21 ",IP,"16,031.70","18,696.21",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$12,110.92 ",IP,"10,353.60","12,110.92",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,,Relative Weights,"$36,442.20 ",IP,"31,214.70","36,442.20",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,,Relative Weights,"$25,048.95 ",IP,"21,448.80","25,048.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$18,436.30 ",IP,"15,792.30","18,436.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-682,RENAL FAILURE WITH MCC,,Relative Weights,"$15,470.91 ",IP,"13,254.30","15,470.91",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-683,RENAL FAILURE WITH CC,,Relative Weights,"$9,240.25 ",IP,"7,913.70","9,240.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,,Relative Weights,"$6,392.72 ",IP,"5,471.10","6,392.72",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,,Relative Weights,"$19,711.68 ",IP,"16,877.70","19,711.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,,Relative Weights,"$11,026.00 ",IP,"9,450.90","11,026.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,,Relative Weights,"$7,211.41 ",IP,"6,172.20","7,211.41",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,,Relative Weights,"$11,694.21 ",IP,"10,027.80","11,694.21",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,,Relative Weights,"$8,336.32 ",IP,"7,146.00","8,336.32",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-693,URINARY STONES WITH MCC,,Relative Weights,"$13,351.58 ",IP,"12,019.50","13,351.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-694,URINARY STONES WITHOUT MCC,,Relative Weights,"$7,674.42 ",IP,"6,940.80","7,674.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,,Relative Weights,"$11,957.28 ",IP,"10,239.30","11,957.28",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,,Relative Weights,"$7,257.71 ",IP,"6,227.10","7,257.71",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-697,URETHRAL STRICTURE,,Relative Weights,"$10,491.43 ",IP,"8,993.70","10,491.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,,Relative Weights,"$16,907.30 ",IP,"14,495.40","16,907.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,,Relative Weights,"$10,788.18 ",IP,"9,243.00","10,788.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$7,837.53 ",IP,"6,718.50","7,837.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,,Relative Weights,"$20,210.47 ",IP,"17,299.80","20,210.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$15,694.00 ",IP,"13,420.80","15,694.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,,Relative Weights,"$24,328.12 ",IP,"20,843.10","24,328.12",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$16,835.75 ",IP,"14,414.40","16,835.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,,Relative Weights,"$22,417.15 ",IP,"19,184.40","22,417.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$11,128.07 ",IP,"9,540.00","11,128.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,,Relative Weights,"$15,696.11 ",IP,"13,440.60","15,696.11",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,,Relative Weights,"$9,770.61 ",IP,"8,359.20","9,770.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,,Relative Weights,"$21,244.88 ",IP,"18,194.40","21,244.88",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$13,432.61 ",IP,"11,482.20","13,432.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,,Relative Weights,"$18,925.62 ",IP,"16,205.40","18,925.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$13,008.53 ",IP,"11,111.40","13,008.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,,Relative Weights,"$17,983.81 ",IP,"15,413.40","17,983.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,,Relative Weights,"$11,460.60 ",IP,"9,827.10","11,460.60",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,,Relative Weights,"$6,833.64 ",IP,"5,832.90","6,833.64",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,,Relative Weights,"$13,489.43 ",IP,"11,569.50","13,489.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,,Relative Weights,"$7,821.75 ",IP,"6,702.30","7,821.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,,Relative Weights,"$14,922.67 ",IP,"12,789.00","14,922.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,,Relative Weights,"$8,455.23 ",IP,"7,251.30","8,455.23",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,,Relative Weights,"$10,573.51 ",IP,"9,067.50","10,573.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$5,952.86 ",IP,"5,120.10","5,952.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,,Relative Weights,"$23,390.52 ",IP,"20,018.70","23,390.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,,Relative Weights,"$14,874.26 ",IP,"12,722.40","14,874.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,,Relative Weights,"$44,809.04 ",IP,"38,346.30","44,809.04",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,,Relative Weights,"$21,658.44 ",IP,"18,522.90","21,658.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$15,538.26 ",IP,"13,283.10","15,538.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,,Relative Weights,"$40,215.75 ",IP,"34,416.00","40,215.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,,Relative Weights,"$18,941.40 ",IP,"16,214.40","18,941.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,,Relative Weights,"$13,464.18 ",IP,"11,519.10","13,464.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Hysterectomy,Per Case,"$11,830.00 ",IP,"11,830.00","16,723.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Hysterectomy,Per Case,"$11,830.00 ",IP,"10,195.20","11,830.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,,Relative Weights,"$18,878.26 ",IP,"16,158.60","18,878.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,,Relative Weights,"$12,317.17 ",IP,"10,530.00","12,317.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,,Relative Weights,"$16,935.72 ",IP,"14,503.50","16,935.72",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$9,870.57 ",IP,"8,451.90","9,870.57",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$14,188.16 ",IP,"12,128.40","14,188.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,,Relative Weights,"$28,489.97 ",IP,"24,424.20","28,489.97",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$15,425.67 ",IP,"13,174.20","15,425.67",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,,Relative Weights,"$19,162.38 ",IP,"16,435.80","19,162.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,,Relative Weights,"$11,865.73 ",IP,"10,163.70","11,865.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,,Relative Weights,"$9,640.12 ",IP,"8,265.60","9,640.12",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,,Relative Weights,"$16,017.06 ",IP,"13,722.30","16,017.06",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,,Relative Weights,"$10,175.74 ",IP,"8,727.30","10,175.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,,Relative Weights,"$7,189.31 ",IP,"6,150.60","7,189.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,,Relative Weights,"$9,708.52 ",IP,"8,280.90","9,708.52",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,,Relative Weights,"$6,208.57 ",IP,"5,317.20","6,208.57",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,,Relative Weights,"$12,320.33 ",IP,"3,245.00","12,320.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Vaginal Delivery,Per Diem,"$3,258.00 ",IP,"3,245.00","12,320.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,,Relative Weights,"$17,051.47 ",IP,"14,558.40","17,051.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$9,345.48 ",IP,"8,008.20","9,345.48",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,,Relative Weights,"$8,090.08 ",IP,"6,970.50","8,090.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-779,ABORTION WITHOUT D&C,,Relative Weights,"$10,948.13 ",IP,"9,531.00","10,948.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,,Relative Weights,"$19,706.42 ",IP,"4,275.00","19,706.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,C-Section,Per Diem,"$4,275.00 ",IP,"4,275.00","19,706.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,,Relative Weights,"$11,521.63 ",IP,"4,275.00","11,521.63",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,C-Section,Per Diem,"$4,275.00 ",IP,"4,275.00","11,521.63",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,,Relative Weights,"$9,631.70 ",IP,"4,275.00","9,631.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$4,275.00 ",IP,"4,275.00","9,631.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,,Relative Weights,"$16,743.15 ",IP,"4,275.00","16,743.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,C-Section,Per Diem,"$4,275.00 ",IP,"4,275.00","16,743.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,,Relative Weights,"$11,182.79 ",IP,"4,275.00","11,182.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,C-Section,Per Diem,"$4,275.00 ",IP,"4,275.00","11,182.79",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,,Relative Weights,"$9,334.95 ",IP,"4,275.00","9,334.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,C-Section,Per Diem,"$4,275.00 ",IP,"4,275.00","9,334.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-789,NEONATES- DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY,,Relative Weights,"$18,083.78 ",IP,"15,480.00","18,083.78",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-790,EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME- NEONATE,,Relative Weights,"$59,634.89 ",IP,"51,048.90","59,634.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-791,PREMATURITY WITH MAJOR PROBLEMS,,Relative Weights,"$40,728.22 ",IP,"34,864.20","40,728.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-792,PREMATURITY WITHOUT MAJOR PROBLEMS,,Relative Weights,"$24,574.36 ",IP,"21,036.60","24,574.36",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-793,FULL TERM NEONATE WITH MAJOR PROBLEMS,,Relative Weights,"$41,836.29 ",IP,"35,812.80","41,836.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,,Relative Weights,"$14,807.97 ",IP,"12,675.60","14,807.97",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-795,NORMAL NEWBORN,,Relative Weights,"$2,004.63 ",IP,"1,716.30","2,004.63",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,,Relative Weights,"$11,237.51 ",IP,"3,245.00","11,237.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Vaginal Delivery,Per Diem,"$3,258.00 ",IP,"3,245.00","11,237.51",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,,Relative Weights,"$9,680.11 ",IP,"3,245.00","9,680.11",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Vaginal Delivery,Per Diem,"$3,258.00 ",IP,"3,245.00","9,680.11",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,,Relative Weights,"$8,705.68 ",IP,"3,245.00","8,705.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Diem,"$3,258.00 ",IP,"3,245.00","8,705.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-799,SPLENECTOMY WITH MCC,,Relative Weights,"$54,129.26 ",IP,"46,326.60","54,129.26",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-800,SPLENECTOMY WITH CC,,Relative Weights,"$31,057.58 ",IP,"26,585.10","31,057.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,,Relative Weights,"$17,715.47 ",IP,"15,156.00","17,715.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,,Relative Weights,"$39,026.65 ",IP,"33,405.30","39,026.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,,Relative Weights,"$19,833.75 ",IP,"16,978.50","19,833.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,,Relative Weights,"$14,355.48 ",IP,"12,293.10","14,355.48",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,,Relative Weights,"$10,805.02 ",IP,"3,245.00","10,805.02",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Vaginal Delivery,Per Diem,"$3,258.00 ",IP,"3,245.00","10,805.02",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,,Relative Weights,"$7,722.83 ",IP,"3,245.00","7,722.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Vaginal Delivery,Per Diem,"$3,258.00 ",IP,"3,245.00","7,722.83",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,,Relative Weights,"$6,746.30 ",IP,"3,245.00","6,746.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Vaginal Delivery,Per Diem,"$3,258.00 ",IP,"3,245.00","6,746.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,,Relative Weights,"$22,918.04 ",IP,"19,672.20","22,918.04",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,,Relative Weights,"$12,855.95 ",IP,"11,010.60","12,855.95",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,,Relative Weights,"$10,109.45 ",IP,"8,655.30","10,109.45",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,,Relative Weights,"$14,496.48 ",IP,"12,413.70","14,496.48",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,,Relative Weights,"$9,257.08 ",IP,"7,922.70","9,257.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-813,COAGULATION DISORDERS,,Relative Weights,"$16,254.88 ",IP,"13,905.90","16,254.88",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,,Relative Weights,"$19,896.89 ",IP,"17,025.30","19,896.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,,Relative Weights,"$10,444.08 ",IP,"8,940.60","10,444.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,,Relative Weights,"$6,954.65 ",IP,"5,949.90","6,954.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,,Relative Weights,"$24,221.84 ",IP,"20,761.20","24,221.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,,Relative Weights,"$13,853.53 ",IP,"12,238.20","13,853.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$10,500.90 ",IP,"8,884.80","10,500.90",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,,Relative Weights,"$59,847.46 ",IP,"51,225.30","59,847.46",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,,Relative Weights,"$22,678.12 ",IP,"19,396.80","22,678.12",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$13,170.59 ",IP,"11,263.50","13,170.59",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,,Relative Weights,"$47,322.98 ",IP,"40,516.20","47,322.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,,Relative Weights,"$24,862.69 ",IP,"21,279.60","24,862.69",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,739.57 ",IP,"12,613.50","14,739.57",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,,Relative Weights,"$53,002.25 ",IP,"45,400.50","53,002.25",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,,Relative Weights,"$26,282.24 ",IP,"22,505.40","26,282.24",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$17,654.44 ",IP,"15,066.00","17,654.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,,Relative Weights,"$33,733.58 ",IP,"28,875.60","33,733.58",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$15,537.21 ",IP,"13,338.00","15,537.21",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,,Relative Weights,"$11,797.34 ",IP,"10,096.20","11,797.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,,Relative Weights,"$8,205.84 ",IP,"7,004.70","8,205.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$5,640.33 ",IP,"4,833.00","5,640.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,,Relative Weights,"$63,665.20 ",IP,"54,469.80","63,665.20",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,,Relative Weights,"$22,242.47 ",IP,"19,023.30","22,242.47",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$12,307.70 ",IP,"10,561.50","12,307.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,,Relative Weights,"$59,972.68 ",IP,"51,293.70","59,972.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,,Relative Weights,"$23,769.35 ",IP,"20,341.80","23,769.35",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,,Relative Weights,"$15,640.33 ",IP,"13,384.80","15,640.33",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,,Relative Weights,"$33,838.81 ",IP,"28,984.50","33,838.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,,Relative Weights,"$17,055.68 ",IP,"14,594.40","17,055.68",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,,Relative Weights,"$11,525.84 ",IP,"9,873.00","11,525.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,,Relative Weights,"$20,024.22 ",IP,"17,168.40","20,024.22",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,,Relative Weights,"$12,422.40 ",IP,"10,657.80","12,422.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$8,917.19 ",IP,"7,640.10","8,917.19",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,,Relative Weights,"$28,095.36 ",IP,"24,056.10","28,095.36",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,,Relative Weights,"$14,050.31 ",IP,"12,024.90","14,050.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,,Relative Weights,"$10,828.17 ",IP,"9,290.70","10,828.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-849,RADIOTHERAPY,,Relative Weights,"$26,175.96 ",IP,"22,442.40","26,175.96",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,,Relative Weights,"$52,032.03 ",IP,"44,710.20","52,032.03",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,,Relative Weights,"$22,039.37 ",IP,"19,099.80","22,039.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$15,731.89 ",IP,"13,678.20","15,731.89",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,,Relative Weights,"$47,834.40 ",IP,"41,975.10","47,834.40",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,,Relative Weights,"$21,411.15 ",IP,"18,921.60","21,411.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,,Relative Weights,"$14,189.21 ",IP,"12,236.40","14,189.21",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,,Relative Weights,"$19,770.61 ",IP,"17,070.30","19,770.61",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,,Relative Weights,"$10,285.18 ",IP,"9,102.60","10,285.18",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,,Relative Weights,"$9,207.63 ",IP,"7,888.50","9,207.63",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-865,VIRAL ILLNESS WITH MCC,,Relative Weights,"$15,562.46 ",IP,"13,300.20","15,562.46",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,,Relative Weights,"$8,809.86 ",IP,"7,551.00","8,809.86",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,,Relative Weights,"$23,461.03 ",IP,"20,133.90","23,461.03",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,,Relative Weights,"$11,137.54 ",IP,"9,594.00","11,137.54",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,,Relative Weights,"$7,639.70 ",IP,"6,556.50","7,639.70",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,,Relative Weights,"$67,608.17 ",IP,"57,951.00","67,608.17",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,,Relative Weights,"$19,659.07 ",IP,"16,849.80","19,659.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,,Relative Weights,"$10,750.30 ",IP,"9,236.70","10,750.30",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,,Relative Weights,"$34,318.66 ",IP,"29,412.00","34,318.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-880,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,,Relative Weights,"$9,087.66 ",IP,"7,780.50","9,087.66",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-881,DEPRESSIVE NEUROSES,,Relative Weights,"$8,433.13 ",IP,"7,218.00","8,433.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-882,NEUROSES EXCEPT DEPRESSIVE,,Relative Weights,"$8,660.43 ",IP,"7,412.40","8,660.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-883,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,,Relative Weights,"$16,608.45 ",IP,"14,236.20","16,608.45",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-884,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,,Relative Weights,"$15,193.11 ",IP,"13,025.70","15,193.11",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-885,PSYCHOSES,,Relative Weights,"$13,018.00 ",IP,"11,154.60","13,018.00",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-886,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,,Relative Weights,"$12,853.84 ",IP,"11,013.30","12,853.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-887,OTHER MENTAL DISORDER DIAGNOSES,,Relative Weights,"$11,351.16 ",IP,"9,718.20","11,351.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-894,ALCOHOL- DRUG ABUSE OR DEPENDENCE- LEFT AMA,,Relative Weights,"$5,761.34 ",IP,"4,941.00","5,761.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-895,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,,Relative Weights,"$16,752.62 ",IP,"14,392.80","16,752.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-896,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC,,Relative Weights,"$18,699.37 ",IP,"16,022.70","18,699.37",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-897,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC,,Relative Weights,"$8,686.74 ",IP,"7,443.00","8,686.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,,Relative Weights,"$44,851.13 ",IP,"38,418.30","44,851.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,,Relative Weights,"$20,650.34 ",IP,"17,678.70","20,650.34",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,,Relative Weights,"$11,937.29 ",IP,"10,217.70","11,937.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,,Relative Weights,"$39,160.29 ",IP,"33,543.00","39,160.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,,Relative Weights,"$17,277.71 ",IP,"14,850.00","17,277.71",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-906,HAND PROCEDURES FOR INJURIES,,Relative Weights,"$18,876.16 ",IP,"16,234.20","18,876.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,,Relative Weights,"$41,640.56 ",IP,"35,533.80","41,640.56",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,,Relative Weights,"$21,471.13 ",IP,"18,453.60","21,471.13",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,,Relative Weights,"$14,468.07 ",IP,"12,339.00","14,468.07",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-913,TRAUMATIC INJURY WITH MCC,,Relative Weights,"$17,219.84 ",IP,"14,747.40","17,219.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,,Relative Weights,"$9,350.74 ",IP,"7,982.10","9,350.74",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,,Relative Weights,"$17,863.84 ",IP,"15,295.50","17,863.84",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,,Relative Weights,"$6,916.77 ",IP,"5,925.60","6,916.77",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,,Relative Weights,"$15,547.73 ",IP,"13,306.50","15,547.73",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,,Relative Weights,"$8,324.75 ",IP,"7,124.40","8,324.75",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,,Relative Weights,"$19,303.39 ",IP,"16,596.90","19,303.39",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,,Relative Weights,"$10,810.28 ",IP,"9,221.40","10,810.28",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,,Relative Weights,"$7,275.60 ",IP,"6,281.10","7,275.60",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,,Relative Weights,"$16,706.31 ",IP,"14,293.80","16,706.31",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,,Relative Weights,"$9,790.60 ",IP,"8,458.20","9,790.60",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,,Relative Weights,"$221,308.16 ",IP,"189,821.70","221,308.16",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,,Relative Weights,"$68,600.49 ",IP,"58,784.40","68,600.49",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,,Relative Weights,"$31,662.65 ",IP,"27,125.10","31,662.65",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,,Relative Weights,"$23,756.72 ",IP,"20,366.10","23,756.72",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,,Relative Weights,"$20,386.21 ",IP,"17,468.10","20,386.21",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-935,NON-EXTENSIVE BURNS,,Relative Weights,"$20,344.12 ",IP,"17,396.10","20,344.12",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,,Relative Weights,"$35,632.98 ",IP,"30,371.40","35,632.98",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,,Relative Weights,"$23,335.80 ",IP,"19,988.10","23,335.80",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,,Relative Weights,"$20,253.62 ",IP,"17,307.90","20,253.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-945,REHABILITATION WITH CC/MCC,,Relative Weights,"$15,623.50 ",IP,"13,337.10","15,623.50",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-946,REHABILITATION WITHOUT CC/MCC,,Relative Weights,"$11,861.53 ",IP,"10,135.80","11,861.53",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,,Relative Weights,"$12,523.42 ",IP,"10,746.00","12,523.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,,Relative Weights,"$8,266.87 ",IP,"7,083.90","8,266.87",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-949,AFTERCARE WITH CC/MCC,,Relative Weights,"$11,650.01 ",IP,"9,989.10","11,650.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,,Relative Weights,"$7,775.44 ",IP,"6,661.80","7,775.44",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$5,873.94 ",IP,"5,036.40","5,873.94",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$66,168.62 ",IP,"56,603.70","66,168.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$40,500.92 ",IP,"34,650.00","40,500.92",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,,Relative Weights,"$78,089.08 ",IP,"66,788.10","78,089.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,,Relative Weights,"$44,253.42 ",IP,"37,851.30","44,253.42",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,,Relative Weights,"$28,771.99 ",IP,"24,624.90","28,771.99",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,,Relative Weights,"$28,666.76 ",IP,"24,569.10","28,666.76",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,,Relative Weights,"$15,662.43 ",IP,"13,426.20","15,662.43",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,,Relative Weights,"$9,606.45 ",IP,"8,212.50","9,606.45",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,,Relative Weights,"$60,900.81 ",IP,"52,667.10","60,900.81",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,,Relative Weights,"$30,991.29 ",IP,"26,898.30","30,991.29",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,,Relative Weights,"$28,261.62 ",IP,"24,214.50","28,261.62",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,,Relative Weights,"$13,459.97 ",IP,"11,538.90","13,459.97",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,,Relative Weights,"$9,987.38 ",IP,"8,546.40","9,987.38",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,,Relative Weights,"$13,898.78 ",IP,"11,918.70","13,898.78",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,,Relative Weights,"$48,487.88 ",IP,"41,530.50","48,487.88",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,,Relative Weights,"$26,743.15 ",IP,"22,829.40","26,743.15",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,,Relative Weights,"$17,413.46 ",IP,"14,870.70","17,413.46",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,,Relative Weights,"$34,327.08 ",IP,"29,483.10","34,327.08",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,,Relative Weights,"$17,686.01 ",IP,"15,357.60","17,686.01",,,,,,,,,,,,,
Healthlink PPO,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,,Relative Weights,"$11,742.62 ",IP,"10,112.40","11,742.62",,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,274,Medical/Surgical Supplies: Prosthetic/Orthotic devices,Prosthetics and Orthotics,Straight Discount,60.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,275,Medical/Surgical Supplies: Pacemaker,Prosthetics and Orthotics,Straight Discount,60.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,276,Medical/Surgical Supplies: Intraocular lens,Prosthetics and Orthotics,Straight Discount,60.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,278,Medical/Surgical Supplies: Other implants,Implants,Straight Discount,60.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,360,Operating Room Services,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,450,Emergency Room,ER,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,490,Ambulatory Surgery,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,636,Drugs Require Specific ID: Drugs requiring detail coding,Drugs,Straight Discount,50.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,750,Gastrointestinal,Outpatient Surgery,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,760,Treatment/Observation Room,Observation,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,762,Treatment/Observation Room: Observation room,Observation,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,ExceptRevenueCode,769,Treatment/Observation Room: Other treatment room,Observation,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Healthlink PPO,CPT,29848,Wrist endoscopy/surgery,Carpal Tunnel,Per Case,"$4,174.00 ",OP,"4,174.00","4,174.00",,,,,,,,,,,,,
Healthlink PPO,CPT,44346,Revision of colostomy,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,47562,Laparoscopic cholecystectomy,Laparoscopic Cholecystostomy,Per Case,"$11,730.00 ",OP,"11,730.00","11,730.00",,,,,,,,,,,,,
Healthlink PPO,CPT,47563,Laparo cholecystectomy/graph,Laparoscopic Cholecystostomy,Per Case,"$11,730.00 ",OP,"11,730.00","11,730.00",,,,,,,,,,,,,
Healthlink PPO,CPT,47564,Laparo cholecystectomy/explr,Laparoscopic Cholecystostomy,Per Case,"$11,730.00 ",OP,"11,730.00","11,730.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49255,Removal of omentum,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49491,Rpr hern preemie reduc,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49492,Rpr ing hern premie blocked,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49495,Rpr ing hernia baby reduc,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49496,Rpr ing hernia baby blocked,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49500,Rpr ing hernia init reduce,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49501,Rpr ing hernia init blocked,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49505,Prp i/hern init reduc >5 yr,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49507,Prp i/hern init block >5 yr,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49520,Rerepair ing hernia reduce,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49521,Rerepair ing hernia blocked,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49650,Lap ing hernia repair init,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,CPT,49651,Lap ing hernia repair recur,Hernia,Per Case,"$7,751.00 ",OP,"7,751.00","7,751.00",,,,,,,,,,,,,
Healthlink PPO,,,,All Other,Straight Discount,70.00%,OP,,,,,,,,,,,,,,,
Meridian Medicaid,DRG,11,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$38,043.18 ",IP,"38,043.18","38,043.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,12,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$40,281.56 ",IP,"40,281.56","40,281.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,13,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$42,053.29 ",IP,"42,053.29","42,053.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,14,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$78,175.26 ",IP,"78,175.26","78,175.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,21,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$45,599.51 ",IP,"45,599.51","45,599.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,22,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$58,026.75 ",IP,"58,026.75","58,026.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,23,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$74,400.53 ",IP,"74,400.53","74,400.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,24,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$107,953.54 ",IP,"107,953.54","107,953.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,41,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$33,014.21 ",IP,"33,014.21","33,014.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,42,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$37,820.51 ",IP,"37,820.51","37,820.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,43,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$49,052.96 ",IP,"49,052.96","49,052.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,44,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$72,921.22 ",IP,"72,921.22","72,921.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,51,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$23,684.08 ",IP,"23,684.08","23,684.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,52,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$26,315.91 ",IP,"26,315.91","26,315.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,53,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$36,197.91 ",IP,"36,197.91","36,197.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,54,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$48,934.75 ",IP,"48,934.75","48,934.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,61,PANCREAS TRANSPLANT,,Relative Weights,"$40,520.03 ",IP,"40,520.03","40,520.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,62,PANCREAS TRANSPLANT,,Relative Weights,"$45,022.22 ",IP,"45,022.22","45,022.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,63,PANCREAS TRANSPLANT,,Relative Weights,"$47,794.94 ",IP,"47,794.94","47,794.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,64,PANCREAS TRANSPLANT,,Relative Weights,"$66,459.33 ",IP,"66,459.33","66,459.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,71,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$38,434.91 ",IP,"38,434.91","38,434.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,72,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$48,059.19 ",IP,"48,059.19","48,059.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,73,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$59,827.69 ",IP,"59,827.69","59,827.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,74,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$99,672.84 ",IP,"99,672.84","99,672.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,81,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$22,091.37 ",IP,"22,091.37","22,091.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,82,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$27,118.96 ",IP,"27,118.96","27,118.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,83,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$32,175.76 ",IP,"32,175.76","32,175.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,84,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$51,576.54 ",IP,"51,576.54","51,576.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,91,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$27,699.69 ",IP,"27,699.69","27,699.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,92,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$30,776.86 ",IP,"30,776.86","30,776.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,93,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$36,358.72 ",IP,"36,358.72","36,358.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,94,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$79,300.63 ",IP,"79,300.63","79,300.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,101,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$4,104.27 ",IP,"4,104.27","4,104.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,102,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$7,527.81 ",IP,"7,527.81","7,527.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,103,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$12,592.86 ",IP,"12,592.86","12,592.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,104,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$37,584.09 ",IP,"37,584.09","37,584.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,201,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$9,991.61 ",IP,"9,991.61","9,991.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,202,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$11,868.15 ",IP,"11,868.15","11,868.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,203,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$16,002.32 ",IP,"16,002.32","16,002.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,204,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$28,673.87 ",IP,"28,673.87","28,673.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,211,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$9,882.68 ",IP,"9,882.68","9,882.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,212,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$13,243.69 ",IP,"13,243.69","13,243.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,213,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$18,834.48 ",IP,"18,834.48","18,834.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,214,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$27,671.86 ",IP,"27,671.86","27,671.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,221,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$6,449.86 ",IP,"6,449.86","6,449.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,222,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$7,492.76 ",IP,"7,492.76","7,492.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,223,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$10,628.01 ",IP,"10,628.01","10,628.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,224,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$25,450.32 ",IP,"25,450.32","25,450.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,231,SPINAL PROCEDURES,,Relative Weights,"$7,646.71 ",IP,"7,646.71","7,646.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,232,SPINAL PROCEDURES,,Relative Weights,"$9,630.12 ",IP,"9,630.12","9,630.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,233,SPINAL PROCEDURES,,Relative Weights,"$16,000.26 ",IP,"16,000.26","16,000.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,234,SPINAL PROCEDURES,,Relative Weights,"$29,075.91 ",IP,"29,075.91","29,075.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,241,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$5,741.65 ",IP,"5,741.65","5,741.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,242,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$6,726.14 ",IP,"6,726.14","6,726.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,243,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$13,747.79 ",IP,"13,747.79","13,747.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,244,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$24,782.31 ",IP,"24,782.31","24,782.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,261,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$7,157.39 ",IP,"7,157.39","7,157.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,262,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$8,935.31 ",IP,"8,935.31","8,935.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,263,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$12,455.76 ",IP,"12,455.76","12,455.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,264,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$22,781.03 ",IP,"22,781.03","22,781.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,401,SPINAL DISORDERS and INJURIES,,Relative Weights,"$5,482.55 ",IP,"5,482.55","5,482.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,402,SPINAL DISORDERS and INJURIES,,Relative Weights,"$5,877.72 ",IP,"5,877.72","5,877.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,403,SPINAL DISORDERS and INJURIES,,Relative Weights,"$8,545.98 ",IP,"8,545.98","8,545.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,404,SPINAL DISORDERS and INJURIES,,Relative Weights,"$17,945.87 ",IP,"17,945.87","17,945.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,411,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$4,340.00 ",IP,"4,340.00","4,340.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,412,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$4,441.02 ",IP,"4,441.02","4,441.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,413,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$5,802.81 ",IP,"5,802.81","5,802.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,414,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$8,029.51 ",IP,"8,029.51","8,029.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,421,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$3,328.02 ",IP,"3,328.02","3,328.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,422,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$3,814.25 ",IP,"3,814.25","3,814.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,423,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$5,381.53 ",IP,"5,381.53","5,381.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,424,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$12,544.07 ",IP,"12,544.07","12,544.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,431,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$4,040.70 ",IP,"4,040.70","4,040.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,432,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$5,014.88 ",IP,"5,014.88","5,014.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,433,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$7,268.72 ",IP,"7,268.72","7,268.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,434,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$15,032.61 ",IP,"15,032.61","15,032.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,441,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$3,968.19 ",IP,"3,968.19","3,968.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,442,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$4,927.25 ",IP,"4,927.25","4,927.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,443,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$6,702.77 ",IP,"6,702.77","6,702.77",,,,,,,,,,,,,
Meridian Medicaid,DRG,444,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$9,326.01 ",IP,"9,326.01","9,326.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,451,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$3,612.20 ",IP,"3,612.20","3,612.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,452,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$4,429.34 ",IP,"4,429.34","4,429.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,453,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$5,951.60 ",IP,"5,951.60","5,951.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,454,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$10,976.10 ",IP,"10,976.10","10,976.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,461,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$3,784.70 ",IP,"3,784.70","3,784.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,462,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$4,264.40 ",IP,"4,264.40","4,264.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,463,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$5,292.53 ",IP,"5,292.53","5,292.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,464,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$10,621.82 ",IP,"10,621.82","10,621.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,471,TRANSIENT ISCHEMIA,,Relative Weights,"$3,321.15 ",IP,"3,321.15","3,321.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,472,TRANSIENT ISCHEMIA,,Relative Weights,"$3,597.42 ",IP,"3,597.42","3,597.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,473,TRANSIENT ISCHEMIA,,Relative Weights,"$4,242.41 ",IP,"4,242.41","4,242.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,474,TRANSIENT ISCHEMIA,,Relative Weights,"$7,719.21 ",IP,"7,719.21","7,719.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,481,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$3,400.87 ",IP,"3,400.87","3,400.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,482,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$3,627.32 ",IP,"3,627.32","3,627.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,483,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$4,545.48 ",IP,"4,545.48","4,545.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,484,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$10,429.39 ",IP,"10,429.39","10,429.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,491,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$5,943.01 ",IP,"5,943.01","5,943.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,492,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$9,716.03 ",IP,"9,716.03","9,716.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,493,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$11,066.13 ",IP,"11,066.13","11,066.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,494,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$20,732.33 ",IP,"20,732.33","20,732.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,501,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$3,211.53 ",IP,"3,211.53","3,211.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,502,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$6,688.34 ",IP,"6,688.34","6,688.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,503,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$10,165.49 ",IP,"10,165.49","10,165.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,504,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$22,308.54 ",IP,"22,308.54","22,308.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,511,VIRAL MENINGITIS,,Relative Weights,"$2,048.35 ",IP,"2,048.35","2,048.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,512,VIRAL MENINGITIS,,Relative Weights,"$3,205.00 ",IP,"3,205.00","3,205.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,513,VIRAL MENINGITIS,,Relative Weights,"$5,993.52 ",IP,"5,993.52","5,993.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,514,VIRAL MENINGITIS,,Relative Weights,"$12,441.32 ",IP,"12,441.32","12,441.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,521,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$3,101.91 ",IP,"3,101.91","3,101.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,522,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$3,492.61 ",IP,"3,492.61","3,492.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,523,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$4,423.15 ",IP,"4,423.15","4,423.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,524,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$9,303.33 ",IP,"9,303.33","9,303.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,531,SEIZURE,,Relative Weights,"$2,710.87 ",IP,"2,710.87","2,710.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,532,SEIZURE,,Relative Weights,"$3,311.87 ",IP,"3,311.87","3,311.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,533,SEIZURE,,Relative Weights,"$4,410.44 ",IP,"4,410.44","4,410.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,534,SEIZURE,,Relative Weights,"$10,918.03 ",IP,"10,918.03","10,918.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,541,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$2,681.66 ",IP,"2,681.66","2,681.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,542,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$3,180.26 ",IP,"3,180.26","3,180.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,543,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$3,960.98 ",IP,"3,960.98","3,960.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,544,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$6,681.46 ",IP,"6,681.46","6,681.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,551,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$3,376.47 ",IP,"3,376.47","3,376.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,552,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$4,570.57 ",IP,"4,570.57","4,570.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,553,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$6,561.54 ",IP,"6,561.54","6,561.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,554,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$13,008.65 ",IP,"13,008.65","13,008.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,561,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$3,264.10 ",IP,"3,264.10","3,264.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,562,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$4,370.58 ",IP,"4,370.58","4,370.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,563,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$6,249.87 ",IP,"6,249.87","6,249.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,564,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$13,974.93 ",IP,"13,974.93","13,974.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,571,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$2,653.48 ",IP,"2,653.48","2,653.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,572,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$3,996.71 ",IP,"3,996.71","3,996.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,573,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$5,550.25 ",IP,"5,550.25","5,550.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,574,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$10,437.98 ",IP,"10,437.98","10,437.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,581,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$3,385.75 ",IP,"3,385.75","3,385.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,582,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$4,062.35 ",IP,"4,062.35","4,062.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,583,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$5,313.15 ",IP,"5,313.15","5,313.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,584,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$10,386.78 ",IP,"10,386.78","10,386.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,591,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$3,746.90 ",IP,"3,746.90","3,746.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,592,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$4,463.01 ",IP,"4,463.01","4,463.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,593,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$6,809.98 ",IP,"6,809.98","6,809.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,594,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$11,699.43 ",IP,"11,699.43","11,699.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,731,ORBIT AND EYE PROCEDURES,,Relative Weights,"$5,014.53 ",IP,"5,014.53","5,014.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,732,ORBIT AND EYE PROCEDURES,,Relative Weights,"$6,421.34 ",IP,"6,421.34","6,421.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,733,ORBIT AND EYE PROCEDURES,,Relative Weights,"$9,718.43 ",IP,"9,718.43","9,718.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,734,ORBIT AND EYE PROCEDURES,,Relative Weights,"$22,403.73 ",IP,"22,403.73","22,403.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,821,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$2,633.21 ",IP,"2,633.21","2,633.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,822,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$3,410.83 ",IP,"3,410.83","3,410.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,823,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$4,809.73 ",IP,"4,809.73","4,809.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,824,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$13,027.89 ",IP,"13,027.89","13,027.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,891,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$9,059.01 ",IP,"9,059.01","9,059.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,892,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$11,457.52 ",IP,"11,457.52","11,457.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,893,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$17,804.98 ",IP,"17,804.98","17,804.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,894,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$32,041.75 ",IP,"32,041.75","32,041.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,911,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$6,729.57 ",IP,"6,729.57","6,729.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,912,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$9,964.47 ",IP,"9,964.47","9,964.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,913,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$16,613.29 ",IP,"16,613.29","16,613.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,914,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$32,825.56 ",IP,"32,825.56","32,825.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,921,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$6,039.23 ",IP,"6,039.23","6,039.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,922,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$8,191.36 ",IP,"8,191.36","8,191.36",,,,,,,,,,,,,
Meridian Medicaid,DRG,923,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$13,246.44 ",IP,"13,246.44","13,246.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,924,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$30,839.40 ",IP,"30,839.40","30,839.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,951,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$4,246.53 ",IP,"4,246.53","4,246.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,952,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$4,867.46 ",IP,"4,867.46","4,867.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,953,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$7,436.75 ",IP,"7,436.75","7,436.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,954,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$14,987.25 ",IP,"14,987.25","14,987.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,971,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$2,853.47 ",IP,"2,853.47","2,853.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,972,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$3,981.59 ",IP,"3,981.59","3,981.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,973,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$6,406.56 ",IP,"6,406.56","6,406.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,974,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$15,100.30 ",IP,"15,100.30","15,100.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,981,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$4,806.30 ",IP,"4,806.30","4,806.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,982,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$6,289.73 ",IP,"6,289.73","6,289.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,983,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$10,153.46 ",IP,"10,153.46","10,153.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,984,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$19,630.32 ",IP,"19,630.32","19,630.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,1101,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$4,539.30 ",IP,"4,539.30","4,539.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,1102,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$4,571.26 ",IP,"4,571.26","4,571.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,1103,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$6,424.43 ",IP,"6,424.43","6,424.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,1104,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$10,388.84 ",IP,"10,388.84","10,388.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,1111,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$3,014.97 ",IP,"3,014.97","3,014.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,1112,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$3,232.83 ",IP,"3,232.83","3,232.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,1113,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$3,830.06 ",IP,"3,830.06","3,830.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,1114,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$5,856.07 ",IP,"5,856.07","5,856.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,1131,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$1,710.57 ",IP,"1,710.57","1,710.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,1132,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$2,449.71 ",IP,"2,449.71","2,449.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,1133,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$3,709.10 ",IP,"3,709.10","3,709.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,1134,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$7,363.91 ",IP,"7,363.91","7,363.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,1141,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$2,233.23 ",IP,"2,233.23","2,233.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,1142,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$3,024.94 ",IP,"3,024.94","3,024.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,1143,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$4,392.57 ",IP,"4,392.57","4,392.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,1144,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$11,476.08 ",IP,"11,476.08","11,476.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,1151,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$2,472.39 ",IP,"2,472.39","2,472.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,1152,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$3,380.25 ",IP,"3,380.25","3,380.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,1153,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$4,829.66 ",IP,"4,829.66","4,829.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,1154,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$10,560.66 ",IP,"10,560.66","10,560.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,1201,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$8,978.60 ",IP,"8,978.60","8,978.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,1202,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$10,724.22 ",IP,"10,724.22","10,724.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,1203,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$15,096.86 ",IP,"15,096.86","15,096.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,1204,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$30,187.20 ",IP,"30,187.20","30,187.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,1211,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$6,647.79 ",IP,"6,647.79","6,647.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,1212,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$8,066.62 ",IP,"8,066.62","8,066.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,1213,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$12,267.10 ",IP,"12,267.10","12,267.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,1214,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$23,708.13 ",IP,"23,708.13","23,708.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,1301,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$15,152.88 ",IP,"15,152.88","15,152.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,1302,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$17,209.82 ",IP,"17,209.82","17,209.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,1303,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$20,315.17 ",IP,"20,315.17","20,315.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,1304,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$28,326.47 ",IP,"28,326.47","28,326.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,1311,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$6,540.23 ",IP,"6,540.23","6,540.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,1312,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$9,797.46 ",IP,"9,797.46","9,797.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,1313,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$13,253.65 ",IP,"13,253.65","13,253.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,1314,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$17,241.78 ",IP,"17,241.78","17,241.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,1321,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$2,377.20 ",IP,"2,377.20","2,377.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,1322,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$3,157.24 ",IP,"3,157.24","3,157.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,1323,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$5,204.90 ",IP,"5,204.90","5,204.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,1324,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$9,706.75 ",IP,"9,706.75","9,706.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,1331,RESPIRATORY FAILURE,,Relative Weights,"$2,072.41 ",IP,"2,072.41","2,072.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,1332,RESPIRATORY FAILURE,,Relative Weights,"$3,703.26 ",IP,"3,703.26","3,703.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,1333,RESPIRATORY FAILURE,,Relative Weights,"$5,064.70 ",IP,"5,064.70","5,064.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,1334,RESPIRATORY FAILURE,,Relative Weights,"$9,349.38 ",IP,"9,349.38","9,349.38",,,,,,,,,,,,,
Meridian Medicaid,DRG,1341,PULMONARY EMBOLISM,,Relative Weights,"$2,977.18 ",IP,"2,977.18","2,977.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,1342,PULMONARY EMBOLISM,,Relative Weights,"$3,832.12 ",IP,"3,832.12","3,832.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,1343,PULMONARY EMBOLISM,,Relative Weights,"$5,276.03 ",IP,"5,276.03","5,276.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,1344,PULMONARY EMBOLISM,,Relative Weights,"$8,166.27 ",IP,"8,166.27","8,166.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,1351,MAJOR CHEST and RESPIRAZORY TRAUMA,,Relative Weights,"$3,792.26 ",IP,"3,792.26","3,792.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,1352,MAJOR CHEST and RESPIRATORY TRAUMA,,Relative Weights,"$3,955.48 ",IP,"3,955.48","3,955.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,1353,MAJOR CHEST and RESPIRATORY TRAUMA,,Relative Weights,"$5,683.92 ",IP,"5,683.92","5,683.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,1354,MAJOR CHEST and RESPIRATORY TRAUMA,,Relative Weights,"$10,178.89 ",IP,"10,178.89","10,178.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,1361,RESPIRATORY MALIGNANCY,,Relative Weights,"$4,244.47 ",IP,"4,244.47","4,244.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,1362,RESPIRATORY MALIGNANCY,,Relative Weights,"$4,742.73 ",IP,"4,742.73","4,742.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,1363,RESPIRATORY MALIGNANCY,,Relative Weights,"$6,049.19 ",IP,"6,049.19","6,049.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,1364,RESPIRATORY MALIGNANCY,,Relative Weights,"$9,049.05 ",IP,"9,049.05","9,049.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,1371,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$3,151.74 ",IP,"3,151.74","3,151.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,1372,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$3,930.39 ",IP,"3,930.39","3,930.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,1373,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$5,471.90 ",IP,"5,471.90","5,471.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,1374,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$8,758.68 ",IP,"8,758.68","8,758.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,1381,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$1,796.82 ",IP,"1,796.82","1,796.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,1382,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$2,575.82 ",IP,"2,575.82","2,575.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,1383,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$4,712.83 ",IP,"4,712.83","4,712.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,1384,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$9,865.85 ",IP,"9,865.85","9,865.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,1391,OTHER PNEUMONIA,,Relative Weights,"$2,182.71 ",IP,"2,182.71","2,182.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,1392,OTHER PNEUMONIA,,Relative Weights,"$3,016.35 ",IP,"3,016.35","3,016.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,1393,OTHER PNEUMONIA,,Relative Weights,"$4,342.75 ",IP,"4,342.75","4,342.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,1394,OTHER PNEUMONIA,,Relative Weights,"$7,186.59 ",IP,"7,186.59","7,186.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,1401,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$2,639.05 ",IP,"2,639.05","2,639.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,1402,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$3,167.20 ",IP,"3,167.20","3,167.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,1403,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$3,958.92 ",IP,"3,958.92","3,958.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,1404,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$5,969.47 ",IP,"5,969.47","5,969.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,1411,ASTHMA,,Relative Weights,"$2,018.80 ",IP,"2,018.80","2,018.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,1412,ASTHMA,,Relative Weights,"$2,763.78 ",IP,"2,763.78","2,763.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,1413,ASTHMA,,Relative Weights,"$4,049.98 ",IP,"4,049.98","4,049.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,1414,ASTHMA,,Relative Weights,"$6,508.28 ",IP,"6,508.28","6,508.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,1421,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$3,358.26 ",IP,"3,358.26","3,358.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,1422,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$3,679.89 ",IP,"3,679.89","3,679.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,1423,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$4,888.08 ",IP,"4,888.08","4,888.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,1424,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$7,901.68 ",IP,"7,901.68","7,901.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,1431,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$2,504.69 ",IP,"2,504.69","2,504.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,1432,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$3,509.11 ",IP,"3,509.11","3,509.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,1433,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$5,145.11 ",IP,"5,145.11","5,145.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,1434,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$8,358.70 ",IP,"8,358.70","8,358.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,1441,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$2,636.99 ",IP,"2,636.99","2,636.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,1442,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$3,405.68 ",IP,"3,405.68","3,405.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,1443,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$4,454.42 ",IP,"4,454.42","4,454.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,1444,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$7,998.24 ",IP,"7,998.24","7,998.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,1451,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$2,478.23 ",IP,"2,478.23","2,478.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,1452,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$2,974.43 ",IP,"2,974.43","2,974.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,1453,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$3,820.09 ",IP,"3,820.09","3,820.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,1454,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$6,746.07 ",IP,"6,746.07","6,746.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,1601,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$19,007.33 ",IP,"19,007.33","19,007.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,1602,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$21,418.55 ",IP,"21,418.55","21,418.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,1603,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$29,897.52 ",IP,"29,897.52","29,897.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,1604,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$58,616.75 ",IP,"58,616.75","58,616.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,1611,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$21,623.70 ",IP,"21,623.70","21,623.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,1612,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$25,324.21 ",IP,"25,324.21","25,324.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,1613,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$37,168.99 ",IP,"37,168.99","37,168.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,1614,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$84,952.59 ",IP,"84,952.59","84,952.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,1621,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$21,734.00 ",IP,"21,734.00","21,734.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,1622,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$25,647.21 ",IP,"25,647.21","25,647.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,1623,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$32,557.19 ",IP,"32,557.19","32,557.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,1624,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$51,493.39 ",IP,"51,493.39","51,493.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,1631,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$18,870.57 ",IP,"18,870.57","18,870.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,1632,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$20,678.38 ",IP,"20,678.38","20,678.38",,,,,,,,,,,,,
Meridian Medicaid,DRG,1633,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$25,441.73 ",IP,"25,441.73","25,441.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,1634,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$42,290.40 ",IP,"42,290.40","42,290.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,1651,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$17,424.93 ",IP,"17,424.93","17,424.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,1652,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$20,592.13 ",IP,"20,592.13","20,592.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,1653,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$24,876.46 ",IP,"24,876.46","24,876.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,1654,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$37,414.00 ",IP,"37,414.00","37,414.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,1661,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$16,087.19 ",IP,"16,087.19","16,087.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,1662,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$17,173.40 ",IP,"17,173.40","17,173.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,1663,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$20,743.67 ",IP,"20,743.67","20,743.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,1664,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$33,503.88 ",IP,"33,503.88","33,503.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,1671,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$15,753.88 ",IP,"15,753.88","15,753.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,1672,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$16,654.52 ",IP,"16,654.52","16,654.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,1673,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$20,943.66 ",IP,"20,943.66","20,943.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,1674,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$39,564.41 ",IP,"39,564.41","39,564.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,1691,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$9,314.67 ",IP,"9,314.67","9,314.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,1692,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$12,244.08 ",IP,"12,244.08","12,244.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,1693,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$19,456.45 ",IP,"19,456.45","19,456.45",,,,,,,,,,,,,
Meridian Medicaid,DRG,1694,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$33,906.95 ",IP,"33,906.95","33,906.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,1701,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$10,265.14 ",IP,"10,265.14","10,265.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,1702,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$10,949.99 ",IP,"10,949.99","10,949.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,1703,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$13,975.61 ",IP,"13,975.61","13,975.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,1704,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$19,895.26 ",IP,"19,895.26","19,895.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,1711,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$8,272.45 ",IP,"8,272.45","8,272.45",,,,,,,,,,,,,
Meridian Medicaid,DRG,1712,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$9,180.66 ",IP,"9,180.66","9,180.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,1713,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$10,971.29 ",IP,"10,971.29","10,971.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,1714,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$17,965.80 ",IP,"17,965.80","17,965.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,1741,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$9,597.47 ",IP,"9,597.47","9,597.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,1742,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$10,364.10 ",IP,"10,364.10","10,364.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,1743,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$12,874.29 ",IP,"12,874.29","12,874.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,1744,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$19,364.01 ",IP,"19,364.01","19,364.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,1751,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$11,256.84 ",IP,"11,256.84","11,256.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,1752,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$12,009.39 ",IP,"12,009.39","12,009.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,1753,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$14,253.95 ",IP,"14,253.95","14,253.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,1754,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$25,147.58 ",IP,"25,147.58","25,147.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,1761,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$9,268.97 ",IP,"9,268.97","9,268.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,1762,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$10,537.63 ",IP,"10,537.63","10,537.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,1763,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$15,961.08 ",IP,"15,961.08","15,961.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,1764,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$25,961.29 ",IP,"25,961.29","25,961.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,1771,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$6,530.96 ",IP,"6,530.96","6,530.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,1772,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$9,029.80 ",IP,"9,029.80","9,029.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,1773,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$11,280.21 ",IP,"11,280.21","11,280.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,1774,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$17,033.20 ",IP,"17,033.20","17,033.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,1801,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$6,351.58 ",IP,"6,351.58","6,351.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,1802,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$7,715.78 ",IP,"7,715.78","7,715.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,1803,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$10,872.33 ",IP,"10,872.33","10,872.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,1804,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$20,062.95 ",IP,"20,062.95","20,062.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,1811,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$9,268.28 ",IP,"9,268.28","9,268.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,1812,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$11,438.97 ",IP,"11,438.97","11,438.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,1813,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$16,303.68 ",IP,"16,303.68","16,303.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,1814,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$27,105.22 ",IP,"27,105.22","27,105.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,1821,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$9,585.79 ",IP,"9,585.79","9,585.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,1822,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$11,451.68 ",IP,"11,451.68","11,451.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,1823,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$12,966.73 ",IP,"12,966.73","12,966.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,1824,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$25,526.94 ",IP,"25,526.94","25,526.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,1901,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$3,454.82 ",IP,"3,454.82","3,454.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,1902,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$4,023.17 ",IP,"4,023.17","4,023.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,1903,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$5,278.78 ",IP,"5,278.78","5,278.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,1904,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$8,568.66 ",IP,"8,568.66","8,568.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,1911,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$4,795.99 ",IP,"4,795.99","4,795.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,1912,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$5,349.23 ",IP,"5,349.23","5,349.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,1913,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$6,652.26 ",IP,"6,652.26","6,652.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,1914,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$10,568.22 ",IP,"10,568.22","10,568.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,1921,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$5,126.56 ",IP,"5,126.56","5,126.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,1922,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$5,995.59 ",IP,"5,995.59","5,995.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,1923,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$8,192.04 ",IP,"8,192.04","8,192.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,1924,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$14,030.25 ",IP,"14,030.25","14,030.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,1931,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$4,156.16 ",IP,"4,156.16","4,156.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,1932,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$5,201.81 ",IP,"5,201.81","5,201.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,1933,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$7,472.15 ",IP,"7,472.15","7,472.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,1934,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$12,655.75 ",IP,"12,655.75","12,655.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,1941,HEART FAILURE,,Relative Weights,"$2,590.60 ",IP,"2,590.60","2,590.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,1942,HEART FAILURE,,Relative Weights,"$3,135.24 ",IP,"3,135.24","3,135.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,1943,HEART FAILURE,,Relative Weights,"$4,368.86 ",IP,"4,368.86","4,368.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,1944,HEART FAILURE,,Relative Weights,"$7,070.79 ",IP,"7,070.79","7,070.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,1961,CARDIAC ARREST and SHOCK,,Relative Weights,"$2,365.52 ",IP,"2,365.52","2,365.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,1962,CARDIAC ARREST and SHOCK,,Relative Weights,"$2,596.44 ",IP,"2,596.44","2,596.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,1963,CARDIAC ARREST and SHOCK,,Relative Weights,"$4,010.12 ",IP,"4,010.12","4,010.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,1964,CARDIAC ARREST and SHOCK,,Relative Weights,"$8,325.03 ",IP,"8,325.03","8,325.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,1971,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$2,758.63 ",IP,"2,758.63","2,758.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,1972,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$3,488.49 ",IP,"3,488.49","3,488.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,1973,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$4,794.61 ",IP,"4,794.61","4,794.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,1974,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$9,053.51 ",IP,"9,053.51","9,053.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,1981,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$2,680.28 ",IP,"2,680.28","2,680.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,1982,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$2,985.77 ",IP,"2,985.77","2,985.77",,,,,,,,,,,,,
Meridian Medicaid,DRG,1983,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$3,628.00 ",IP,"3,628.00","3,628.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,1984,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$6,763.25 ",IP,"6,763.25","6,763.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,1991,HYPERTENSION,,Relative Weights,"$2,662.41 ",IP,"2,662.41","2,662.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,1992,HYPERTENSION,,Relative Weights,"$2,956.56 ",IP,"2,956.56","2,956.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,1993,HYPERTENSION,,Relative Weights,"$3,736.93 ",IP,"3,736.93","3,736.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,1994,HYPERTENSION,,Relative Weights,"$6,634.39 ",IP,"6,634.39","6,634.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,2001,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$2,919.45 ",IP,"2,919.45","2,919.45",,,,,,,,,,,,,
Meridian Medicaid,DRG,2002,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$3,565.12 ",IP,"3,565.12","3,565.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,2003,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$4,853.03 ",IP,"4,853.03","4,853.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,2004,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$10,524.92 ",IP,"10,524.92","10,524.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,2011,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$2,322.91 ",IP,"2,322.91","2,322.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,2012,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$2,865.50 ",IP,"2,865.50","2,865.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,2013,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$3,988.81 ",IP,"3,988.81","3,988.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,2014,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$7,490.70 ",IP,"7,490.70","7,490.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,2031,CHEST PAIN,,Relative Weights,"$2,896.08 ",IP,"2,896.08","2,896.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,2032,CHEST PAIN,,Relative Weights,"$3,156.55 ",IP,"3,156.55","3,156.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,2033,CHEST PAIN,,Relative Weights,"$3,647.25 ",IP,"3,647.25","3,647.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,2034,CHEST PAIN,,Relative Weights,"$5,656.08 ",IP,"5,656.08","5,656.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,2041,SYNCOPE and COLLAPSE,,Relative Weights,"$3,210.15 ",IP,"3,210.15","3,210.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,2042,SYNCOPE and COLLAPSE,,Relative Weights,"$3,469.25 ",IP,"3,469.25","3,469.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,2043,SYNCOPE and COLLAPSE,,Relative Weights,"$3,913.56 ",IP,"3,913.56","3,913.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,2044,SYNCOPE and COLLAPSE,,Relative Weights,"$6,621.67 ",IP,"6,621.67","6,621.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,2051,CARDIOMYOPATHY,,Relative Weights,"$3,094.70 ",IP,"3,094.70","3,094.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,2052,CARDIOMYOPATHY,,Relative Weights,"$3,108.78 ",IP,"3,108.78","3,108.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,2053,CARDIOMYOPATHY,,Relative Weights,"$4,834.47 ",IP,"4,834.47","4,834.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,2054,CARDIOMYOPATHY,,Relative Weights,"$12,099.76 ",IP,"12,099.76","12,099.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,2061,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$3,915.62 ",IP,"3,915.62","3,915.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,2062,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$4,064.41 ",IP,"4,064.41","4,064.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,2063,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$5,616.22 ",IP,"5,616.22","5,616.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,2064,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$11,629.68 ",IP,"11,629.68","11,629.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,2071,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$2,947.97 ",IP,"2,947.97","2,947.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,2072,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$3,511.17 ",IP,"3,511.17","3,511.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,2073,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$4,590.50 ",IP,"4,590.50","4,590.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,2074,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$8,837.72 ",IP,"8,837.72","8,837.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,2201,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$7,004.47 ",IP,"7,004.47","7,004.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,2202,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$10,124.94 ",IP,"10,124.94","10,124.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,2203,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$15,446.33 ",IP,"15,446.33","15,446.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,2204,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$29,728.80 ",IP,"29,728.80","29,728.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,2221,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$3,629.38 ",IP,"3,629.38","3,629.38",,,,,,,,,,,,,
Meridian Medicaid,DRG,2222,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$5,962.94 ",IP,"5,962.94","5,962.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,2223,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$9,116.74 ",IP,"9,116.74","9,116.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,2224,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$19,946.46 ",IP,"19,946.46","19,946.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,2231,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$5,180.51 ",IP,"5,180.51","5,180.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,2232,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$7,107.90 ",IP,"7,107.90","7,107.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,2233,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$10,759.27 ",IP,"10,759.27","10,759.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,2234,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$20,449.53 ",IP,"20,449.53","20,449.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,2241,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$6,143.69 ",IP,"6,143.69","6,143.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,2242,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$7,746.36 ",IP,"7,746.36","7,746.36",,,,,,,,,,,,,
Meridian Medicaid,DRG,2243,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$11,242.41 ",IP,"11,242.41","11,242.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,2244,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$20,422.04 ",IP,"20,422.04","20,422.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,2261,ANAL PROCEDURES,,Relative Weights,"$4,263.71 ",IP,"4,263.71","4,263.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,2262,ANAL PROCEDURES,,Relative Weights,"$5,861.92 ",IP,"5,861.92","5,861.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,2263,ANAL PROCEDURES,,Relative Weights,"$7,950.47 ",IP,"7,950.47","7,950.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,2264,ANAL PROCEDURES,,Relative Weights,"$17,017.73 ",IP,"17,017.73","17,017.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,2271,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$5,689.07 ",IP,"5,689.07","5,689.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,2272,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$6,795.89 ",IP,"6,795.89","6,795.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,2273,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$10,114.97 ",IP,"10,114.97","10,114.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,2274,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$20,038.21 ",IP,"20,038.21","20,038.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,2281,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$4,335.53 ",IP,"4,335.53","4,335.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,2282,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$5,502.48 ",IP,"5,502.48","5,502.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,2283,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$7,788.28 ",IP,"7,788.28","7,788.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,2284,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$16,501.95 ",IP,"16,501.95","16,501.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,2291,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$5,564.34 ",IP,"5,564.34","5,564.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,2292,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$7,117.87 ",IP,"7,117.87","7,117.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,2293,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$10,259.30 ",IP,"10,259.30","10,259.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,2294,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$20,018.28 ",IP,"20,018.28","20,018.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,2301,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$6,770.12 ",IP,"6,770.12","6,770.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,2302,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$8,787.20 ",IP,"8,787.20","8,787.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,2303,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$13,506.56 ",IP,"13,506.56","13,506.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,2304,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$27,168.10 ",IP,"27,168.10","27,168.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,2311,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$6,900.01 ",IP,"6,900.01","6,900.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,2312,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$8,451.83 ",IP,"8,451.83","8,451.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,2313,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$12,656.43 ",IP,"12,656.43","12,656.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,2314,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$23,212.62 ",IP,"23,212.62","23,212.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,2321,GASTRIC FUNDOPLICATION,,Relative Weights,"$5,317.96 ",IP,"5,317.96","5,317.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,2322,GASTRIC FUNDOPLICATION,,Relative Weights,"$6,619.27 ",IP,"6,619.27","6,619.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,2323,GASTRIC FUNDOPLICATION,,Relative Weights,"$9,668.60 ",IP,"9,668.60","9,668.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,2324,GASTRIC FUNDOPLICATION,,Relative Weights,"$26,510.06 ",IP,"26,510.06","26,510.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,2331,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$5,328.61 ",IP,"5,328.61","5,328.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,2332,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$6,525.46 ",IP,"6,525.46","6,525.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,2333,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$9,426.35 ",IP,"9,426.35","9,426.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,2334,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$16,969.28 ",IP,"16,969.28","16,969.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,2341,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$3,837.96 ",IP,"3,837.96","3,837.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,2342,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$4,853.72 ",IP,"4,853.72","4,853.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,2343,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$7,767.67 ",IP,"7,767.67","7,767.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,2344,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$15,153.91 ",IP,"15,153.91","15,153.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,2401,DIGESTIVE MALIGNANCY,,Relative Weights,"$4,130.38 ",IP,"4,130.38","4,130.38",,,,,,,,,,,,,
Meridian Medicaid,DRG,2402,DIGESTIVE MALIGNANCY,,Relative Weights,"$4,471.61 ",IP,"4,471.61","4,471.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,2403,DIGESTIVE MALIGNANCY,,Relative Weights,"$5,940.95 ",IP,"5,940.95","5,940.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,2404,DIGESTIVE MALIGNANCY,,Relative Weights,"$10,480.94 ",IP,"10,480.94","10,480.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,2411,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$3,142.46 ",IP,"3,142.46","3,142.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,2412,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$3,833.49 ",IP,"3,833.49","3,833.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,2413,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$5,293.90 ",IP,"5,293.90","5,293.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,2414,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$11,497.38 ",IP,"11,497.38","11,497.38",,,,,,,,,,,,,
Meridian Medicaid,DRG,2421,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$2,834.23 ",IP,"2,834.23","2,834.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,2422,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$3,630.75 ",IP,"3,630.75","3,630.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,2423,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$5,095.29 ",IP,"5,095.29","5,095.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,2424,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$11,235.54 ",IP,"11,235.54","11,235.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,2431,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$2,619.12 ",IP,"2,619.12","2,619.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,2432,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$3,394.34 ",IP,"3,394.34","3,394.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,2433,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$4,672.28 ",IP,"4,672.28","4,672.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,2434,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$10,028.72 ",IP,"10,028.72","10,028.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,2441,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$2,541.46 ",IP,"2,541.46","2,541.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,2442,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$3,268.57 ",IP,"3,268.57","3,268.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,2443,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$4,670.91 ",IP,"4,670.91","4,670.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,2444,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$10,075.80 ",IP,"10,075.80","10,075.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,2451,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$3,109.82 ",IP,"3,109.82","3,109.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,2452,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$3,884.35 ",IP,"3,884.35","3,884.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,2453,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$5,370.53 ",IP,"5,370.53","5,370.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,2454,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$12,127.25 ",IP,"12,127.25","12,127.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,2461,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$3,009.82 ",IP,"3,009.82","3,009.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,2462,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$3,644.84 ",IP,"3,644.84","3,644.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,2463,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$5,068.14 ",IP,"5,068.14","5,068.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,2464,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$9,550.40 ",IP,"9,550.40","9,550.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,2471,INTESTINAL OBSTRUCTION,,Relative Weights,"$2,323.60 ",IP,"2,323.60","2,323.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,2472,INTESTINAL OBSTRUCTION,,Relative Weights,"$2,999.17 ",IP,"2,999.17","2,999.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,2473,INTESTINAL OBSTRUCTION,,Relative Weights,"$4,431.74 ",IP,"4,431.74","4,431.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,2474,INTESTINAL OBSTRUCTION,,Relative Weights,"$9,108.15 ",IP,"9,108.15","9,108.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,2481,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$2,573.42 ",IP,"2,573.42","2,573.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,2482,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$3,590.89 ",IP,"3,590.89","3,590.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,2483,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$4,839.63 ",IP,"4,839.63","4,839.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,2484,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$10,133.19 ",IP,"10,133.19","10,133.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,2491,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$2,187.52 ",IP,"2,187.52","2,187.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,2492,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$2,797.80 ",IP,"2,797.80","2,797.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,2493,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$3,754.80 ",IP,"3,754.80","3,754.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,2494,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$8,298.22 ",IP,"8,298.22","8,298.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,2511,ABDOMINAL PAIN,,Relative Weights,"$2,520.84 ",IP,"2,520.84","2,520.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,2512,ABDOMINAL PAIN,,Relative Weights,"$3,175.79 ",IP,"3,175.79","3,175.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,2513,ABDOMINAL PAIN,,Relative Weights,"$4,112.86 ",IP,"4,112.86","4,112.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,2514,ABDOMINAL PAIN,,Relative Weights,"$7,334.01 ",IP,"7,334.01","7,334.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,2521,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$2,913.26 ",IP,"2,913.26","2,913.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,2522,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$3,639.34 ",IP,"3,639.34","3,639.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,2523,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$5,172.60 ",IP,"5,172.60","5,172.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,2524,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$11,168.53 ",IP,"11,168.53","11,168.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,2531,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$2,890.24 ",IP,"2,890.24","2,890.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,2532,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$3,602.23 ",IP,"3,602.23","3,602.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,2533,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$5,054.39 ",IP,"5,054.39","5,054.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,2534,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$9,586.48 ",IP,"9,586.48","9,586.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,2541,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$2,614.99 ",IP,"2,614.99","2,614.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,2542,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$3,386.43 ",IP,"3,386.43","3,386.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,2543,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$4,771.93 ",IP,"4,771.93","4,771.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,2544,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$9,778.91 ",IP,"9,778.91","9,778.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,2601,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$9,438.72 ",IP,"9,438.72","9,438.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,2602,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$11,500.13 ",IP,"11,500.13","11,500.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,2603,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$16,312.61 ",IP,"16,312.61","16,312.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,2604,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$34,324.11 ",IP,"34,324.11","34,324.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,2611,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$6,801.05 ",IP,"6,801.05","6,801.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,2612,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$10,119.10 ",IP,"10,119.10","10,119.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,2613,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$14,491.05 ",IP,"14,491.05","14,491.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,2614,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$28,576.97 ",IP,"28,576.97","28,576.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,2631,CHOLECYSTECTOMY,,Relative Weights,"$5,153.36 ",IP,"5,153.36","5,153.36",,,,,,,,,,,,,
Meridian Medicaid,DRG,2632,CHOLECYSTECTOMY,,Relative Weights,"$6,574.60 ",IP,"6,574.60","6,574.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,2633,CHOLECYSTECTOMY,,Relative Weights,"$8,823.28 ",IP,"8,823.28","8,823.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,2634,CHOLECYSTECTOMY,,Relative Weights,"$16,983.37 ",IP,"16,983.37","16,983.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,2641,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$6,826.47 ",IP,"6,826.47","6,826.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,2642,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$7,584.86 ",IP,"7,584.86","7,584.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,2643,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$11,612.15 ",IP,"11,612.15","11,612.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,2644,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$29,218.86 ",IP,"29,218.86","29,218.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,2791,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$2,567.92 ",IP,"2,567.92","2,567.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,2792,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$3,323.89 ",IP,"3,323.89","3,323.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,2793,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$4,704.93 ",IP,"4,704.93","4,704.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,2794,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$11,290.86 ",IP,"11,290.86","11,290.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,2801,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$2,499.54 ",IP,"2,499.54","2,499.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,2802,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$3,093.32 ",IP,"3,093.32","3,093.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,2803,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$4,638.26 ",IP,"4,638.26","4,638.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,2804,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$10,324.24 ",IP,"10,324.24","10,324.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,2811,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$3,619.41 ",IP,"3,619.41","3,619.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,2812,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$4,564.04 ",IP,"4,564.04","4,564.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,2813,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$5,844.73 ",IP,"5,844.73","5,844.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,2814,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$9,186.50 ",IP,"9,186.50","9,186.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,2821,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$2,462.42 ",IP,"2,462.42","2,462.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,2822,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$3,135.24 ",IP,"3,135.24","3,135.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,2823,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$4,746.16 ",IP,"4,746.16","4,746.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,2824,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$12,503.18 ",IP,"12,503.18","12,503.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,2831,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$2,720.83 ",IP,"2,720.83","2,720.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,2832,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$3,349.67 ",IP,"3,349.67","3,349.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,2833,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$4,885.67 ",IP,"4,885.67","4,885.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,2834,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$10,248.65 ",IP,"10,248.65","10,248.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,2841,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$3,351.73 ",IP,"3,351.73","3,351.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,2842,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$4,147.57 ",IP,"4,147.57","4,147.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,2843,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$5,552.31 ",IP,"5,552.31","5,552.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,2844,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$10,788.48 ",IP,"10,788.48","10,788.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,3011,HIP JOINT REPLACEMENT,,Relative Weights,"$7,771.10 ",IP,"7,771.10","7,771.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,3012,HIP JOINT REPLACEMENT,,Relative Weights,"$8,122.29 ",IP,"8,122.29","8,122.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,3013,HIP JOINT REPLACEMENT,,Relative Weights,"$10,480.59 ",IP,"10,480.59","10,480.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,3014,HIP JOINT REPLACEMENT,,Relative Weights,"$16,617.41 ",IP,"16,617.41","16,617.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,3021,KNEE JOINT REPLACEMENT,,Relative Weights,"$7,208.24 ",IP,"7,208.24","7,208.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,3022,KNEE JOINT REPLACEMENT,,Relative Weights,"$7,702.03 ",IP,"7,702.03","7,702.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,3023,KNEE JOINT REPLACEMENT,,Relative Weights,"$9,864.13 ",IP,"9,864.13","9,864.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,3024,KNEE JOINT REPLACEMENT,,Relative Weights,"$17,075.12 ",IP,"17,075.12","17,075.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,3031,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$22,622.27 ",IP,"22,622.27","22,622.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,3032,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$26,401.82 ",IP,"26,401.82","26,401.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,3033,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$36,462.15 ",IP,"36,462.15","36,462.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,3034,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$46,680.22 ",IP,"46,680.22","46,680.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,3041,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$13,662.91 ",IP,"13,662.91","13,662.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,3042,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$15,568.66 ",IP,"15,568.66","15,568.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,3043,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$23,409.86 ",IP,"23,409.86","23,409.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,3044,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$37,522.24 ",IP,"37,522.24","37,522.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,3051,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$4,866.09 ",IP,"4,866.09","4,866.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,3052,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$6,637.82 ",IP,"6,637.82","6,637.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,3053,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$10,080.61 ",IP,"10,080.61","10,080.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,3054,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$19,786.33 ",IP,"19,786.33","19,786.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,3081,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$6,633.70 ",IP,"6,633.70","6,633.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,3082,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$7,529.88 ",IP,"7,529.88","7,529.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,3083,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$9,249.72 ",IP,"9,249.72","9,249.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,3084,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$14,744.30 ",IP,"14,744.30","14,744.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,3091,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$7,238.83 ",IP,"7,238.83","7,238.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,3092,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$9,130.83 ",IP,"9,130.83","9,130.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,3093,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$12,063.33 ",IP,"12,063.33","12,063.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,3094,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$21,019.95 ",IP,"21,019.95","21,019.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,3101,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$5,634.78 ",IP,"5,634.78","5,634.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,3102,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$6,775.27 ",IP,"6,775.27","6,775.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,3103,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$9,328.07 ",IP,"9,328.07","9,328.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,3104,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$18,301.18 ",IP,"18,301.18","18,301.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,3121,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$6,515.49 ",IP,"6,515.49","6,515.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,3122,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$8,587.21 ",IP,"8,587.21","8,587.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,3123,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$12,636.50 ",IP,"12,636.50","12,636.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,3124,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$31,602.60 ",IP,"31,602.60","31,602.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,3131,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$5,906.59 ",IP,"5,906.59","5,906.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,3132,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$7,791.03 ",IP,"7,791.03","7,791.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,3133,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$10,674.40 ",IP,"10,674.40","10,674.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,3134,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$18,704.94 ",IP,"18,704.94","18,704.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,3141,FOOT and TOE PROCEDURES,,Relative Weights,"$5,184.29 ",IP,"5,184.29","5,184.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,3142,FOOT and TOE PROCEDURES,,Relative Weights,"$5,760.89 ",IP,"5,760.89","5,760.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,3143,FOOT and TOE PROCEDURES,,Relative Weights,"$7,587.61 ",IP,"7,587.61","7,587.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,3144,FOOT and TOE PROCEDURES,,Relative Weights,"$15,541.86 ",IP,"15,541.86","15,541.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,3151,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$4,407.35 ",IP,"4,407.35","4,407.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,3152,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$7,204.46 ",IP,"7,204.46","7,204.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,3153,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$9,814.99 ",IP,"9,814.99","9,814.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,3154,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$17,630.42 ",IP,"17,630.42","17,630.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,3161,HAND and WRIST PROCEDURES,,Relative Weights,"$4,228.66 ",IP,"4,228.66","4,228.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,3162,HAND and WRIST PROCEDURES,,Relative Weights,"$5,513.82 ",IP,"5,513.82","5,513.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,3163,HAND and WRIST PROCEDURES,,Relative Weights,"$8,327.78 ",IP,"8,327.78","8,327.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,3164,HAND and WRIST PROCEDURES,,Relative Weights,"$17,742.44 ",IP,"17,742.44","17,742.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,3171,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$4,914.20 ",IP,"4,914.20","4,914.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,3172,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$6,410.69 ",IP,"6,410.69","6,410.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,3173,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$9,611.56 ",IP,"9,611.56","9,611.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,3174,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$20,290.08 ",IP,"20,290.08","20,290.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,3201,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$5,415.55 ",IP,"5,415.55","5,415.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,3202,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$6,995.19 ",IP,"6,995.19","6,995.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,3203,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$10,390.22 ",IP,"10,390.22","10,390.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,3204,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$19,965.01 ",IP,"19,965.01","19,965.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,3211,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$8,441.17 ",IP,"8,441.17","8,441.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,3212,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$10,023.57 ",IP,"10,023.57","10,023.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,3213,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$14,027.50 ",IP,"14,027.50","14,027.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,3214,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$25,569.90 ",IP,"25,569.90","25,569.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,3221,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$8,466.60 ",IP,"8,466.60","8,466.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,3222,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$8,949.40 ",IP,"8,949.40","8,949.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,3223,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$11,526.59 ",IP,"11,526.59","11,526.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,3224,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$17,494.69 ",IP,"17,494.69","17,494.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,3401,FRACTURE OF FEMUR,,Relative Weights,"$2,284.43 ",IP,"2,284.43","2,284.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,3402,FRACTURE OF FEMUR,,Relative Weights,"$2,649.70 ",IP,"2,649.70","2,649.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,3403,FRACTURE OF FEMUR,,Relative Weights,"$3,664.08 ",IP,"3,664.08","3,664.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,3404,FRACTURE OF FEMUR,,Relative Weights,"$6,893.48 ",IP,"6,893.48","6,893.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,3411,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$2,584.41 ",IP,"2,584.41","2,584.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,3412,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$2,958.62 ",IP,"2,958.62","2,958.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,3413,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$3,751.71 ",IP,"3,751.71","3,751.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,3414,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$8,259.05 ",IP,"8,259.05","8,259.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,3421,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$2,677.53 ",IP,"2,677.53","2,677.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,3422,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$3,262.04 ",IP,"3,262.04","3,262.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,3423,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$4,236.57 ",IP,"4,236.57","4,236.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,3424,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$8,410.59 ",IP,"8,410.59","8,410.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,3431,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$4,528.30 ",IP,"4,528.30","4,528.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,3432,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$4,916.60 ",IP,"4,916.60","4,916.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,3433,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$6,907.57 ",IP,"6,907.57","6,907.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,3434,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$11,710.09 ",IP,"11,710.09","11,710.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,3441,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$3,603.61 ",IP,"3,603.61","3,603.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,3442,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$4,272.99 ",IP,"4,272.99","4,272.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,3443,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$5,859.85 ",IP,"5,859.85","5,859.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,3444,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$10,885.73 ",IP,"10,885.73","10,885.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,3461,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$3,601.54 ",IP,"3,601.54","3,601.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,3462,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$4,539.99 ",IP,"4,539.99","4,539.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,3463,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$6,445.74 ",IP,"6,445.74","6,445.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,3464,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$15,116.11 ",IP,"15,116.11","15,116.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,3471,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$3,279.91 ",IP,"3,279.91","3,279.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,3472,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$3,772.33 ",IP,"3,772.33","3,772.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,3473,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$4,894.95 ",IP,"4,894.95","4,894.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,3474,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$9,864.13 ",IP,"9,864.13","9,864.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,3491,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$2,603.31 ",IP,"2,603.31","2,603.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,3492,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$3,535.91 ",IP,"3,535.91","3,535.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,3493,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$5,006.97 ",IP,"5,006.97","5,006.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,3494,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$9,666.89 ",IP,"9,666.89","9,666.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,3511,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$2,708.80 ",IP,"2,708.80","2,708.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,3512,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$3,066.17 ",IP,"3,066.17","3,066.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,3513,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$4,449.61 ",IP,"4,449.61","4,449.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,3514,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$8,785.14 ",IP,"8,785.14","8,785.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,3611,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$5,861.92 ",IP,"5,861.92","5,861.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,3612,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$6,759.47 ",IP,"6,759.47","6,759.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,3613,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$10,411.18 ",IP,"10,411.18","10,411.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,3614,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$23,051.12 ",IP,"23,051.12","23,051.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,3621,MASTECTOMY PROCEDURES,,Relative Weights,"$5,733.06 ",IP,"5,733.06","5,733.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,3622,MASTECTOMY PROCEDURES,,Relative Weights,"$6,783.86 ",IP,"6,783.86","6,783.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,3623,MASTECTOMY PROCEDURES,,Relative Weights,"$8,730.85 ",IP,"8,730.85","8,730.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,3624,MASTECTOMY PROCEDURES,,Relative Weights,"$15,662.13 ",IP,"15,662.13","15,662.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,3631,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$5,772.23 ",IP,"5,772.23","5,772.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,3632,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$7,919.20 ",IP,"7,919.20","7,919.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,3633,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$10,641.07 ",IP,"10,641.07","10,641.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,3634,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$13,007.96 ",IP,"13,007.96","13,007.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,3641,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$3,659.27 ",IP,"3,659.27","3,659.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,3642,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$5,232.39 ",IP,"5,232.39","5,232.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,3643,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$8,152.18 ",IP,"8,152.18","8,152.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,3644,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$16,685.79 ",IP,"16,685.79","16,685.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,3801,SKIN ULCERS,,Relative Weights,"$2,950.72 ",IP,"2,950.72","2,950.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,3802,SKIN ULCERS,,Relative Weights,"$3,415.64 ",IP,"3,415.64","3,415.64",,,,,,,,,,,,,
Meridian Medicaid,DRG,3803,SKIN ULCERS,,Relative Weights,"$4,667.13 ",IP,"4,667.13","4,667.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,3804,SKIN ULCERS,,Relative Weights,"$9,197.15 ",IP,"9,197.15","9,197.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,3811,MAJOR SKIN DISORDERS,,Relative Weights,"$2,135.64 ",IP,"2,135.64","2,135.64",,,,,,,,,,,,,
Meridian Medicaid,DRG,3812,MAJOR SKIN DISORDERS,,Relative Weights,"$3,426.98 ",IP,"3,426.98","3,426.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,3813,MAJOR SKIN DISORDERS,,Relative Weights,"$6,058.47 ",IP,"6,058.47","6,058.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,3814,MAJOR SKIN DISORDERS,,Relative Weights,"$15,997.51 ",IP,"15,997.51","15,997.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,3821,MALIGNANT BREAST DISORDERS,,Relative Weights,"$3,708.41 ",IP,"3,708.41","3,708.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,3822,MALIGNANT BREAST DISORDERS,,Relative Weights,"$3,837.96 ",IP,"3,837.96","3,837.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,3823,MALIGNANT BREAST DISORDERS,,Relative Weights,"$5,221.05 ",IP,"5,221.05","5,221.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,3824,MALIGNANT BREAST DISORDERS,,Relative Weights,"$8,582.75 ",IP,"8,582.75","8,582.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,3831,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$2,128.08 ",IP,"2,128.08","2,128.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,3832,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$2,886.11 ",IP,"2,886.11","2,886.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,3833,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$4,151.00 ",IP,"4,151.00","4,151.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,3834,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$8,552.16 ",IP,"8,552.16","8,552.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,3841,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$2,690.94 ",IP,"2,690.94","2,690.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,3842,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$3,464.09 ",IP,"3,464.09","3,464.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,3843,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$4,737.92 ",IP,"4,737.92","4,737.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,3844,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$9,439.41 ",IP,"9,439.41","9,439.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,3851,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$2,189.24 ",IP,"2,189.24","2,189.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,3852,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$2,880.96 ",IP,"2,880.96","2,880.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,3853,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$4,186.05 ",IP,"4,186.05","4,186.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,3854,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$8,871.05 ",IP,"8,871.05","8,871.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,4011,ADRENAL PROCEDURES,,Relative Weights,"$6,855.68 ",IP,"6,855.68","6,855.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,4012,ADRENAL PROCEDURES,,Relative Weights,"$10,778.52 ",IP,"10,778.52","10,778.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,4013,ADRENAL PROCEDURES,,Relative Weights,"$13,300.04 ",IP,"13,300.04","13,300.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,4014,ADRENAL PROCEDURES,,Relative Weights,"$24,027.70 ",IP,"24,027.70","24,027.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,4031,PROCEDURES FOR OBESITY,,Relative Weights,"$5,110.06 ",IP,"5,110.06","5,110.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,4032,PROCEDURES FOR OBESITY,,Relative Weights,"$6,108.30 ",IP,"6,108.30","6,108.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,4033,PROCEDURES FOR OBESITY,,Relative Weights,"$9,074.13 ",IP,"9,074.13","9,074.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,4034,PROCEDURES FOR OBESITY,,Relative Weights,"$26,392.19 ",IP,"26,392.19","26,392.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,4041,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$4,728.64 ",IP,"4,728.64","4,728.64",,,,,,,,,,,,,
Meridian Medicaid,DRG,4042,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$6,537.48 ",IP,"6,537.48","6,537.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,4043,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$10,989.85 ",IP,"10,989.85","10,989.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,4044,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$24,206.39 ",IP,"24,206.39","24,206.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,4051,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$7,505.82 ",IP,"7,505.82","7,505.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,4052,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$8,475.19 ",IP,"8,475.19","8,475.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,4053,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$12,612.79 ",IP,"12,612.79","12,612.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,4054,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$26,164.03 ",IP,"26,164.03","26,164.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,4201,DIABETES,,Relative Weights,"$2,259.68 ",IP,"2,259.68","2,259.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,4202,DIABETES,,Relative Weights,"$2,723.24 ",IP,"2,723.24","2,723.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,4203,DIABETES,,Relative Weights,"$3,776.79 ",IP,"3,776.79","3,776.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,4204,DIABETES,,Relative Weights,"$8,028.82 ",IP,"8,028.82","8,028.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,4211,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$2,343.53 ",IP,"2,343.53","2,343.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,4212,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$3,329.74 ",IP,"3,329.74","3,329.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,4213,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$5,181.88 ",IP,"5,181.88","5,181.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,4214,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$10,295.72 ",IP,"10,295.72","10,295.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,4221,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$1,870.01 ",IP,"1,870.01","1,870.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,4222,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$2,609.84 ",IP,"2,609.84","2,609.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,4223,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$3,459.28 ",IP,"3,459.28","3,459.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,4224,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$7,038.84 ",IP,"7,038.84","7,038.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,4231,INBORN ERRORS OF METABOLISM,,Relative Weights,"$5,529.29 ",IP,"5,529.29","5,529.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,4232,INBORN ERRORS OF METABOLISM,,Relative Weights,"$5,948.85 ",IP,"5,948.85","5,948.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,4233,INBORN ERRORS OF METABOLISM,,Relative Weights,"$8,447.01 ",IP,"8,447.01","8,447.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,4234,INBORN ERRORS OF METABOLISM,,Relative Weights,"$27,194.91 ",IP,"27,194.91","27,194.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,4241,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$2,869.62 ",IP,"2,869.62","2,869.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,4242,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$3,662.02 ",IP,"3,662.02","3,662.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,4243,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$5,028.28 ",IP,"5,028.28","5,028.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,4244,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$10,807.73 ",IP,"10,807.73","10,807.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,4251,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$2,221.89 ",IP,"2,221.89","2,221.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,4252,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$2,908.79 ",IP,"2,908.79","2,908.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,4253,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$3,943.11 ",IP,"3,943.11","3,943.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,4254,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$7,662.17 ",IP,"7,662.17","7,662.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,4261,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$2,409.16 ",IP,"2,409.16","2,409.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,4262,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$2,941.78 ",IP,"2,941.78","2,941.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,4263,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$4,191.21 ",IP,"4,191.21","4,191.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,4264,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$8,224.69 ",IP,"8,224.69","8,224.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,4271,THYROID DISORDERS,,Relative Weights,"$2,411.91 ",IP,"2,411.91","2,411.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,4272,THYROID DISORDERS,,Relative Weights,"$3,208.44 ",IP,"3,208.44","3,208.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,4273,THYROID DISORDERS,,Relative Weights,"$4,621.77 ",IP,"4,621.77","4,621.77",,,,,,,,,,,,,
Meridian Medicaid,DRG,4274,THYROID DISORDERS,,Relative Weights,"$9,834.92 ",IP,"9,834.92","9,834.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,4401,KIDNEY TRANSPLANT,,Relative Weights,"$26,376.39 ",IP,"26,376.39","26,376.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,4402,KIDNEY TRANSPLANT,,Relative Weights,"$28,441.58 ",IP,"28,441.58","28,441.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,4403,KIDNEY TRANSPLANT,,Relative Weights,"$31,863.75 ",IP,"31,863.75","31,863.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,4404,KIDNEY TRANSPLANT,,Relative Weights,"$48,433.40 ",IP,"48,433.40","48,433.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,4411,MAJOR BLADDER PROCEDURES,,Relative Weights,"$7,124.74 ",IP,"7,124.74","7,124.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,4412,MAJOR BLADDER PROCEDURES,,Relative Weights,"$11,337.94 ",IP,"11,337.94","11,337.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,4413,MAJOR BLADDER PROCEDURES,,Relative Weights,"$14,853.23 ",IP,"14,853.23","14,853.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,4414,MAJOR BLADDER PROCEDURES,,Relative Weights,"$32,299.47 ",IP,"32,299.47","32,299.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,4421,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$7,007.22 ",IP,"7,007.22","7,007.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,4422,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$7,784.16 ",IP,"7,784.16","7,784.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,4423,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$11,551.33 ",IP,"11,551.33","11,551.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,4424,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$20,973.56 ",IP,"20,973.56","20,973.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,4431,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$5,745.77 ",IP,"5,745.77","5,745.77",,,,,,,,,,,,,
Meridian Medicaid,DRG,4432,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$6,928.19 ",IP,"6,928.19","6,928.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,4433,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$10,300.53 ",IP,"10,300.53","10,300.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,4434,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$21,259.80 ",IP,"21,259.80","21,259.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,4441,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$6,643.67 ",IP,"6,643.67","6,643.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,4442,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$8,351.49 ",IP,"8,351.49","8,351.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,4443,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$12,840.62 ",IP,"12,840.62","12,840.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,4444,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$25,251.70 ",IP,"25,251.70","25,251.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,4451,OTHER BLADDER PROCEDURES,,Relative Weights,"$4,867.46 ",IP,"4,867.46","4,867.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,4452,OTHER BLADDER PROCEDURES,,Relative Weights,"$6,607.93 ",IP,"6,607.93","6,607.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,4453,OTHER BLADDER PROCEDURES,,Relative Weights,"$8,634.63 ",IP,"8,634.63","8,634.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,4454,OTHER BLADDER PROCEDURES,,Relative Weights,"$17,913.22 ",IP,"17,913.22","17,913.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,4461,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$4,096.37 ",IP,"4,096.37","4,096.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,4462,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$5,093.91 ",IP,"5,093.91","5,093.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,4463,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$7,454.97 ",IP,"7,454.97","7,454.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,4464,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$15,279.67 ",IP,"15,279.67","15,279.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,4471,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$6,383.54 ",IP,"6,383.54","6,383.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,4472,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$7,988.27 ",IP,"7,988.27","7,988.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,4473,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$11,578.48 ",IP,"11,578.48","11,578.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,4474,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$26,335.15 ",IP,"26,335.15","26,335.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,4611,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$4,213.89 ",IP,"4,213.89","4,213.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,4612,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$4,354.09 ",IP,"4,354.09","4,354.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,4613,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$5,833.40 ",IP,"5,833.40","5,833.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,4614,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$10,495.71 ",IP,"10,495.71","10,495.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,4621,NEPHRITIS and NEPHROSIS,,Relative Weights,"$2,361.40 ",IP,"2,361.40","2,361.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,4622,NEPHRITIS and NEPHROSIS,,Relative Weights,"$3,007.07 ",IP,"3,007.07","3,007.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,4623,NEPHRITIS and NEPHROSIS,,Relative Weights,"$5,343.04 ",IP,"5,343.04","5,343.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,4624,NEPHRITIS and NEPHROSIS,,Relative Weights,"$14,645.34 ",IP,"14,645.34","14,645.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,4631,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$2,386.48 ",IP,"2,386.48","2,386.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,4632,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$2,925.29 ",IP,"2,925.29","2,925.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,4633,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$3,755.49 ",IP,"3,755.49","3,755.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,4634,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$6,746.75 ",IP,"6,746.75","6,746.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,4651,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$2,676.16 ",IP,"2,676.16","2,676.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,4652,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$3,212.22 ",IP,"3,212.22","3,212.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,4653,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$4,385.36 ",IP,"4,385.36","4,385.36",,,,,,,,,,,,,
Meridian Medicaid,DRG,4654,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$8,949.40 ",IP,"8,949.40","8,949.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,4661,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$2,602.62 ",IP,"2,602.62","2,602.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,4662,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$3,336.61 ",IP,"3,336.61","3,336.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,4663,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$4,821.07 ",IP,"4,821.07","4,821.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,4664,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$8,281.73 ",IP,"8,281.73","8,281.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,4681,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$2,645.58 ",IP,"2,645.58","2,645.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,4682,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$3,341.08 ",IP,"3,341.08","3,341.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,4683,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$4,559.92 ",IP,"4,559.92","4,559.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,4684,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$9,588.20 ",IP,"9,588.20","9,588.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,4691,ACUTE KIDNEY INJURY,,Relative Weights,"$2,379.95 ",IP,"2,379.95","2,379.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,4692,ACUTE KIDNEY INJURY,,Relative Weights,"$3,050.71 ",IP,"3,050.71","3,050.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,4693,ACUTE KIDNEY INJURY,,Relative Weights,"$4,563.35 ",IP,"4,563.35","4,563.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,4694,ACUTE KIDNEY INJURY,,Relative Weights,"$9,568.95 ",IP,"9,568.95","9,568.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,4701,CHRONIC KIDNEY DISEASE,,Relative Weights,"$2,503.66 ",IP,"2,503.66","2,503.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,4702,CHRONIC KIDNEY DISEASE,,Relative Weights,"$3,283.35 ",IP,"3,283.35","3,283.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,4703,CHRONIC KIDNEY DISEASE,,Relative Weights,"$4,530.02 ",IP,"4,530.02","4,530.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,4704,CHRONIC KIDNEY DISEASE,,Relative Weights,"$8,193.42 ",IP,"8,193.42","8,193.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,4801,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$6,131.66 ",IP,"6,131.66","6,131.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,4802,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$6,485.60 ",IP,"6,485.60","6,485.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,4803,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$10,188.85 ",IP,"10,188.85","10,188.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,4804,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$21,900.66 ",IP,"21,900.66","21,900.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,4821,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$4,027.30 ",IP,"4,027.30","4,027.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,4822,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$4,459.58 ",IP,"4,459.58","4,459.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,4823,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$7,759.08 ",IP,"7,759.08","7,759.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,4824,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$15,069.03 ",IP,"15,069.03","15,069.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,4831,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$5,523.10 ",IP,"5,523.10","5,523.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,4832,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$6,593.84 ",IP,"6,593.84","6,593.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,4833,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$8,503.71 ",IP,"8,503.71","8,503.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,4834,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$16,764.14 ",IP,"16,764.14","16,764.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,4841,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$6,414.47 ",IP,"6,414.47","6,414.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,4842,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$6,893.48 ",IP,"6,893.48","6,893.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,4843,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$7,922.98 ",IP,"7,922.98","7,922.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,4844,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$22,148.41 ",IP,"22,148.41","22,148.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,5001,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$3,471.31 ",IP,"3,471.31","3,471.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,5002,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$3,960.98 ",IP,"3,960.98","3,960.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,5003,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$5,381.18 ",IP,"5,381.18","5,381.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,5004,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$8,653.88 ",IP,"8,653.88","8,653.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,5011,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$2,269.65 ",IP,"2,269.65","2,269.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,5012,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$2,988.52 ",IP,"2,988.52","2,988.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,5013,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$4,126.95 ",IP,"4,126.95","4,126.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,5014,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$8,519.52 ",IP,"8,519.52","8,519.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,5101,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$6,667.03 ",IP,"6,667.03","6,667.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,5102,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$7,636.06 ",IP,"7,636.06","7,636.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,5103,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$12,159.55 ",IP,"12,159.55","12,159.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,5104,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$22,308.54 ",IP,"22,308.54","22,308.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,5111,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$6,477.69 ",IP,"6,477.69","6,477.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,5112,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$7,830.89 ",IP,"7,830.89","7,830.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,5113,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$10,746.90 ",IP,"10,746.90","10,746.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,5114,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$23,120.88 ",IP,"23,120.88","23,120.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,5121,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$6,341.62 ",IP,"6,341.62","6,341.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,5122,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$7,038.84 ",IP,"7,038.84","7,038.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,5123,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$9,937.66 ",IP,"9,937.66","9,937.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,5124,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$20,453.99 ",IP,"20,453.99","20,453.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,5131,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$4,384.67 ",IP,"4,384.67","4,384.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,5132,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$5,107.31 ",IP,"5,107.31","5,107.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,5133,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$8,107.86 ",IP,"8,107.86","8,107.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,5134,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$16,632.53 ",IP,"16,632.53","16,632.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,5141,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$3,945.51 ",IP,"3,945.51","3,945.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,5142,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$5,893.19 ",IP,"5,893.19","5,893.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,5143,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$10,581.96 ",IP,"10,581.96","10,581.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,5144,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$22,849.41 ",IP,"22,849.41","22,849.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,5171,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$3,258.61 ",IP,"3,258.61","3,258.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,5172,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$4,494.28 ",IP,"4,494.28","4,494.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,5173,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$6,942.62 ",IP,"6,942.62","6,942.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,5174,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$14,767.33 ",IP,"14,767.33","14,767.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,5181,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$4,123.51 ",IP,"4,123.51","4,123.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,5182,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$5,436.16 ",IP,"5,436.16","5,436.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,5183,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$9,420.16 ",IP,"9,420.16","9,420.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,5184,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$21,115.47 ",IP,"21,115.47","21,115.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,5191,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$3,160.33 ",IP,"3,160.33","3,160.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,5192,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$3,849.30 ",IP,"3,849.30","3,849.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,5193,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$7,527.81 ",IP,"7,527.81","7,527.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,5194,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$15,622.96 ",IP,"15,622.96","15,622.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,5301,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$3,382.31 ",IP,"3,382.31","3,382.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,5302,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$3,815.97 ",IP,"3,815.97","3,815.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,5303,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$5,327.23 ",IP,"5,327.23","5,327.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,5304,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$9,039.08 ",IP,"9,039.08","9,039.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,5311,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$2,096.46 ",IP,"2,096.46","2,096.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,5312,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$2,868.93 ",IP,"2,868.93","2,868.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,5313,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$4,503.56 ",IP,"4,503.56","4,503.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,5314,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$9,958.97 ",IP,"9,958.97","9,958.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,5321,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$2,302.29 ",IP,"2,302.29","2,302.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,5322,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$2,696.78 ",IP,"2,696.78","2,696.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,5323,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$4,143.44 ",IP,"4,143.44","4,143.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,5324,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$9,044.24 ",IP,"9,044.24","9,044.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,5401,CESAREAN DELIVERY,,Relative Weights,"$2,493.69 ",IP,"2,493.69","2,493.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,5402,CESAREAN DELIVERY,,Relative Weights,"$2,909.48 ",IP,"2,909.48","2,909.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,5403,CESAREAN DELIVERY,,Relative Weights,"$4,140.35 ",IP,"4,140.35","4,140.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,5404,CESAREAN DELIVERY,,Relative Weights,"$8,525.02 ",IP,"8,525.02","8,525.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,5411,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$2,683.03 ",IP,"2,683.03","2,683.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,5412,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$2,694.03 ",IP,"2,694.03","2,694.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,5413,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$3,800.85 ",IP,"3,800.85","3,800.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,5414,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$9,356.59 ",IP,"9,356.59","9,356.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,5421,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$1,729.81 ",IP,"1,729.81","1,729.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,5422,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$1,962.10 ",IP,"1,962.10","1,962.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,5423,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$2,979.24 ",IP,"2,979.24","2,979.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,5424,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$11,346.53 ",IP,"11,346.53","11,346.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,5441,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$1,946.30 ",IP,"1,946.30","1,946.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,5442,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$2,595.06 ",IP,"2,595.06","2,595.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,5443,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$3,856.51 ",IP,"3,856.51","3,856.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,5444,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$14,310.30 ",IP,"14,310.30","14,310.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,5451,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$2,785.09 ",IP,"2,785.09","2,785.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,5452,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$3,114.63 ",IP,"3,114.63","3,114.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,5453,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$3,214.96 ",IP,"3,214.96","3,214.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,5454,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$4,812.48 ",IP,"4,812.48","4,812.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,5461,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$2,385.45 ",IP,"2,385.45","2,385.45",,,,,,,,,,,,,
Meridian Medicaid,DRG,5462,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$4,587.41 ",IP,"4,587.41","4,587.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,5463,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$5,857.79 ",IP,"5,857.79","5,857.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,5464,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$11,895.30 ",IP,"11,895.30","11,895.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,5601,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$1,539.10 ",IP,"1,539.10","1,539.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,5602,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$1,659.37 ",IP,"1,659.37","1,659.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,5603,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$2,337.34 ",IP,"2,337.34","2,337.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,5604,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$4,292.23 ",IP,"4,292.23","4,292.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,5611,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$1,236.71 ",IP,"1,236.71","1,236.71",,,,,,,,,,,,,
Meridian Medicaid,DRG,5612,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$1,778.26 ",IP,"1,778.26","1,778.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,5613,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$2,747.29 ",IP,"2,747.29","2,747.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,5614,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$5,898.34 ",IP,"5,898.34","5,898.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,5631,PRETERM LABOR,,Relative Weights,"$1,387.56 ",IP,"1,387.56","1,387.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,5632,PRETERM LABOR,,Relative Weights,"$1,719.85 ",IP,"1,719.85","1,719.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,5633,PRETERM LABOR,,Relative Weights,"$2,634.92 ",IP,"2,634.92","2,634.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,5634,PRETERM LABOR,,Relative Weights,"$4,637.23 ",IP,"4,637.23","4,637.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,5641,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$1,463.85 ",IP,"1,463.85","1,463.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,5642,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$1,520.55 ",IP,"1,520.55","1,520.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,5643,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$2,435.62 ",IP,"2,435.62","2,435.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,5644,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$3,935.55 ",IP,"3,935.55","3,935.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,5651,FALSE LABOR,FALSE LABOR,Relative Weights,$992.39 ,IP,992.39,992.39,,,,,,,,,,,,,
Meridian Medicaid,DRG,5652,FALSE LABOR,FALSE LABOR,Relative Weights,"$1,254.23 ",IP,"1,254.23","1,254.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,5653,FALSE LABOR,FALSE LABOR,Relative Weights,"$2,123.61 ",IP,"2,123.61","2,123.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,5654,FALSE LABOR,FALSE LABOR,Relative Weights,"$2,123.61 ",IP,"2,123.61","2,123.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,5661,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$1,462.82 ",IP,"1,462.82","1,462.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,5662,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$1,906.44 ",IP,"1,906.44","1,906.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,5663,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$2,718.08 ",IP,"2,718.08","2,718.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,5664,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$5,715.19 ",IP,"5,715.19","5,715.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,5801,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$1,625.35 ",IP,"1,625.35","1,625.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,5802,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$2,301.61 ",IP,"2,301.61","2,301.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,5803,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$3,477.84 ",IP,"3,477.84","3,477.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,5804,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$6,537.48 ",IP,"6,537.48","6,537.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,5811,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,$559.42 ,IP,559.42,559.42,,,,,,,,,,,,,
Meridian Medicaid,DRG,5812,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,$716.80 ,IP,716.8,716.8,,,,,,,,,,,,,
Meridian Medicaid,DRG,5813,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,"$1,204.41 ",IP,"1,204.41","1,204.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,5814,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,"$2,109.52 ",IP,"2,109.52","2,109.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,5831,NEONATE W ECMO,,Relative Weights,"$87,271.04 ",IP,"87,271.04","87,271.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,5832,NEONATE W ECMO,,Relative Weights,"$87,459.00 ",IP,"87,459.00","87,459.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,5833,NEONATE W ECMO,,Relative Weights,"$148,358.12 ",IP,"148,358.12","148,358.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,5834,NEONATE W ECMO,,Relative Weights,"$163,193.83 ",IP,"163,193.83","163,193.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,5881,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$67,852.39 ",IP,"67,852.39","67,852.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,5882,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$75,391.54 ",IP,"75,391.54","75,391.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,5883,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$83,636.16 ",IP,"83,636.16","83,636.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,5884,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$133,619.66 ",IP,"133,619.66","133,619.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,5891,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$98,896.59 ",IP,"98,896.59","98,896.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,5892,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$69,370.87 ",IP,"69,370.87","69,370.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,5893,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$63,064.65 ",IP,"63,064.65","63,064.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,5894,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$11,889.12 ",IP,"11,889.12","11,889.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,5911,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$57,344.65 ",IP,"57,344.65","57,344.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,5912,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$79,559.04 ",IP,"79,559.04","79,559.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,5913,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$85,488.65 ",IP,"85,488.65","85,488.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,5914,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$110,417.00 ",IP,"110,417.00","110,417.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,5931,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$37,781.34 ",IP,"37,781.34","37,781.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,5932,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$59,330.12 ",IP,"59,330.12","59,330.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,5933,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$71,323.01 ",IP,"71,323.01","71,323.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,5934,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$96,423.52 ",IP,"96,423.52","96,423.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,6021,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$36,367.31 ",IP,"36,367.31","36,367.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,6022,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$43,081.42 ",IP,"43,081.42","43,081.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,6023,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$56,708.94 ",IP,"56,708.94","56,708.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,6024,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$82,218.02 ",IP,"82,218.02","82,218.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,6031,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$21,131.62 ",IP,"21,131.62","21,131.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,6032,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$31,760.66 ",IP,"31,760.66","31,760.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,6033,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$45,733.18 ",IP,"45,733.18","45,733.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,6034,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$71,521.63 ",IP,"71,521.63","71,521.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,6071,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$24,973.02 ",IP,"24,973.02","24,973.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,6072,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$31,699.15 ",IP,"31,699.15","31,699.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,6073,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$41,632.01 ",IP,"41,632.01","41,632.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,6074,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$64,492.07 ",IP,"64,492.07","64,492.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,6081,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$16,607.44 ",IP,"16,607.44","16,607.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,6082,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$23,967.23 ",IP,"23,967.23","23,967.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,6083,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$34,646.09 ",IP,"34,646.09","34,646.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,6084,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$60,788.81 ",IP,"60,788.81","60,788.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,6091,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$25,499.11 ",IP,"25,499.11","25,499.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,6092,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$27,431.32 ",IP,"27,431.32","27,431.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,6093,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$47,002.54 ",IP,"47,002.54","47,002.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,6094,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$99,687.62 ",IP,"99,687.62","99,687.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,6111,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$12,585.30 ",IP,"12,585.30","12,585.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,6112,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$19,393.91 ",IP,"19,393.91","19,393.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,6113,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$32,347.92 ",IP,"32,347.92","32,347.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,6114,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$58,174.51 ",IP,"58,174.51","58,174.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,6121,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$16,224.65 ",IP,"16,224.65","16,224.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,6122,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$21,637.79 ",IP,"21,637.79","21,637.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,6123,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$29,186.22 ",IP,"29,186.22","29,186.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,6124,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$42,407.23 ",IP,"42,407.23","42,407.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,6131,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$13,196.61 ",IP,"13,196.61","13,196.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,6132,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$21,189.35 ",IP,"21,189.35","21,189.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,6133,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$27,656.40 ",IP,"27,656.40","27,656.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,6134,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$47,731.03 ",IP,"47,731.03","47,731.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,6141,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$8,925.34 ",IP,"8,925.34","8,925.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,6142,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$15,030.54 ",IP,"15,030.54","15,030.54",,,,,,,,,,,,,
Meridian Medicaid,DRG,6143,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$25,580.55 ",IP,"25,580.55","25,580.55",,,,,,,,,,,,,
Meridian Medicaid,DRG,6144,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$45,341.79 ",IP,"45,341.79","45,341.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,6211,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$6,929.91 ",IP,"6,929.91","6,929.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,6212,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$14,367.69 ",IP,"14,367.69","14,367.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,6213,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$26,320.72 ",IP,"26,320.72","26,320.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,6214,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$49,514.79 ",IP,"49,514.79","49,514.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,6221,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$10,129.06 ",IP,"10,129.06","10,129.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,6222,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$13,681.47 ",IP,"13,681.47","13,681.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,6223,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$17,417.03 ",IP,"17,417.03","17,417.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,6224,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$32,501.52 ",IP,"32,501.52","32,501.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,6231,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$7,947.73 ",IP,"7,947.73","7,947.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,6232,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$11,704.59 ",IP,"11,704.59","11,704.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,6233,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$18,604.26 ",IP,"18,604.26","18,604.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,6234,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$29,470.40 ",IP,"29,470.40","29,470.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,6251,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$8,481.72 ",IP,"8,481.72","8,481.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,6252,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$12,056.81 ",IP,"12,056.81","12,056.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,6253,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$17,253.12 ",IP,"17,253.12","17,253.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,6254,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$25,500.83 ",IP,"25,500.83","25,500.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,6261,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$1,026.75 ",IP,"1,026.75","1,026.75",,,,,,,,,,,,,
Meridian Medicaid,DRG,6262,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$1,832.56 ",IP,"1,832.56","1,832.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,6263,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$5,129.99 ",IP,"5,129.99","5,129.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,6264,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$14,511.67 ",IP,"14,511.67","14,511.67",,,,,,,,,,,,,
Meridian Medicaid,DRG,6301,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$14,642.59 ",IP,"14,642.59","14,642.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,6302,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$26,499.41 ",IP,"26,499.41","26,499.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,6303,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$44,508.84 ",IP,"44,508.84","44,508.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,6304,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$79,154.59 ",IP,"79,154.59","79,154.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,6311,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$11,884.65 ",IP,"11,884.65","11,884.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,6312,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$19,077.77 ",IP,"19,077.77","19,077.77",,,,,,,,,,,,,
Meridian Medicaid,DRG,6313,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$33,764.00 ",IP,"33,764.00","33,764.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,6314,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$74,464.79 ",IP,"74,464.79","74,464.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,6331,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$2,688.87 ",IP,"2,688.87","2,688.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,6332,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$7,851.51 ",IP,"7,851.51","7,851.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,6333,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$17,713.92 ",IP,"17,713.92","17,713.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,6334,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$44,843.19 ",IP,"44,843.19","44,843.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,6341,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$4,461.64 ",IP,"4,461.64","4,461.64",,,,,,,,,,,,,
Meridian Medicaid,DRG,6342,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$7,881.41 ",IP,"7,881.41","7,881.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,6343,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$11,444.81 ",IP,"11,444.81","11,444.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,6344,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$28,806.17 ",IP,"28,806.17","28,806.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,6361,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$4,375.39 ",IP,"4,375.39","4,375.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,6362,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$6,615.83 ",IP,"6,615.83","6,615.83",,,,,,,,,,,,,
Meridian Medicaid,DRG,6363,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$13,140.60 ",IP,"13,140.60","13,140.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,6364,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$22,289.30 ",IP,"22,289.30","22,289.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,6391,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$4,122.14 ",IP,"4,122.14","4,122.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,6392,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$7,440.19 ",IP,"7,440.19","7,440.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,6393,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$11,681.22 ",IP,"11,681.22","11,681.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,6394,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$20,735.08 ",IP,"20,735.08","20,735.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,6401,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,$571.11 ,IP,571.11,571.11,,,,,,,,,,,,,
Meridian Medicaid,DRG,6402,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,$900.64 ,IP,900.64,900.64,,,,,,,,,,,,,
Meridian Medicaid,DRG,6403,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$2,228.41 ",IP,"2,228.41","2,228.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,6404,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$13,890.74 ",IP,"13,890.74","13,890.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,6501,SPLENECTOMY,,Relative Weights,"$6,304.16 ",IP,"6,304.16","6,304.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,6502,SPLENECTOMY,,Relative Weights,"$8,491.69 ",IP,"8,491.69","8,491.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,6503,SPLENECTOMY,,Relative Weights,"$13,332.00 ",IP,"13,332.00","13,332.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,6504,SPLENECTOMY,,Relative Weights,"$23,483.06 ",IP,"23,483.06","23,483.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,6511,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$5,293.90 ",IP,"5,293.90","5,293.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,6512,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$7,236.76 ",IP,"7,236.76","7,236.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,6513,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$10,916.31 ",IP,"10,916.31","10,916.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,6514,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$33,538.24 ",IP,"33,538.24","33,538.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,6601,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$3,747.59 ",IP,"3,747.59","3,747.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,6602,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$4,287.77 ",IP,"4,287.77","4,287.77",,,,,,,,,,,,,
Meridian Medicaid,DRG,6603,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$6,366.70 ",IP,"6,366.70","6,366.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,6604,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$16,194.41 ",IP,"16,194.41","16,194.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,6611,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$3,902.56 ",IP,"3,902.56","3,902.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,6612,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$5,668.11 ",IP,"5,668.11","5,668.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,6613,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$9,739.74 ",IP,"9,739.74","9,739.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,6614,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$15,545.30 ",IP,"15,545.30","15,545.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,6621,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$2,821.17 ",IP,"2,821.17","2,821.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,6622,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$3,681.27 ",IP,"3,681.27","3,681.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,6623,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$5,206.96 ",IP,"5,206.96","5,206.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,6624,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$10,694.33 ",IP,"10,694.33","10,694.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,6631,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$2,701.59 ",IP,"2,701.59","2,701.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,6632,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$3,327.33 ",IP,"3,327.33","3,327.33",,,,,,,,,,,,,
Meridian Medicaid,DRG,6633,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$4,391.20 ",IP,"4,391.20","4,391.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,6634,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$8,007.52 ",IP,"8,007.52","8,007.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,6801,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$7,740.52 ",IP,"7,740.52","7,740.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,6802,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$10,236.62 ",IP,"10,236.62","10,236.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,6803,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$16,199.56 ",IP,"16,199.56","16,199.56",,,,,,,,,,,,,
Meridian Medicaid,DRG,6804,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$34,974.94 ",IP,"34,974.94","34,974.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,6811,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$6,220.66 ",IP,"6,220.66","6,220.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,6812,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$7,805.46 ",IP,"7,805.46","7,805.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,6813,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$13,731.30 ",IP,"13,731.30","13,731.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,6814,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$32,311.50 ",IP,"32,311.50","32,311.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,6901,ACUTE LEUKEMIA,,Relative Weights,"$8,376.23 ",IP,"8,376.23","8,376.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,6902,ACUTE LEUKEMIA,,Relative Weights,"$11,965.06 ",IP,"11,965.06","11,965.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,6903,ACUTE LEUKEMIA,,Relative Weights,"$18,264.07 ",IP,"18,264.07","18,264.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,6904,ACUTE LEUKEMIA,,Relative Weights,"$33,495.63 ",IP,"33,495.63","33,495.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,6911,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$6,184.92 ",IP,"6,184.92","6,184.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,6912,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$6,251.93 ",IP,"6,251.93","6,251.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,6913,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$9,090.97 ",IP,"9,090.97","9,090.97",,,,,,,,,,,,,
Meridian Medicaid,DRG,6914,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$18,806.65 ",IP,"18,806.65","18,806.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,6921,RADIOTHERAPY,,Relative Weights,"$5,028.28 ",IP,"5,028.28","5,028.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,6922,RADIOTHERAPY,,Relative Weights,"$8,603.36 ",IP,"8,603.36","8,603.36",,,,,,,,,,,,,
Meridian Medicaid,DRG,6923,RADIOTHERAPY,,Relative Weights,"$11,232.45 ",IP,"11,232.45","11,232.45",,,,,,,,,,,,,
Meridian Medicaid,DRG,6924,RADIOTHERAPY,,Relative Weights,"$22,232.95 ",IP,"22,232.95","22,232.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,6941,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$3,669.93 ",IP,"3,669.93","3,669.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,6942,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$4,230.04 ",IP,"4,230.04","4,230.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,6943,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$5,867.41 ",IP,"5,867.41","5,867.41",,,,,,,,,,,,,
Meridian Medicaid,DRG,6944,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$11,092.25 ",IP,"11,092.25","11,092.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,6951,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$3,844.14 ",IP,"3,844.14","3,844.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,6952,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$4,908.70 ",IP,"4,908.70","4,908.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,6953,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$11,375.74 ",IP,"11,375.74","11,375.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,6954,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$32,868.17 ",IP,"32,868.17","32,868.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,6961,OTHER CHEMOTHERAPY,,Relative Weights,"$4,174.03 ",IP,"4,174.03","4,174.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,6962,OTHER CHEMOTHERAPY,,Relative Weights,"$5,397.68 ",IP,"5,397.68","5,397.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,6963,OTHER CHEMOTHERAPY,,Relative Weights,"$7,757.01 ",IP,"7,757.01","7,757.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,6964,OTHER CHEMOTHERAPY,,Relative Weights,"$17,845.53 ",IP,"17,845.53","17,845.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,7101,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$5,318.64 ",IP,"5,318.64","5,318.64",,,,,,,,,,,,,
Meridian Medicaid,DRG,7102,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$7,922.30 ",IP,"7,922.30","7,922.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,7103,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$12,117.63 ",IP,"12,117.63","12,117.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,7104,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$24,582.32 ",IP,"24,582.32","24,582.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,7111,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$5,432.73 ",IP,"5,432.73","5,432.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,7112,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$7,124.05 ",IP,"7,124.05","7,124.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,7113,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$12,166.42 ",IP,"12,166.42","12,166.42",,,,,,,,,,,,,
Meridian Medicaid,DRG,7114,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$25,010.82 ",IP,"25,010.82","25,010.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,7201,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$2,801.24 ",IP,"2,801.24","2,801.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,7202,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$3,678.52 ",IP,"3,678.52","3,678.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,7203,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$5,399.74 ",IP,"5,399.74","5,399.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,7204,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$10,740.72 ",IP,"10,740.72","10,740.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,7211,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$2,917.38 ",IP,"2,917.38","2,917.38",,,,,,,,,,,,,
Meridian Medicaid,DRG,7212,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$3,837.27 ",IP,"3,837.27","3,837.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,7213,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$6,182.18 ",IP,"6,182.18","6,182.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,7214,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$12,158.86 ",IP,"12,158.86","12,158.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,7221,FEVER,,Relative Weights,"$1,952.14 ",IP,"1,952.14","1,952.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,7222,FEVER,,Relative Weights,"$2,920.13 ",IP,"2,920.13","2,920.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,7223,FEVER,,Relative Weights,"$3,952.39 ",IP,"3,952.39","3,952.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,7224,FEVER,,Relative Weights,"$6,941.25 ",IP,"6,941.25","6,941.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,7231,VIRAL ILLNESS,,Relative Weights,"$1,908.50 ",IP,"1,908.50","1,908.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,7232,VIRAL ILLNESS,,Relative Weights,"$2,685.44 ",IP,"2,685.44","2,685.44",,,,,,,,,,,,,
Meridian Medicaid,DRG,7233,VIRAL ILLNESS,,Relative Weights,"$4,131.07 ",IP,"4,131.07","4,131.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,7234,VIRAL ILLNESS,,Relative Weights,"$10,429.39 ",IP,"10,429.39","10,429.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,7241,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$3,048.31 ",IP,"3,048.31","3,048.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,7242,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$3,655.49 ",IP,"3,655.49","3,655.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,7243,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$5,820.68 ",IP,"5,820.68","5,820.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,7244,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$13,099.02 ",IP,"13,099.02","13,099.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,7401,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$6,032.70 ",IP,"6,032.70","6,032.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,7402,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$6,703.46 ",IP,"6,703.46","6,703.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,7403,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$13,324.79 ",IP,"13,324.79","13,324.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,7404,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$26,668.81 ",IP,"26,668.81","26,668.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,7501,SCHIZOPHRENIA,,Relative Weights,"$2,530.12 ",IP,"2,530.12","2,530.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,7502,SCHIZOPHRENIA,,Relative Weights,"$2,708.80 ",IP,"2,708.80","2,708.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,7503,SCHIZOPHRENIA,,Relative Weights,"$4,799.08 ",IP,"4,799.08","4,799.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,7504,SCHIZOPHRENIA,,Relative Weights,"$13,473.58 ",IP,"13,473.58","13,473.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,7511,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$1,760.40 ",IP,"1,760.40","1,760.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,7512,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$2,237.01 ",IP,"2,237.01","2,237.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,7513,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$3,773.70 ",IP,"3,773.70","3,773.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,7514,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$8,518.14 ",IP,"8,518.14","8,518.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,7521,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$1,687.20 ",IP,"1,687.20","1,687.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,7522,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$2,102.30 ",IP,"2,102.30","2,102.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,7523,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$3,885.72 ",IP,"3,885.72","3,885.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,7524,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$13,737.14 ",IP,"13,737.14","13,737.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,7531,BIPOLAR DISORDERS,,Relative Weights,"$1,873.11 ",IP,"1,873.11","1,873.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,7532,BIPOLAR DISORDERS,,Relative Weights,"$2,183.40 ",IP,"2,183.40","2,183.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,7533,BIPOLAR DISORDERS,,Relative Weights,"$3,541.07 ",IP,"3,541.07","3,541.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,7534,BIPOLAR DISORDERS,,Relative Weights,"$10,043.84 ",IP,"10,043.84","10,043.84",,,,,,,,,,,,,
Meridian Medicaid,DRG,7541,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$1,523.64 ",IP,"1,523.64","1,523.64",,,,,,,,,,,,,
Meridian Medicaid,DRG,7542,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$2,007.46 ",IP,"2,007.46","2,007.46",,,,,,,,,,,,,
Meridian Medicaid,DRG,7543,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$3,012.23 ",IP,"3,012.23","3,012.23",,,,,,,,,,,,,
Meridian Medicaid,DRG,7544,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$7,979.68 ",IP,"7,979.68","7,979.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,7551,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$1,532.57 ",IP,"1,532.57","1,532.57",,,,,,,,,,,,,
Meridian Medicaid,DRG,7552,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$2,506.06 ",IP,"2,506.06","2,506.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,7553,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$3,538.32 ",IP,"3,538.32","3,538.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,7554,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$6,118.26 ",IP,"6,118.26","6,118.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,7561,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$2,496.79 ",IP,"2,496.79","2,496.79",,,,,,,,,,,,,
Meridian Medicaid,DRG,7562,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$3,057.58 ",IP,"3,057.58","3,057.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,7563,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$3,397.43 ",IP,"3,397.43","3,397.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,7564,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$7,384.52 ",IP,"7,384.52","7,384.52",,,,,,,,,,,,,
Meridian Medicaid,DRG,7571,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$2,504.35 ",IP,"2,504.35","2,504.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,7572,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$3,161.02 ",IP,"3,161.02","3,161.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,7573,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$5,750.24 ",IP,"5,750.24","5,750.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,7574,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$15,933.94 ",IP,"15,933.94","15,933.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,7581,BEHAVIORAL DISORDERS,,Relative Weights,"$2,326.35 ",IP,"2,326.35","2,326.35",,,,,,,,,,,,,
Meridian Medicaid,DRG,7582,BEHAVIORAL DISORDERS,,Relative Weights,"$2,881.65 ",IP,"2,881.65","2,881.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,7583,BEHAVIORAL DISORDERS,,Relative Weights,"$4,037.26 ",IP,"4,037.26","4,037.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,7584,BEHAVIORAL DISORDERS,,Relative Weights,"$5,464.00 ",IP,"5,464.00","5,464.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,7591,EATING DISORDERS,,Relative Weights,"$4,564.04 ",IP,"4,564.04","4,564.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,7592,EATING DISORDERS,,Relative Weights,"$5,955.04 ",IP,"5,955.04","5,955.04",,,,,,,,,,,,,
Meridian Medicaid,DRG,7593,EATING DISORDERS,,Relative Weights,"$9,440.78 ",IP,"9,440.78","9,440.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,7594,EATING DISORDERS,,Relative Weights,"$12,954.01 ",IP,"12,954.01","12,954.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,7601,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$2,553.48 ",IP,"2,553.48","2,553.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,7602,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$3,467.19 ",IP,"3,467.19","3,467.19",,,,,,,,,,,,,
Meridian Medicaid,DRG,7603,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$6,902.07 ",IP,"6,902.07","6,902.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,7604,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$12,546.82 ",IP,"12,546.82","12,546.82",,,,,,,,,,,,,
Meridian Medicaid,DRG,7701,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$1,041.53 ",IP,"1,041.53","1,041.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,7702,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$1,522.95 ",IP,"1,522.95","1,522.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,7703,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$2,633.89 ",IP,"2,633.89","2,633.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,7704,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$6,153.65 ",IP,"6,153.65","6,153.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,7721,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$2,743.85 ",IP,"2,743.85","2,743.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,7722,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$3,502.58 ",IP,"3,502.58","3,502.58",,,,,,,,,,,,,
Meridian Medicaid,DRG,7723,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$4,241.72 ",IP,"4,241.72","4,241.72",,,,,,,,,,,,,
Meridian Medicaid,DRG,7724,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$9,550.40 ",IP,"9,550.40","9,550.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,7731,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$1,275.88 ",IP,"1,275.88","1,275.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,7732,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$1,881.01 ",IP,"1,881.01","1,881.01",,,,,,,,,,,,,
Meridian Medicaid,DRG,7733,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$3,476.12 ",IP,"3,476.12","3,476.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,7734,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$9,565.86 ",IP,"9,565.86","9,565.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,7741,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$1,761.43 ",IP,"1,761.43","1,761.43",,,,,,,,,,,,,
Meridian Medicaid,DRG,7742,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$1,956.95 ",IP,"1,956.95","1,956.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,7743,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$3,314.62 ",IP,"3,314.62","3,314.62",,,,,,,,,,,,,
Meridian Medicaid,DRG,7744,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$9,105.40 ",IP,"9,105.40","9,105.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,7751,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$1,741.50 ",IP,"1,741.50","1,741.50",,,,,,,,,,,,,
Meridian Medicaid,DRG,7752,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$2,441.81 ",IP,"2,441.81","2,441.81",,,,,,,,,,,,,
Meridian Medicaid,DRG,7753,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$3,986.06 ",IP,"3,986.06","3,986.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,7754,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$10,751.37 ",IP,"10,751.37","10,751.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,7761,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$2,414.66 ",IP,"2,414.66","2,414.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,7762,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$2,653.48 ",IP,"2,653.48","2,653.48",,,,,,,,,,,,,
Meridian Medicaid,DRG,7763,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$4,175.40 ",IP,"4,175.40","4,175.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,7764,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$7,699.28 ",IP,"7,699.28","7,699.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,7921,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$7,773.51 ",IP,"7,773.51","7,773.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,7922,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$8,931.53 ",IP,"8,931.53","8,931.53",,,,,,,,,,,,,
Meridian Medicaid,DRG,7923,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$13,005.21 ",IP,"13,005.21","13,005.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,7924,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$27,591.45 ",IP,"27,591.45","27,591.45",,,,,,,,,,,,,
Meridian Medicaid,DRG,7931,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$4,608.37 ",IP,"4,608.37","4,608.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,7932,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$6,350.90 ",IP,"6,350.90","6,350.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,7933,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$9,808.12 ",IP,"9,808.12","9,808.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,7934,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$20,177.03 ",IP,"20,177.03","20,177.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,7941,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$3,990.87 ",IP,"3,990.87","3,990.87",,,,,,,,,,,,,
Meridian Medicaid,DRG,7942,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$5,327.92 ",IP,"5,327.92","5,327.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,7943,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$7,911.30 ",IP,"7,911.30","7,911.30",,,,,,,,,,,,,
Meridian Medicaid,DRG,7944,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$16,457.28 ",IP,"16,457.28","16,457.28",,,,,,,,,,,,,
Meridian Medicaid,DRG,8101,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$2,594.03 ",IP,"2,594.03","2,594.03",,,,,,,,,,,,,
Meridian Medicaid,DRG,8102,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$3,420.11 ",IP,"3,420.11","3,420.11",,,,,,,,,,,,,
Meridian Medicaid,DRG,8103,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$5,351.98 ",IP,"5,351.98","5,351.98",,,,,,,,,,,,,
Meridian Medicaid,DRG,8104,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$10,772.68 ",IP,"10,772.68","10,772.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,8111,ALLERGIC REACTIONS,,Relative Weights,"$1,582.40 ",IP,"1,582.40","1,582.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,8112,ALLERGIC REACTIONS,,Relative Weights,"$2,325.66 ",IP,"2,325.66","2,325.66",,,,,,,,,,,,,
Meridian Medicaid,DRG,8113,ALLERGIC REACTIONS,,Relative Weights,"$4,003.24 ",IP,"4,003.24","4,003.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,8114,ALLERGIC REACTIONS,,Relative Weights,"$9,358.65 ",IP,"9,358.65","9,358.65",,,,,,,,,,,,,
Meridian Medicaid,DRG,8121,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$1,778.95 ",IP,"1,778.95","1,778.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,8122,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$2,471.70 ",IP,"2,471.70","2,471.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,8123,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$3,713.91 ",IP,"3,713.91","3,713.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,8124,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$7,487.95 ",IP,"7,487.95","7,487.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,8131,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$2,963.09 ",IP,"2,963.09","2,963.09",,,,,,,,,,,,,
Meridian Medicaid,DRG,8132,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$3,546.91 ",IP,"3,546.91","3,546.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,8133,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$5,048.90 ",IP,"5,048.90","5,048.90",,,,,,,,,,,,,
Meridian Medicaid,DRG,8134,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$10,108.45 ",IP,"10,108.45","10,108.45",,,,,,,,,,,,,
Meridian Medicaid,DRG,8151,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$2,225.32 ",IP,"2,225.32","2,225.32",,,,,,,,,,,,,
Meridian Medicaid,DRG,8152,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$3,062.74 ",IP,"3,062.74","3,062.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,8153,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$5,006.29 ",IP,"5,006.29","5,006.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,8154,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$14,243.99 ",IP,"14,243.99","14,243.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,8161,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$2,832.85 ",IP,"2,832.85","2,832.85",,,,,,,,,,,,,
Meridian Medicaid,DRG,8162,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$3,147.27 ",IP,"3,147.27","3,147.27",,,,,,,,,,,,,
Meridian Medicaid,DRG,8163,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$3,543.13 ",IP,"3,543.13","3,543.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,8164,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$7,485.21 ",IP,"7,485.21","7,485.21",,,,,,,,,,,,,
Meridian Medicaid,DRG,8171,OVERDOSE,,Relative Weights,"$1,970.70 ",IP,"1,970.70","1,970.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,8172,OVERDOSE,,Relative Weights,"$2,320.16 ",IP,"2,320.16","2,320.16",,,,,,,,,,,,,
Meridian Medicaid,DRG,8173,OVERDOSE,,Relative Weights,"$3,714.94 ",IP,"3,714.94","3,714.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,8174,OVERDOSE,,Relative Weights,"$7,902.37 ",IP,"7,902.37","7,902.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,8411,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$22,662.13 ",IP,"22,662.13","22,662.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,8412,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$23,053.18 ",IP,"23,053.18","23,053.18",,,,,,,,,,,,,
Meridian Medicaid,DRG,8413,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$35,475.26 ",IP,"35,475.26","35,475.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,8414,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$76,935.80 ",IP,"76,935.80","76,935.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,8421,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$7,378.34 ",IP,"7,378.34","7,378.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,8422,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$11,298.08 ",IP,"11,298.08","11,298.08",,,,,,,,,,,,,
Meridian Medicaid,DRG,8423,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$20,251.94 ",IP,"20,251.94","20,251.94",,,,,,,,,,,,,
Meridian Medicaid,DRG,8424,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$47,998.02 ",IP,"47,998.02","47,998.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,8431,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$3,499.14 ",IP,"3,499.14","3,499.14",,,,,,,,,,,,,
Meridian Medicaid,DRG,8432,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$3,888.47 ",IP,"3,888.47","3,888.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,8433,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$4,320.07 ",IP,"4,320.07","4,320.07",,,,,,,,,,,,,
Meridian Medicaid,DRG,8434,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$12,575.34 ",IP,"12,575.34","12,575.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,8441,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$2,201.96 ",IP,"2,201.96","2,201.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,8442,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$3,652.06 ",IP,"3,652.06","3,652.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,8443,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$7,050.86 ",IP,"7,050.86","7,050.86",,,,,,,,,,,,,
Meridian Medicaid,DRG,8444,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$19,183.95 ",IP,"19,183.95","19,183.95",,,,,,,,,,,,,
Meridian Medicaid,DRG,8501,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$9,879.93 ",IP,"9,879.93","9,879.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,8502,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$12,498.36 ",IP,"12,498.36","12,498.36",,,,,,,,,,,,,
Meridian Medicaid,DRG,8503,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$15,265.59 ",IP,"15,265.59","15,265.59",,,,,,,,,,,,,
Meridian Medicaid,DRG,8504,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$33,306.29 ",IP,"33,306.29","33,306.29",,,,,,,,,,,,,
Meridian Medicaid,DRG,8601,REHABILITATION,REHABILITATION,Relative Weights,"$2,725.99 ",IP,"2,725.99","2,725.99",,,,,,,,,,,,,
Meridian Medicaid,DRG,8602,REHABILITATION,REHABILITATION,Relative Weights,"$2,784.40 ",IP,"2,784.40","2,784.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,8603,REHABILITATION,REHABILITATION,Relative Weights,"$4,569.88 ",IP,"4,569.88","4,569.88",,,,,,,,,,,,,
Meridian Medicaid,DRG,8604,REHABILITATION,REHABILITATION,Relative Weights,"$7,353.25 ",IP,"7,353.25","7,353.25",,,,,,,,,,,,,
Meridian Medicaid,DRG,8611,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$2,528.74 ",IP,"2,528.74","2,528.74",,,,,,,,,,,,,
Meridian Medicaid,DRG,8612,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$3,061.36 ",IP,"3,061.36","3,061.36",,,,,,,,,,,,,
Meridian Medicaid,DRG,8613,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$4,043.10 ",IP,"4,043.10","4,043.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,8614,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$7,783.47 ",IP,"7,783.47","7,783.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,8621,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$2,738.70 ",IP,"2,738.70","2,738.70",,,,,,,,,,,,,
Meridian Medicaid,DRG,8622,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$3,392.96 ",IP,"3,392.96","3,392.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,8623,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$4,971.92 ",IP,"4,971.92","4,971.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,8624,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$9,845.92 ",IP,"9,845.92","9,845.92",,,,,,,,,,,,,
Meridian Medicaid,DRG,8631,NEONATAL AFTERCARE,,Relative Weights,"$4,260.96 ",IP,"4,260.96","4,260.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,8632,NEONATAL AFTERCARE,,Relative Weights,"$10,340.39 ",IP,"10,340.39","10,340.39",,,,,,,,,,,,,
Meridian Medicaid,DRG,8633,NEONATAL AFTERCARE,,Relative Weights,"$23,505.05 ",IP,"23,505.05","23,505.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,8634,NEONATAL AFTERCARE,,Relative Weights,"$48,982.51 ",IP,"48,982.51","48,982.51",,,,,,,,,,,,,
Meridian Medicaid,DRG,8901,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$3,464.78 ",IP,"3,464.78","3,464.78",,,,,,,,,,,,,
Meridian Medicaid,DRG,8902,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$4,475.73 ",IP,"4,475.73","4,475.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,8903,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$6,306.22 ",IP,"6,306.22","6,306.22",,,,,,,,,,,,,
Meridian Medicaid,DRG,8904,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$13,523.40 ",IP,"13,523.40","13,523.40",,,,,,,,,,,,,
Meridian Medicaid,DRG,8921,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$3,450.69 ",IP,"3,450.69","3,450.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,8922,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$4,178.15 ",IP,"4,178.15","4,178.15",,,,,,,,,,,,,
Meridian Medicaid,DRG,8923,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$4,816.26 ",IP,"4,816.26","4,816.26",,,,,,,,,,,,,
Meridian Medicaid,DRG,8924,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$8,453.20 ",IP,"8,453.20","8,453.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,8931,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$2,817.73 ",IP,"2,817.73","2,817.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,8932,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$4,010.80 ",IP,"4,010.80","4,010.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,8933,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$5,201.12 ",IP,"5,201.12","5,201.12",,,,,,,,,,,,,
Meridian Medicaid,DRG,8934,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$9,134.61 ",IP,"9,134.61","9,134.61",,,,,,,,,,,,,
Meridian Medicaid,DRG,8941,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$2,969.96 ",IP,"2,969.96","2,969.96",,,,,,,,,,,,,
Meridian Medicaid,DRG,8942,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$3,496.05 ",IP,"3,496.05","3,496.05",,,,,,,,,,,,,
Meridian Medicaid,DRG,8943,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$4,518.34 ",IP,"4,518.34","4,518.34",,,,,,,,,,,,,
Meridian Medicaid,DRG,8944,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$6,751.91 ",IP,"6,751.91","6,751.91",,,,,,,,,,,,,
Meridian Medicaid,DRG,9101,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$13,920.63 ",IP,"13,920.63","13,920.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,9102,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$15,317.47 ",IP,"15,317.47","15,317.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,9103,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$18,619.37 ",IP,"18,619.37","18,619.37",,,,,,,,,,,,,
Meridian Medicaid,DRG,9104,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$36,457.00 ",IP,"36,457.00","36,457.00",,,,,,,,,,,,,
Meridian Medicaid,DRG,9111,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$7,838.80 ",IP,"7,838.80","7,838.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,9112,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$10,303.63 ",IP,"10,303.63","10,303.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,9113,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$13,414.47 ",IP,"13,414.47","13,414.47",,,,,,,,,,,,,
Meridian Medicaid,DRG,9114,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$32,085.73 ",IP,"32,085.73","32,085.73",,,,,,,,,,,,,
Meridian Medicaid,DRG,9121,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$8,688.93 ",IP,"8,688.93","8,688.93",,,,,,,,,,,,,
Meridian Medicaid,DRG,9122,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$9,567.24 ",IP,"9,567.24","9,567.24",,,,,,,,,,,,,
Meridian Medicaid,DRG,9123,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$14,948.76 ",IP,"14,948.76","14,948.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,9124,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$30,211.60 ",IP,"30,211.60","30,211.60",,,,,,,,,,,,,
Meridian Medicaid,DRG,9301,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$3,875.76 ",IP,"3,875.76","3,875.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,9302,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$4,609.06 ",IP,"4,609.06","4,609.06",,,,,,,,,,,,,
Meridian Medicaid,DRG,9303,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$7,139.17 ",IP,"7,139.17","7,139.17",,,,,,,,,,,,,
Meridian Medicaid,DRG,9304,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$15,709.89 ",IP,"15,709.89","15,709.89",,,,,,,,,,,,,
Meridian Medicaid,DRG,9501,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$7,265.63 ",IP,"7,265.63","7,265.63",,,,,,,,,,,,,
Meridian Medicaid,DRG,9502,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$9,410.20 ",IP,"9,410.20","9,410.20",,,,,,,,,,,,,
Meridian Medicaid,DRG,9503,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$12,679.80 ",IP,"12,679.80","12,679.80",,,,,,,,,,,,,
Meridian Medicaid,DRG,9504,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$27,388.02 ",IP,"27,388.02","27,388.02",,,,,,,,,,,,,
Meridian Medicaid,DRG,9511,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$5,641.31 ",IP,"5,641.31","5,641.31",,,,,,,,,,,,,
Meridian Medicaid,DRG,9512,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$7,394.49 ",IP,"7,394.49","7,394.49",,,,,,,,,,,,,
Meridian Medicaid,DRG,9513,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$11,184.68 ",IP,"11,184.68","11,184.68",,,,,,,,,,,,,
Meridian Medicaid,DRG,9514,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$22,584.13 ",IP,"22,584.13","22,584.13",,,,,,,,,,,,,
Meridian Medicaid,DRG,9521,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$4,663.69 ",IP,"4,663.69","4,663.69",,,,,,,,,,,,,
Meridian Medicaid,DRG,9522,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$6,212.76 ",IP,"6,212.76","6,212.76",,,,,,,,,,,,,
Meridian Medicaid,DRG,9523,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$9,852.10 ",IP,"9,852.10","9,852.10",,,,,,,,,,,,,
Meridian Medicaid,DRG,9524,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$20,519.28 ",IP,"20,519.28","20,519.28",,,,,,,,,,,,,
Meridian Medicaid,CPT,100,Anesth salivary gland,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,102,Anesth repair of cleft lip,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,103,Anesth blepharoplasty,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,104,Anesth electroshock,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,120,Anesth ear surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,124,Anesth ear exam,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,126,Anesth tympanotomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,140,Anesth procedures on eye,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,142,Anesth lens surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,144,Anesth corneal transplant,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,145,Anesth vitreoretinal surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,147,Anesth iridectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,148,Anesth eye exam,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,160,Anesth nose/sinus surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,162,Anesth nose/sinus surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,164,Anesth biopsy of nose,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,170,Anesth procedure on mouth,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,172,Anesth cleft palate repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,174,Anesth pharyngeal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,176,Anesth pharyngeal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,190,Anesth face/skull bone surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,192,Anesth facial bone surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,210,Anesth cranial surg nos,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,211,Anesth cran surg hemotoma,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,212,Anesth skull drainage,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,214,Anesth skull drainage,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,215,Anesth skull repair/fract,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,216,Anesth head vessel surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,218,Anesth special head surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,220,Anesth intrcrn nerve,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,222,Anesth head nerve surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,300,Anesth head/neck/ptrunk,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,320,Anesth neck organ 1yr/>,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,322,Anesth biopsy of thyroid,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,326,Anesth larynx/trach < 1 yr,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,350,Anesth neck vessel surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,352,Anesth neck vessel surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,400,Anesth skin ext/per/atrunk,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,402,Anesth surgery of breast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,404,Anesth surgery of breast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,406,Anesth surgery of breast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,410,Anesth correct heart rhythm,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,450,Anesth surgery of shoulder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,454,Anesth collar bone biopsy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,470,Anesth removal of rib,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,472,Anesth chest wall repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,474,Anesth surgery of rib,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,500,Anesth esophageal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,520,Anesth chest procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,522,Anesth chest lining biopsy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,524,Anesth chest drainage,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,528,Anes mediascpy & dx thorscpy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,529,Anes medscpy&thorscpy 1 lung,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,530,Anesth pacemaker insertion,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,532,Anesth vascular access,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,534,Anesth cardioverter/defib,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,537,Anesth cardiac electrophys,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,539,Anesth trach-bronch reconst,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,540,Anesth chest surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,541,Anesth one lung ventilation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,542,Anesthesia removal pleura,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,546,Anesth lung chest wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,548,Anesth trachea bronchi surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,550,Anesth sternal debridement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,560,Anesth heart surg w/o pump,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,561,Anesth heart surg <1 yr,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,562,Anesth hrt surg w/pmp age 1+,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,563,Anesth heart surg w/arrest,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,566,Anesth cabg w/o pump,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,567,Anesth cabg w/pump,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,580,Anesth heart/lung transplnt,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,600,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,604,Anesth sitting procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,620,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,625,Anes spine tranthor w/o vent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,626,Anes spine transthor w/vent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,630,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,632,Anesth removal of nerves,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,635,Anesth lumbar puncture,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,640,Anesth spine manipulation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,670,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,700,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,702,Anesth for liver biopsy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,730,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,731,Anes upr gi ndsc px nos,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,732,Anes upr gi ndsc px ercp,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,740,Anesth upper gi visualize,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,750,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,752,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,754,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,756,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,770,Anesth blood vessel repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,790,Anesth surg upper abdomen,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,792,Anesth hemorr/excise liver,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,794,Anesth pancreas removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,796,Anesth for liver transplant,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,797,Anesth surgery for obesity,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,800,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,802,Anesth fat layer removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,810,Anesth low intestine scope,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,811,Anes lwr intst ndsc nos,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,812,Anes lwr intst scr colsc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,813,Anes upr lwr gi ndsc px,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,820,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,830,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,832,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,834,Anesth hernia repair < 1 yr,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,836,Anesth hernia repair preemie,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,840,Anesth surg lower abdomen,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,842,Anesth amniocentesis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,844,Anesth pelvis surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,846,Anesth hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,848,Anesth pelvic organ surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,851,Anesth tubal ligation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,860,Anesth surgery of abdomen,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,862,Anesth kidney/ureter surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,864,Anesth removal of bladder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,865,Anesth removal of prostate,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,866,Anesth removal of adrenal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,868,Anesth kidney transplant,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,870,Anesth bladder stone surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,872,Anesth kidney stone destruct,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,873,Anesth kidney stone destruct,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,880,Anesth abdomen vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,882,Anesth major vein ligation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,902,Anesth anorectal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,904,Anesth perineal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,906,Anesth removal of vulva,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,908,Anesth removal of prostate,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,910,Anesth bladder surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,912,Anesth bladder tumor surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,914,Anesth removal of prostate,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,916,Anesth bleeding control,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,918,Anesth stone removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,920,Anesth genitalia surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,921,Anesth vasectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,922,Anesth sperm duct surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,924,Anesth testis exploration,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,926,Anesth removal of testis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,928,Anesth removal of testis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,930,Anesth testis suspension,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,932,Anesth amputation of penis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,934,Anesth penis nodes removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,936,Anesth penis nodes removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,938,Anesth insert penis device,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,940,Anesth vaginal procedures,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,942,Anesth surg on vag/urethral,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,944,Anesth vaginal hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,948,Anesth repair of cervix,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,950,Anesth vaginal endoscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,952,Anesth hysteroscope/graph,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1112,Anesth bone aspirate/bx,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1120,Anesth pelvis surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1130,Anesth body cast procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1140,Anesth amputation at pelvis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1150,Anesth pelvic tumor surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1160,Anesth pelvis procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1170,Anesth pelvis surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1173,Anesth fx repair pelvis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1180,Anesth pelvis nerve removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1190,Anesth pelvis nerve removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1200,Anesth hip joint procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1202,Anesth arthroscopy of hip,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1210,Anesth hip joint surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1212,Anesth hip disarticulation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1214,Anesth hip arthroplasty,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1215,Anesth revise hip repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1220,Anesth procedure on femur,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1230,Anesth surgery of femur,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1232,Anesth amputation of femur,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1234,Anesth radical femur surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1250,Anesth upper leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1260,Anesth upper leg veins surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1270,Anesth thigh arteries surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1272,Anesth femoral artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1274,Anesth femoral embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1320,Anesth knee area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1340,Anesth knee area procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1360,Anesth knee area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1380,Anesth knee joint procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1382,Anesth dx knee arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1390,Anesth knee area procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1392,Anesth knee area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1400,Anesth knee joint surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1402,Anesth knee arthroplasty,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1404,Anesth amputation at knee,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1420,Anesth knee joint casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1430,Anesth knee veins surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1432,Anesth knee vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1440,Anesth knee arteries surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1442,Anesth knee artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1444,Anesth knee artery repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1462,Anesth lower leg procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1464,Anesth ankle/ft arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1470,Anesth lower leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1472,Anesth achilles tendon surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1474,Anesth lower leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1480,Anesth lower leg bone surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1482,Anesth radical leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1484,Anesth lower leg revision,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1486,Anesth ankle replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1490,Anesth lower leg casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1500,Anesth leg arteries surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1502,Anesth lwr leg embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1520,Anesth lower leg vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1522,Anesth lower leg vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1610,Anesth surgery of shoulder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1620,Anesth shoulder procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1622,Anes dx shoulder arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1630,Anesth surgery of shoulder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1634,Anesth shoulder joint amput,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1636,Anesth forequarter amput,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1638,Anesth shoulder replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1650,Anesth shoulder artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1652,Anesth shoulder vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1654,Anesth shoulder vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1656,Anesth arm-leg vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1670,Anesth shoulder vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1680,Anesth shoulder casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1682,Anesth airplane cast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1710,Anesth elbow area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1712,Anesth uppr arm tendon surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1714,Anesth uppr arm tendon surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1716,Anesth biceps tendon repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1730,Anesth uppr arm procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1732,Anesth dx elbow arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1740,Anesth upper arm surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1742,Anesth humerus surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1744,Anesth humerus repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1756,Anesth radical humerus surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1758,Anesth humeral lesion surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1760,Anesth elbow replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1770,Anesth uppr arm artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1772,Anesth uppr arm embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1780,Anesth upper arm vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1782,Anesth uppr arm vein repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1810,Anesth lower arm surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1820,Anesth lower arm procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1829,Anesth dx wrist arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1830,Anesth lower arm surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1832,Anesth wrist replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1840,Anesth lwr arm artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1842,Anesth lwr arm embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1844,Anesth vascular shunt surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1850,Anesth lower arm vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1852,Anesth lwr arm vein repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1860,Anesth lower arm casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1916,Anesth dx arteriography,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1920,Anesth catheterize heart,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1922,Anesth cat or mri scan,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1924,Anes ther interven rad artrl,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1925,Anes ther interven rad card,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1926,Anes tx interv rad hrt/cran,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1930,Anes ther interven rad vein,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1931,Anes ther interven rad tips,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1932,Anes tx interv rad th vein,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1933,Anes tx interv rad cran vein,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1935,Anesth perc img dx sp proc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1936,Anesth perc img tx sp proc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1951,Anesth burn less 4 percent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1952,Anesth burn 4-9 percent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1953,Anesth burn each 9 percent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1958,Anesth antepartum manipul,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1960,Anesth vaginal delivery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1961,Anesth cs delivery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1962,Anesth emer hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1963,Anesth cs hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1965,Anesth inc/missed ab proc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1966,Anesth induced ab procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1967,Anesth/analg vag delivery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1968,Anes/analg cs deliver add-on,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1969,Anesth/analg cs hyst add-on,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1991,Anesth nerve block/inj,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1992,Anesth n block/inj prone,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1996,Hosp manage cont drug admin,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,1999,Unlisted anesth procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10004,Fna bx w/o img gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10005,Fna bx w/us gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10006,Fna bx w/us gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10007,Fna bx w/fluor gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10008,Fna bx w/fluor gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10009,Fna bx w/ct gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10010,Fna bx w/ct gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10011,Fna bx w/mr gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10012,Fna bx w/mr gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10021,Fna bx w/o img gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10022,Fna w/image,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10030,Guide cathet fluid drainage,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10040,Acne surgery,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10060,Drainage of skin abscess,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10061,Drainage of skin abscess,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10080,Drainage of pilonidal cyst,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10081,Drainage of pilonidal cyst,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10120,Remove foreign body,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10121,Remove foreign body,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10140,Drainage of hematoma/fluid,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,10160,Puncture drainage of lesion,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11055,Trim skin lesion,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11056,Trim skin lesions 2 to 4,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11057,Trim skin lesions over 4,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11100,Biopsy skin lesion,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11101,Biopsy skin add-on,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11102,Tangntl bx skin single les,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11103,Tangntl bx skin ea sep/addl,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11104,Punch bx skin single lesion,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11105,Punch bx skin ea sep/addl,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11106,Incal bx skn single les,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11107,Incal bx skn ea sep/addl,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11200,Removal of skin tags 2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11305,Shave skin lesion 0.5 cm/<,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11306,Shave skin lesion 0.6-1.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11307,Shave skin lesion 1.1-2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11308,Shave skin lesion >2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11310,Shave skin lesion 0.5 cm/<,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11311,Shave skin lesion 0.6-1.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11312,Shave skin lesion 1.1-2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11313,Shave skin lesion >2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11400,Exc tr-ext b9+marg 0.5 cm<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11401,Exc tr-ext b9+marg 0.6-1 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11402,Exc tr-ext b9+marg 1.1-2 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11403,Exc tr-ext b9+marg 2.1-3cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11404,Exc tr-ext b9+marg 3.1-4 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11406,Exc tr-ext b9+marg >4.0 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11420,Exc h-f-nk-sp b9+marg 0.5/<,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11421,Exc h-f-nk-sp b9+marg 0.6-1,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11422,Exc h-f-nk-sp b9+marg 1.1-2,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11423,Exc h-f-nk-sp b9+marg 2.1-3,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11424,Exc h-f-nk-sp b9+marg 3.1-4,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11426,Exc h-f-nk-sp b9+marg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11440,Exc face-mm b9+marg 0.5 cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11441,Exc face-mm b9+marg 0.6-1 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11442,Exc face-mm b9+marg 1.1-2 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11443,Exc face-mm b9+marg 2.1-3 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11444,Exc face-mm b9+marg 3.1-4 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11446,Exc face-mm b9+marg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11450,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11451,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11462,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11463,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11470,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11471,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11600,Exc tr-ext mal+marg 0.5 cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11601,Exc tr-ext mal+marg 0.6-1 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11602,Exc tr-ext mal+marg 1.1-2 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11603,Exc tr-ext mal+marg 2.1-3 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11604,Exc tr-ext mal+marg 3.1-4 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11606,Exc tr-ext mal+marg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11620,Exc h-f-nk-sp mal+marg 0.5/<,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11621,Exc s/n/h/f/g mal+mrg 0.6-1,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11622,Exc s/n/h/f/g mal+mrg 1.1-2,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11623,Exc s/n/h/f/g mal+mrg 2.1-3,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11624,Exc s/n/h/f/g mal+mrg 3.1-4,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11626,Exc s/n/h/f/g mal+mrg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11640,Exc f/e/e/n/l mal+mrg 0.5cm<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11641,Exc f/e/e/n/l mal+mrg 0.6-1,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11642,Exc f/e/e/n/l mal+mrg 1.1-2,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11643,Exc f/e/e/n/l mal+mrg 2.1-3,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11644,Exc f/e/e/n/l mal+mrg 3.1-4,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11646,Exc f/e/e/n/l mal+mrg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11719,Trim nail(s) any number,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11720,Debride nail 1-5,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11721,Debride nail 6 or more,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11730,Removal of nail plate,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11732,Remove nail plate add-on,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11740,Drain blood from under nail,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11750,Removal of nail bed,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11752,Remove nail bed/tip,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11755,Biopsy nail unit,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11760,Repair of nail bed,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11762,Reconstruction of nail bed,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11765,Excision of nail fold toe,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11770,Remove pilonidal cyst simple,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11771,Remove pilonidal cyst exten,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11772,Remove pilonidal cyst compl,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11900,Inject skin lesions 7,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11920,Correct skin color 6.0 cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11921,Correct skn color 6.1-20.0cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11922,Correct skin color ea 20.0cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11950,Tx contour defects 1 cc/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11951,Tx contour defects 1.1-5.0cc,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11952,Tx contour defects 5.1-10cc,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11954,Tx contour defects >10.0 cc,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11960,Insert tissue expander(s),General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,11971,Rmvl tis xpndr wo insj implt,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11976,Remove contraceptive capsule,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11980,Implant hormone pellet(s),General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11981,Insert drug implant device,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11982,Remove drug implant device,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,11983,Remove/insert drug implant,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13100,Cmplx rpr trunk 1.1-2.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13101,Cmplx rpr trunk 2.6-7.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13102,Cmplx rpr trunk addl 5cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13120,Cmplx rpr s/a/l 1.1-2.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13121,Cmplx rpr s/a/l 2.6-7.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13122,Cmplx rpr s/a/l addl 5 cm/>,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13131,Cmplx rpr f/c/c/m/n/ax/g/h/f,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13132,Cmplx rpr f/c/c/m/n/ax/g/h/f,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13133,Cmplx rpr f/c/c/m/n/ax/g/h/f,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13151,Cmplx rpr e/n/e/l 1.1-2.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13152,Cmplx rpr e/n/e/l 2.6-7.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,13153,Cmplx rpr e/n/e/l addl 5cm/<,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15050,Skin pinch graft,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15775,Hair trnspl 1-15 punch grfts,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15776,Hair trnspl >15 punch grafts,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15780,Dermabrasion total face,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15781,Dermabrasion segmental face,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15782,Dermabrasion other than face,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15783,Dermabrasion suprfl any site,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15786,Abrasion lesion single,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15787,Abrasion lesions add-on,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15788,Chemical peel face epiderm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15789,Chemical peel face dermal,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15792,Chemical peel nonfacial,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15793,Chemical peel nonfacial,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15819,Plastic surgery neck,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15820,Revision of lower eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15821,Revision of lower eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15822,Revision of upper eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15823,Revision of upper eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15824,Removal of forehead wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15825,Removal of neck wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15826,Removal of brow wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15828,Removal of face wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15829,Removal of skin wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15830,Exc skin abd,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15832,Excise excessive skin thigh,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15833,Excise excessive skin leg,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15834,Excise excessive skin hip,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15835,Excise excessive skin buttck,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15836,Excise excessive skin arm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15837,Excise excess skin arm/hand,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15838,Excise excess skin fat pad,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15839,Excise excess skin & tissue,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15847,Exc skin abd add-on,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15850,Remove sutures same surgeon,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15851,Remove sutures diff surgeon,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,15876,Suction lipectomy head&neck,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15877,Suction lipectomy trunk,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15878,Suction lipectomy upr extrem,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,15879,Suction lipectomy lwr extrem,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,17000,Destruct premalg lesion,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17003,Destruct premalg les 2-14,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17004,Destroy premal lesions 15/>,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17106,Destruction of skin lesions,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17107,Destruction of skin lesions,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17108,Destruction of skin lesions,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17110,Destruct b9 lesion 1-14,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17111,Destruct lesion 15 or more,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17250,Chem caut of granltj tissue,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17260,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17261,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17262,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17263,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17264,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17266,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17270,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17271,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17272,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17273,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17274,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17276,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17280,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17281,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17282,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17283,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17284,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17286,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17340,Cryotherapy of skin,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17360,Skin peel therapy,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17380,Hair removal by electrolysis,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,17999,Skin tissue procedure,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19000,Drainage of breast lesion,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19001,Drain breast lesion add-on,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19020,Incision of breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19081,Bx breast 1st lesion strtctc,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19082,Bx breast add lesion strtctc,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19083,Bx breast 1st lesion us imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19084,Bx breast add lesion us imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19085,Bx breast 1st lesion mr imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19086,Bx breast add lesion mr imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19100,Bx breast percut w/o image,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19101,Biopsy of breast open,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19105,Cryosurg ablate fa each,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19110,Nipple exploration,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19112,Excise breast duct fistula,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19120,Removal of breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19125,Excision breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19126,Excision addl breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19294,Prep tum cav iort prtl mast,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19297,Place breast cath for rad,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19298,Place breast rad tube/caths,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19300,Removal of breast tissue,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19301,Partial mastectomy,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19302,P-mastectomy w/ln removal,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19303,Mast simple complete,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19304,Mast subq,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19305,Mast radical,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19306,Mast rad urban type,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19307,Mast mod rad,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19316,Suspension of breast,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19318,Breast reduction,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19324,Enlarge breast,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19325,Breast augmentation w/implt,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19328,Rmvl intact breast implant,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19330,Rmvl ruptured breast implant,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19340,Insj breast implt sm d mast,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19342,Insj/rplcmt brst implt sep d,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19350,Breast reconstruction,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19355,Correct inverted nipple(s),General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19357,Tiss xpndr plmt brst rcnstj,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19361,Brst rcnstj latsms drsi flap,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19364,Brst rcnstj free flap,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19366,Breast reconstruction,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19367,Brst rcnstj 1 pdcl tram flap,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19368,Brst rcnstj 1pdcl tram anast,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19369,Brst rcnstj 2 pdcl tram flap,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19370,Revj peri-implt capsule brst,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19371,Peri-implt capslc brst compl,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19380,Revj reconstructed breast,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,19396,Design custom breast implant,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,19499,Breast surgery procedure,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20206,Needle biopsy muscle,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20220,Bone biopsy trocar/needle,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20500,Injection of sinus tract,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20526,Ther injection carp tunnel,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20527,Inj dupuytren cord w/enzyme,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20550,Inj tendon sheath/ligament,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20551,Inj tendon origin/insertion,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20552,Inj trigger point 1/2 muscl,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20553,Inject trigger points 3/>,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20560,Ndl insj w/o njx 1 or 2 musc,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20561,Ndl insj w/o njx 3+ musc,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20600,Drain/inj joint/bursa w/o us,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20605,Drain/inj joint/bursa w/o us,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20610,Drain/inj joint/bursa w/o us,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20612,Aspirate/inj ganglion cyst,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,20822,Replantation digit complete,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,20824,Replantation thumb complete,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,20827,Replantation thumb complete,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,20957,Mt bone graft microvasc,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,20972,Bone/skin graft metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,20973,Bone/skin graft great toe,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,20999,Musculoskeletal surgery,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21010,Incision of jaw joint,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21025,Excision of bone lower jaw,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21030,Excise max/zygoma b9 tumor,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21031,Remove exostosis mandible,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21032,Remove exostosis maxilla,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21034,Excise max/zygoma mal tumor,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21040,Excise mandible lesion,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21044,Removal of jaw bone lesion,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21045,Extensive jaw surgery,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21046,Remove mandible cyst complex,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21047,Excise lwr jaw cyst w/repair,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21048,Remove maxilla cyst complex,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21049,Excis uppr jaw cyst w/repair,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21050,Removal of jaw joint,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21060,Remove jaw joint cartilage,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21070,Remove coronoid process,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21073,Mnpj of tmj w/anesth,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21076,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21077,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21079,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21080,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21081,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21082,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21083,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21084,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21085,Prepare face/oral prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21086,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21087,Prepare face/oral prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21088,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21089,Prepare face/oral prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21100,Maxillofacial fixation,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21110,Interdental fixation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21120,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21121,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21122,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21123,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21125,Augmentation lower jaw bone,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21127,Augmentation lower jaw bone,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21138,Reduction of forehead,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21172,Reconstruct orbit/forehead,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21175,Reconstruct orbit/forehead,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21193,Reconst lwr jaw w/o graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21195,Reconst lwr jaw w/o fixation,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21196,Reconst lwr jaw w/fixation,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21198,Reconstr lwr jaw segment,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21199,Reconstr lwr jaw w/advance,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21206,Reconstruct upper jaw bone,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21215,Lower jaw bone graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21235,Ear cartilage graft,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21240,Reconstruction of jaw joint,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21242,Reconstruction of jaw joint,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21243,Reconstruction of jaw joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21244,Reconstruction of lower jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21245,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21246,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21248,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21249,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21270,Augmentation cheek bone,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21280,Revision of eyelid,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21282,Revision of eyelid,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21295,Revision of jaw muscle/bone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21296,Revision of jaw muscle/bone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21315,Closed tx nose fx w/o stablj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21320,Closed tx nose fx w/ stablj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21336,Open tx septal fx w/wo stabj,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21337,Closed tx septal&nose fx,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21345,Closed tx nose/jaw fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21346,Opn tx nasomax fx w/fixj,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21400,Closed tx orbit w/o manipulj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21401,Closed tx orbit w/manipulj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21421,Treat mouth roof fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21422,Treat mouth roof fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21440,Treat dental ridge fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21445,Treat dental ridge fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21450,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21451,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21452,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21453,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21454,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21461,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21462,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21465,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21470,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21485,Reset dislocated jaw,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21490,Repair dislocated jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21495,Treat hyoid bone fracture,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21497,Interdental wiring,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21685,Hyoid myotomy & suspension,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21805,Treatment of rib fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21811,Optx of rib fx w/fixj scope,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21812,Treatment of rib fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21813,Treatment of rib fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,21820,Treat sternum fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,21825,Treat sternum fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,22305,Closed tx spine process fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,22310,Closed tx vert fx w/o manj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,22315,Closed tx vert fx w/manj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,22505,Manipulation of spine,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,22515,Perq vertebral augmentation,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,22999,Abdomen surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23470,Reconstruct shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23472,Reconstruct shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23473,Revis reconst shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23474,Revis reconst shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23500,Treat clavicle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23505,Treat clavicle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23515,Treat clavicle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23520,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23525,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23530,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23532,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23540,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23545,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23550,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23552,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23570,Treat shoulder blade fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23575,Treat shoulder blade fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23585,Treat scapula fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23600,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23605,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23615,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23616,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23620,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23625,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23630,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23650,Treat shoulder dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23655,Treat shoulder dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23660,Treat shoulder dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23665,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23670,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23675,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23680,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,23700,Fixation of shoulder,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,23929,Shoulder surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24300,Manipulate elbow w/anesth,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24360,Reconstruct elbow joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24361,Reconstruct elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24362,Reconstruct elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24363,Replace elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24365,Reconstruct head of radius,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24366,Reconstruct head of radius,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24370,Revise reconst elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24371,Revise reconst elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24500,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24505,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24515,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24516,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24530,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24535,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24538,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24545,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24546,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24560,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24565,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24566,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24575,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24576,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24577,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24579,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24582,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24586,Treat elbow fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24587,Treat elbow fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24600,Treat elbow dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24605,Treat elbow dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24615,Treat elbow dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24620,Treat elbow fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24635,Treat elbow fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24640,Treat elbow dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24650,Treat radius fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24655,Treat radius fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24665,Treat radius fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24666,Treat radius fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24670,Treat ulnar fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24675,Treat ulnar fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,24685,Treat ulnar fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,24999,Upper arm/elbow surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25001,Incise flexor carpi radialis,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25111,Remove wrist tendon lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25112,Reremove wrist tendon lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25136,Remove & graft wrist lesion,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25210,Removal of wrist bone,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25215,Removal of wrist bones,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25259,Manipulate wrist w/anesthes,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25315,Revise palsy hand tendon(s),Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25316,Revise palsy hand tendon(s),Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25332,Revise wrist joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25394,Repair carpal bone shorten,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25430,Vasc graft into carpal bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25431,Repair nonunion carpal bone,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25441,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25442,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25443,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25444,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25445,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25446,Wrist replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25447,Repair wrist joints,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25449,Remove wrist joint implant,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25500,Treat fracture of radius,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25505,Treat fracture of radius,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25515,Treat fracture of radius,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25520,Treat fracture of radius,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25525,Treat fracture of radius,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25526,Treat fracture of radius,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25530,Treat fracture of ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25535,Treat fracture of ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25545,Treat fracture of ulna,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25560,Treat fracture radius & ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25565,Treat fracture radius & ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25574,Treat fracture radius & ulna,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25575,Treat fracture radius/ulna,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25600,Treat fracture radius/ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25605,Treat fracture radius/ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25606,Treat fx distal radial,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25607,Treat fx rad extra-articul,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25608,Treat fx rad intra-articul,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25609,Treat fx radial 3+ frag,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25622,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25624,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25628,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25630,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25635,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25645,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25650,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25651,Pin ulnar styloid fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25652,Treat fracture ulnar styloid,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25660,Treat wrist dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25670,Treat wrist dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25671,Pin radioulnar dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25675,Treat wrist dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25676,Treat wrist dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25680,Treat wrist fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25685,Treat wrist fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25690,Treat wrist dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25695,Treat wrist dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25820,Fusion of hand bones,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25825,Fuse hand bones with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,25929,Amputation follow-up surgery,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,25999,Forearm or wrist surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26010,Drainage of finger abscess,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26011,Drainage of finger abscess,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26020,Drain hand tendon sheath,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26025,Drainage of palm bursa,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26030,Drainage of palm bursas,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26034,Treat hand bone lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26035,Decompress fingers/hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26037,Decompress fingers/hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26040,Release palm contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26045,Release palm contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26055,Incise finger tendon sheath,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26060,Incision of finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26070,Explore/treat hand joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26075,Explore/treat finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26080,Explore/treat finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26100,Biopsy hand joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26105,Biopsy finger joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26110,Biopsy finger joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26111,Exc hand les sc 1.5 cm/>,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26113,Exc hand tum deep 1.5 cm/>,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26115,Exc hand les sc < 1.5 cm,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26116,Exc hand tum deep < 1.5 cm,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26117,Rad resect hand tumor < 3 cm,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26118,Rad resect hand tumor 3 cm/>,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26121,Release palm contracture,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26123,Release palm contracture,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26125,Release palm contracture,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26130,Remove wrist joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26135,Revise finger joint each,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26140,Revise finger joint each,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26145,Tendon excision palm/finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26160,Remove tendon sheath lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26170,Removal of palm tendon each,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26180,Removal of finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26185,Remove finger bone,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26200,Remove hand bone lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26205,Remove/graft bone lesion,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26210,Removal of finger lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26215,Remove/graft finger lesion,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26230,Partial removal of hand bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26235,Partial removal finger bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26236,Partial removal finger bone,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26250,Extensive hand surgery,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26260,Resect prox finger tumor,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26262,Resect distal finger tumor,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26320,Removal of implant from hand,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26340,Manipulate finger w/anesth,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26341,Manipulat palm cord post inj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26350,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26352,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26356,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26357,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26358,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26370,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26372,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26373,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26390,Revise hand/finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26392,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26410,Repair hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26412,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26415,Excision hand/finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26416,Graft hand or finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26418,Repair finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26420,Repair/graft finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26426,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26428,Repair/graft finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26432,Repair finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26433,Repair finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26434,Repair/graft finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26437,Realignment of tendons,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26440,Release palm/finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26442,Release palm & finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26445,Release hand/finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26449,Release forearm/hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26450,Incision of palm tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26455,Incision of finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26460,Incise hand/finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26471,Fusion of finger tendons,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26474,Fusion of finger tendons,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26476,Tendon lengthening,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26477,Tendon shortening,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26478,Lengthening of hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26479,Shortening of hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26480,Transplant hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26483,Transplant/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26485,Transplant palm tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26489,Transplant/graft palm tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26490,Revise thumb tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26492,Tendon transfer with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26494,Hand tendon/muscle transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26496,Revise thumb tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26497,Finger tendon transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26498,Finger tendon transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26499,Revision of finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26500,Hand tendon reconstruction,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26502,Hand tendon reconstruction,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26508,Release thumb contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26510,Thumb tendon transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26516,Fusion of knuckle joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26517,Fusion of knuckle joints,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26518,Fusion of knuckle joints,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26520,Release knuckle contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26525,Release finger contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26530,Revise knuckle joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26531,Revise knuckle with implant,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26535,Revise finger joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26536,Revise/implant finger joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26540,Repair hand joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26541,Repair hand joint with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26542,Repair hand joint with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26545,Reconstruct finger joint,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26546,Repair nonunion hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26548,Reconstruct finger joint,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26550,Construct thumb replacement,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26555,Positional change of finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26560,Repair of web finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26561,Repair of web finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26562,Repair of web finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26565,Correct metacarpal flaw,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26567,Correct finger deformity,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26568,Lengthen metacarpal/finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26580,Repair hand deformity,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26587,Reconstruct extra finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26590,Repair finger deformity,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26591,Repair muscles of hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26593,Release muscles of hand,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26596,Excision constricting tissue,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26600,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26605,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26607,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26608,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26615,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26641,Treat thumb dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26645,Treat thumb fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26650,Treat thumb fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26665,Treat thumb fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26670,Treat hand dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26675,Treat hand dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26676,Pin hand dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26685,Treat hand dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26686,Treat hand dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26700,Treat knuckle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26705,Treat knuckle dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26706,Pin knuckle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26715,Treat knuckle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26720,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26725,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26727,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26735,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26740,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26742,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26746,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26750,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26755,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26756,Pin finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26765,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26770,Treat finger dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26775,Treat finger dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26776,Pin finger dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26785,Treat finger dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26820,Thumb fusion with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26841,Fusion of thumb,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26842,Thumb fusion with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26843,Fusion of hand joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26844,Fusion/graft of hand joint,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26850,Fusion of knuckle,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26852,Fusion of knuckle with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26860,Fusion of finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26861,Fusion of finger jnt add-on,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26862,Fusion/graft of finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26863,Fuse/graft added joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26910,Amputate metacarpal bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26951,Amputation of finger/thumb,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,26952,Amputation of finger/thumb,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,26989,Hand/finger surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27125,Partial hip replacement,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27130,Total hip arthroplasty,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27132,Total hip arthroplasty,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27134,Revise hip joint replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27137,Revise hip joint replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27138,Revise hip joint replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27175,Treat slipped epiphysis,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27178,Treat slipped epiphysis,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27181,Treat slipped epiphysis,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27193,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27194,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27197,Clsd tx pelvic ring fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27198,Clsd tx pelvic ring fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27200,Treat tail bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27202,Treat tail bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27215,Treat pelvic fracture(s),Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27216,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27217,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27218,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27220,Treat hip socket fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27222,Treat hip socket fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27226,Treat hip wall fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27227,Treat hip fracture(s),Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27230,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27232,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27235,Treat thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27236,Treat thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27238,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27240,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27246,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27248,Treat thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27250,Treat hip dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27252,Treat hip dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27253,Treat hip dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27256,Treat hip dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27257,Treat hip dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27265,Treat hip dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27266,Treat hip dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27267,Cltx thigh fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27268,Cltx thigh fx w/mnpj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27269,Optx thigh fx,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27275,Manipulation of hip joint,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27299,Pelvis/hip joint surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27412,Autochondrocyte implant knee,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27415,Osteochondral knee allograft,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27437,Revise kneecap,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27438,Revise kneecap with implant,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27440,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27441,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27442,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27443,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27445,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27446,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27447,Total knee arthroplasty,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27486,Revise/replace knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27487,Revise/replace knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27500,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27501,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27502,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27503,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27507,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27508,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27509,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27510,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27511,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27513,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27514,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27516,Treat thigh fx growth plate,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27517,Treat thigh fx growth plate,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27520,Treat kneecap fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27524,Treat kneecap fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27530,Treat knee fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27532,Treat knee fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27535,Treat knee fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27536,Treat knee fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27538,Treat knee fracture(s),Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27540,Treat knee fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27550,Treat knee dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27552,Treat knee dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27560,Treat kneecap dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27562,Treat kneecap dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27566,Treat kneecap dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27570,Fixation of knee joint,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27599,Leg surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27605,Incision of achilles tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27700,Revision of ankle joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27702,Reconstruct ankle joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27703,Reconstruction ankle joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27720,Repair of tibia,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27722,Repair/graft of tibia,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27724,Repair/graft of tibia,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27726,Repair fibula nonunion,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27750,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27752,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27756,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27758,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27759,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27760,Cltx medial ankle fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27762,Cltx med ankle fx w/mnpj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27766,Optx medial ankle fx,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27767,Cltx post ankle fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27768,Cltx post ankle fx w/mnpj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27769,Optx post ankle fx,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27780,Treatment of fibula fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27781,Treatment of fibula fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27784,Treatment of fibula fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27786,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27788,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27792,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27808,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27810,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27814,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27816,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27818,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27822,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27823,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27824,Treat lower leg fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27825,Treat lower leg fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27826,Treat lower leg fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27827,Treat lower leg fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27828,Treat lower leg fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27829,Treat lower leg joint,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27830,Treat lower leg dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27831,Treat lower leg dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27832,Treat lower leg dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27840,Treat ankle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27842,Treat ankle dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27846,Treat ankle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27848,Treat ankle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,27860,Fixation of ankle joint,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,27899,Leg/ankle surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28001,Drainage of bursa of foot,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28002,Treatment of foot infection,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28005,Treat foot bone lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28008,Incision of foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28010,Incision of toe tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28011,Incision of toe tendons,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28020,Exploration of foot joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28022,Exploration of foot joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28024,Exploration of toe joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28039,Exc foot/toe tum sc 1.5 cm/>,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28041,Exc foot/toe tum dep 1.5cm/>,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28045,Exc foot/toe tum deep <1.5cm,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28046,Resect foot/toe tumor < 3 cm,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28047,Resect foot/toe tumor 3 cm/>,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28050,Biopsy of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28052,Biopsy of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28054,Biopsy of toe joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28055,Neurectomy foot,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28060,Partial removal foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28062,Removal of foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28070,Removal of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28072,Removal of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28080,Removal of foot lesion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28086,Excise foot tendon sheath,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28088,Excise foot tendon sheath,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28090,Removal of foot lesion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28092,Removal of toe lesions,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28100,Removal of ankle/heel lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28102,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28103,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28104,Removal of foot lesion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28106,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28107,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28108,Removal of toe lesions,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28110,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28111,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28112,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28113,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28114,Removal of metatarsal heads,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28116,Revision of foot,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28118,Removal of heel bone,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28119,Removal of heel spur,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28120,Part removal of ankle/heel,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28122,Partial removal of foot bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28124,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28126,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28130,Removal of ankle bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28140,Removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28150,Removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28153,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28160,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28171,Resect tarsal tumor,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28173,Resect metatarsal tumor,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28175,Resect phalanx of toe tumor,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28190,Removal of foot foreign body,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28193,Removal of foot foreign body,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28200,Repair of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28202,Repair/graft of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28208,Repair of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28210,Repair/graft of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28220,Release of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28222,Release of foot tendons,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28225,Release of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28226,Release of foot tendons,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28230,Incision of foot tendon(s),Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28232,Incision of toe tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28234,Incision of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28238,Revision of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28240,Release of big toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28250,Revision of foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28260,Release of midfoot joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28261,Revision of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28262,Revision of foot and ankle,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28264,Release of midfoot joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28270,Release of foot contracture,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28272,Release of toe joint each,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28280,Fusion of toes,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28285,Repair of hammertoe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28286,Repair of hammertoe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28288,Partial removal of foot bone,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28289,Corrj halux rigdus w/o implt,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28290,Correction of bunion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28291,Corrj halux rigdus w/implt,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28292,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28293,Correction of bunion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28294,Correction of bunion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28295,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28296,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28297,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28298,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28299,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28300,Incision of heel bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28302,Incision of ankle bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28304,Incision of midfoot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28305,Incise/graft midfoot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28306,Incision of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28307,Incision of metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28308,Incision of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28309,Incision of metatarsals,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28310,Revision of big toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28312,Revision of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28313,Repair deformity of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28315,Removal of sesamoid bone,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28320,Repair of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28322,Repair of metatarsals,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28340,Resect enlarged toe tissue,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28341,Resect enlarged toe,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28344,Repair extra toe(s),Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28345,Repair webbed toe(s),Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28360,Reconstruct cleft foot,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28400,Treatment of heel fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28405,Treatment of heel fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28406,Treatment of heel fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28415,Treat heel fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28420,Treat/graft heel fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28430,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28435,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28436,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28445,Treat ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28446,Osteochondral talus autogrft,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28450,Treat midfoot fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28455,Treat midfoot fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28456,Treat midfoot fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28465,Treat midfoot fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28470,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28475,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28476,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28485,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28490,Treat big toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28495,Treat big toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28496,Treat big toe fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28505,Treat big toe fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28510,Treatment of toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28515,Treatment of toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28525,Treat toe fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28530,Treat sesamoid bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28531,Treat sesamoid bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28540,Treat foot dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28545,Treat foot dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28546,Treat foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28555,Repair foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28570,Treat foot dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28575,Treat foot dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28576,Treat foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28585,Repair foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28600,Treat foot dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28605,Treat foot dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28606,Treat foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28615,Repair foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28630,Treat toe dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28635,Treat toe dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28636,Treat toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28645,Repair toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28660,Treat toe dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28665,Treat toe dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,28666,Treat toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28675,Repair of toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28705,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28715,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28725,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28730,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28735,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28737,Revision of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28740,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28750,Fusion of big toe joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28755,Fusion of big toe joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28760,Fusion of big toe joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28805,Amputation thru metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28810,Amputation toe & metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28820,Amputation of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28825,Partial amputation of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28890,Hi enrgy eswt plantar fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,28899,Foot/toes surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29000,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29010,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29015,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29035,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29040,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29044,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29046,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29049,Application of figure eight,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29055,Application of shoulder cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29058,Application of shoulder cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29065,Application of long arm cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29075,Application of forearm cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29085,Apply hand/wrist cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29086,Apply finger cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29105,Apply long arm splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29125,Apply forearm splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29126,Apply forearm splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29130,Application of finger splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29131,Application of finger splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29200,Strapping of chest,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29240,Strapping of shoulder,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29260,Strapping of elbow or wrist,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29280,Strapping of hand or finger,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29305,Application of hip cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29325,Application of hip casts,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29345,Application of long leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29355,Application of long leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29358,Apply long leg cast brace,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29365,Application of long leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29405,Apply short leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29425,Apply short leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29435,Apply short leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29440,Addition of walker to cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29445,Apply rigid leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29450,Application of leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29505,Application long leg splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29515,Application lower leg splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29520,Strapping of hip,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29530,Strapping of knee,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29540,Strapping of ankle and/or ft,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29550,Strapping of toes,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29580,Application of paste boot,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29581,Apply multlay comprs lwr leg,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29582,Apply multlay comprs upr leg,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29583,Apply multlay comprs upr arm,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29584,Appl multlay comprs arm/hand,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29700,Removal/revision of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29705,Removal/revision of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29710,Removal/revision of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29720,Repair of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29730,Windowing of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29740,Wedging of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29750,Wedging of clubfoot cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29799,Casting/strapping procedure,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,29800,Jaw arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29804,Jaw arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29805,Sho arthrs dx +- synovial bx,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29806,Sho arthrs srg capsulorpaphy,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29807,Sho arthrs srg rpr slap les,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29819,Sho arthrs srg rmvl loose/fb,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29820,Sho arthrs srg prtl synvct,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29821,Sho arthrs srg compl synvct,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29822,Sho arthrs srg lmtd dbrdmt,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29823,Sho arthrs srg xtnsv dbrdmt,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29824,Sho arthrs srg dstl claviclc,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29825,Sho arthrs srg lss&rescj ads,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29826,Sho arthrs srg decompression,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29827,Sho arthrs srg rt8tr cuf rpr,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29828,Sho arthrs srg bicp tenodsis,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29830,Elbow arthroscopy,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29834,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29835,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29836,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29837,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29838,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29840,Wrist arthroscopy,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29843,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29844,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29845,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29846,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29847,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29848,Wrist endoscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29850,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29851,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29855,Tibial arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29856,Tibial arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29860,Hip arthroscopy dx,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29861,Hip arthro w/fb removal,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29862,Hip arthr0 w/debridement,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29863,Hip arthr0 w/synovectomy,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29866,Autgrft implnt knee w/scope,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29867,Allgrft implnt knee w/scope,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29868,Meniscal trnspl knee w/scpe,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29870,Knee arthroscopy dx,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29871,Knee arthroscopy/drainage,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29873,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29874,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29875,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29876,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29877,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29879,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29880,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29881,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29882,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29883,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29884,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29885,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29886,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29887,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29888,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29889,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29891,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29892,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29893,Scope plantar fasciotomy,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29894,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29895,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29897,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29898,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29899,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29900,Mcp joint arthroscopy dx,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29901,Mcp joint arthroscopy surg,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29902,Mcp joint arthroscopy surg,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29904,Subtalar arthro w/fb rmvl,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29905,Subtalar arthro w/exc,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29906,Subtalar arthro w/deb,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29907,Subtalar arthro w/fusion,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29914,Hip arthro w/femoroplasty,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29915,Hip arthro acetabuloplasty,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29916,Hip arthro w/labral repair,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,29999,Arthroscopy of joint,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30020,Drainage of nose lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30100,Intranasal biopsy,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30110,Removal of nose polyp(s),Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30115,Removal of nose polyp(s),Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30117,Removal of intranasal lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30118,Removal of intranasal lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30120,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30124,Removal of nose lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30125,Removal of nose lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30130,Excise inferior turbinate,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30140,Resect inferior turbinate,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30150,Partial removal of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30160,Removal of nose,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30200,Injection treatment of nose,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30220,Insert nasal septal button,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30310,Remove nasal foreign body,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30320,Remove nasal foreign body,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30400,Reconstruction of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30410,Reconstruction of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30420,Reconstruction of nose,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30430,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30435,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30450,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30460,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30462,Revision of nose,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30465,Repair nasal stenosis,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30468,Rpr nsl vlv collapse w/implt,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30520,Repair of nasal septum,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30540,Repair nasal defect,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30560,Release of nasal adhesions,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30580,Repair upper jaw fistula,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30600,Repair mouth/nose fistula,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30620,Intranasal reconstruction,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30630,Repair nasal septum defect,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30801,Ablate inf turbinate superf,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30802,Ablate inf turbinate submuc,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,30915,Ligation nasal sinus artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30920,Ligation upper jaw artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30930,Ther fx nasal inf turbinate,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,30999,Nasal surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31000,Irrigation maxillary sinus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31002,Irrigation sphenoid sinus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31020,Exploration maxillary sinus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31030,Exploration maxillary sinus,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31032,Explore sinus remove polyps,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31050,Exploration sphenoid sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31051,Sphenoid sinus surgery,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31070,Exploration of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31075,Exploration of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31080,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31081,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31084,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31085,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31086,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31087,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31090,Exploration of sinuses,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31200,Removal of ethmoid sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31201,Removal of ethmoid sinus,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31205,Removal of ethmoid sinus,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31225,Removal of upper jaw,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31233,Nsl/sins ndsc dx max sinusc,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31235,Nsl/sins ndsc dx sphn sinusc,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31237,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31238,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31239,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31240,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31241,Nsl/sins ndsc w/artery lig,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31253,Nsl/sins ndsc total,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31254,Nsl/sins ndsc w/prtl ethmdct,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31255,Nsl/sins ndsc w/tot ethmdct,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31256,Exploration maxillary sinus,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31257,Nsl/sins ndsc tot w/sphendt,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31259,Nsl/sins ndsc sphn tiss rmvl,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31267,Endoscopy maxillary sinus,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31276,Nsl/sins ndsc frnt tiss rmvl,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31287,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31288,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31290,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31291,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31292,Nsl/sins ndsc med/inf dcmprn,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31293,Nsl/sins ndsc med&inf dcmprn,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31294,Nsl/sins ndsc surg on dcmprn,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31295,Nsl/sins ndsc surg max sins,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31296,Nsl/sins ndsc surg frnt sins,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31297,Nsl/sins ndsc surg sphn sins,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31298,Nsl/sins ndsc surg frnt&sphn,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31299,Sinus surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31300,Removal of larynx lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31320,Diagnostic incision larynx,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31375,Partial removal of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31400,Revision of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31420,Removal of epiglottis,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31500,Insert emergency airway,General Medicine,Per Unit,$385.17 ,OP,$385.17 ,$385.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31510,Laryngoscopy with biopsy,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31512,Removal of larynx lesion,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31513,Injection into vocal cord,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31515,Laryngoscopy for aspiration,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31520,Dx laryngoscopy newborn,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31525,Dx laryngoscopy excl nb,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31526,Dx laryngoscopy w/oper scope,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31527,Laryngoscopy for treatment,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31528,Laryngoscopy and dilation,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31529,Laryngoscopy and dilation,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31530,Laryngoscopy w/fb removal,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31531,Laryngoscopy w/fb & op scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31535,Laryngoscopy w/biopsy,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31536,Laryngoscopy w/bx & op scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31540,Laryngoscopy w/exc of tumor,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31541,Larynscop w/tumr exc + scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31545,Remove vc lesion w/scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31546,Remove vc lesion scope/graft,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31551,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31552,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31553,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31554,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31560,Laryngoscop w/arytenoidectom,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31561,Larynscop remve cart + scop,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31570,Laryngoscope w/vc inj,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31571,Laryngoscop w/vc inj + scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31572,Largsc w/laser dstrj les,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31573,Largsc w/ther injection,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31574,Largsc w/njx augmentation,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31576,Laryngoscopy with biopsy,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31577,Largsc w/rmvl foreign bdy(s),Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31578,Largsc w/removal lesion,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31579,Laryngoscopy telescopic,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31580,Laryngoplasty laryngeal web,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31582,Revision of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31584,Laryngoplasty fx rdctj fixj,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31587,Laryngoplasty cricoid split,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31588,Revision of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31590,Reinnervate larynx,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31591,Laryngoplasty medialization,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31595,Larynx nerve surgery,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,31599,Larynx surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31615,Visualization of windpipe,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31622,Dx bronchoscope/wash,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31623,Dx bronchoscope/brush,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31624,Dx bronchoscope/lavage,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31625,Bronchoscopy w/biopsy(s),Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31626,Bronchoscopy w/markers,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31627,Navigational bronchoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31628,Bronchoscopy/lung bx each,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31629,Bronchoscopy/needle bx each,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31632,Bronchoscopy/lung bx addl,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31633,Bronchoscopy/needle bx addl,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31635,Bronchoscopy w/fb removal,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31643,Diag bronchoscope/catheter,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31645,Brnchsc w/ther aspir 1st,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31646,Brnchsc w/ther aspir sbsq,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31720,Clearance of airways,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31725,Clearance of airways,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,31899,Airways surgical procedure,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,33206,Insert heart pm atrial,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33207,Insert heart pm ventricular,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33208,Insrt heart pm atrial & vent,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33212,Insert pulse gen sngl lead,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33213,Insert pulse gen dual leads,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33214,Upgrade of pacemaker system,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33221,Insert pulse gen mult leads,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33224,Insert pacing lead & connect,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33225,L ventric pacing lead add-on,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33226,Reposition l ventric lead,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33227,Remove&replace pm gen singl,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33228,Remv&replc pm gen dual lead,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33229,Remv&replc pm gen mult leads,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33230,Insrt pulse gen w/dual leads,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33231,Insrt pulse gen w/mult leads,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33233,Removal of pm generator,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33240,Insrt pulse gen w/singl lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33241,Remove pulse generator,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33249,Insj/rplcmt defib w/lead(s),Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33262,Rmvl& replc pulse gen 1 lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33263,Rmvl & rplcmt dfb gen 2 lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33264,Rmvl & rplcmt dfb gen mlt ld,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33270,Ins/rep subq defibrillator,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33274,Tcat insj/rpl perm ldls pm,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33275,Tcat rmvl perm ldls pm w/img,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33282,Implant pat-active ht record,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33285,Insj subq car rhythm mntr,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33289,Tcat impl wrls p-art prs snr,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33889,Artery transpose/endovas taa,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33967,Insert i-aort percut device,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33968,Remove aortic assist device,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33990,Insj perq vad l hrt arterial,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33991,Insj perq vad l hrt artl&ven,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33992,Rmvl perq left heart vad,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33993,Reposg perq r/l hrt vad,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33995,Insj perq vad r hrt venous,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33997,Rmvl perq right heart vad,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,33999,Cardiac surgery procedure,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34001,Removal of artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34101,Removal of artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34111,Removal of arm artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34201,Removal of artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34203,Removal of leg artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34421,Removal of vein clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34471,Removal of vein clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34490,Removal of vein clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34501,Repair valve femoral vein,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34510,Transposition of vein valve,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34520,Cross-over vein graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34530,Leg vein fusion,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34714,Opn fem art expos cndt crtj,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34715,Opn ax/subcla art expos,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34716,Opn ax/subcla art expos cndt,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34812,Opn fem art expos,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,34834,Opn brach art expos,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35011,Repair defect of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35013,Repair artery rupture arm,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35045,Repair defect of arm artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35180,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35184,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35188,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35190,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35201,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35206,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35207,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35226,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35231,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35236,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35256,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35261,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35266,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35301,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35302,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35303,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35304,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35305,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35306,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35321,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35355,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35371,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35372,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35390,Reoperation carotid add-on,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35400,Angioscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,35452,Repair arterial blockage,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35472,Repair arterial blockage,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35694,Art trnsposj subclav carotid,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35697,Reimplant artery each,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35700,Reoperation bypass graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35701,Expl n/flwd surg neck art,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35702,Expl n/flwd surg uxtr art,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35703,Expl n/flwd surg lxtr art,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35721,Exploration femoral artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35741,Exploration popliteal artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35761,Exploration of artery/vein,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35800,Explore neck vessels,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35820,Explore chest vessels,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35860,Explore limb vessels,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35875,Removal of clot in graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35876,Removal of clot in graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35901,Excision graft neck,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,35903,Excision graft extremity,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36005,Injection ext venography,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36010,Place catheter in vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36011,Place catheter in vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36012,Place catheter in vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36013,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36014,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36015,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36100,Establish access to artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36120,Establish access to artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36140,Intro ndl icath upr/lxtr art,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36160,Establish access to aorta,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36200,Place catheter in aorta,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36215,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36216,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36217,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36218,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36221,Place cath thoracic aorta,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36222,Place cath carotid/inom art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36223,Place cath carotid/inom art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36224,Place cath carotd art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36225,Place cath subclavian art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36226,Place cath vertebral art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36227,Place cath xtrnl carotid,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36228,Place cath intracranial art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36245,Ins cath abd/l-ext art 1st,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36246,Ins cath abd/l-ext art 2nd,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36247,Ins cath abd/l-ext art 3rd,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36248,Ins cath abd/l-ext art addl,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36251,Ins cath ren art 1st unilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36252,Ins cath ren art 1st bilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36253,Ins cath ren art 2nd+ unilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36254,Ins cath ren art 2nd+ bilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36260,Insertion of infusion pump,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36299,Vessel injection procedure,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36430,Blood transfusion service,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36440,Bl push transfuse 2 yr/<,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36450,Bl exchange/transfuse nb,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36455,Bl exchange/transfuse non-nb,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36456,Prtl exchange transfuse nb,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36460,Transfusion service fetal,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36465,Njx noncmpnd sclrsnt 1 vein,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36466,Njx noncmpnd sclrsnt mlt vn,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36468,Njx sclrsnt spider veins,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36470,Njx sclrsnt 1 incmptnt vein,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36471,Njx sclrsnt mlt incmptnt vn,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36481,Insertion of catheter vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36500,Insertion of catheter vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36511,Apheresis wbc,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36512,Apheresis rbc,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36513,Apheresis platelets,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36514,Apheresis plasma,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36515,Apheresis adsorp/reinfuse,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36516,Apheresis immunoads slctv,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36522,Photopheresis,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36557,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36558,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36560,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36561,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36563,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36565,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36566,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36581,Replace tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36582,Replace tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36583,Replace tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36593,Declot vascular device,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36620,Insertion catheter artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36625,Insertion catheter artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36640,Insertion catheter artery,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36680,Insert needle bone cavity,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36800,Insertion of cannula,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36810,Insertion of cannula,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36815,Insertion of cannula,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36823,Insertion of cannula(s),Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36838,Dist revas ligation hemo,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36860,External cannula declotting,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,36903,Intro cath dialysis circuit,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36905,Thrmbc/nfs dialysis circuit,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36906,Thrmbc/nfs dialysis circuit,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36907,Balo angiop ctr dialysis seg,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36908,Stent plmt ctr dialysis seg,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,36909,Dialysis circuit embolj,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37145,Revision of circulation,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37182,Insert hepatic shunt (tips),Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37183,Remove hepatic shunt (tips),Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37184,Prim art m-thrmbc 1st vsl,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37185,Prim art m-thrmbc sbsq vsl,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37186,Sec art thrombectomy add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37195,Thrombolytic therapy stroke,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,37202,Transcatheter therapy infuse,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,37215,Transcath stent cca w/eps,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37216,Transcath stent cca w/o eps,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37217,Stent placemt retro carotid,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37218,Stent placemt ante carotid,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37220,Iliac revasc,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37221,Iliac revasc w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37222,Iliac revasc add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37223,Iliac revasc w/stent add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37224,Fem/popl revas w/tla,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37225,Fem/popl revas w/ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37226,Fem/popl revasc w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37227,Fem/popl revasc stnt & ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37228,Tib/per revasc w/tla,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37229,Tib/per revasc w/ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37230,Tib/per revasc w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37231,Tib/per revasc stent & ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37232,Tib/per revasc add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37233,Tibper revasc w/ather add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37234,Revsc opn/prq tib/pero stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37235,Tib/per revasc stnt & ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37236,Open/perq place stent 1st,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37237,Open/perq place stent ea add,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37238,Open/perq place stent same,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37239,Open/perq place stent ea add,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37241,Vasc embolize/occlude venous,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37242,Vasc embolize/occlude artery,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37243,Vasc embolize/occlude organ,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37244,Vasc embolize/occlude bleed,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37247,Trluml balo angiop addl art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37249,Trluml balo angiop addl vein,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37250,Iv us first vessel add-on,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,37251,Iv us each add vessel add-on,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,37500,Endoscopy ligate perf veins,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37501,Vascular endoscopy procedure,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,37565,Ligation of neck vein,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37600,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37605,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37606,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37607,Ligation of a-v fistula,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37609,Temporal artery procedure,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37615,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37618,Ligation of extremity artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37619,Ligation of inf vena cava,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37650,Revision of major vein,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37790,Penile venous occlusion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,37799,Vascular surgery procedure,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38102,Removal of spleen total,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38120,Laparoscopy splenectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38129,Laparoscope proc spleen,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38205,Harvest allogeneic stem cell,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38206,Harvest auto stem cells,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38207,Cryopreserve stem cells,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38208,Thaw preserved stem cells,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38209,Wash harvest stem cells,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38210,T-cell depletion of harvest,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38211,Tumor cell deplete of harvst,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38212,Rbc depletion of harvest,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38213,Platelet deplete of harvest,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38214,Volume deplete of harvest,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38215,Harvest stem cell concentrte,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38230,Bone marrow harvest allogen,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38232,Bone marrow harvest autolog,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38240,Transplt allo hct/donor,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38241,Transplt autol hct/donor,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38242,Transplt allo lymphocytes,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38243,Transplj hematopoietic boost,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38300,Drainage lymph node lesion,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38305,Drainage lymph node lesion,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38308,Incision of lymph channels,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38380,Thoracic duct procedure,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38500,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38505,Needle biopsy lymph nodes,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38510,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38520,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38525,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38530,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38531,Open bx/exc inguinofem nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38542,Explore deep node(s) neck,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38550,Removal neck/armpit lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38555,Removal neck/armpit lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38562,Removal pelvic lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38570,Laparoscopy lymph node biop,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38571,Laparoscopy lymphadenectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38572,Laparoscopy lymphadenectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38573,Laps pelvic lymphadec,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38589,Laparoscope proc lymphatic,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38700,Removal of lymph nodes neck,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38720,Removal of lymph nodes neck,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38724,Removal of lymph nodes neck,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38740,Remove armpit lymph nodes,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38745,Remove armpit lymph nodes,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38747,Remove abdominal lymph nodes,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38760,Remove groin lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,38792,Ra tracer id of sentinl node,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38794,Access thoracic lymph duct,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,38999,Blood/lymph system procedure,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,39545,Revision of diaphragm,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,39599,Diaphragm surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40490,Biopsy of lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40500,Partial excision of lip,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40510,Partial excision of lip,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40520,Partial excision of lip,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40525,Reconstruct lip with flap,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40527,Reconstruct lip with flap,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40530,Partial removal of lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40650,Repair lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40652,Repair lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40654,Repair lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40799,Lip surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40801,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40805,Removal foreign body mouth,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40806,Incision of lip fold,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40808,Biopsy of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40810,Excision of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40812,Excise/repair mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40814,Excise/repair mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40816,Excision of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40818,Excise oral mucosa for graft,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40819,Excise lip or cheek fold,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40820,Treatment of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40830,Repair mouth laceration,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40831,Repair mouth laceration,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,40840,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40842,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40843,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40844,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40845,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,40899,Mouth surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41000,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41005,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41006,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41007,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41008,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41009,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41010,Incision of tongue fold,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41015,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41016,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41017,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41018,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41100,Biopsy of tongue,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41105,Biopsy of tongue,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41108,Biopsy of floor of mouth,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41110,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41112,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41113,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41114,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41115,Excision of tongue fold,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41116,Excision of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41120,Partial removal of tongue,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41130,Partial removal of tongue,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41135,Tongue and neck surgery,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41150,Tongue mouth jaw surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41500,Fixation of tongue,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41510,Tongue to lip surgery,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41512,Tongue suspension,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41520,Reconstruction tongue fold,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41530,Tongue base vol reduction,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41599,Tongue and mouth surgery,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41805,Removal foreign body gum,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41806,Removal foreign body jawbone,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41820,Excision gum each quadrant,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41821,Excision of gum flap,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41822,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41823,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41825,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41826,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41827,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41828,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41830,Removal of gum tissue,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41850,Treatment of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41870,Gum graft,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,41872,Repair gum,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41874,Repair tooth socket,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,41899,Dental surgery procedure,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42100,Biopsy roof of mouth,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42104,Excision lesion mouth roof,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42106,Excision lesion mouth roof,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42107,Excision lesion mouth roof,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42120,Remove palate/lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42140,Excision of uvula,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42160,Treatment mouth roof lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42180,Repair palate,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42182,Repair palate,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42260,Repair nose to lip fistula,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42280,Preparation palate mold,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42281,Insertion palate prosthesis,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42299,Palate/uvula surgery,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42300,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42305,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42310,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42320,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42330,Removal of salivary stone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42335,Removal of salivary stone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42340,Removal of salivary stone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42400,Biopsy of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42405,Biopsy of salivary gland,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42408,Excision of salivary cyst,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42409,Drainage of salivary cyst,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42410,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42415,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42420,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42425,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42426,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42440,Excise submaxillary gland,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42450,Excise sublingual gland,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42500,Repair salivary duct,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42505,Repair salivary duct,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42507,Parotid duct diversion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42509,Parotid duct diversion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42510,Parotid duct diversion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42600,Closure of salivary fistula,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42650,Dilation of salivary duct,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42660,Dilation of salivary duct,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42665,Ligation of salivary duct,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42699,Salivary surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42720,Drainage of throat abscess,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42725,Drainage of throat abscess,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42800,Biopsy of throat,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42804,Biopsy of upper nose/throat,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42806,Biopsy of upper nose/throat,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42808,Excise pharynx lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42810,Excision of neck cyst,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42815,Excision of neck cyst,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42820,Remove tonsils and adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42821,Remove tonsils and adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42825,Removal of tonsils,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42826,Removal of tonsils,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42830,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42831,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42835,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42836,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42842,Extensive surgery of throat,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42844,Extensive surgery of throat,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42860,Excision of tonsil tags,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42870,Excision of lingual tonsil,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42890,Partial removal of pharynx,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42892,Revision of pharyngeal walls,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42900,Repair throat wound,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42950,Reconstruction of throat,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42953,Repair throat esophagus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42955,Surgical opening of throat,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42960,Control throat bleeding,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42962,Control throat bleeding,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,42970,Control nose/throat bleeding,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42972,Control nose/throat bleeding,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,42999,Throat surgery procedure,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43020,Incision of esophagus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43030,Throat muscle surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43100,Excision of esophagus lesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43130,Removal of esophagus pouch,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43191,Esophagoscopy rigid trnso dx,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43192,Esophagoscp rig trnso inject,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43193,Esophagoscp rig trnso biopsy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43194,Esophagoscp rig trnso rem fb,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43196,Esophagoscp guide wire dilat,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43197,Esophagoscopy flex dx brush,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43198,Esophagosc flex trnsn biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43200,Esophagoscopy flexible brush,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43201,Esoph scope w/submucous inj,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43202,Esophagoscopy flex biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43204,Esoph scope w/sclerosis inj,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43205,Esophagus endoscopy/ligation,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43206,Esoph optical endomicroscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43211,Esophagoscop mucosal resect,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43213,Esophagoscopy retro balloon,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43214,Esophagosc dilate balloon 30,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43215,Esophagoscopy flex remove fb,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43216,Esophagoscopy lesion removal,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43217,Esophagoscopy snare les remv,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43220,Esophagoscopy balloon <30mm,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43226,Esoph endoscopy dilation,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43227,Esophagoscopy control bleed,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43229,Esophagoscopy lesion ablate,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43231,Esophagoscop ultrasound exam,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43232,Esophagoscopy w/us needle bx,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43233,Egd balloon dil esoph30 mm/>,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43235,Egd diagnostic brush wash,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43236,Uppr gi scope w/submuc inj,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43237,Endoscopic us exam esoph,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43238,Egd us fine needle bx/aspir,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43239,Egd biopsy single/multiple,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43241,Egd tube/cath insertion,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43242,Egd us fine needle bx/aspir,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43243,Egd injection varices,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43244,Egd varices ligation,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43245,Egd dilate stricture,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43246,Egd place gastrostomy tube,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43247,Egd remove foreign body,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43248,Egd guide wire insertion,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43249,Esoph egd dilation <30 mm,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43250,Egd cautery tumor polyp,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43251,Egd remove lesion snare,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43253,Egd us transmural injxn/mark,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43254,Egd endo mucosal resection,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43255,Egd control bleeding any,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43257,Egd w/thrml txmnt gerd,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43259,Egd us exam duodenum/jejunum,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43260,Ercp w/specimen collection,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43261,Endo cholangiopancreatograph,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43262,Endo cholangiopancreatograph,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43263,Ercp sphincter pressure meas,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43270,Egd lesion ablation,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43275,Ercp remove forgn body duct,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43276,Ercp stent exchange w/dilate,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43277,Ercp ea duct/ampulla dilate,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43279,Lap myotomy heller,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43280,Laparoscopy fundoplasty,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43281,Lap paraesophag hern repair,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43282,Lap paraesoph her rpr w/mesh,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43283,Lap esoph lengthening,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43284,Laps esophgl sphnctr agmntj,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43285,Rmvl esophgl sphnctr dev,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43289,Laparoscope proc esoph,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43300,Repair of esophagus,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43305,Repair esophagus and fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43320,Fuse esophagus & stomach,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43332,Transab esoph hiat hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43333,Transab esoph hiat hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43334,Transthor diaphrag hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43335,Transthor diaphrag hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43336,Thorabd diaphr hern repair,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43337,Thorabd diaphr hern repair,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43338,Esoph lengthening,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43401,Esophagus surgery for veins,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43410,Repair esophagus wound,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43420,Repair esophagus opening,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43450,Dilate esophagus 1/mult pass,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43453,Dilate esophagus,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43499,Esophagus surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43500,Surgical opening of stomach,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43510,Surgical opening of stomach,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43520,Incision of pyloric muscle,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43610,Excision of stomach lesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43644,Lap gastric bypass/roux-en-y,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43645,Lap gastr bypass incl smll i,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43647,Lap impl electrode antrum,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43648,Lap revise/remv eltrd antrum,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43651,Laparoscopy vagus nerve,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43652,Laparoscopy vagus nerve,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43653,Laparoscopy gastrostomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43659,Laparoscope proc stom,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43752,Nasal/orogastric w/tube plmt,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43753,Tx gastro intub w/asp,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43754,Dx gastr intub w/asp spec,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43755,Dx gastr intub w/asp specs,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43756,Dx duod intub w/asp spec,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43757,Dx duod intub w/asp specs,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43760,Change gastrostomy tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43761,Reposition gastrostomy tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43762,Rplc gtube no revj trc,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43763,Rplc gtube revj gstrst trc,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43770,Lap place gastr adj device,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43771,Lap revise gastr adj device,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43772,Lap rmvl gastr adj device,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43773,Lap replace gastr adj device,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43774,Lap rmvl gastr adj all parts,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43775,Lap sleeve gastrectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43830,Place gastrostomy tube,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43831,Place gastrostomy tube,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43832,Place gastrostomy tube,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43842,V-band gastroplasty,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43843,Gastroplasty w/o v-band,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43848,Revision gastroplasty,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43860,Revise stomach-bowel fusion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43870,Repair stomach opening,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43880,Repair stomach-bowel fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43881,Impl/redo electrd antrum,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43882,Revise/remove electrd antrum,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,43886,Revise gastric port open,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43887,Remove gastric port open,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43888,Change gastric port open,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,43999,Stomach surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44005,Freeing of bowel adhesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44015,Insert needle cath bowel,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44020,Explore small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44050,Reduce bowel obstruction,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44055,Correct malrotation of bowel,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44100,Biopsy of bowel,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44110,Excise intestine lesion(s),General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44111,Excision of bowel lesion(s),General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44125,Removal of small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44130,Bowel to bowel fusion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44139,Mobilization of colon,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44141,Partial removal of colon,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44143,Partial removal of colon,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44180,Lap enterolysis,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44186,Lap jejunostomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44187,Lap ileo/jejuno-stomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44188,Lap colostomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44204,Laparo partial colectomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44206,Lap part colectomy w/stoma,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44207,L colectomy/coloproctostomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44208,L colectomy/coloproctostomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44213,Lap mobil splenic fl add-on,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44238,Laparoscope proc intestine,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44300,Open bowel to skin,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44312,Revision of ileostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44320,Colostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44340,Revision of colostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44346,Revision of colostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44360,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44361,Small bowel endoscopy/biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44363,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44364,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44365,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44366,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44369,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44370,Small bowel endoscopy/stent,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44372,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44373,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44376,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44377,Small bowel endoscopy/biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44378,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44379,S bowel endoscope w/stent,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44380,Small bowel endoscopy br/wa,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44381,Small bowel endoscopy br/wa,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44382,Small bowel endoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44384,Small bowel endoscopy,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44385,Endoscopy of bowel pouch,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44386,Endoscopy bowel pouch/biop,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44388,Colonoscopy thru stoma spx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44389,Colonoscopy with biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44390,Colonoscopy for foreign body,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44391,Colonoscopy for bleeding,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44392,Colonoscopy & polypectomy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44394,Colonoscopy w/snare,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44401,Colonoscopy with ablation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44402,Colonoscopy w/stent plcmt,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44403,Colonoscopy w/resection,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44404,Colonoscopy w/injection,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44405,Colonoscopy w/dilation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44406,Colonoscopy w/ultrasound,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44407,Colonoscopy w/ndl aspir/bx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44408,Colonoscopy w/decompression,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44500,Intro gastrointestinal tube,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44602,Suture small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44603,Suture small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44615,Intestinal stricturoplasty,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44620,Repair bowel opening,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44640,Repair bowel-skin fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44650,Repair bowel fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44799,Unlisted px small intestine,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44800,Excision of bowel pouch,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44820,Excision of mesentery lesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44850,Repair of mesentery,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44899,Bowel surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,44900,Drain appendix abscess open,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44950,Appendectomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44955,Appendectomy add-on,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44960,Appendectomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44970,Laparoscopy appendectomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,44979,Laparoscope proc app,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45000,Drainage of pelvic abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45005,Drainage of rectal abscess,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45020,Drainage of rectal abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45100,Biopsy of rectum,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45108,Removal of anorectal lesion,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45113,Partial proctectomy,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45123,Partial proctectomy,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45130,Excision of rectal prolapse,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45136,Excise ileoanal reservior,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45150,Excision of rectal stricture,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45160,Excision of rectal lesion,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45171,Exc rect tum transanal part,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45172,Exc rect tum transanal full,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45190,Destruction rectal tumor,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45300,Proctosigmoidoscopy dx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45303,Proctosigmoidoscopy dilate,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45305,Proctosigmoidoscopy w/bx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45307,Proctosigmoidoscopy fb,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45308,Proctosigmoidoscopy removal,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45309,Proctosigmoidoscopy removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45315,Proctosigmoidoscopy removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45317,Proctosigmoidoscopy bleed,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45320,Proctosigmoidoscopy ablate,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45321,Proctosigmoidoscopy volvul,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45327,Proctosigmoidoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45330,Diagnostic sigmoidoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45331,Sigmoidoscopy and biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45332,Sigmoidoscopy w/fb removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45333,Sigmoidoscopy & polypectomy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45334,Sigmoidoscopy for bleeding,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45335,Sigmoidoscopy w/submuc inj,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45337,Sigmoidoscopy & decompress,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45338,Sigmoidoscopy w/tumr remove,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45340,Sig w/tndsc balloon dilation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45341,Sigmoidoscopy w/ultrasound,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45342,Sigmoidoscopy w/us guide bx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45346,Sigmoidoscopy w/ablation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45347,Sigmoidoscopy w/plcmt stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45349,Sigmoidoscopy w/resection,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45350,Sgmdsc w/band ligation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45378,Diagnostic colonoscopy,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45379,Colonoscopy w/fb removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45380,Colonoscopy and biopsy,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45381,Colonoscopy submucous njx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45382,Colonoscopy w/control bleed,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45384,Colonoscopy w/lesion removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45385,Colonoscopy w/lesion removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45386,Colonoscopy w/balloon dilat,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45388,Colonoscopy w/ablation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45389,Colonoscopy w/stent plcmt,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45390,Colonoscopy w/resection,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45391,Colonoscopy w/endoscope us,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45392,Colonoscopy w/endoscopic fnb,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45393,Colonoscopy w/decompression,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45398,Colonoscopy w/band ligation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45399,Unlisted procedure colon,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45400,Laparoscopic proc,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45402,Lap proctopexy w/sig resect,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45499,Laparoscope proc rectum,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45500,Repair of rectum,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45505,Repair of rectum,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45520,Treatment of rectal prolapse,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45541,Correct rectal prolapse,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45560,Repair of rectocele,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45562,Exploration/repair of rectum,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45800,Repair rect/bladder fistula,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45820,Repair rectourethral fistula,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,45900,Reduction of rectal prolapse,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45905,Dilation of anal sphincter,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45910,Dilation of rectal narrowing,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45915,Remove rectal obstruction,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45990,Surg dx exam anorectal,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,45999,Rectum surgery procedure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46020,Placement of seton,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46030,Removal of rectal marker,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46040,Incision of rectal abscess,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46045,Incision of rectal abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46050,Incision of anal abscess,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46060,Incision of rectal abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46070,Incision of anal septum,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46080,Incision of anal sphincter,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46083,Incise external hemorrhoid,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46200,Removal of anal fissure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46220,Excise anal ext tag/papilla,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46221,Ligation of hemorrhoid(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46230,Removal of anal tags,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46250,Remove ext hem groups 2+,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46255,Remove int/ext hem 1 group,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46257,Remove in/ex hem grp & fiss,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46258,Remove in/ex hem grp w/fistu,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46260,Remove in/ex hem groups 2+,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46261,Remove in/ex hem grps & fiss,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46262,Remove in/ex hem grps w/fist,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46270,Remove anal fist subq,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46275,Remove anal fist inter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46280,Remove anal fist complex,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46285,Remove anal fist 2 stage,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46288,Repair anal fistula,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46320,Removal of hemorrhoid clot,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46500,Injection into hemorrhoid(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46505,Chemodenervation anal musc,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46600,Diagnostic anoscopy spx,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46601,Diagnostic anoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46604,Anoscopy and dilation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46606,Anoscopy and biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46607,Diagnostic anoscopy & biopsy,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46608,Anoscopy remove for body,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46610,Anoscopy remove lesion,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46611,Anoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46612,Anoscopy remove lesions,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46614,Anoscopy control bleeding,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46615,Anoscopy,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46700,Repair of anal stricture,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46705,Repair of anal stricture,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46706,Repr of anal fistula w/glue,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46707,Repair anorectal fist w/plug,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46710,Repr per/vag pouch sngl proc,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46712,Repr per/vag pouch dbl proc,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46715,Rep perf anoper fistu,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46716,Rep perf anoper/vestib fistu,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46740,Construction of absent anus,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46750,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46751,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46753,Reconstruction of anus,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46754,Removal of suture from anus,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46760,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46761,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46762,Implant artificial sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46900,Destruction anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46910,Destruction anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46916,Cryosurgery anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46917,Laser surgery anal lesions,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46922,Excision of anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46924,Destruction anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46930,Destroy internal hemorrhoids,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46940,Treatment of anal fissure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46942,Treatment of anal fissure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46945,Int hrhc lig 1 hroid w/o img,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46946,Int hrhc lig 2+hroid w/o img,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,46947,Hemorrhoidopexy by stapling,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46948,Int hrhc tranal dartlzj 2+,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,46999,Anus surgery procedure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,47370,Laparo ablate liver tumor rf,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47371,Laparo ablate liver cryosurg,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47379,Laparoscope procedure liver,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47510,Insert catheter bile duct,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47511,Insert bile duct drain,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47525,Change bile duct catheter,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,47530,Revise/reinsert bile tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,47537,Removal biliary drg cath,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,47560,Laparoscopy w/cholangio,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47561,Laparo w/cholangio/biopsy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47562,Laparoscopic cholecystectomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47563,Laparo cholecystectomy/graph,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47564,Laparo cholecystectomy/explr,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47570,Laparo cholecystoenterostomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47579,Laparoscope proc biliary,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,47630,Remove bile duct stone,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,48550,Donor pancreatectomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49000,Exploration of abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49002,Reopening of abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49010,Exploration behind abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49203,Exc abd tum 5 cm or less,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49204,Exc abd tum over 5 cm,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49205,Exc abd tum over 10 cm,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49215,Excise sacral spine tumor,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49220,Multiple surgery abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49250,Excision of umbilicus,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49255,Removal of omentum,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49320,Diag laparo separate proc,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49321,Laparoscopy biopsy,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49322,Laparoscopy aspiration,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49323,Laparo drain lymphocele,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49324,Lap insert tunnel ip cath,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49325,Lap revision perm ip cath,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49326,Lap w/omentopexy add-on,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49329,Laparo proc abdm/per/oment,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49402,Remove foreign body adbomen,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49425,Insert abdomen-venous drain,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49426,Revise abdomen-venous shunt,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49428,Ligation of shunt,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49429,Removal of shunt,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49440,Place gastrostomy tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49441,Place duod/jej tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49442,Place cecostomy tube perc,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49446,Change g-tube to g-j perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49450,Replace g/c tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49451,Replace duod/jej tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49452,Replace g-j tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49460,Fix g/colon tube w/device,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49491,Rpr hern preemie reduc,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49492,Rpr ing hern premie blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49495,Rpr ing hernia baby reduc,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49496,Rpr ing hernia baby blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49500,Rpr ing hernia init reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49501,Rpr ing hernia init blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49505,Prp i/hern init reduc >5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49507,Prp i/hern init block >5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49520,Rerepair ing hernia reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49521,Rerepair ing hernia blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49525,Repair ing hernia sliding,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49540,Repair lumbar hernia,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49550,Rpr rem hernia init reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49553,Rpr fem hernia init blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49555,Rerepair fem hernia reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49557,Rerepair fem hernia blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49560,Rpr ventral hern init reduc,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49561,Rpr ventral hern init block,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49565,Rerepair ventrl hern reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49566,Rerepair ventrl hern block,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49568,Hernia repair w/mesh,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49570,Rpr epigastric hern reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49572,Rpr epigastric hern blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49580,Rpr umbil hern reduc < 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49582,Rpr umbil hern block < 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49585,Rpr umbil hern reduc > 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49587,Rpr umbil hern block > 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49590,Repair spigelian hernia,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49600,Repair umbilical lesion,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49606,Repair umbilical lesion,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49610,Repair umbilical lesion,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49650,Lap ing hernia repair init,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49651,Lap ing hernia repair recur,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49652,Lap vent/abd hernia repair,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49653,Lap vent/abd hern proc comp,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49654,Lap inc hernia repair,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49655,Lap inc hern repair comp,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49656,Lap inc hernia repair recur,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49657,Lap inc hern recur comp,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49659,Laparo proc hernia repair,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49900,Repair of abdominal wall,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49904,Omental flap extra-abdom,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,49905,Omental flap intra-abdom,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49906,Free omental flap microvasc,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,49999,Abdomen surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50389,Remove renal tube w/fluoro,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50390,Drainage of kidney lesion,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50391,Instll rx agnt into rnal tub,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50396,Measure kidney pressure,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50398,Change kidney tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50430,Njx px nfrosgrm &/urtrgrm,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50431,Njx px nfrosgrm &/urtrgrm,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,50541,Laparo ablate renal cyst,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50542,Laparo ablate renal mass,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50543,Laparo partial nephrectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50544,Laparoscopy pyeloplasty,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50549,Laparoscope proc renal,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50945,Laparoscopy ureterolithotomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50947,Laparo new ureter/bladder,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50948,Laparo new ureter/bladder,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,50949,Laparoscope proc ureter,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,51100,Drain bladder by needle,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51500,Removal of bladder cyst,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,51705,Change of bladder tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51710,Change of bladder tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51715,Endoscopic injection/implant,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51720,Treatment of bladder lesion,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51725,Simple cystometrogram,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51726,Complex cystometrogram,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51727,Cystometrogram w/up,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51728,Cystometrogram w/vp,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51729,Cystometrogram w/vp&up,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51741,Electro-uroflowmetry first,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51784,Anal/urinary muscle study,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51785,Anal/urinary muscle study,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51792,Urinary reflex study,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,51990,Laparo urethral suspension,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,51992,Laparo sling operation,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,51999,Laparoscope proc bla,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,52010,Cystoscopy & duct catheter,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52270,Cystoscopy & revise urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52275,Cystoscopy & revise urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52276,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52277,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52282,Cystoscopy implant stent,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52283,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52285,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52400,Cystouretero w/congen repr,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52402,Cystourethro cut ejacul duct,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,52442,Cystourethro w/addl implant,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,52601,Prostatectomy (turp),Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,52630,Remove prostate regrowth,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,52647,Laser surgery of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,52648,Laser surgery of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,52649,Prostate laser enucleation,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53000,Incision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53010,Incision of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53020,Incision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53025,Incision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53040,Drainage of urethra abscess,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53060,Drainage of urethra abscess,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53080,Drainage of urinary leakage,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53085,Drainage of urinary leakage,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53200,Biopsy of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53210,Removal of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53215,Removal of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53220,Treatment of urethra lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53230,Removal of urethra lesion,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53235,Removal of urethra lesion,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53240,Surgery for urethra pouch,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53250,Removal of urethra gland,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53260,Treatment of urethra lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53265,Treatment of urethra lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53270,Removal of urethra gland,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53275,Repair of urethra defect,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53400,Revise urethra stage 1,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53405,Revise urethra stage 2,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53410,Reconstruction of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53415,Reconstruction of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53420,Reconstruct urethra stage 1,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53425,Reconstruct urethra stage 2,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53430,Reconstruction of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53431,Reconstruct urethra/bladder,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53440,Male sling procedure,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53442,Remove/revise male sling,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53444,Insert tandem cuff,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53446,Remove uro sphincter,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53448,Remov/replc ur sphinctr comp,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53449,Repair uro sphincter,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53450,Revision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53460,Revision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53500,Urethrlys transvag w/ scope,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53502,Repair of urethra injury,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53505,Repair of urethra injury,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53510,Repair of urethra injury,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53515,Repair of urethra injury,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53520,Repair of urethra defect,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,53605,Dilate urethra stricture,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53620,Dilate urethra stricture,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53621,Dilate urethra stricture,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53665,Dilation of urethra,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53855,Insert prost urethral stent,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,53860,Transurethral rf treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54000,Slitting of prepuce,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54001,Slitting of prepuce,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54015,Drain penis lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54050,Destruction penis lesion(s),Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54055,Destruction penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54056,Cryosurgery penis lesion(s),Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54057,Laser surg penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54060,Excision of penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54065,Destruction penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54100,Biopsy of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54105,Biopsy of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54110,Treatment of penis lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54115,Treatment of penis lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54150,Circumcision w/regionl block,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54160,Circumcision neonate,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54161,Circum 28 days or older,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54162,Lysis penil circumic lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54163,Repair of circumcision,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54164,Frenulotomy of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54230,Prepare penis study,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54231,Dynamic cavernosometry,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54300,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54304,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54340,Secondary urethral surgery,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54360,Penis plastic surgery,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54380,Repair penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54385,Repair penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54400,Insert semi-rigid prosthesis,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54401,Insert self-contd prosthesis,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54405,Insert multi-comp penis pros,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54406,Remove muti-comp penis pros,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54408,Repair multi-comp penis pros,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54410,Remove/replace penis prosth,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54411,Remov/replc penis pros comp,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54415,Remove self-contd penis pros,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54416,Remv/repl penis contain pros,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54417,Remv/replc penis pros compl,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54420,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54430,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54435,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54440,Repair of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54450,Preputial stretching,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54500,Biopsy of testis,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54505,Biopsy of testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54512,Excise lesion testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54520,Removal of testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54522,Orchiectomy partial,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54530,Removal of testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54535,Extensive testis surgery,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54550,Exploration for testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54560,Exploration for testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54600,Reduce testis torsion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54620,Suspension of testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54640,Orchiopexy ingun/scrot appr,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54650,Orchiopexy (fowler-stephens),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54660,Revision of testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54670,Repair testis injury,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54680,Relocation of testis(es),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54690,Laparoscopy orchiectomy,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54692,Laparoscopy orchiopexy,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54699,Laparoscope proc testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54700,Drainage of scrotum,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54800,Biopsy of epididymis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54830,Remove epididymis lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54840,Remove epididymis lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54860,Removal of epididymis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54861,Removal of epididymis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,54865,Explore epididymis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54900,Fusion of spermatic ducts,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,54901,Fusion of spermatic ducts,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55040,Removal of hydrocele,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55041,Removal of hydroceles,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55060,Repair of hydrocele,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55100,Drainage of scrotum abscess,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55110,Explore scrotum,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55120,Removal of scrotum lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55150,Removal of scrotum,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55175,Revision of scrotum,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55180,Revision of scrotum,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55200,Incision of sperm duct,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55250,Removal of sperm duct(s),Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55400,Repair of sperm duct,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55450,Ligation of sperm duct,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55500,Removal of hydrocele,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55520,Removal of sperm cord lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55530,Revise spermatic cord veins,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55535,Revise spermatic cord veins,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55540,Revise hernia & sperm veins,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55550,Laparo ligate spermatic vein,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55559,Laparo proc spermatic cord,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55600,Incise sperm duct pouch,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55605,Incise sperm duct pouch,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55650,Remove sperm duct pouch,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55680,Remove sperm pouch lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55801,Removal of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55810,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55815,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55821,Removal of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55831,Removal of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55840,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55842,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55845,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55860,Surgical exposure prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55866,Laparo radical prostatectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55870,Electroejaculation,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,55873,Cryoablate prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55874,Tprnl plmt biodegrdabl matrl,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55880,Abltj mal prst8 tiss hifu,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,55899,Genital surgery procedure,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,56405,I & d of vulva/perineum,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,56420,Drainage of gland abscess,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,56820,Exam of vulva w/scope,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57150,Treat vagina infection,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57160,Insert pessary/other device,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57170,Fitting of diaphragm/cap,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57220,Revision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57230,Repair of urethral lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57240,Anterior colporrhaphy,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57250,Repair rectum & vagina,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57260,Cmbn ant pst colprhy,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57265,Cmbn ap colprhy w/ntrcl rpr,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57267,Insert mesh/pelvic flr addon,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,57268,Repair of bowel bulge,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57270,Repair of bowel pouch,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57287,Revise/remove sling repair,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57288,Repair bladder defect,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57289,Repair bladder & vagina,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,57410,Pelvic examination,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58300,Insert intrauterine device,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58301,Remove intrauterine device,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58321,Artificial insemination,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58322,Artificial insemination,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58323,Sperm washing,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58970,Retrieval of oocyte,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58974,Transfer of embryo,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,58976,Transfer of embryo,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59020,Fetal contract stress test,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59025,Fetal non-stress test,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59030,Fetal scalp blood sample,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59050,Fetal monitor w/report,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59072,Umbilical cord occlud w/us,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59074,Fetal fluid drainage w/us,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59076,Fetal shunt placement w/us,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59400,Obstetrical care,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,59409,Obstetrical care,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,59410,Obstetrical care,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,59610,Vbac delivery,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,59612,Vbac delivery only,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,59614,Vbac care after delivery,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,59812,Treatment of miscarriage,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59820,Care of miscarriage,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59821,Treatment of miscarriage,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59830,Treat uterus infection,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59840,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59841,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59850,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59851,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59852,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59855,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59856,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59857,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59866,Abortion (mpr),Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,59897,Fetal invas px w/us,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,60000,Drain thyroid/tongue cyst,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,60100,Biopsy of thyroid,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,60300,Aspir/inj thyroid cyst,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,60650,Laparoscopy adrenalectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,60659,Laparo proc endocrine,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,60699,Endocrine surgery procedure,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61000,Remove cranial cavity fluid,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,61001,Remove cranial cavity fluid,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,61020,Remove brain cavity fluid,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,61026,Injection into brain canal,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,61070,Brain canal shunt procedure,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,61215,Insert brain-fluid device,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61623,Endovasc tempory vessel occl,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61624,Transcath occlusion cns,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61626,Transcath occlusion non-cns,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61630,Intracranial angioplasty,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61635,Intracran angioplsty w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61640,Dilate ic vasospasm init,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61641,Dilat ic vspsm ea vsl sm ter,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61642,Dilat ic vspsm ea diff ter,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61645,Perq art m-thrombect &/nfs,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61651,Evasc prlng admn rx agnt add,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61720,Incise skull/brain surgery,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61770,Incise skull for treatment,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61790,Treat trigeminal nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,61791,Treat trigeminal tract,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,61796,Srs cranial lesion simple,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61797,Srs cran les simple addl,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61798,Srs cranial lesion complex,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61799,Srs cran les complex addl,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61800,Apply srs headframe add-on,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61850,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61880,Revise/remove neuroelectrode,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61885,Insrt/redo neurostim 1 array,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61886,Implant neurostim arrays,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,61888,Revise/remove neuroreceiver,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,62000,Treat skull fracture,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62194,Replace/irrigate catheter,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62225,Replace/irrigate catheter,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,62230,Replace/revise brain shunt,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,62252,Csf shunt reprogram,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62292,Njx chemonucleolysis lmbr,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62302,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62303,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62304,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62305,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62310,Inject spine cerv/thoracic,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62311,Inject spine lumbar/sacral,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62318,Inject spine w/cath crv/thrc,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62319,Inject spine w/cath lmb/scrl,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62350,Implant spinal canal cath,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,62355,Remove spinal canal catheter,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62360,Insert spine infusion device,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,62361,Implant spine infusion pump,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,62362,Implant spine infusion pump,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,62365,Remove spine infusion device,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62367,Analyze spine infus pump,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62368,Analyze sp inf pump w/reprog,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62369,Anal sp inf pmp w/reprg&fill,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,62370,Anl sp inf pmp w/mdreprg&fil,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,63600,Remove spinal cord lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,63610,Stimulation of spinal cord,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,63615,Remove lesion of spinal cord,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,63620,Srs spinal lesion,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63621,Srs spinal lesion addl,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63650,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63661,Remove spine eltrd perq aray,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,63662,Remove spine eltrd plate,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,63663,Revise spine eltrd perq aray,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63664,Revise spine eltrd plate,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63685,Insrt/redo spine n generator,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63688,Revise/remove neuroreceiver,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63707,Repair spinal fluid leakage,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63741,Install spinal shunt,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63744,Revision of spinal shunt,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,63746,Removal of spinal shunt,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64400,Njx aa&/strd trigeminal nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64402,N block inj facial,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64405,Njx aa&/strd gr ocpl nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64408,Njx aa&/strd vagus nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64410,N block inj phrenic,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64412,N block inj spinal accessor,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64413,N block inj cervical plexus,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64415,Njx aa&/strd brach plexus,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64416,Njx aa&/strd brach plex nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64417,Njx aa&/strd axillary nrv,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64418,Njx aa&/strd sprscap nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64420,Njx aa&/strd ntrcost nrv 1,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64421,Njx aa&/strd ntrcost nrv ea,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64425,Njx aa&/strd ii ih nerves,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64430,Njx aa&/strd pudendal nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64435,Njx aa&/strd paracrv nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64445,Njx aa&/strd sciatic nerve,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64446,Njx aa&/strd sciatic nrv nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64447,Njx aa&/strd femoral nerve,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64448,Njx aa&/strd fem nerve nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64449,Njx aa&/strd lmbr plex nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64450,Njx aa&/strd other pn/branch,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64454,Njx aa&/strd gnclr nrv brnch,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64455,Njx aa&/strd pltr com dg nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64486,Tap block unil by injection,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64487,Tap block uni by infusion,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64488,Tap block bi injection,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64489,Tap block bi by infusion,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64505,N block spenopalatine gangl,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64508,N block carotid sinus s/p,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64510,N block stellate ganglion,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64517,N block inj hypogas plxs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64530,N block inj celiac pelus,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64550,Appl surface neurostimulator,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64553,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64555,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64561,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64565,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64566,Neuroeltrd stim post tibial,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64568,Inc for vagus n elect impl,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64569,Revise/repl vagus n eltrd,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64570,Remove vagus n eltrd,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64575,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64580,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64581,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64585,Revise/remove neuroelectrode,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64590,Insrt/redo pn/gastr stimul,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64595,Revise/rmv pn/gastr stimul,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64600,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64605,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64610,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64611,Chemodenerv saliv glands,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64612,Destroy nerve face muscle,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64615,Chemodenerv musc migraine,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64616,Chemodenerv musc neck dyston,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64617,Chemodener muscle larynx emg,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64620,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64624,Dstrj nulyt agt gnclr nrv,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64625,Rf abltj nrv nrvtg si jt,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64630,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64632,N block inj common digit,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64640,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64642,Chemodenerv 1 extremity 1-4,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64643,Chemodenerv 1 extrem 1-4 ea,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64644,Chemodenerv 1 extrem 5/> mus,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64645,Chemodenerv 1 extrem 5/> ea,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64646,Chemodenerv trunk musc 1-5,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64647,Chemodenerv trunk musc 6/>,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64650,Chemodenerv eccrine glands,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64653,Chemodenerv eccrine glands,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64680,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64681,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64702,Revise finger/toe nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64704,Revise hand/foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64708,Revise arm/leg nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64712,Revision of sciatic nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64713,Revision of arm nerve(s),Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64714,Revise low back nerve(s),Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64716,Revision of cranial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64718,Revise ulnar nerve at elbow,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64719,Revise ulnar nerve at wrist,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64721,Carpal tunnel surgery,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64722,Relieve pressure on nerve(s),Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64726,Release foot/toe nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64727,Internal nerve revision,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64732,Incision of brow nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64734,Incision of cheek nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64736,Incision of chin nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64738,Incision of jaw nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64740,Incision of tongue nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64742,Incision of facial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64744,Incise nerve back of head,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64746,Incise diaphragm nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64763,Incise hip/thigh nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64766,Incise hip/thigh nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64771,Sever cranial nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64772,Incision of spinal nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64774,Remove skin nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64776,Remove digit nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64778,Digit nerve surgery add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64782,Remove limb nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64783,Limb nerve surgery add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64784,Remove nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64786,Remove sciatic nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64787,Implant nerve end,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64788,Remove skin nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64790,Removal of nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64792,Removal of nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64795,Biopsy of nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64802,Sympathectomy cervical,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64804,Remove sympathetic nerves,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64818,Remove sympathetic nerves,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64820,Sympathectomy digital artery,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64821,Remove sympathetic nerves,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64822,Remove sympathetic nerves,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64823,Sympathectomy supfc palmar,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64831,Repair of digit nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64832,Repair nerve add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64834,Repair of hand or foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64835,Repair of hand or foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64836,Repair of hand or foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64837,Repair nerve add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64840,Repair of leg nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64856,Repair/transpose nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64857,Repair arm/leg nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64858,Repair sciatic nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64859,Nerve surgery,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64861,Repair of arm nerves,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64862,Repair of low back nerves,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64864,Repair of facial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64865,Repair of facial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64866,Fusion of facial/other nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64868,Fusion of facial/other nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64872,Subsequent repair of nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64874,Repair & revise nerve add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64876,Repair nerve/shorten bone,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64885,Nerve graft head/neck 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64886,Nerve graft head/neck >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64890,Nerve graft hand/foot 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64891,Nerve graft hand/foot >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64892,Nerve graft arm/leg <4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64893,Nerve graft arm/leg >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64895,Nerve graft hand/foot 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64896,Nerve graft hand/foot >4 cm,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64897,Nerve graft arm/leg 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64898,Nerve graft arm/leg >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64901,Nerve graft add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,64902,Nerve graft add-on,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64905,Nerve pedicle transfer,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64907,Nerve pedicle transfer,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64910,Nerve repair w/allograft,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64911,Neurorraphy w/vein autograft,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64912,Nrv rpr w/nrv algrft 1st,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64913,Nrv rpr w/nrv algrft ea addl,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,64999,Nervous system surgery,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65091,Revise eye,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65093,Revise eye with implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65101,Removal of eye,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65103,Remove eye/insert implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65105,Remove eye/attach implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65110,Removal of eye,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65112,Remove eye/revise socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65114,Remove eye/revise socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65125,Revise ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65130,Insert ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65135,Insert ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65140,Attach ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65150,Revise ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65155,Reinsert ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65175,Removal of ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65205,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65210,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65220,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65222,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65235,Remove foreign body from eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65260,Remove foreign body from eye,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65265,Remove foreign body from eye,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65270,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65272,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65275,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65280,Repair of eye wound,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65285,Repair of eye wound,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65286,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65290,Repair of eye socket wound,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65400,Removal of eye lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65410,Biopsy of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65420,Removal of eye lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65426,Removal of eye lesion,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65430,Corneal smear,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65435,Curette/treat cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65436,Curette/treat cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65450,Treatment of corneal lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65600,Revision of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65710,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65730,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65750,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65755,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65756,Corneal trnspl endothelial,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65757,Prep corneal endo allograft,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65760,Revision of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65765,Revision of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65767,Corneal tissue transplant,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65770,Revise cornea with implant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65771,Radial keratotomy,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65772,Correction of astigmatism,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65775,Correction of astigmatism,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65778,Cover eye w/membrane,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65779,Cover eye w/membrane suture,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65780,Ocular reconst transplant,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65781,Ocular reconst transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65782,Ocular reconst transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65785,Impltj ntrstrml crnl rng seg,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65800,Drainage of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65810,Drainage of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65815,Drainage of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65820,Relieve inner eye pressure,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65850,Incision of eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65855,Trabeculoplasty laser surg,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65860,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,65865,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65870,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65875,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65880,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65900,Remove eye lesion,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65920,Remove implant of eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,65930,Remove blood clot from eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66020,Injection treatment of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66030,Injection treatment of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66130,Remove eye lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66150,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66155,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66160,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66170,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66172,Incision of eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66174,Translum dil eye canal,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66175,Trnslum dil eye canal w/stnt,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66179,Aqueous shunt eye w/o graft,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66180,Aqueous shunt eye w/graft,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66183,Insert ant drainage device,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66184,Revision of aqueous shunt,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66185,Revise aqueous shunt eye,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66220,Repair eye lesion,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66225,Repair/graft eye lesion,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66250,Follow-up surgery of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66500,Incision of iris,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66505,Incision of iris,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66600,Remove iris and lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66605,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66625,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66630,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66635,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66680,Repair iris & ciliary body,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66682,Repair iris & ciliary body,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66700,Destruction ciliary body,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66710,Ciliary transsleral therapy,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66711,Ecp ciliary body destruction,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66720,Destruction ciliary body,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66740,Destruction ciliary body,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66761,Revision of iris,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66762,Revision of iris,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66770,Removal of inner eye lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66820,Incision secondary cataract,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66821,After cataract laser surgery,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66825,Reposition intraocular lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66830,Removal of lens lesion,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66840,Removal of lens material,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66850,Removal of lens material,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66852,Removal of lens material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,66920,Extraction of lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66930,Extraction of lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66940,Extraction of lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66982,Xcapsl ctrc rmvl cplx wo ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66983,Cataract surg w/iol 1 stage,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66984,Xcapsl ctrc rmvl w/o ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66985,Insert lens prosthesis,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66986,Exchange lens prosthesis,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66987,Xcapsl ctrc rmvl cplx w/ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66988,Xcapsl ctrc rmvl w/ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,66999,Eye surgery procedure,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67005,Partial removal of eye fluid,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67010,Partial removal of eye fluid,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67015,Release of eye fluid,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67025,Replace eye fluid,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67027,Implant eye drug system,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67028,Injection eye drug,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67030,Incise inner eye strands,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67031,Laser surgery eye strands,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67036,Removal of inner eye fluid,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67039,Laser treatment of retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67040,Laser treatment of retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67041,Vit for macular pucker,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67042,Vit for macular hole,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67043,Vit for membrane dissect,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67101,Repair detached retina crtx,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67105,Repair detached retina pc,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67107,Repair detached retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67108,Repair detached retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67110,Repair detached retina,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67112,Rerepair detached retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67113,Repair retinal detach cplx,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67115,Release encircling material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67120,Remove eye implant material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67121,Remove eye implant material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67141,Treatment of retina,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67145,Treatment of retina,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67208,Treatment of retinal lesion,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67210,Treatment of retinal lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67218,Treatment of retinal lesion,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67220,Treatment of choroid lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67221,Ocular photodynamic ther,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67225,Eye photodynamic ther add-on,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67227,Dstrj extensive retinopathy,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67228,Treatment x10sv retinopathy,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67229,Tr retinal les preterm inf,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67250,Reinforce eye wall,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67255,Reinforce/graft eye wall,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67299,Eye surgery procedure,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67311,Revise eye muscle,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67312,Revise two eye muscles,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67314,Revise eye muscle,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67316,Revise two eye muscles,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67318,Revise eye muscle(s),Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67320,Revise eye muscle(s) add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67331,Eye surgery follow-up add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67332,Rerevise eye muscles add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67334,Revise eye muscle w/suture,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67335,Eye suture during surgery,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67340,Revise eye muscle add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67343,Release eye tissue,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67345,Destroy nerve of eye muscle,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67346,Biopsy eye muscle,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67399,Unlisted px extraocular musc,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,67400,Explore/biopsy eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67405,Explore/drain eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67412,Explore/treat eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67413,Explore/treat eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67414,Explr/decompress eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67415,Aspiration orbital contents,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67445,Explr/decompress eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67500,Inject/treat eye socket,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67505,Inject/treat eye socket,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67515,Inject/treat eye socket,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67550,Insert eye socket implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67560,Revise eye socket implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67570,Decompress optic nerve,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67599,Orbit surgery procedure,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67700,Drainage of eyelid abscess,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67710,Incision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67715,Incision of eyelid fold,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67800,Remove eyelid lesion,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67801,Remove eyelid lesions,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67805,Remove eyelid lesions,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67808,Remove eyelid lesion(s),Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67810,Biopsy eyelid & lid margin,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67820,Revise eyelashes,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67825,Revise eyelashes,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67830,Revise eyelashes,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67835,Revise eyelashes,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67840,Remove eyelid lesion,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67850,Treat eyelid lesion,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67875,Closure of eyelid by suture,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67880,Revision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67882,Revision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67900,Repair brow defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67901,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67902,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67903,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67904,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67906,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67908,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67909,Revise eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67911,Revise eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67912,Correction eyelid w/implant,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67914,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67915,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67916,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67917,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67921,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67922,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67923,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67924,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67930,Repair eyelid wound,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67935,Repair eyelid wound,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67938,Remove eyelid foreign body,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67950,Revision of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67961,Revision of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67966,Revision of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67971,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67973,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67974,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67975,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,67999,Revision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68020,Incise/drain eyelid lining,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68040,Treatment of eyelid lesions,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68100,Biopsy of eyelid lining,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68110,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68115,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68130,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68135,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68200,Treat eyelid by injection,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68320,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68325,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68326,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68328,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68330,Revise eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68335,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68340,Separate eyelid adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68360,Revise eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68362,Revise eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,68371,Harvest eye tissue alograft,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68399,Eyelid lining surgery,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68400,Incise/drain tear gland,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68420,Incise/drain tear sac,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68440,Incise tear duct opening,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68500,Removal of tear gland,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68505,Partial removal tear gland,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68510,Biopsy of tear gland,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68520,Removal of tear sac,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68525,Biopsy of tear sac,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68530,Clearance of tear duct,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68540,Remove tear gland lesion,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68550,Remove tear gland lesion,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68700,Repair tear ducts,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68705,Revise tear duct opening,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68720,Create tear sac drain,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68745,Create tear duct drain,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68750,Create tear duct drain,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68760,Close tear duct opening,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68761,Close tear duct opening,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68770,Close tear system fistula,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68801,Dilate tear duct opening,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68810,Probe nasolacrimal duct,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68811,Probe nasolacrimal duct,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68815,Probe nasolacrimal duct,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68816,Probe nl duct w/balloon,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68840,Explore/irrigate tear ducts,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,68899,Tear duct system surgery,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69005,Drain external ear lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69100,Biopsy of external ear,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69105,Biopsy of external ear canal,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69110,Remove external ear partial,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69120,Removal of external ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69140,Remove ear canal lesion(s),Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69145,Remove ear canal lesion(s),Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69150,Extensive ear canal surgery,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69155,Extensive ear/neck surgery,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69205,Clear outer ear canal,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69222,Clean out mastoid cavity,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69300,Revise external ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69310,Rebuild outer ear canal,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69320,Rebuild outer ear canal,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69399,Outer ear surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69421,Incision of eardrum,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69424,Remove ventilating tube,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69433,Create eardrum opening,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69436,Create eardrum opening,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69440,Exploration of middle ear,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69450,Eardrum revision,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69501,Mastoidectomy,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69502,Mastoidectomy,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69505,Remove mastoid structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69511,Extensive mastoid surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69530,Extensive mastoid surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69540,Remove ear lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69550,Remove ear lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69552,Remove ear lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69601,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69602,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69603,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69604,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69605,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69610,Repair of eardrum,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69620,Repair of eardrum,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69631,Repair eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69632,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69633,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69635,Repair eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69636,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69637,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69641,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69642,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69643,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69644,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69645,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69646,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69650,Release middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69660,Revise middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69661,Revise middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69662,Revise middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69666,Repair middle ear structures,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69667,Repair middle ear structures,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69670,Remove mastoid air cells,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69676,Remove middle ear nerve,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69700,Close mastoid fistula,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69705,Nps surg dilat eust tube uni,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69706,Nps surg dilat eust tube bi,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69710,Implant/replace hearing aid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69711,Remove/repair hearing aid,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69714,Implant temple bone w/stimul,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69715,Temple bne implnt w/stimulat,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69717,Temple bone implant revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69718,Revise temple bone implant,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69720,Release facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69725,Release facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69740,Repair facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69745,Repair facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69799,Middle ear surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69801,Incise inner ear,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69805,Explore inner ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69806,Explore inner ear,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69820,Establish inner ear window,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69840,Revise inner ear window,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69905,Remove inner ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69910,Remove inner ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69915,Incise inner ear nerve,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69930,Implant cochlear device,Otolaryngology Surgery,Per Unit,"$15,529.51 ",OP,"$15,529.51 ","$15,529.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69949,Inner ear surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,69955,Release facial nerve,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,69960,Release inner ear canal,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,70010,Contrast x-ray of brain,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70015,Contrast x-ray of brain,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70030,X-ray eye for foreign body,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70100,X-ray exam of jaw <4views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70110,X-ray exam of jaw 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70120,X-ray exam of mastoids,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70130,X-ray exam of mastoids,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70134,X-ray exam of middle ear,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70140,X-ray exam of facial bones,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70150,X-ray exam of facial bones,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70160,X-ray exam of nasal bones,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70190,X-ray exam of eye sockets,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70200,X-ray exam of eye sockets,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70210,X-ray exam of sinuses,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70220,X-ray exam of sinuses,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70240,X-ray exam pituitary saddle,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70250,X-ray exam of skull,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70260,X-ray exam of skull,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70300,X-ray exam of teeth,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70310,X-ray exam of teeth,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70320,Full mouth x-ray of teeth,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70328,X-ray exam of jaw joint,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70330,X-ray exam of jaw joints,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70336,Magnetic image jaw joint,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70350,X-ray head for orthodontia,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70355,Panoramic x-ray of jaws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70360,X-ray exam of neck,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70370,Throat x-ray & fluoroscopy,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70373,Contrast x-ray of larynx,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70380,X-ray exam of salivary gland,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70450,Ct head/brain w/o dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70460,Ct head/brain w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70470,Ct head/brain w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70480,Ct orbit/ear/fossa w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70481,Ct orbit/ear/fossa w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70482,Ct orbit/ear/fossa w/o&w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70486,Ct maxillofacial w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70487,Ct maxillofacial w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70488,Ct maxillofacial w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70490,Ct soft tissue neck w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70491,Ct soft tissue neck w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70492,Ct sft tsue nck w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70496,Ct angiography head,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70498,Ct angiography neck,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70540,Mri orbit/face/neck w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70542,Mri orbit/face/neck w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70543,Mri orbt/fac/nck w/o &w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70544,Mr angiography head w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70545,Mr angiography head w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70546,Mr angiograph head w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70547,Mr angiography neck w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70548,Mr angiography neck w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70549,Mr angiograph neck w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70551,Mri brain stem w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70552,Mri brain stem w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70553,Mri brain stem w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70554,Fmri brain by tech,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70555,Fmri brain by phys/psych,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70557,Mri brain w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70558,Mri brain w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,70559,Mri brain w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71010,Chest x-ray 1 view frontal,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71015,Chest x-ray stereo frontal,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71020,Chest x-ray 2vw frontal&latl,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71021,Chest x-ray frnt lat lordotc,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71022,Chest x-ray frnt lat oblique,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71023,Chest x-ray and fluoroscopy,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71030,Chest x-ray 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71034,Chest x-ray&fluoro 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71035,Chest x-ray special views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71045,X-ray exam chest 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71046,X-ray exam chest 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71047,X-ray exam chest 3 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71048,X-ray exam chest 4+ views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71100,X-ray exam ribs uni 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71101,X-ray exam unilat ribs/chest,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71110,X-ray exam ribs bil 3 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71111,X-ray exam ribs/chest4/> vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71120,X-ray exam breastbone 2/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71130,X-ray strenoclavic jt 3/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71250,Ct thorax dx c-,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71260,Ct thorax dx c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71270,Ct thorax dx c-/c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71271,Ct thorax lung cancer scr c-,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71275,Ct angiography chest,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71550,Mri chest w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71551,Mri chest w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71552,Mri chest w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,71555,Mri angio chest w or w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72010,X-ray exam spine ap&lat,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72020,X-ray exam of spine 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72040,X-ray exam neck spine 2-3 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72050,X-ray exam neck spine 4/5vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72052,X-ray exam neck spine 6/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72069,X-ray exam trunk spine stand,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72070,X-ray exam thorac spine 2vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72072,X-ray exam thorac spine 3vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72074,X-ray exam thorac spine4/>vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72080,X-ray exam thoracolmb 2/> vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72081,X-ray exam entire spi 1 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72082,X-ray exam entire spi 2/3 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72083,X-ray exam entire spi 4/5 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72084,X-ray exam entire spi 6/> vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72090,X-ray exam scloiosis erect,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72100,X-ray exam l-s spine 2/3 vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72110,X-ray exam l-2 spine 4/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72114,X-ray exam l-s spine bending,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72120,X-ray bend only l-s spine,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72125,Ct neck spine w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72126,Ct neck spine w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72127,Ct neck spine w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72128,Ct chest spine w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72129,Ct chest spine w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72130,Ct chest spine w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72131,Ct lumbar spine w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72132,Ct lumbar spine w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72133,Ct lumbar spine w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72141,Mri neck spine w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72142,Mri neck spine w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72146,Mri chest spine w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72147,Mri chest spine w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72148,Mri lumbar spine w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72149,Mri lumbar spine w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72156,Mri neck spine w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72157,Mri chest spine w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72158,Mri lumbar spine w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72159,Mr angio spine w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72170,X-ray exam of pelvis,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72190,X-ray exam of pelvis,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72191,Ct angiograph pelv w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72192,Ct pelvis w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72193,Ct pelvis w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72194,Ct pelvis w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72195,Mri pelvis w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72196,Mri pelvis w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72197,Mri pelvis w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72198,Mr angio pelvis w/o & w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72200,X-ray exam si joints,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72202,X-ray exam si joints 3/> vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72220,X-ray exam sacrum tailbone,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72240,Myelography neck spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72255,Myelography thoracic spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72265,Myelography l-s spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72270,Myelogphy 2/> spine regions,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72275,Epidurography,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72285,Discography cerv/thor spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,72295,X-ray of lower spine disk,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73000,X-ray exam of collar bone,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73010,X-ray exam of shoulder blade,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73020,X-ray exam of shoulder,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73030,X-ray exam of shoulder,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73050,X-ray exam of shoulders,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73060,X-ray exam of humerus,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73070,X-ray exam of elbow,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73080,X-ray exam of elbow,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73090,X-ray exam of forearm,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73092,X-ray exam of arm infant,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73100,X-ray exam of wrist,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73110,X-ray exam of wrist,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73120,X-ray exam of hand,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73130,X-ray exam of hand,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73140,X-ray exam of finger(s),Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73200,Ct upper extremity w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73201,Ct upper extremity w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73202,Ct uppr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73206,Ct angio upr extrm w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73218,Mri upper extremity w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73219,Mri upper extremity w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73220,Mri uppr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73221,Mri joint upr extrem w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73222,Mri joint upr extrem w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73223,Mri joint upr extr w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73225,Mr angio upr extr w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73500,X-ray exam of hip,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73501,X-ray exam hip uni 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73502,X-ray exam hip uni 2-3 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73503,X-ray exam hip uni 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73510,X-ray exam of hip,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73520,X-ray exam of hips,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73521,X-ray exam hips bi 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73522,X-ray exam hips bi 3-4 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73523,X-ray exam hips bi 5/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73530,X-ray exam of hip,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73540,X-ray exam of pelvis & hips,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73550,X-ray exam of thigh,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73551,X-ray exam of femur 1,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73552,X-ray exam of femur 2/>,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73560,X-ray exam of knee 1 or 2,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73562,X-ray exam of knee 3,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73564,X-ray exam knee 4 or more,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73565,X-ray exam of knees,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73590,X-ray exam of lower leg,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73592,X-ray exam of leg infant,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73600,X-ray exam of ankle,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73610,X-ray exam of ankle,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73620,X-ray exam of foot,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73630,X-ray exam of foot,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73650,X-ray exam of heel,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73660,X-ray exam of toe(s),Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73700,Ct lower extremity w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73701,Ct lower extremity w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73702,Ct lwr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73706,Ct angio lwr extr w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73718,Mri lower extremity w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73719,Mri lower extremity w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73720,Mri lwr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73721,Mri jnt of lwr extre w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73722,Mri joint of lwr extr w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73723,Mri joint lwr extr w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,73725,Mr ang lwr ext w or w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74000,X-ray exam of abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74010,X-ray exam of abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74018,X-ray exam abdomen 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74019,X-ray exam abdomen 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74020,X-ray exam of abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74021,X-ray exam abdomen 3+ views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74022,X-ray exam complete abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74150,Ct abdomen w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74160,Ct abdomen w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74170,Ct abdomen w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74174,Ct angio abd&pelv w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74175,Ct angio abdom w/o & w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74176,Ct abd & pelvis w/o contrast,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74177,Ct abd & pelv w/contrast,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74178,Ct abd & pelv 1/> regns,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74181,Mri abdomen w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74182,Mri abdomen w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74183,Mri abdomen w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74185,Mri angio abdom w orw/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74210,X-ray xm phrnx&/crv esoph c+,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74220,X-ray xm esophagus 1cntrst,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74235,Remove esophagus obstruction,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74261,Ct colonography dx,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74262,Ct colonography dx w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74263,Ct colonography screening,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74300,X-ray bile ducts/pancreas,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74301,X-rays at surgery add-on,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74305,X-ray bile ducts/pancreas,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74320,Contrast x-ray of bile ducts,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74327,X-ray bile stone removal,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74328,X-ray bile duct endoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74329,X-ray for pancreas endoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74330,X-ray bile/panc endoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74340,X-ray guide for gi tube,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74355,X-ray guide intestinal tube,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74360,X-ray guide gi dilation,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74363,X-ray bile duct dilation,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74475,X-ray control cath insert,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74480,X-ray control cath insert,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74485,Dilation urtr/urt rs&i,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74710,X-ray measurement of pelvis,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74712,Mri fetal sngl/1st gestation,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74713,Mri fetal ea addl gestation,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,74742,X-ray fallopian tube,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75557,Cardiac mri for morph,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75559,Cardiac mri w/stress img,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75561,Cardiac mri for morph w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75563,Card mri w/stress img & dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75565,Card mri veloc flow mapping,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75571,Ct hrt w/o dye w/ca test,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75572,Ct hrt w/3d image,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75573,Ct hrt w/3d image congen,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75574,Ct angio hrt w/3d image,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75605,Contrast exam thoracic aorta,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,75635,Ct angio abdominal arteries,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75705,Artery x-rays spine,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,75726,Artery x-rays abdomen,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,75736,Artery x-rays pelvis,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,75774,Artery x-ray each vessel,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,75791,Av dialysis shunt imaging,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75842,Vein x-ray adrenal glands,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,75893,Venous sampling by catheter,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,75894,X-rays transcath therapy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75896,X-rays transcath therapy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75901,Remove cva device obstruct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75902,Remove cva lumen obstruct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75945,Intravascular us,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75946,Intravascular us add-on,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75952,Endovasc repair abdom aorta,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75953,Abdom aneurysm endovas rpr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75954,Iliac aneurysm endovas rpr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75956,Xray endovasc thor ao repr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75957,Xray endovasc thor ao repr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75958,Xray place prox ext thor ao,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75959,Xray place dist ext thor ao,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75962,Repair arterial blockage,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75964,Repair artery blockage each,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75966,Repair arterial blockage,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75968,Repair artery blockage each,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75970,Vascular biopsy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75980,Contrast xray exam bile duct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75982,Contrast xray exam bile duct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75984,Xray control catheter change,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,75989,Abscess drainage under x-ray,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76010,X-ray nose to rectum,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76100,X-ray exam of body section,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76101,Complex body section x-ray,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76102,Complex body section x-rays,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76120,Cine/video x-rays,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76125,Cine/video x-rays add-on,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76145,Med physic dos eval rad exps,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76380,Cat scan follow-up study,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76390,Mr spectroscopy,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76391,Mr elastography,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76496,Fluoroscopic procedure,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76497,Ct procedure,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76498,Mri procedure,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76499,Radiographic procedure,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76506,Echo exam of head,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76510,Oph us dx b-scan&quan a-scan,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76511,Oph us dx quan a-scan only,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76512,Oph us dx b-scan,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76513,Oph us dx ant sgm us uni/bi,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76514,Echo exam of eye thickness,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76516,Echo exam of eye,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76519,Echo exam of eye,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76529,Echo exam of eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76536,Us exam of head and neck,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76604,Us exam chest,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76641,Ultrasound breast complete,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76642,Ultrasound breast limited,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76700,Us exam abdom complete,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76705,Echo exam of abdomen,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76706,Us abdl aorta screen aaa,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76770,Us exam abdo back wall comp,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76775,Us exam abdo back wall lim,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76776,Us exam k transpl w/doppler,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76800,Us exam spinal canal,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76801,Ob us < 14 wks single fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76802,Ob us < 14 wks addl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76805,Ob us >= 14 wks sngl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76810,Ob us >= 14 wks addl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76811,Ob us detailed sngl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76812,Ob us detailed addl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76813,Ob us nuchal meas 1 gest,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76814,Ob us nuchal meas add-on,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76815,Ob us limited fetus(s),Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76816,Ob us follow-up per fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76817,Transvaginal us obstetric,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76818,Fetal biophys profile w/nst,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76819,Fetal biophys profil w/o nst,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76820,Umbilical artery echo,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76821,Middle cerebral artery echo,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76825,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76826,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76827,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76828,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76830,Transvaginal us non-ob,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76831,Echo exam uterus,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76856,Us exam pelvic complete,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76857,Us exam pelvic limited,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76870,Us exam scrotum,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76872,Us transrectal,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76873,Echograp trans r pros study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76881,Us compl joint r-t w/img,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76882,Us lmtd jt/nonvasc xtr strux,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76885,Us exam infant hips dynamic,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76886,Us exam infant hips static,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76930,Echo guide cardiocentesis,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76932,Echo guide for heart biopsy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76936,Echo guide for artery repair,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76937,Us guide vascular access,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76940,Us guide tissue ablation,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76941,Echo guide for transfusion,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76942,Echo guide for biopsy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76945,Echo guide villus sampling,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76946,Echo guide for amniocentesis,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76948,Echo guide ova aspiration,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76965,Echo guidance radiotherapy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76970,Ultrasound exam follow-up,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76975,Gi endoscopic ultrasound,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76977,Us bone density measure,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76978,Us trgt dyn mbubb 1st les,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76979,Us trgt dyn mbubb ea addl,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76981,Use parenchyma,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76982,Use 1st target lesion,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76983,Use ea addl target lesion,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76998,Us guide intraop,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,76999,Echo examination procedure,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77001,Fluoroguide for vein device,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77002,Needle localization by xray,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77003,Fluoroguide for spine inject,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77011,Ct scan for localization,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77012,Ct scan for needle biopsy,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77013,Ct guide for tissue ablation,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77014,Ct scan for therapy guide,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77021,Mri guidance ndl plmt rs&i,Interventional Radiology,Per Unit,$108.13 ,OP,$108.13 ,$108.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77022,Mri gdn parnchyma tiss abltj,Interventional Radiology,Per Unit,$108.13 ,OP,$108.13 ,$108.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77046,Mri breast c- unilateral,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77047,Mri breast c- bilateral,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77048,Mri breast c-+ w/cad uni,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77049,Mri breast c-+ w/cad bi,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77055,Mammogram one breast,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77056,Mammogram both breasts,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77057,Mammogram screening,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77058,Mri one breast,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77059,Mri both breasts,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77061,Breast tomosynthesis uni,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77062,Breast tomosynthesis bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77063,Breast tomosynthesis bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77065,Dx mammo incl cad uni,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77066,Dx mammo incl cad bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77067,Scr mammo bi incl cad,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77072,X-rays for bone age,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77073,X-rays bone length studies,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77074,X-rays bone survey limited,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77076,X-rays bone survey infant,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77077,Joint survey single view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77078,Ct bone density axial,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77080,Dxa bone density axial,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77081,Dxa bone density/peripheral,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77084,Magnetic image bone marrow,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77085,Dxa bone density study,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77086,Fracture assessment via dxa,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77261,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77262,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77263,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77280,Set radiation therapy field,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77285,Set radiation therapy field,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77290,Set radiation therapy field,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77293,Respirator motion mgmt simul,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77295,3-d radiotherapy plan,Therapeutic Radiology,Per Unit,$68.45 ,OP,$68.45 ,$68.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77299,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77300,Radiation therapy dose plan,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77301,Radiotherapy dose plan imrt,Therapeutic Radiology,Per Unit,$68.45 ,OP,$68.45 ,$68.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77306,Telethx isodose plan simple,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77307,Telethx isodose plan cplx,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77316,Brachytx isodose plan simple,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77317,Brachytx isodose intermed,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77318,Brachytx isodose complex,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77321,Special teletx port plan,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77331,Special radiation dosimetry,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77332,Radiation treatment aid(s),Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77333,Radiation treatment aid(s),Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77334,Radiation treatment aid(s),Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77336,Radiation physics consult,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77338,Design mlc device for imrt,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77370,Radiation physics consult,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77371,Srs multisource,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77372,Srs linear based,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77373,Sbrt delivery,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77385,Ntsty modul rad tx dlvr smpl,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77386,Ntsty modul rad tx dlvr cplx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77387,Guidance for radj tx dlvr,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77399,External radiation dosimetry,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77401,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77402,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77407,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77412,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77417,Radiology port images(s),Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77422,Neutron beam tx simple,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77423,Neutron beam tx complex,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77424,Io rad tx delivery by x-ray,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77425,Io rad tx deliver by elctrns,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77427,Radiation tx management x5,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77431,Radiation therapy management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77432,Stereotactic radiation trmt,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77435,Sbrt management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77469,Io radiation tx management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77470,Special radiation treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77499,Radiation therapy management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77520,Proton trmt simple w/o comp,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77522,Proton trmt simple w/comp,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77523,Proton trmt intermediate,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77525,Proton treatment complex,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77600,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77605,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77610,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77615,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77620,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77750,Infuse radioactive materials,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77761,Apply intrcav radiat simple,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77762,Apply intrcav radiat interm,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77763,Apply intrcav radiat compl,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77767,Hdr rdncl skn surf brachytx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77768,Hdr rdncl skn surf brachytx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77770,Hdr rdncl ntrstl/icav brchtx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77771,Hdr rdncl ntrstl/icav brchtx,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77772,Hdr rdncl ntrstl/icav brchtx,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77776,Apply interstit radiat simpl,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77777,Apply interstit radiat inter,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77778,Apply interstit radiat compl,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77785,Hdr brachytx 1 channel,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77786,Hdr brachytx 2-12 channel,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77787,Hdr brachytx over 12 chan,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,77789,Apply surf ldr radionuclide,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77790,Radiation handling,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,77799,Radium/radioisotope therapy,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78012,Thyroid uptake measurement,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78013,Thyroid imaging w/blood flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78014,Thyroid imaging w/blood flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78015,Thyroid met imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78016,Thyroid met imaging/studies,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78018,Thyroid met imaging body,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78020,Thyroid met uptake,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78070,Parathyroid planar imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78071,Parathyrd planar w/wo subtrj,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78072,Parathyrd planar w/spect&ct,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78075,Adrenal cortex & medulla img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78099,Endocrine nuclear procedure,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78102,Bone marrow imaging ltd,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78103,Bone marrow imaging mult,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78104,Bone marrow imaging body,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78110,Plasma volume single,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78111,Plasma volume multiple,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78120,Red cell mass single,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78121,Red cell mass multiple,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78122,Blood volume,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78130,Red cell survival study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78135,Red cell survival kinetics,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78140,Red cell sequestration,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78185,Spleen imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78190,Platelet survival kinetics,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78191,Platelet survival,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78195,Lymph system imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78199,Blood/lymph nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78201,Liver imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78202,Liver imaging with flow,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78205,Liver imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78206,Liver image (3d) with flow,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78215,Liver and spleen imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78216,Liver & spleen image/flow,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78226,Hepatobiliary system imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78227,Hepatobil syst image w/drug,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78230,Salivary gland imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78231,Serial salivary imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78232,Salivary gland function exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78258,Esophageal motility study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78261,Gastric mucosa imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78262,Gastroesophageal reflux exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78264,Gastric emptying imag study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78265,Gastric emptying imag study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78266,Gastric emptying imag study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78267,Breath tst attain/anal c-14,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78270,Vit b-12 absorption exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78271,Vit b-12 absrp exam int fac,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78272,Vit b-12 absorp combined,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78278,Acute gi blood loss imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78282,Gi protein loss exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78290,Meckels divert exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78291,Leveen/shunt patency exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78299,Gi nuclear procedure,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78300,Bone imaging limited area,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78305,Bone imaging multiple areas,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78306,Bone imaging whole body,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78315,Bone imaging 3 phase,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78320,Bone imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78350,Bone mineral single photon,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78351,Bone mineral dual photon,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78399,Musculoskeletal nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78414,Non-imaging heart function,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78428,Cardiac shunt imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78429,Myocrd img pet 1 std w/ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78430,Myocrd img pet rst/strs w/ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78431,Myocrd img pet rst&strs ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78432,Myocrd img pet 2rtracer,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78433,Myocrd img pet 2rtracer ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78434,Aqmbf pet rest & rx stress,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78445,Vascular flow imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78451,Ht muscle image spect sing,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78452,Ht muscle image spect mult,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78453,Ht muscle image planar sing,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78454,Ht musc image planar mult,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78456,Acute venous thrombus image,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78457,Venous thrombosis imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78458,Ven thrombosis images bilat,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78459,Myocrd img pet single study,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78466,Heart infarct image,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78468,Heart infarct image (ef),Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78469,Heart infarct image (3d),Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78472,Gated heart planar single,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78473,Gated heart multiple,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78481,Heart first pass single,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78483,Heart first pass multiple,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78491,Myocrd img pet 1std rst/strs,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78492,Myocrd img pet mlt rst&strs,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78494,Heart image spect,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78496,Heart first pass add-on,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78499,Cardiovascular nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78579,Lung ventilation imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78580,Lung perfusion imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78582,Lung ventilat&perfus imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78597,Lung perfusion differential,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78598,Lung perf&ventilat diferentl,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78599,Respiratory nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78600,Brain image < 4 views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78601,Brain image w/flow < 4 views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78605,Brain image 4+ views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78606,Brain image w/flow 4 + views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78607,Brain imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78608,Brain imaging (pet),Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78609,Brain imaging (pet),Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78610,Brain flow imaging only,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78630,Cerebrospinal fluid scan,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78635,Csf ventriculography,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78645,Csf shunt evaluation,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78647,Cerebrospinal fluid scan,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78650,Csf leakage imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78660,Nuclear exam of tear flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78699,Nervous system nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78700,Kidney imaging morphol,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78701,Kidney imaging with flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78707,K flow/funct image w/o drug,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78708,K flow/funct image w/drug,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78709,K flow/funct image multiple,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78710,Kidney imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78725,Kidney function study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78730,Urinary bladder retention,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78740,Ureteral reflux study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78761,Testicular imaging w/flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78799,Genitourinary nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78800,Rp loclzj tum 1 area 1 d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78801,Rp loclzj tum 2+area 1+d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78802,Rp loclzj tum whbdy 1 d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78803,Rp loclzj tum spect 1 area,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78804,Rp loclzj tum whbdy 2+d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78805,Abscess imaging ltd area,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78806,Abscess imaging whole body,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78807,Nuclear localization/abscess,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78811,Pet image ltd area,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78812,Pet image skull-thigh,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78813,Pet image full body,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78814,Pet image w/ct lmtd,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78815,Pet image w/ct skull-thigh,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78816,Pet image w/ct full body,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78830,Rp loclzj tum spect w/ct 1,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78831,Rp loclzj tum spect 2 areas,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78832,Rp loclzj tum spect w/ct 2,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78835,Rp quan meas single area,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,78999,Nuclear diagnostic exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79005,Nuclear rx oral admin,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79101,Nuclear rx iv admin,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79200,Nuclear rx intracav admin,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79300,Nuclr rx interstit colloid,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79403,Hematopoietic nuclear tx,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79440,Nuclear rx intra-articular,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79445,Nuclear rx intra-arterial,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,79999,Nuclear medicine therapy,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80047,Metabolic panel ionized ca,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80048,Metabolic panel total ca,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80050,General health panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80051,Electrolyte panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80053,Comprehen metabolic panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80055,Obstetric panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80061,Lipid panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80069,Renal function panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80074,Acute hepatitis panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80076,Hepatic function panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80081,Obstetric panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80143,Drug assay acetaminophen,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80145,Drug assay adalimumab,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80150,Assay of amikacin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80151,Drug assay amiodarone,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80155,Drug assay caffeine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80156,Assay carbamazepine total,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80157,Assay carbamazepine free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80158,Drug assay cyclosporine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80159,Drug assay clozapine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80161,"Asy carbamazepin 10,11-epxid",Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80162,Assay of digoxin total,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80163,Assay of digoxin free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80164,Assay dipropylacetic acd tot,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80165,Dipropylacetic acid free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80167,Drug assay felbamate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80168,Assay of ethosuximide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80169,Drug assay everolimus,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80170,Assay of gentamicin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80171,Drug screen quant gabapentin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80173,Assay of haloperidol,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80175,Drug screen quan lamotrigine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80176,Assay of lidocaine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80177,Drug scrn quan levetiracetam,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80178,Assay of lithium,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80179,Drug assay salicylate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80180,Drug scrn quan mycophenolate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80181,Drug assay flecainide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80183,Drug scrn quant oxcarbazepin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80184,Assay of phenobarbital,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80185,Assay of phenytoin total,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80186,Assay of phenytoin free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80187,Drug assay posaconazole,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80188,Assay of primidone,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80189,Drug assay itraconzaole,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80190,Assay of procainamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80192,Assay of procainamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80193,Drug assay leflunomide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80194,Assay of quinidine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80195,Assay of sirolimus,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80197,Assay of tacrolimus,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80198,Assay of theophylline,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80199,Drug screen quant tiagabine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80200,Assay of tobramycin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80201,Assay of topiramate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80202,Assay of vancomycin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80203,Drug screen quant zonisamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80204,Drug assay methotrexate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80210,Drug assay rufinamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80230,Drug assay infliximab,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80235,Drug assay lacosamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80280,Drug assay vedolizumab,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80285,Drug assay voriconazole,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80299,Quantitative assay drug,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80300,Drug screen non tlc devices,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80301,Drug screen class list a,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80302,Drug screen prsmptv 1 class,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80303,Drug screen one/mult class,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80304,Drug screen one/mult class,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80305,Drug test prsmv dir opt obs,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80306,Drug test prsmv instrmnt,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80307,Drug test prsmv chem anlyzr,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80320,Drug screen quantalcohols,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80321,Alcohols biomarkers 1or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80322,Alcohols biomarkers 3/more,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80323,Alkaloids nos,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80324,Drug screen amphetamines 1/2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80325,Amphetamines 3or 4,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80326,Amphetamines 5 or more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80327,Anabolic steroid 1 or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80328,Anabolic steroid 3 or more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80329,Analgesics non-opioid 1 or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80330,Analgesics non-opioid 3-5,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80331,Analgesics non-opioid 6/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80332,Antidepressants class 1 or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80333,Antidepressants class 3-5,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80334,Antidepressants class 6/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80335,Antidepressant tricyclic 1/2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80336,Antidepressant tricyclic 3-5,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80337,Tricyclic & cyclicals 6/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80338,Antidepressant not specified,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80339,Antiepileptics nos 1-3,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80340,Antiepileptics nos 4-6,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80341,Antiepileptics nos 7/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80342,Antipsychotics nos 1-3,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80343,Antipsychotics nos 4-6,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80344,Antipsychotics nos 7/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80345,Drug screening barbiturates,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80346,Benzodiazepines1-12,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80347,Benzodiazepines 13 or more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80348,Drug screening buprenorphine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80349,Cannabinoids natural,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80350,Cannabinoids synthetic 1-3,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80351,Cannabinoids synthetic 4-6,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80352,Cannabinoid synthetic 7/more,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80353,Drug screening cocaine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80354,Drug screening fentanyl,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80355,Gabapentin non-blood,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80356,Heroin metabolite,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80357,Ketamine and norketamine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80358,Drug screening methadone,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80359,Methylenedioxyamphetamines,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80360,Methylphenidate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80361,Opiates 1 or more,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80362,Opioids & opiate analogs 1/2,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80363,Opioids & opiate analogs 3/4,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80364,Opioid &opiate analog 5/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80365,Drug screening oxycodone,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80366,Drug screening pregabalin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80367,Drug screening propoxyphene,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80368,Sedative hypnotics,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80369,Skeletal muscle relaxant 1/2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80370,Skel musc relaxant 3 or more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80371,Stimulants synthetic,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80372,Drug screening tapentadol,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80373,Drug screening tramadol,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80374,Stereoisomer analysis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80375,Drug/substance nos 1-3,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80376,Drug/substance nos 4-6,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80377,Drug/substance nos 7/more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80400,Acth stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80402,Acth stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80406,Acth stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80408,Aldosterone suppression eval,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80410,Calcitonin stimul panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80412,Crh stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80414,Testosterone response panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80415,Tot estradiol response panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80416,Renin stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80417,Renin stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80418,Pituitary evaluation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80420,Dexamethasone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80422,Glucagon tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80424,Glucagon tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80426,Gonadotropin hormone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80428,Growth hormone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80430,Growth hormone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80432,Insulin suppression panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80434,Insulin tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80435,Insulin tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80436,Metyrapone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80438,Trh stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80439,Trh stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80500,Lab pathology consultation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,80502,Lab pathology consultation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81000,Urinalysis nonauto w/scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81001,Urinalysis auto w/scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81002,Urinalysis nonauto w/o scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81003,Urinalysis auto w/o scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81005,Urinalysis,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81007,Urine screen for bacteria,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81015,Microscopic exam of urine,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81020,Urinalysis glass test,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81025,Urine pregnancy test,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81050,Urinalysis volume measure,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81099,Urinalysis test procedure,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81105,Hpa-1 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81106,Hpa-2 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81107,Hpa-3 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81108,Hpa-4 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81109,Hpa-5 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81110,Hpa-6 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81111,Hpa-9 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81112,Hpa-15 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81120,Idh1 common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81121,Idh2 common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81161,Dmd dup/delet analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81162,Brca1&2 gen full seq dup/del,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81163,Brca1&2 gene full seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81164,Brca1&2 gen ful dup/del alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81165,Brca1 gene full seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81166,Brca1 gene full dup/del alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81167,Brca2 gene full dup/del alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81168,Ccnd1/igh translocation alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81170,Abl1 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81171,Aff2 gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81172,Aff2 gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81173,Ar gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81174,Ar gene known famil variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81175,Asxl1 full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81176,Asxl1 gene target seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81177,Atn1 gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81178,Atxn1 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81179,Atxn2 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81180,Atxn3 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81181,Atxn7 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81182,Atxn8os gen detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81183,Atxn10 gene detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81184,Cacna1a gen detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81185,Cacna1a gene full gene seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81186,Cacna1a gen known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81187,Cnbp gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81188,Cstb gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81189,Cstb gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81190,Cstb gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81191,Ntrk1 translocation analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81192,Ntrk2 translocation analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81193,Ntrk3 translocation analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81194,Ntrk translocation analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81200,Aspa gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81201,Apc gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81202,Apc gene known fam variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81203,Apc gene dup/delet variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81204,Ar gene charac alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81205,Bckdhb gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81206,Bcr/abl1 gene major bp,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81207,Bcr/abl1 gene minor bp,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81208,Bcr/abl1 gene other bp,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81209,Blm gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81210,Braf gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81211,Brca1&2 seq & com dup/del,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81212,Brca1&2 185&5385&6174 vrnt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81213,Brca1&2 uncom dup/del var,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81214,Brca1 full seq & com dup/del,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81215,Brca1 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81216,Brca2 gene full seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81217,Brca2 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81218,Cebpa gene full sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81219,Calr gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81220,Cftr gene com variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81221,Cftr gene known fam variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81222,Cftr gene dup/delet variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81223,Cftr gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81224,Cftr gene intron poly t,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81225,Cyp2c19 gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81226,Cyp2d6 gene com variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81227,Cyp2c9 gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81228,Cytogen micrarray copy nmbr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81229,Cytogen m array copy no&snp,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81230,Cyp3a4 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81231,Cyp3a5 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81232,Dpyd gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81233,Btk gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81234,Dmpk gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81235,Egfr gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81236,Ezh2 gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81237,Ezh2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81238,F9 full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81239,Dmpk gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81240,F2 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81241,F5 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81242,Fancc gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81243,Fmr1 gene detection,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81244,Fmr1 gene charac alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81245,Flt3 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81246,Flt3 gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81247,G6pd gene alys cmn variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81248,G6pd known familial variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81249,G6pd full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81250,G6pc gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81251,Gba gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81252,Gjb2 gene full sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81253,Gjb2 gene known fam variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81254,Gjb6 gene com variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81255,Hexa gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81256,Hfe gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81257,Hba1/hba2 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81258,Hba1/hba2 gene fam vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81259,Hba1/hba2 full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81260,Ikbkap gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81261,Igh gene rearrange amp meth,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81262,Igh gene rearrang dir probe,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81263,Igh vari regional mutation,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81264,Igk rearrangeabn clonal pop,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81265,Str markers specimen anal,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81266,Str markers spec anal addl,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81267,Chimerism anal no cell selec,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81268,Chimerism anal w/cell select,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81269,Hba1/hba2 gene dup/del vrnts,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81270,Jak2 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81271,Htt gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81272,Kit gene targeted seq analys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81273,Kit gene analys d816 variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81274,Htt gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81275,Kras gene variants exon 2,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81276,Kras gene addl variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81277,Cytogenomic neo microra alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81278,Igh/bcl2 translocation alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81279,Jak2 gene trgt sequence alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81280,Long qt synd gene full seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81281,Long qt synd known fam var,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81282,Long qt syn gene dup/dlt var,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81283,Ifnl3 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81284,Fxn gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81285,Fxn gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81286,Fxn gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81287,Mgmt gene prmtr mthyltn alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81288,Mlh1 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81289,Fxn gene known famil variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81290,Mcoln1 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81291,Mthfr gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81292,Mlh1 gene full seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81293,Mlh1 gene known variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81294,Mlh1 gene dup/delete variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81295,Msh2 gene full seq,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81296,Msh2 gene known variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81297,Msh2 gene dup/delete variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81298,Msh6 gene full seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81299,Msh6 gene known variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81300,Msh6 gene dup/delete variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81301,Microsatellite instability,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81302,Mecp2 gene full seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81303,Mecp2 gene known variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81304,Mecp2 gene dup/delet variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81305,Myd88 gene p.leu265pro vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81306,Nudt15 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81307,Palb2 gene full gene seq,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81308,Palb2 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81309,Pik3ca gene trgt seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81310,Npm1 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81311,Nras gene variants exon 2&3,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81312,Pabpn1 gene detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81313,Pca3/klk3 antigen,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81314,Pdgfra gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81315,Pml/raralpha com breakpoints,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81316,Pml/raralpha 1 breakpoint,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81317,Pms2 gene full seq analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81318,Pms2 known familial variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81319,Pms2 gene dup/delet variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81320,Plcg2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81321,Pten gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81322,Pten gene known fam variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81323,Pten gene dup/delet variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81324,Pmp22 gene dup/delet,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81325,Pmp22 gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81326,Pmp22 gene known fam variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81327,Sept9 gen prmtr mthyltn alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81328,Slco1b1 gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81329,Smn1 gene dos/deletion alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81330,Smpd1 gene common variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81331,Snrpn/ube3a gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81332,Serpina1 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81333,Tgfbi gene common variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81334,Runx1 gene targeted seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81335,Tpmt gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81336,Smn1 gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81337,Smn1 gen nown famil seq vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81338,Mpl gene common variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81339,Mpl gene seq alys exon 10,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81340,Trb@ gene rearrange amplify,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81341,Trb@ gene rearrange dirprobe,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81342,Trg gene rearrangement anal,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81343,Ppp2r2b gen detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81344,Tbp gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81345,Tert gene targeted seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81346,Tyms gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81347,Sf3b1 gene common variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81348,Srsf2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81350,Ugt1a1 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81351,Tp53 gene full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81352,Tp53 gene trgt sequence alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81353,Tp53 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81355,Vkorc1 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81357,U2af1 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81360,Zrsr2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81361,Hbb gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81362,Hbb gene known fam variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81363,Hbb gene dup/del variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81364,Hbb full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81370,Hla i & ii typing lr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81371,Hla i & ii type verify lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81372,Hla i typing complete lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81373,Hla i typing 1 locus lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81374,Hla i typing 1 antigen lr,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81375,Hla ii typing ag equiv lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81376,Hla ii typing 1 locus lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81377,Hla ii type 1 ag equiv lr,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81378,Hla i & ii typing hr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81379,Hla i typing complete hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81380,Hla i typing 1 locus hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81381,Hla i typing 1 allele hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81382,Hla ii typing 1 loc hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81383,Hla ii typing 1 allele hr,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81400,Mopath procedure level 1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81401,Mopath procedure level 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81402,Mopath procedure level 3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81403,Mopath procedure level 4,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81404,Mopath procedure level 5,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81405,Mopath procedure level 6,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81406,Mopath procedure level 7,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81407,Mopath procedure level 8,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81408,Mopath procedure level 9,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81410,Aortic dysfunction/dilation,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81411,Aortic dysfunction/dilation,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81412,Ashkenazi jewish assoc dis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81413,Car ion chnnlpath inc 10 gns,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81414,Car ion chnnlpath inc 2 gns,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81415,Exome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81416,Exome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81417,Exome re-evaluation,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81419,Epilepsy gen seq alys panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81420,Fetal chrmoml aneuploidy,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81422,Fetal chrmoml microdeltj,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81425,Genome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81426,Genome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81427,Genome re-evaluation,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81430,Hearing loss sequence analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81431,Hearing loss dup/del analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81432,Hrdtry brst ca-rlatd dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81433,Hrdtry brst ca-rlatd dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81434,Hereditary retinal disorders,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81435,Hereditary colon ca dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81436,Hereditary colon ca dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81437,Heredtry nurondcrn tum dsrdr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81438,Heredtry nurondcrn tum dsrdr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81439,Hrdtry cardmypy gene panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81440,Mitochondrial gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81442,Noonan spectrum disorders,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81443,Genetic tstg severe inh cond,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81445,Targeted genomic seq analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81448,Hrdtry perph neurphy panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81450,Targeted genomic seq analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81455,Targeted genomic seq analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81460,Whole mitochondrial genome,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81465,Whole mitochondrial genome,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81470,X-linked intellectual dblt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81471,X-linked intellectual dblt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81479,Unlisted molecular pathology,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81490,Autoimmune rheumatoid arthr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81493,Cor artery disease mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81500,Onco (ovar) two proteins,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81503,Onco (ovar) five proteins,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81504,Oncology tissue of origin,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81506,Endo assay seven anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81507,Fetal aneuploidy trisom risk,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81508,Ftl cgen abnor two proteins,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81509,Ftl cgen abnor 3 proteins,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81510,Ftl cgen abnor three anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81511,Ftl cgen abnor four anal,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81512,Ftl cgen abnor five anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81513,Nfct ds bv rna vag flu alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81514,Nfct ds bv&vaginitis dna alg,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81518,Onc brst mrna 11 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81519,Oncology breast mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81520,Onc breast mrna 58 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81521,Onc breast mrna 70 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81522,Onc breast mrna 12 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81525,Oncology colon mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81528,Oncology colorectal scr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81529,Onc cutan mlnma mrna 31 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81535,Oncology gynecologic,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81536,Oncology gynecologic,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81538,Oncology lung,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81539,Oncology prostate prob score,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81540,Oncology tum unknown origin,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81541,Onc prostate mrna 46 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81542,Onc prostate mrna 22 cnt gen,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81545,Oncology thyroid,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81546,"Onc thyr mrna 10,196 gen alg",Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81551,Onc prostate 3 genes,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81552,Onc uveal mlnma mrna 15 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81554,Pulm ds ipf mrna 190 gen alg,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81595,Cardiology hrt trnspl mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81596,Nfct ds chrnc hcv 6 assays,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,81599,Unlisted maaa,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82009,Test for acetone/ketones,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82010,Acetone assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82013,Acetylcholinesterase assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82016,Acylcarnitines qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82017,Acylcarnitines quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82024,Assay of acth,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82030,Assay of adp & amp,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82040,Assay of serum albumin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82042,Other source albumin quan ea,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82043,Ur albumin quantitative,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82044,Ur albumin semiquantitative,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82045,Albumin ischemia modified,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82075,Assay of breath ethanol,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82077,Assay spec xcp ur&breath ia,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82085,Assay of aldolase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82088,Assay of aldosterone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82103,Alpha-1-antitrypsin total,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82104,Alpha-1-antitrypsin pheno,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82105,Alpha-fetoprotein serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82106,Alpha-fetoprotein amniotic,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82107,Alpha-fetoprotein l3,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82108,Assay of aluminum,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82120,Amines vaginal fluid qual,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82127,Amino acid single qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82128,Amino acids mult qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82131,Amino acids single quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82135,Assay aminolevulinic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82136,Amino acids quant 2-5,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82139,Amino acids quan 6 or more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82140,Assay of ammonia,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82143,Amniotic fluid scan,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82150,Assay of amylase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82154,Androstanediol glucuronide,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82157,Assay of androstenedione,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82160,Assay of androsterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82163,Assay of angiotensin ii,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82164,Angiotensin i enzyme test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82172,Assay of apolipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82175,Assay of arsenic,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82180,Assay of ascorbic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82190,Atomic absorption,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82232,Assay of beta-2 protein,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82239,Bile acids total,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82240,Bile acids cholylglycine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82247,Bilirubin total,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82248,Bilirubin direct,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82252,Fecal bilirubin test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82261,Assay of biotinidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82270,Occult blood feces,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82271,Occult blood other sources,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82272,Occult bld feces 1-3 tests,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82274,Assay test for blood fecal,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82286,Assay of bradykinin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82300,Assay of cadmium,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82306,Vitamin d 25 hydroxy,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82308,Assay of calcitonin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82310,Assay of calcium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82330,Assay of calcium,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82331,Calcium infusion test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82340,Assay of calcium in urine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82355,Calculus analysis qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82360,Calculus assay quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82365,Calculus spectroscopy,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82370,X-ray assay calculus,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82373,Assay c-d transfer measure,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82374,Assay blood carbon dioxide,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82375,Assay carboxyhb quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82376,Assay carboxyhb qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82378,Carcinoembryonic antigen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82379,Assay of carnitine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82380,Assay of carotene,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82382,Assay urine catecholamines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82383,Assay blood catecholamines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82384,Assay three catecholamines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82387,Assay of cathepsin-d,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82390,Assay of ceruloplasmin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82397,Chemiluminescent assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82415,Assay of chloramphenicol,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82435,Assay of blood chloride,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82436,Assay of urine chloride,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82438,Assay other fluid chlorides,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82441,Test for chlorohydrocarbons,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82465,Assay bld/serum cholesterol,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82480,Assay serum cholinesterase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82482,Assay rbc cholinesterase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82485,Assay chondroitin sulfate,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82486,Gas/liquid chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82487,Paper chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82488,Paper chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82489,Thin layer chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82491,Chromotography quant sing,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82492,Chromotography quant mult,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82495,Assay of chromium,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82507,Assay of citrate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82523,Collagen crosslinks,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82525,Assay of copper,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82528,Assay of corticosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82530,Cortisol free,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82533,Total cortisol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82540,Assay of creatine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82541,Column chromotography qual,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82542,Col chromotography qual/quan,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82543,Column chromotograph/isotope,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82544,Column chromotograph/isotope,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82550,Assay of ck (cpk),Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82552,Assay of cpk in blood,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82553,Creatine mb fraction,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82554,Creatine isoforms,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82565,Assay of creatinine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82570,Assay of urine creatinine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82575,Creatinine clearance test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82585,Assay of cryofibrinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82595,Assay of cryoglobulin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82600,Assay of cyanide,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82607,Vitamin b-12,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82608,B-12 binding capacity,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82610,Cystatin c,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82615,Test for urine cystines,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82626,Dehydroepiandrosterone,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82627,Dehydroepiandrosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82633,Desoxycorticosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82634,Deoxycortisol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82638,Assay of dibucaine number,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82642,Dihydrotestosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82652,Vit d 1 25-dihydroxy,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82656,Pancreatic elastase fecal,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82657,Enzyme cell activity,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82658,Enzyme cell activity ra,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82664,Electrophoretic test,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82668,Assay of erythropoietin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82670,Assay of total estradiol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82671,Assay of estrogens,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82672,Assay of estrogen,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82677,Assay of estriol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82679,Assay of estrone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82681,Assay dir meas fr estradiol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82693,Assay of ethylene glycol,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82696,Assay of etiocholanolone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82705,Fats/lipids feces qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82710,Fats/lipids feces quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82715,Assay of fecal fat,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82725,Assay of blood fatty acids,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82726,Long chain fatty acids,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82728,Assay of ferritin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82731,Assay of fetal fibronectin,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82735,Assay of fluoride,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82746,Assay of folic acid serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82747,Assay of folic acid rbc,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82757,Assay of semen fructose,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82759,Assay of rbc galactokinase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82760,Assay of galactose,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82775,Assay galactose transferase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82776,Galactose transferase test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82777,Galectin-3,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82784,Assay iga/igd/igg/igm each,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82785,Assay of ige,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82787,Igg 1 2 3 or 4 each,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82800,Blood ph,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82803,Blood gases any combination,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82805,Blood gases w/o2 saturation,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82810,Blood gases o2 sat only,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82820,Hemoglobin-oxygen affinity,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82930,Gastric analy w/ph ea spec,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82938,Gastrin test,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82941,Assay of gastrin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82943,Assay of glucagon,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82945,Glucose other fluid,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82946,Glucagon tolerance test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82947,Assay glucose blood quant,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82948,Reagent strip/blood glucose,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82950,Glucose test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82951,Glucose tolerance test (gtt),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82952,Gtt-added samples,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82955,Assay of g6pd enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82960,Test for g6pd enzyme,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82962,Glucose blood test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82963,Assay of glucosidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82965,Assay of gdh enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82977,Assay of ggt,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82978,Assay of glutathione,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82979,Assay rbc glutathione,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,82985,Assay of glycated protein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83001,Assay of gonadotropin (fsh),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83002,Assay of gonadotropin (lh),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83003,Assay growth hormone (hgh),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83006,Growth stimulation gene 2,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83009,H pylori (c-13) blood,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83010,Assay of haptoglobin quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83012,Assay of haptoglobins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83013,H pylori (c-13) breath,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83014,H pylori drug admin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83015,Heavy metal qual any anal,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83018,Heavy metal quant each nes,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83020,Hemoglobin electrophoresis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83021,Hemoglobin chromotography,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83026,Hemoglobin copper sulfate,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83030,Fetal hemoglobin chemical,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83033,Fetal hemoglobin assay qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83036,Glycosylated hemoglobin test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83037,Glycosylated hb home device,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83045,Blood methemoglobin test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83050,Blood methemoglobin assay,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83051,Assay of plasma hemoglobin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83060,Blood sulfhemoglobin assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83065,Assay of hemoglobin heat,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83068,Hemoglobin stability screen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83069,Assay of urine hemoglobin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83070,Assay of hemosiderin qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83080,Assay of b hexosaminidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83088,Assay of histamine,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83090,Assay of homocystine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83150,Assay of homovanillic acid,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83491,Assay of corticosteroids 17,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83497,Assay of 5-hiaa,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83498,Assay of progesterone 17-d,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83499,Assay of progesterone 20-,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83500,Assay free hydroxyproline,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83505,Assay total hydroxyproline,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83516,Immunoassay nonantibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83518,Immunoassay dipstick,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83519,Ria nonantibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83520,Immunoassay quant nos nonab,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83525,Assay of insulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83527,Assay of insulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83528,Assay of intrinsic factor,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83540,Assay of iron,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83550,Iron binding test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83570,Assay of idh enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83582,Assay of ketogenic steroids,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83586,Assay 17- ketosteroids,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83593,Fractionation ketosteroids,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83605,Assay of lactic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83615,Lactate (ld) (ldh) enzyme,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83625,Assay of ldh enzymes,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83630,Lactoferrin fecal (qual),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83631,Lactoferrin fecal (quant),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83632,Placental lactogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83633,Test urine for lactose,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83655,Assay of lead,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83661,L/s ratio fetal lung,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83662,Foam stability fetal lung,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83663,Fluoro polarize fetal lung,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83664,Lamellar bdy fetal lung,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83670,Assay of lap enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83690,Assay of lipase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83695,Assay of lipoprotein(a),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83698,Assay lipoprotein pla2,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83700,Lipopro bld electrophoretic,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83701,Lipoprotein bld hr fraction,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83704,Lipoprotein bld quan part,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83718,Assay of lipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83719,Assay of blood lipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83721,Assay of blood lipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83722,Lipoprtn dir meas sd ldl chl,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83727,Assay of lrh hormone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83735,Assay of magnesium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83775,Assay malate dehydrogenase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83785,Assay of manganese,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83788,Mass spectrometry qual,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83789,Mass spectrometry qual/quan,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83825,Assay of mercury,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83835,Assay of metanephrines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83857,Assay of methemalbumin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83861,Microfluid analy tears,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83864,Mucopolysaccharides,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83872,Assay synovial fluid mucin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83873,Assay of csf protein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83874,Assay of myoglobin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83876,Assay myeloperoxidase,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83880,Assay of natriuretic peptide,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83883,Assay nephelometry not spec,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83885,Assay of nickel,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83915,Assay of nucleotidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83916,Oligoclonal bands,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83918,Organic acids total quant,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83919,Organic acids qual each,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83921,Organic acid single quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83930,Assay of blood osmolality,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83935,Assay of urine osmolality,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83937,Assay of osteocalcin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83945,Assay of oxalate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83950,Oncoprotein her-2/neu,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83951,Oncoprotein dcp,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83970,Assay of parathormone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83986,Assay ph body fluid nos,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83987,Exhaled breath condensate,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83992,Assay for phencyclidine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,83993,Assay for calprotectin fecal,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84030,Assay of blood pku,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84035,Assay of phenylketones,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84060,Assay acid phosphatase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84061,Phosphatase forensic exam,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84066,Assay prostate phosphatase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84075,Assay alkaline phosphatase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84078,Assay alkaline phosphatase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84080,Assay alkaline phosphatases,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84081,Assay phosphatidylglycerol,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84085,Assay of rbc pg6d enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84087,Assay phosphohexose enzymes,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84100,Assay of phosphorus,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84105,Assay of urine phosphorus,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84106,Test for porphobilinogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84110,Assay of porphobilinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84112,Eval amniotic fluid protein,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84119,Test urine for porphyrins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84120,Assay of urine porphyrins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84126,Assay of feces porphyrins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84132,Assay of serum potassium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84133,Assay of urine potassium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84134,Assay of prealbumin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84135,Assay of pregnanediol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84138,Assay of pregnanetriol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84140,Assay of pregnenolone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84143,Assay of 17-hydroxypregneno,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84144,Assay of progesterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84145,Procalcitonin (pct),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84146,Assay of prolactin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84150,Assay of prostaglandin,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84152,Assay of psa complexed,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84153,Assay of psa total,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84154,Assay of psa free,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84155,Assay of protein serum,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84156,Assay of protein urine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84157,Assay of protein other,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84160,Assay of protein any source,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84163,Pappa serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84165,Protein e-phoresis serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84166,Protein e-phoresis/urine/csf,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84181,Western blot test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84182,Protein western blot test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84202,Assay rbc protoporphyrin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84203,Test rbc protoporphyrin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84206,Assay of proinsulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84207,Assay of vitamin b-6,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84210,Assay of pyruvate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84220,Assay of pyruvate kinase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84228,Assay of quinine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84233,Assay of estrogen,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84234,Assay of progesterone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84235,Assay of endocrine hormone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84238,Assay nonendocrine receptor,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84244,Assay of renin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84252,Assay of vitamin b-2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84255,Assay of selenium,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84260,Assay of serotonin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84270,Assay of sex hormone globul,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84275,Assay of sialic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84285,Assay of silica,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84295,Assay of serum sodium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84300,Assay of urine sodium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84302,Assay of sweat sodium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84305,Assay of somatomedin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84307,Assay of somatostatin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84311,Spectrophotometry,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84315,Body fluid specific gravity,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84375,Chromatogram assay sugars,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84376,Sugars single qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84377,Sugars multiple qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84378,Sugars single quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84379,Sugars multiple quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84392,Assay of urine sulfate,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84402,Assay of free testosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84403,Assay of total testosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84410,Testosterone bioavailable,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84425,Assay of vitamin b-1,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84430,Assay of thiocyanate,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84431,Thromboxane urine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84432,Assay of thyroglobulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84436,Assay of total thyroxine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84437,Assay of neonatal thyroxine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84439,Assay of free thyroxine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84442,Assay of thyroid activity,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84443,Assay thyroid stim hormone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84445,Assay of tsi globulin,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84446,Assay of vitamin e,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84449,Assay of transcortin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84450,Transferase (ast) (sgot),Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84460,Alanine amino (alt) (sgpt),Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84466,Assay of transferrin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84478,Assay of triglycerides,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84479,Assay of thyroid (t3 or t4),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84480,Assay triiodothyronine (t3),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84481,Free assay (ft-3),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84482,T3 reverse,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84484,Assay of troponin quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84485,Assay duodenal fluid trypsin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84488,Test feces for trypsin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84490,Assay of feces for trypsin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84510,Assay of tyrosine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84512,Assay of troponin qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84520,Assay of urea nitrogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84525,Urea nitrogen semi-quant,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84540,Assay of urine/urea-n,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84545,Urea-n clearance test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84550,Assay of blood/uric acid,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84560,Assay of urine/uric acid,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84577,Assay of feces/urobilinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84578,Test urine urobilinogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84580,Assay of urine urobilinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84583,Assay of urine urobilinogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84585,Assay of urine vma,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84586,Assay of vip,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84588,Assay of vasopressin,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84590,Assay of vitamin a,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84591,Assay of nos vitamin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84597,Assay of vitamin k,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84600,Assay of volatiles,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84620,Xylose tolerance test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84630,Assay of zinc,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84681,Assay of c-peptide,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84702,Chorionic gonadotropin test,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84703,Chorionic gonadotropin assay,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84704,Hcg free betachain test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84830,Ovulation tests,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,84999,Clinical chemistry test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85002,Bleeding time test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85004,Automated diff wbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85007,Bl smear w/diff wbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85008,Bl smear w/o diff wbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85009,Manual diff wbc count b-coat,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85013,Spun microhematocrit,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85014,Hematocrit,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85018,Hemoglobin,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85025,Complete cbc w/auto diff wbc,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85027,Complete cbc automated,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85032,Manual cell count each,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85041,Automated rbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85044,Manual reticulocyte count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85045,Automated reticulocyte count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85046,Reticyte/hgb concentrate,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85048,Automated leukocyte count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85049,Automated platelet count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85055,Reticulated platelet assay,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85060,Blood smear interpretation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85097,Bone marrow interpretation,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85130,Chromogenic substrate assay,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85170,Blood clot retraction,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85175,Blood clot lysis time,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85210,Clot factor ii prothrom spec,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85220,Blooc clot factor v test,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85230,Clot factor vii proconvertin,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85240,Clot factor viii ahg 1 stage,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85244,Clot factor viii reltd antgn,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85245,Clot factor viii vw ristoctn,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85246,Clot factor viii vw antigen,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85247,Clot factor viii multimetric,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85250,Clot factor ix ptc/chrstmas,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85260,Clot factor x stuart-power,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85270,Clot factor xi pta,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85280,Clot factor xii hageman,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85290,Clot factor xiii fibrin stab,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85291,Clot factor xiii fibrin scrn,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85292,Clot factor fletcher fact,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85293,Clot factor wght kininogen,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85300,Antithrombin iii activity,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85301,Antithrombin iii antigen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85302,Clot inhibit prot c antigen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85303,Clot inhibit prot c activity,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85305,Clot inhibit prot s total,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85306,Clot inhibit prot s free,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85307,Assay activated protein c,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85335,Factor inhibitor test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85337,Thrombomodulin,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85345,Coagulation time lee & white,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85347,Coagulation time activated,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85348,Coagulation time otr method,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85360,Euglobulin lysis,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85362,Fibrin degradation products,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85366,Fibrinogen test,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85370,Fibrinogen test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85378,Fibrin degrade semiquant,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85379,Fibrin degradation quant,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85380,Fibrin degradj d-dimer,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85384,Fibrinogen activity,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85385,Fibrinogen antigen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85390,Fibrinolysins screen i&r,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85396,Clotting assay whole blood,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85397,Clotting funct activity,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85400,Fibrinolytic plasmin,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85410,Fibrinolytic antiplasmin,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85415,Fibrinolytic plasminogen,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85420,Fibrinolytic plasminogen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85421,Fibrinolytic plasminogen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85441,Heinz bodies direct,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85445,Heinz bodies induced,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85460,Hemoglobin fetal,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85461,Hemoglobin fetal,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85475,Hemolysin acid,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85520,Heparin assay,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85525,Heparin neutralization,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85530,Heparin-protamine tolerance,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85536,Iron stain peripheral blood,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85540,Wbc alkaline phosphatase,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85547,Rbc mechanical fragility,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85549,Muramidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85555,Rbc osmotic fragility,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85557,Rbc osmotic fragility,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85576,Blood platelet aggregation,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85597,Phospholipid pltlt neutraliz,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85598,Hexagnal phosph pltlt neutrl,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85610,Prothrombin time,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85611,Prothrombin test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85612,Viper venom prothrombin time,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85613,Russell viper venom diluted,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85635,Reptilase test,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85651,Rbc sed rate nonautomated,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85652,Rbc sed rate automated,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85660,Rbc sickle cell test,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85670,Thrombin time plasma,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85675,Thrombin time titer,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85705,Thromboplastin inhibition,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85730,Thromboplastin time partial,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85732,Thromboplastin time partial,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85810,Blood viscosity examination,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,85999,Hematology procedure,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86000,Agglutinins febrile antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86001,Allergen specific igg,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86003,Allg spec ige crude xtrc ea,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86005,Allg spec ige multiallg scr,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86008,Allg spec ige recomb ea,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86021,Wbc antibody identification,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86022,Platelet antibodies,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86023,Immunoglobulin assay,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86038,Antinuclear antibodies,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86039,Antinuclear antibodies (ana),Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86060,Antistreptolysin o titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86063,Antistreptolysin o screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86140,C-reactive protein,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86141,C-reactive protein hs,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86146,Beta-2 glycoprotein antibody,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86147,Cardiolipin antibody ea ig,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86148,Anti-phospholipid antibody,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86152,Cell enumeration & id,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86153,Cell enumeration phys interp,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86155,Chemotaxis assay,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86156,Cold agglutinin screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86157,Cold agglutinin titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86160,Complement antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86161,Complement/function activity,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86162,Complement total (ch50),Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86171,Complement fixation each,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86185,Counterimmunoelectrophoresis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86200,Ccp antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86215,Deoxyribonuclease antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86225,Dna antibody native,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86226,Dna antibody single strand,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86235,Nuclear antigen antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86243,Fc receptor,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86255,Fluorescent antibody screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86256,Fluorescent antibody titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86277,Growth hormone antibody,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86280,Hemagglutination inhibition,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86294,Immunoassay tumor qual,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86300,Immunoassay tumor ca 15-3,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86301,Immunoassay tumor ca 19-9,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86304,Immunoassay tumor ca 125,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86305,Human epididymis protein 4,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86308,Heterophile antibody screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86309,Heterophile antibody titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86310,Heterophile antibody absrbj,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86316,Immunoassay tumor other,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86317,Immunoassay infectious agent,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86318,Ia infectious agent antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86320,Serum immunoelectrophoresis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86325,Other immunoelectrophoresis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86327,Immunoelectrophoresis assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86328,Ia nfct ab sarscov2 covid19,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86329,Immunodiffusion nes,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86331,Immunodiffusion ouchterlony,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86332,Immune complex assay,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86334,Immunofix e-phoresis serum,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86335,Immunfix e-phorsis/urine/csf,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86336,Inhibin a,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86337,Insulin antibodies,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86340,Intrinsic factor antibody,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86341,Islet cell antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86343,Leukocyte histamine release,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86344,Leukocyte phagocytosis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86352,Cell function assay w/stim,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86353,Lymphocyte transformation,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86355,B cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86356,Mononuclear cell antigen,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86357,Nk cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86359,T cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86360,T cell absolute count/ratio,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86361,T cell absolute count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86367,Stem cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86376,Microsomal antibody each,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86378,Migration inhibitory factor,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86382,Neutralization test viral,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86384,Nitroblue tetrazolium dye,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86386,Nuclear matrix protein 22,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86403,Particle agglut antbdy scrn,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86406,Particle agglut antbdy titr,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86408,Neutrlzg antb sarscov2 scr,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86409,Neutrlzg antb sarscov2 titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86413,Sars-cov-2 antb quantitative,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86430,Rheumatoid factor test qual,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86431,Rheumatoid factor quant,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86480,Tb test cell immun measure,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86481,Tb ag response t-cell susp,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86485,Skin test candida,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86486,Skin test nos antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86490,Coccidioidomycosis skin test,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86510,Histoplasmosis skin test,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86580,Tb intradermal test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86590,Streptokinase antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86592,Syphilis test non-trep qual,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86593,Syphilis test non-trep quant,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86602,Antinomyces antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86603,Adenovirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86606,Aspergillus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86609,Bacterium antibody,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86611,Bartonella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86612,Blastomyces antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86615,Bordetella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86617,Lyme disease antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86618,Lyme disease antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86619,Borrelia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86622,Brucella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86625,Campylobacter antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86628,Candida antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86631,Chlamydia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86632,Chlamydia igm antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86635,Coccidioides antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86638,Q fever antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86641,Cryptococcus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86644,Cmv antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86645,Cmv antibody igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86648,Diphtheria antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86651,Encephalitis californ antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86652,Encephaltis east eqne anbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86653,Encephaltis st louis antbody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86654,Encephaltis west eqne antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86658,Enterovirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86663,Epstein-barr antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86664,Epstein-barr nuclear antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86665,Epstein-barr capsid vca,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86666,Ehrlichia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86668,Francisella tularensis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86671,Fungus nes antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86674,Giardia lamblia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86677,Helicobacter pylori antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86682,Helminth antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86684,Hemophilus influenza antibdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86687,Htlv-i antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86688,Htlv-ii antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86689,Htlv/hiv confirmj antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86692,Hepatitis delta agent antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86694,Herpes simplex nes antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86695,Herpes simplex type 1 test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86696,Herpes simplex type 2 test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86698,Histoplasma antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86701,Hiv-1antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86702,Hiv-2 antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86703,Hiv-1/hiv-2 1 result antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86704,Hep b core antibody total,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86705,Hep b core antibody igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86706,Hep b surface antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86707,Hepatitis be antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86708,Hepatitis a antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86709,Hepatitis a igm antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86710,Influenza virus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86711,John cunningham antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86713,Legionella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86717,Leishmania antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86720,Leptospira antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86723,Listeria monocytogenes,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86727,Lymph choriomeningitis ab,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86729,Lympho venereum antibody,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86732,Mucormycosis antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86735,Mumps antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86738,Mycoplasma antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86741,Neisseria meningitidis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86744,Nocardia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86747,Parvovirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86750,Malaria antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86753,Protozoa antibody nos,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86756,Respiratory virus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86757,Rickettsia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86759,Rotavirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86762,Rubella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86765,Rubeola antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86768,Salmonella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86769,Sars-cov-2 covid-19 antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86771,Shigella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86774,Tetanus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86777,Toxoplasma antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86778,Toxoplasma antibody igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86780,Treponema pallidum,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86784,Trichinella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86787,Varicella-zoster antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86788,West nile virus ab igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86789,West nile virus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86790,Virus antibody nos,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86793,Yersinia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86794,Zika virus igm antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86800,Thyroglobulin antibody,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86803,Hepatitis c ab test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86804,Hep c ab test confirm,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86805,Lymphocytotoxicity assay,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86806,Lymphocytotoxicity assay,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86807,Cytotoxic antibody screening,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86808,Cytotoxic antibody screening,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86812,Hla typing a b or c,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86813,Hla typing a b or c,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86816,Hla typing dr/dq,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86817,Hla typing dr/dq,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86821,Lymphocyte culture mixed,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86822,Lymphocyte culture primed,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86825,Hla x-math non-cytotoxic,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86826,Hla x-match noncytotoxc addl,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86828,Hla class i&ii antibody qual,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86829,Hla class i/ii antibody qual,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86830,Hla class i phenotype qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86831,Hla class ii phenotype qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86832,Hla class i high defin qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86833,Hla class ii high defin qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86834,Hla class i semiquant panel,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86835,Hla class ii semiquant panel,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86849,Immunology procedure,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86850,Rbc antibody screen,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86860,Rbc antibody elution,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86870,Rbc antibody identification,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86880,Coombs test direct,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86885,Coombs test indirect qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86886,Coombs test indirect titer,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86900,Blood typing serologic abo,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86901,Blood typing serologic rh(d),Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86902,Blood type antigen donor ea,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86904,Blood typing patient serum,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86905,Blood typing rbc antigens,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86906,Bld typing serologic rh phnt,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86910,Blood typing paternity test,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86911,Blood typing antigen system,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86920,Compatibility test spin,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86921,Compatibility test incubate,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86922,Compatibility test antiglob,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86923,Compatibility test electric,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86940,Hemolysins/agglutinins auto,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86941,Hemolysins/agglutinins,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,86999,Transfusion procedure,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87003,Small animal inoculation,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87015,Specimen infect agnt concntj,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87040,Blood culture for bacteria,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87045,Feces culture aerobic bact,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87046,Stool cultr aerobic bact ea,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87070,Culture othr specimn aerobic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87071,Culture aerobic quant other,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87073,Culture bacteria anaerobic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87075,Cultr bacteria except blood,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87076,Culture anaerobe ident each,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87077,Culture aerobic identify,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87081,Culture screen only,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87084,Culture of specimen by kit,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87086,Urine culture/colony count,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87088,Urine bacteria culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87101,Skin fungi culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87102,Fungus isolation culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87103,Blood fungus culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87106,Fungi identification yeast,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87107,Fungi identification mold,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87109,Mycoplasma,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87110,Chlamydia culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87116,Mycobacteria culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87118,Mycobacteric identification,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87140,Culture type immunofluoresc,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87143,Culture typing glc/hplc,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87147,Culture type immunologic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87149,Dna/rna direct probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87150,Dna/rna amplified probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87152,Culture type pulse field gel,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87158,Culture typing added method,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87164,Dark field examination,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87166,Dark field examination,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87168,Macroscopic exam arthropod,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87169,Macroscopic exam parasite,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87172,Pinworm exam,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87176,Tissue homogenization cultr,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87177,Ova and parasites smears,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87181,Microbe susceptible diffuse,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87184,Microbe susceptible disk,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87185,Microbe susceptible enzyme,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87186,Microbe susceptible mic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87187,Microbe susceptible mlc,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87188,Microbe suscept macrobroth,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87190,Microbe suscept mycobacteri,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87197,Bactericidal level serum,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87205,Smear gram stain,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87206,Smear fluorescent/acid stai,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87207,Smear special stain,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87209,Smear complex stain,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87210,Smear wet mount saline/ink,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87220,Tissue exam for fungi,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87230,Assay toxin or antitoxin,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87250,Virus inoculate eggs/animal,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87252,Virus inoculation tissue,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87253,Virus inoculate tissue addl,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87254,Virus inoculation shell via,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87255,Genet virus isolate hsv,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87260,Adenovirus ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87265,Pertussis ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87267,Enterovirus antibody dfa,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87269,Giardia ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87270,Chlamydia trachomatis ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87271,Cytomegalovirus dfa,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87272,Cryptosporidium ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87273,Herpes simplex 2 ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87274,Herpes simplex 1 ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87275,Influenza b ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87276,Influenza a ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87277,Legionella micdadei ag if,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87278,Legion pneumophilia ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87279,Parainfluenza ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87280,Respiratory syncytial ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87281,Pneumocystis carinii ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87283,Rubeola ag if,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87285,Treponema pallidum ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87290,Varicella zoster ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87299,Antibody detection nos if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87300,Ag detection polyval if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87301,Adenovirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87305,Aspergillus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87320,Chylmd trach ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87324,Clostridium ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87327,Cryptococcus neoform ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87328,Cryptosporidium ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87329,Giardia ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87332,Cytomegalovirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87335,E coli 0157 ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87336,Entamoeb hist dispr ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87337,Entamoeb hist group ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87338,Hpylori stool ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87339,H pylori ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87340,Hepatitis b surface ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87341,Hepatitis b surface ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87350,Hepatitis be ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87380,Hepatitis delta agent ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87385,Histoplasma capsul ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87389,Hiv-1 ag w/hiv-1&2 ab ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87390,Hiv-1 ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87391,Hiv-2 ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87400,Influenza a/b each ag ia,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87420,Resp syncytial virus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87425,Rotavirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87426,Sarscov coronavirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87427,Shiga-like toxin ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87428,Sarscov & inf vir a&b ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87430,Strep a ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87449,Nos each organism ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87450,Ag detect nos ia single,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87451,Polyvalent mult org ea ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87470,Bartonella dna dir probe,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87471,Bartonella dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87472,Bartonella dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87475,Lyme dis dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87476,Lyme dis dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87477,Lyme dis dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87480,Candida dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87481,Candida dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87482,Candida dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87485,Chylmd pneum dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87486,Chylmd pneum dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87487,Chylmd pneum dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87490,Chylmd trach dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87491,Chylmd trach dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87492,Chylmd trach dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87493,C diff amplified probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87495,Cytomeg dna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87496,Cytomeg dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87497,Cytomeg dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87498,Enterovirus probe&revrs trns,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87500,Vanomycin dna amp probe,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87501,Influenza dna amp prob 1+,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87502,Influenza dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87503,Influenza dna amp prob addl,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87510,Gardner vag dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87511,Gardner vag dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87512,Gardner vag dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87515,Hepatitis b dna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87516,Hepatitis b dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87517,Hepatitis b dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87520,Hepatitis c rna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87521,Hepatitis c probe&rvrs trnsc,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87522,Hepatitis c revrs trnscrpj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87525,Hepatitis g dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87526,Hepatitis g dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87527,Hepatitis g dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87528,Hsv dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87529,Hsv dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87530,Hsv dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87531,Hhv-6 dna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87532,Hhv-6 dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87533,Hhv-6 dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87534,Hiv-1 dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87535,Hiv-1 probe&reverse trnscrpj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87536,Hiv-1 quant&revrse trnscrpj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87537,Hiv-2 dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87538,Hiv-2 probe&revrse trnscripj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87539,Hiv-2 quant&revrse trnscripj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87540,Legion pneumo dna dir prob,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87541,Legion pneumo dna amp prob,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87542,Legion pneumo dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87550,Mycobacteria dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87551,Mycobacteria dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87552,Mycobacteria dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87555,M.tuberculo dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87556,M.tuberculo dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87557,M.tuberculo dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87560,M.avium-intra dna dir prob,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87561,M.avium-intra dna amp prob,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87562,M.avium-intra dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87563,M. genitalium amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87580,M.pneumon dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87581,M.pneumon dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87590,N.gonorrhoeae dna dir prob,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87591,N.gonorrhoeae dna amp prob,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87592,N.gonorrhoeae dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87623,Hpv low-risk types,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87624,Hpv high-risk types,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87625,Hpv types 16 & 18 only,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87634,Rsv dna/rna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87635,Sars-cov-2 covid-19 amp prb,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87636,Sarscov2 & inf a&b amp prb,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87637,Sarscov2&inf a&b&rsv amp prb,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87640,Staph a dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87641,Mr-staph dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87650,Strep a dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87651,Strep a dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87652,Strep a dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87653,Strep b dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87660,Trichomonas vagin dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87661,Trichomonas vaginalis amplif,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87662,Zika virus dna/rna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87797,Detect agent nos dna dir,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87798,Detect agent nos dna amp,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87799,Detect agent nos dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87800,Detect agnt mult dna direc,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87801,Detect agnt mult dna ampli,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87802,Strep b assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87803,Clostridium toxin a w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87804,Influenza assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87806,Hiv w/hiv1&2 antb w/optic,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87807,Rsv assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87808,Trichomonas assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87809,Adenovirus assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87810,Chylmd trach assay w/optic,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87811,Sars-cov-2 covid19 w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87850,N. gonorrhoeae assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87880,Strep a assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87899,Agent nos assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87904,Phenotype dna hiv w/clt add,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87905,Sialidase enzyme assay,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,87999,Microbiology procedure,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88104,Cytopath fl nongyn smears,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88106,Cytopath fl nongyn filter,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88108,Cytopath concentrate tech,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88112,Cytopath cell enhance tech,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88120,Cytp urne 3-5 probes ea spec,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88125,Forensic cytopathology,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88130,Sex chromatin identification,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88140,Sex chromatin identification,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88141,Cytopath c/v interpret,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88142,Cytopath c/v thin layer,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88143,Cytopath c/v thin layer redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88147,Cytopath c/v automated,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88148,Cytopath c/v auto rescreen,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88150,Cytopath c/v manual,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88152,Cytopath c/v auto redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88153,Cytopath c/v redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88154,Cytopath c/v select,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88155,Cytopath c/v index add-on,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88160,Cytopath smear other source,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88161,Cytopath smear other source,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88162,Cytopath smear other source,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88164,Cytopath tbs c/v manual,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88165,Cytopath tbs c/v redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88166,Cytopath tbs c/v auto redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88167,Cytopath tbs c/v select,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88172,Cytp dx eval fna 1st ea site,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88173,Cytopath eval fna report,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88174,Cytopath c/v auto in fluid,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88175,Cytopath c/v auto fluid redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88177,Cytp fna eval ea addl,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88182,Cell marker study,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88184,Flowcytometry/ tc 1 marker,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88187,Flowcytometry/read 2-8,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88188,Flowcytometry/read 9-15,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88189,Flowcytometry/read 16 & >,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88199,Cytopathology procedure,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88240,Cell cryopreserve/storage,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88241,Frozen cell preparation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88245,Chromosome analysis 20-25,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88248,Chromosome analysis 50-100,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88249,Chromosome analysis 100,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88261,Chromosome analysis 5,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88262,Chromosome analysis 15-20,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88263,Chromosome analysis 45,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88264,Chromosome analysis 20-25,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88267,Chromosome analys placenta,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88269,Chromosome analys amniotic,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88271,Cytogenetics dna probe,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88272,Cytogenetics 3-5,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88273,Cytogenetics 10-30,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88274,Cytogenetics 25-99,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88275,Cytogenetics 100-300,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88280,Chromosome karyotype study,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88283,Chromosome banding study,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88285,Chromosome count additional,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88289,Chromosome study additional,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88291,Cyto/molecular report,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88299,Cytogenetic study,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88300,Surgical path gross,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88302,Tissue exam by pathologist,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88304,Tissue exam by pathologist,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88305,Tissue exam by pathologist,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88311,Decalcify tissue,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88312,Special stains group 1,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88313,Special stains group 2,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88314,Histochemical stains add-on,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88321,Microslide consultation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88323,Microslide consultation,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88325,Comprehensive review of data,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88329,Path consult introp,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88331,Path consult intraop 1 bloc,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88332,Path consult intraop addl,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88333,Intraop cyto path consult 1,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88334,Intraop cyto path consult 2,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88342,Immunohisto antb 1st stain,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88346,Immunofluor antb 1st stain,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88347,Immunofluorescent study,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88355,Analysis skeletal muscle,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88356,Analysis nerve,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88358,Analysis tumor,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88363,Xm archive tissue molec anal,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88364,Insitu hybridization (fish),Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88369,M/phmtrc alysishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88371,Protein western blot tissue,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88372,Protein analysis w/probe,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88373,M/phmtrc alys ishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88374,M/phmtrc alys ishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88375,Optical endomicroscpy interp,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88377,M/phmtrc alys ishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88380,Microdissection laser,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88381,Microdissection manual,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88387,Tiss exam molecular study,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88388,Tiss ex molecul study add-on,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88399,Surgical pathology procedure,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88720,Bilirubin total transcut,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88738,Hgb quant transcutaneous,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88740,Transcutaneous carboxyhb,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88741,Transcutaneous methb,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,88749,In vivo lab service,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89050,Body fluid cell count,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89051,Body fluid cell count,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89055,Leukocyte assessment fecal,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89060,Exam synovial fluid crystals,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89125,Specimen fat stain,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89160,Exam feces for meat fibers,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89190,Nasal smear for eosinophils,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89220,Sputum specimen collection,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89230,Collect sweat for test,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89240,Pathology lab procedure,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89250,Cultr oocyte/embryo <4 days,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89253,Embryo hatching,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89254,Oocyte identification,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89255,Prepare embryo for transfer,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89257,Sperm identification,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89260,Sperm isolation simple,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89261,Sperm isolation complex,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89264,Identify sperm tissue,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89281,Assist oocyte fertilization,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89290,Biopsy oocyte polar body,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89291,Biopsy oocyte polar body,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89300,Semen analysis w/huhner,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89310,Semen analysis w/count,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89320,Semen anal vol/count/mot,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89321,Semen anal sperm detection,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89322,Semen anal strict criteria,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89325,Sperm antibody test,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89329,Sperm evaluation test,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89330,Evaluation cervical mucus,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89331,Retrograde ejaculation anal,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89335,Cryopreserve testicular tiss,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89353,Thawing cryopresrved sperm,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,89398,Unlisted reprod med lab proc,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90287,Botulinum antitoxin,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90288,Botulism ig iv,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,90291,Cmv ig iv,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,90371,Hep b ig im,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90375,Rabies ig im/sc,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90376,Rabies ig heat treated,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90377,Rabies ig ht&sol human im/sc,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90378,Rsv mab im 50mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90384,Rh ig full-dose im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90386,Rh ig iv,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,90389,Tetanus ig im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90393,Vaccina ig im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90396,Varicella-zoster ig im,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90460,Im admin 1st/only component,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90461,Im admin each addl component,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90471,Immunization admin,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90472,Immunization admin each add,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90473,Immune admin oral/nasal,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90474,Immune admin oral/nasal addl,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90476,Adenovirus vaccine type 4,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90477,Adenovirus vaccine type 7,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90581,Anthrax vaccine sc or im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90585,Bcg vaccine percut,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90586,Bcg vaccine intravesical,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90587,Dengue vacc quad 3 dose subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90619,Menacwy-tt vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90620,Menb-4c vacc 2 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90621,Menb-fhbp vacc 2/3 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90625,Cholera vaccine live oral,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90630,Flu vacc iiv4 no preserv id,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90632,Hepa vaccine adult im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90633,Hepa vacc ped/adol 2 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90634,Hepa vacc ped/adol 3 dose,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90636,Hep a/hep b vacc adult im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90644,Hib-mency vacc 6wk-18m0 im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90645,Hib vaccine hboc im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90646,Hib vaccine prp-d im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90647,Hib prp-omp vacc 3 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90648,Hib prp-t vaccine 4 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90649,4vhpv vaccine 3 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90650,2vhpv vaccine 3 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90651,9vhpv vaccine 2/3 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90653,Iiv adjuvant vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90654,Flu vacc iiv3 no preserv id,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90655,Iiv3 vacc no prsv 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90656,Iiv3 vacc no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90657,Iiv3 vaccine splt 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90658,Iiv3 vaccine splt 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90660,Laiv3 vaccine intranasal,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90661,Cciiv3 vac no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90662,Iiv no prsv increased ag im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90664,Laiv vacc pandemic intranasl,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90666,Flu vac pandem prsrv free im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90667,Iiv vacc pandemic adjuvt im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90668,Iiv vaccine pandemic im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90669,Pneumococcal vacc 7 val im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90670,Pcv13 vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90672,Laiv4 vaccine intranasal,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90673,Riv3 vaccine no preserv im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90674,Cciiv4 vac no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90675,Rabies vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90676,Rabies vaccine id,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90680,Rv5 vacc 3 dose live oral,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90681,Rv1 vacc 2 dose live oral,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90682,Riv4 vacc recombinant dna im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90685,Iiv4 vacc no prsv 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90686,Iiv4 vacc no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90687,Iiv4 vaccine splt 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90688,Iiv4 vaccine splt 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90689,Vacc iiv4 no prsrv 0.25ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90690,Typhoid vaccine oral,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90691,Typhoid vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90692,Typhoid vaccine h-p sc/id,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90693,Typhoid vaccine akd sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90694,Vacc aiiv4 no prsrv 0.5ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90696,Dtap-ipv vaccine 4-6 yrs im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90697,Dtap-ipv-hib-hepb vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90698,Dtap-ipv/hib vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90700,Dtap vaccine < 7 yrs im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90702,Dt vaccine under 7 yrs im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90703,Tetanus vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90704,Mumps vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90705,Measles vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90706,Rubella vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90707,Mmr vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90708,Measles-rubella vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90710,Mmrv vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90712,Oral poliovirus vaccine,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90713,Poliovirus ipv sc/im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90714,Td vacc no presv 7 yrs+ im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90715,Tdap vaccine 7 yrs/> im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90716,Var vaccine live subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90717,Yellow fever vaccine subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90719,Diphtheria vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90720,Dtp/hib vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90721,Dtap/hib vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90723,Dtap-hep b-ipv vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90725,Cholera vaccine injectable,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90727,Plague vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90732,Ppsv23 vacc 2 yrs+ subq/im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90733,Mpsv4 vaccine subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90734,Menacwyd/menacwycrm vacc im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90735,Encephalitis vaccine sc,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90736,Hzv vaccine live subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90738,Inactivated je vacc im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90739,Hepb vacc 2 dose adult im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90740,Hepb vacc 3 dose immunsup im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90743,Hepb vacc 2 dose adolesc im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90744,Hepb vacc 3 dose ped/adol im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90746,Hepb vaccine 3 dose adult im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90747,Hepb vacc 4 dose immunsup im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90748,Hib-hepb vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90749,Vaccine toxoid,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90750,Hzv vacc recombinant im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90756,Cciiv4 vacc abx free im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90785,Psytx complex interactive,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90791,Psych diagnostic evaluation,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90792,Psych diag eval w/med srvcs,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90832,Psytx w pt 30 minutes,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90833,Psytx w pt w e/m 30 min,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90834,Psytx w pt 45 minutes,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90836,Psytx w pt w e/m 45 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90837,Psytx w pt 60 minutes,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90838,Psytx w pt w e/m 60 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90839,Psytx crisis initial 60 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90840,Psytx crisis ea addl 30 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90845,Psychoanalysis,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90846,Family psytx w/o pt 50 min,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90847,Family psytx w/pt 50 min,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90849,Multiple family group psytx,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90853,Group psychotherapy,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90863,Pharmacologic mgmt w/psytx,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90865,Narcosynthesis,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90867,Tcranial magn stim tx plan,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90868,Tcranial magn stim tx deli,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90869,Tcran magn stim redetemine,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90870,Electroconvulsive therapy,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90875,Psychophysiological therapy,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90876,Psychophysiological therapy,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90880,Hypnotherapy,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90882,Environmental manipulation,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90885,Psy evaluation of records,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90887,Consultation with family,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90889,Preparation of report,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90899,Psychiatric service/therapy,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90901,Biofeedback train any meth,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90911,Biofeedback peri/uro/rectal,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90912,Bfb training 1st 15 min,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90913,Bfb training ea addl 15 min,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90935,Hemodialysis one evaluation,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90937,Hemodialysis repeated eval,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90940,Hemodialysis access study,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90945,Dialysis one evaluation,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90947,Dialysis repeated eval,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90989,Dialysis training complete,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90993,Dialysis training incompl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90997,Hemoperfusion,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,90999,Dialysis procedure,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91010,Esophagus motility study,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91013,Esophgl motil w/stim/perfus,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91020,Gastric motility studies,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91022,Duodenal motility study,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91030,Acid perfusion of esophagus,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91034,Gastroesophageal reflux test,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91035,G-esoph reflx tst w/electrod,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91037,Esoph imped function test,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91038,Esoph imped funct test > 1hr,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91040,Esoph balloon distension tst,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91110,Gi tract capsule endoscopy,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,91111,Esophageal capsule endoscopy,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91112,Gi wireless capsule measure,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91117,Colon motility 6 hr study,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91120,Rectal sensation test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91122,Anal pressure record,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91132,Electrogastrography,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91133,Electrogastrography w/test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91200,Liver elastography,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91299,Gastroenterology procedure,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91300,Sarscov2 vac 30mcg/0.3ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91301,Sarscov2 vac 100mcg/0.5ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91302,Coronavirus vaccine 3,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91303,Coronavirus vaccine 4,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91304,Coronavirus vaccine 5,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91305,Coronavirus vaccine 6,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91306,Coronavirus vaccine 7,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91307,Coronavirus vaccine 8,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91308,Coronavirus vaccine 9,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91309,Coronavirus vaccine 10,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,91310,Coronavirus vaccine 11,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92015,Determine refractive state,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92018,New eye exam & treatment,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92019,Eye exam & treatment,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92020,Special eye evaluation,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92025,Corneal topography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92060,Special eye evaluation,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92065,Orthoptic/pleoptic training,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92071,Contact lens fitting for tx,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92072,Fit contac lens for managmnt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92081,Visual field examination(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92082,Visual field examination(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92083,Visual field examination(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92100,Serial tonometry exam(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92132,Cmptr ophth dx img ant segmt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92133,Cmptr ophth img optic nerve,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92134,Cptr ophth dx img post segmt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92136,Ophthalmic biometry,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92140,Glaucoma provocative tests,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92145,Corneal hysteresis deter,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92201,Opscpy extnd rta draw uni/bi,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92202,Opscpy extnd on/mac draw,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92225,Special eye exam initial,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92226,Special eye exam subsequent,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92227,Img rta detcj/mntr ds staff,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92228,Img rta detc/mntr ds phy/qhp,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92229,Img rta detc/mntr ds poc aly,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92230,Eye exam with photos,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92235,Fluorescein angrph uni/bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92240,Icg angiography uni/bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92242,Fluorescein icg angiography,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92250,Eye exam with photos,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92260,Ophthalmoscopy/dynamometry,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92265,Eye muscle evaluation,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92270,Electro-oculography,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92273,Full field erg w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92274,Multifocal erg w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92275,Electroretinography,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92283,Color vision examination,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92284,Dark adaptation eye exam,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92285,Eye photography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92286,Internal eye photography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92287,Internal eye photography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92310,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92311,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92312,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92313,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92314,Prescription of contact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92315,Rx cntact lens aphakia 1 eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92316,Rx cntact lens aphakia 2 eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92317,Rx corneoscleral cntact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92325,Modification of contact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92326,Replacement of contact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92340,Fit spectacles monofocal,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92341,Fit spectacles bifocal,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92342,Fit spectacles multifocal,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92352,Fit aphakia spectcl monofocl,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92353,Fit aphakia spectcl multifoc,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92354,Fit spectacles single system,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92355,Fit spectacles compound lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92358,Aphakia prosth service temp,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92370,Repair & adjust spectacles,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92371,Repair & adjust spectacles,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92499,Eye service or procedure,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92507,Speech/hearing therapy,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92516,Facial nerve function test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92517,Vemp test i&r cervical,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92518,Vemp test i&r ocular,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92519,Vemp tst i&r cervical&ocular,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92520,Laryngeal function studies,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92521,Evaluation of speech fluency,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92522,Evaluate speech production,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92523,Speech sound lang comprehen,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92524,Behavral qualit analys voice,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92534,Optokinetic nystagmus test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92537,Caloric vstblr test w/rec,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92538,Caloric vstblr test w/rec,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92540,Basic vestibular evaluation,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92543,Caloric vestibular test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92546,Sinusoidal rotational test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92547,Supplemental electrical test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92548,Cdp-sot 6 cond w/i&r,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92549,Cdp-sot 6 cond w/i&r mct&adt,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92550,Tympanometry & reflex thresh,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92553,Audiometry air & bone,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92557,Comprehensive hearing test,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92558,Evoked auditory test qual,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92570,Acoustic immitance testing,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92572,Staggered spondaic word test,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92577,Stenger test speech,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92579,Visual audiometry (vra),Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92582,Conditioning play audiometry,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92584,Electrocochleography,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92585,Auditor evoke potent compre,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92586,Auditor evoke potent limit,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92587,Evoked auditory test limited,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92588,Evoked auditory tst complete,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92597,Oral speech device eval,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92601,Cochlear implt f/up exam <7,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92602,Reprogram cochlear implt <7,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92603,Cochlear implt f/up exam 7/>,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92604,Reprogram cochlear implt 7/>,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92605,Ex for nonspeech device rx,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92606,Non-speech device service,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92607,Ex for speech device rx 1hr,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92608,Ex for speech device rx addl,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92610,Evaluate swallowing function,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92618,Ex for nonspeech dev rx add,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92620,Auditory function 60 min,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92621,Auditory function + 15 min,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92625,Tinnitus assessment,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92626,Eval aud funcj 1st hour,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92627,Eval aud funcj ea addl 15,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92630,Aud rehab pre-ling hear loss,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92633,Aud rehab postling hear loss,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92651,Aep hearing status deter i&r,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92652,Aep thrshld est mlt freq i&r,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92653,Aep neurodiagnostic i&r,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92920,Prq cardiac angioplast 1 art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92921,Prq cardiac angio addl art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92924,Prq card angio/athrect 1 art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92925,Prq card angio/athrect addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92928,Prq card stent w/angio 1 vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92929,Prq card stent w/angio addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92933,Prq card stent/ath/angio,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92934,Prq card stent/ath/angio,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92937,Prq revasc byp graft 1 vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92938,Prq revasc byp graft addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92941,Prq card revasc mi 1 vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92943,Prq card revasc chronic 1vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92944,Prq card revasc chronic addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92950,Heart/lung resuscitation cpr,General Medicine,Per Unit,$385.17 ,OP,$385.17 ,$385.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92953,Temporary external pacing,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92960,Cardioversion electric ext,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92961,Cardioversion electric int,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92971,Cardioassist external,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92973,Prq coronary mech thrombect,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92975,Dissolve clot heart vessel,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92977,Dissolve clot heart vessel,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92978,Endoluminl ivus oct c 1st,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92979,Endoluminl ivus oct c ea,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,92986,Revision of aortic valve,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92987,Revision of mitral valve,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92990,Revision of pulmonary valve,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92997,Pul art balloon repr percut,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,92998,Pul art balloon repr percut,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93000,Electrocardiogram complete,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93005,Electrocardiogram tracing,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93010,Electrocardiogram report,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93015,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93016,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93017,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93018,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93024,Cardiac drug stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93025,Microvolt t-wave assess,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93040,Rhythm ecg with report,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93041,Rhythm ecg tracing,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93042,Rhythm ecg report,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93050,Art pressure waveform analys,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93224,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93225,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93226,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93227,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93228,Remote 30 day ecg rev/report,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93229,Remote 30 day ecg tech supp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93241,Ext ecg>48hr<7d rec scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93242,Ext ecg>48hr<7d recording,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93243,Ext ecg>48hr<7d scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93244,Ext ecg>48hr<7d rev&interpj,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93245,Ext ecg>7d<15d rec scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93246,Ext ecg>7d<15d recording,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93247,Ext ecg>7d<15d scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93248,Ext ecg>7d<15d rev&interpj,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93260,Prgrmg dev eval impltbl sys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93261,Interrogate subq defib,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93264,Rem mntr wrls p-art prs snr,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93268,Ecg record/review,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93270,Remote 30 day ecg rev/report,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93271,Ecg/monitoring and analysis,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93272,Ecg/review interpret only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93278,Ecg/signal-averaged,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93279,Prgrmg dev eval pm/ldls pm,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93280,Pm device progr eval dual,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93281,Pm device progr eval multi,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93282,Prgrmg eval implantable dfb,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93283,Prgrmg eval implantable dfb,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93284,Prgrmg eval implantable dfb,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93285,Prgrmg dev eval scrms ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93286,Peri-px eval pm/ldls pm ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93287,Peri-px device eval & prgr,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93288,Interrog evl pm/ldls pm ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93289,Interrog device eval heart,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93290,Interrog dev eval icpms ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93291,Interrog dev eval scrms ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93292,Wcd device interrogate,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93293,Pm phone r-strip device eval,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93294,Rem interrog evl pm/ldls pm,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93295,Dev interrog remote 1/2/mlt,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93296,Rem interrog evl pm/ids,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93297,Rem interrog dev eval icpms,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93298,Rem interrog dev eval scrms,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93299,Interrog eval icpms/scrms,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93303,Echo transthoracic,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93304,Echo transthoracic,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93306,Tte w/doppler complete,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93307,Tte w/o doppler complete,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93308,Tte f-up or lmtd,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93312,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93313,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93314,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93315,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93316,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93317,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93318,Echo transesophageal intraop,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93320,Doppler echo exam heart,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93321,Doppler echo exam heart,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93325,Doppler color flow add-on,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93350,Stress tte only,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93351,Stress tte complete,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93352,Admin ecg contrast agent,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93355,Echo transesophageal (tee),Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93356,Myocrd strain img spckl trck,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93451,Right heart cath,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93452,Left hrt cath w/ventrclgrphy,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93453,R&l hrt cath w/ventriclgrphy,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93454,Coronary artery angio s&i,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93455,Coronary art/grft angio s&i,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93456,R hrt coronary artery angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93457,R hrt art/grft angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93458,L hrt artery/ventricle angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93459,L hrt art/grft angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93460,R&l hrt art/ventricle angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93461,R&l hrt art/ventricle angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93462,L hrt cath trnsptl puncture,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93464,Exercise w/hemodynamic meas,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93505,Biopsy of heart lining,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93530,Rt heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93531,R & l heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93532,R & l heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93533,R & l heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93600,Bundle of his recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93602,Intra-atrial recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93603,Right ventricular recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93609,Map tachycardia add-on,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93610,Intra-atrial pacing,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93612,Intraventricular pacing,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93613,Electrophys map 3d add-on,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93615,Esophageal recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93616,Esophageal recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93618,Heart rhythm pacing,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93619,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93620,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93621,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93622,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93623,Stimulation pacing heart,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93624,Electrophysiologic study,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93631,Heart pacing mapping,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93640,Evaluation heart device,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93641,Electrophysiology evaluation,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93642,Electrophysiology evaluation,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93644,Electrophysiology evaluation,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93650,Ablate heart dysrhythm focus,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93653,Ep & ablate supravent arrhyt,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93654,Ep & ablate ventric tachy,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93655,Ablate arrhythmia add on,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93656,Tx atrial fib pulm vein isol,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93657,Tx l/r atrial fib addl,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93660,Tilt table evaluation,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93662,Intracardiac ecg (ice),Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,93668,Peripheral vascular rehab,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93701,Bioimpedance cv analysis,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93702,Bis xtracell fluid analysis,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93724,Analyze pacemaker system,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93745,Set-up cardiovert-defibrill,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93750,Interrogation vad in person,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93770,Measure venous pressure,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93784,Ambl bp mntr w/software,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93786,Ambl bp mntr w/sw rec only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93788,Ambl bp mntr w/sw a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93790,Ambl bp mntr w/sw i&r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93792,Pt/caregiver traing home inr,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93793,Anticoag mgmt pt warfarin,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93797,Cardiac rehab,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93798,Cardiac rehab/monitor,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93799,Cardiovascular procedure,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93880,Extracranial bilat study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93882,Extracranial uni/ltd study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93886,Intracranial complete study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93888,Intracranial limited study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93890,Tcd vasoreactivity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93892,Tcd emboli detect w/o inj,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93893,Tcd emboli detect w/inj,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93895,Carotid intima atheroma eval,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93922,Upr/l xtremity art 2 levels,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93923,Upr/lxtr art stdy 3+ lvls,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93924,Lwr xtr vasc stdy bilat,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93925,Lower extremity study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93926,Lower extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93930,Upper extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93931,Upper extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93965,Extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93970,Extremity study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93971,Extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93975,Vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93976,Vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93978,Vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93979,Vascular study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93980,Penile vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93981,Penile vascular study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93982,Aneurysm pressure sens study,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93985,Dup-scan hemo compl bi std,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93986,Dup-scan hemo compl uni std,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93990,Doppler flow testing,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,93998,Noninvas vasc dx study proc,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94002,Vent mgmt inpat init day,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94003,Vent mgmt inpat subq day,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94004,Vent mgmt nf per day,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94005,Home vent mgmt supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94010,Breathing capacity test,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94011,Spirometry up to 2 yrs old,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94012,Spirmtry w/brnchdil inf-2 yr,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94013,Meas lung vol thru 2 yrs,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94014,Patient recorded spirometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94015,Patient recorded spirometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94016,Review patient spirometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94060,Evaluation of wheezing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94070,Evaluation of wheezing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94150,Vital capacity test,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94200,Lung function test (mbc/mvv),Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94250,Expired gas collection,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94375,Respiratory flow volume loop,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94400,Co2 breathing response curve,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94450,Hypoxia response curve,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94452,Hast w/report,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94453,Hast w/oxygen titrate,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94610,Surfactant admin thru tube,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94617,Exercise tst brncspsm w/ecg,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94618,Pulmonary stress testing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94619,Exercise tst brncspsm wo ecg,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94620,Pulmonary stress test/simple,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94621,Cardiopulm exercise testing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94640,Airway inhalation treatment,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94642,Aerosol inhalation treatment,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94644,Cbt 1st hour,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94645,Cbt each addl hour,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94660,Pos airway pressure cpap,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94662,Neg press ventilation cnp,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94664,Evaluate pt use of inhaler,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94667,Chest wall manipulation,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94668,Chest wall manipulation,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94669,Mechanical chest wall oscill,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94680,Exhaled air analysis o2,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94681,Exhaled air analysis o2/co2,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94690,Exhaled air analysis,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94726,Pulm funct tst plethysmograp,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94727,Pulm function test by gas,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94728,Airwy resist by oscillometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94729,Co/membane diffuse capacity,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94750,Pulmonary compliance study,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94762,Measure blood oxygen level,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94770,Exhaled carbon dioxide test,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94772,Breath recording infant,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94774,Ped home apnea rec compl,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94775,Ped home apnea rec hk-up,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94776,Ped home apnea rec downld,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94777,Ped home apnea rec report,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94780,Cars/bd tst inft-12mo 60 min,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94781,Cars/bd tst inft-12mo +30min,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,94799,Pulmonary service/procedure,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95004,Percut allergy skin tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95012,Exhaled nitric oxide meas,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95017,Perq & icut allg test venoms,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95018,Perq&ic allg test drugs/biol,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95024,Icut allergy test drug/bug,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95027,Icut allergy titrate-airborn,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95028,Icut allergy test-delayed,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95044,Allergy patch tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95052,Photo patch test,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95056,Photosensitivity tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95060,Eye allergy tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95065,Nose allergy test,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95070,Bronchial allergy tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95071,Bronchial allergy tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95076,Ingest challenge ini 120 min,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95079,Ingest challenge addl 60 min,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95115,Immunotherapy one injection,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95117,Immunotherapy injections,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95120,Immunotherapy one injection,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95125,Immunotherapy 2/> injections,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95130,Immntx 1 sting insect,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95131,Immntx 2 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95132,Immntx 3 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95133,Immntx 4 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95134,Immntx 5 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95144,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95145,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95146,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95147,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95148,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95149,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95165,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95170,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95180,Rapid desensitization,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95199,Allergy immunology services,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95249,Cont gluc mntr pt prov eqp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95250,Cont gluc mntr phys/qhp eqp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95251,Cont gluc mntr analysis i&r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95700,Eeg cont rec w/vid eeg tech,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95705,Eeg w/o vid 2-12 hr unmntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95706,Eeg wo vid 2-12hr intmt mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95707,Eeg w/o vid 2-12hr cont mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95708,Eeg wo vid ea 12-26hr unmntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95709,Eeg w/o vid ea 12-26hr intmt,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95710,Eeg w/o vid ea 12-26hr cont,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95711,Veeg 2-12 hr unmonitored,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95712,Veeg 2-12 hr intmt mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95713,Veeg 2-12 hr cont mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95714,Veeg ea 12-26 hr unmntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95715,Veeg ea 12-26hr intmt mntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95716,Veeg ea 12-26hr cont mntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95717,Eeg phys/qhp 2-12 hr w/o vid,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95718,Eeg phys/qhp 2-12 hr w/veeg,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95719,Eeg phys/qhp ea incr w/o vid,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95720,Eeg phy/qhp ea incr w/veeg,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95721,Eeg phy/qhp>36<60 hr w/o vid,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95722,Eeg phy/qhp>36<60 hr w/veeg,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95723,Eeg phy/qhp>60<84 hr w/o vid,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95724,Eeg phy/qhp>60<84 hr w/veeg,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95725,Eeg phy/qhp>84 hr w/o vid,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95726,Eeg phy/qhp>84 hr w/veeg,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95782,Polysom <6 yrs 4/> paramtrs,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95783,Polysom <6 yrs cpap/bilvl,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95803,Actigraphy testing,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95805,Multiple sleep latency test,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95807,Sleep study attended,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95808,Polysom any age 1-3> param,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95810,Polysom 6/> yrs 4/> param,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95811,Polysom 6/>yrs cpap 4/> parm,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95812,Eeg 41-60 minutes,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95813,Eeg extnd mntr 61-119 min,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95816,Eeg awake and drowsy,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95819,Eeg awake and asleep,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95822,Eeg coma or sleep only,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95824,Eeg cerebral death only,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95827,Eeg all night recording,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95829,Surgery electrocorticogram,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95836,Ecog impltd brn npgt <30 d,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95857,Cholinesterase challenge,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95860,Muscle test one limb,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95861,Muscle test 2 limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95863,Muscle test 3 limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95864,Muscle test 4 limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95865,Muscle test larynx,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95866,Muscle test hemidiaphragm,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95867,Muscle test cran nerv unilat,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95868,Muscle test cran nerve bilat,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95869,Muscle test thor paraspinal,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95870,Muscle test nonparaspinal,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95872,Muscle test one fiber,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95873,Guide nerv destr elec stim,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95874,Guide nerv destr needle emg,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95875,Limb exercise test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95885,Musc tst done w/nerv tst lim,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95886,Musc test done w/n test comp,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95887,Musc tst done w/n tst nonext,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95905,Motor &/ sens nrve cndj test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95907,Nvr cndj tst 1-2 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95908,Nrv cndj tst 3-4 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95909,Nrv cndj tst 5-6 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95910,Nrv cndj test 7-8 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95911,Nrv cndj test 9-10 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95912,Nrv cndj test 11-12 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95913,Nrv cndj test 13/> studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95921,Autonomic nrv parasym inervj,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95922,Autonomic nrv adrenrg inervj,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95923,Autonomic nrv syst funj test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95924,Ans parasymp & symp w/tilt,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95925,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95926,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95927,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95928,C motor evoked uppr limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95929,C motor evoked lwr limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95930,Visual ep test cns w/i&r,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95933,Blink reflex test,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95937,Neuromuscular junction test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95938,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95939,C motor evoked upr&lwr limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95943,Parasymp&symp hrt rate test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95950,Ambulatory eeg monitoring,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95951,Eeg monitoring/videorecord,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95953,Eeg monitoring/computer,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95954,Eeg monitoring/giving drugs,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95955,Eeg during surgery,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95956,Eeg monitor technol attended,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95957,Eeg digital analysis,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95958,Eeg monitoring/function test,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95965,Meg spontaneous,Diagnostic Radiology,Per Unit,$221.34 ,OP,$221.34 ,$221.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95966,Meg evoked single,Diagnostic Radiology,Per Unit,$221.34 ,OP,$221.34 ,$221.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95967,Meg evoked each addl,Diagnostic Radiology,Per Unit,$221.34 ,OP,$221.34 ,$221.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95970,Alys npgt w/o prgrmg,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95971,Alys smpl sp/pn npgt w/prgrm,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95972,Alys cplx sp/pn npgt w/prgrm,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95973,Analyze neurostim complex,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95974,Cranial neurostim complex,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95975,Cranial neurostim complex,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95976,Alys smpl cn npgt prgrmg,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95977,Alys cplx cn npgt prgrmg,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95978,Analyze neurostim brain/1h,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95979,Analyz neurostim brain addon,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95980,Io anal gast n-stim init,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95981,Io anal gast n-stim subsq,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95982,Io ga n-stim subsq w/reprog,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95983,Alys brn npgt prgrmg 15 min,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95984,Alys brn npgt prgrmg addl 15,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,95999,Neurological procedure,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96000,Motion analysis video/3d,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96001,Motion test w/ft press meas,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96002,Dynamic surface emg,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96003,Dynamic fine wire emg,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96020,Functional brain mapping,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96101,Psycho testing by psych/phys,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96102,Psycho testing by technician,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96103,Psycho testing admin by comp,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96105,Assessment of aphasia,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96110,Developmental screen w/score,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96111,Developmental test extend,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96112,Devel tst phys/qhp 1st hr,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96113,Devel tst phys/qhp ea addl,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96116,Nubhvl xm phys/qhp 1st hr,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96118,Neuropsych tst by psych/phys,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96119,Neuropsych testing by tec,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96120,Neuropsych tst admin w/comp,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96121,Nubhvl xm phy/qhp ea addl hr,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96125,Cognitive test by hc pro,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96127,Brief emotional/behav assmt,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96130,Psycl tst eval phys/qhp 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96131,Psycl tst eval phys/qhp ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96132,Nrpsyc tst eval phys/qhp 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96133,Nrpsyc tst eval phys/qhp ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96136,Psycl/nrpsyc tst phy/qhp 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96137,Psycl/nrpsyc tst phy/qhp ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96138,Psycl/nrpsyc tech 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96139,Psycl/nrpsyc tst tech ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96146,Psycl/nrpsyc tst auto result,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96150,Assess hlth/behave init,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96151,Assess hlth/behave subseq,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96153,Intervene hlth/behave group,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96154,Interv hlth/behav fam w/pt,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96155,Interv hlth/behav fam no pt,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96156,Hlth bhv assmt/reassessment,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96160,Pt-focused hlth risk assmt,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96161,Caregiver health risk assmt,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96360,Hydration iv infusion init,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96361,Hydrate iv infusion add-on,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96365,Ther/proph/diag iv inf init,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96366,Ther/proph/diag iv inf addon,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96367,Tx/proph/dg addl seq iv inf,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96368,Ther/diag concurrent inf,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96369,Sc ther infusion up to 1 hr,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96370,Sc ther infusion addl hr,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96371,Sc ther infusion reset pump,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96413,Chemo iv infusion 1 hr,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96415,Chemo iv infusion addl hr,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96416,Chemo prolong infuse w/pump,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96417,Chemo iv infus each addl seq,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96422,Chemo ia infusion up to 1 hr,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96423,Chemo ia infuse each addl hr,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96425,Chemotherapy infusion method,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96446,Chemotx admn prtl cavity,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96450,Chemotherapy into cns,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96549,Chemotherapy unspecified,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96567,Pdt dstr prmlg les skn,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96570,Photodynmc tx 30 min add-on,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96571,Photodynamic tx addl 15 min,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96573,Pdt dstr prmlg les phys/qhp,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96574,Dbrdmt prmlg les w/pdt,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96900,Ultraviolet light therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96902,Trichogram,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96913,Photochemotherapy uv-a or b,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96920,Laser tx skin < 250 sq cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96921,Laser tx skin 250-500 sq cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96922,Laser tx skin >500 sq cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96931,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96932,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96933,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96934,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96935,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96936,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,96999,Dermatological procedure,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97001,Pt evaluation,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97002,Pt re-evaluation,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97003,Ot evaluation,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97004,Ot re-evaluation,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97010,Hot or cold packs therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97012,Mechanical traction therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97014,Electric stimulation therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97016,Vasopneumatic device therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97018,Paraffin bath therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97022,Whirlpool therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97024,Diathermy eg microwave,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97026,Infrared therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97028,Ultraviolet therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97032,Electrical stimulation,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97033,Electric current therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97034,Contrast bath therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97035,Ultrasound therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97039,Physical therapy treatment,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97116,Gait training therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97124,Massage therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97139,Physical medicine procedure,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97161,Pt eval low complex 20 min,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97162,Pt eval mod complex 30 min,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97163,Pt eval high complex 45 min,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97164,Pt re-eval est plan care,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97165,Ot eval low complex 30 min,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97166,Ot eval mod complex 45 min,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97167,Ot eval high complex 60 min,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97168,Ot re-eval est plan care,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97535,Self care mngment training,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97545,Work hardening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97546,Work hardening add-on,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97755,Assistive technology assess,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97762,C/o for orthotic/prosth use,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97799,Physical medicine procedure,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97802,Medical nutrition indiv in,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97803,Med nutrition indiv subseq,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97804,Medical nutrition group,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97810,Acupunct w/o stimul 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97811,Acupunct w/o stimul addl 15m,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97813,Acupunct w/stimul 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,97814,Acupunct w/stimul addl 15m,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98925,Osteopath manj 1-2 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98926,Osteopath manj 3-4 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98927,Osteopath manj 5-6 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98928,Osteopath manj 7-8 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98929,Osteopath manj 9-10 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98940,Chiropract manj 1-2 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98941,Chiropract manj 3-4 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98942,Chiropractic manj 5 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98943,Chiropract manj xtrspinl 1/>,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98960,Self-mgmt educ & train 1 pt,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98961,Self-mgmt educ/train 2-4 pt,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,98962,Self-mgmt educ/train 5-8 pt,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99050,Medical services after hrs,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99051,Med serv eve/wkend/holiday,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99053,Med serv 10pm-8am 24 hr fac,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99058,Office emergency care,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99060,Out of office emerg med serv,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99078,Group health education,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99091,Collj & interpj data ea 30 d,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99100,Special anesthesia service,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99116,Anesthesia with hypothermia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99135,Special anesthesia procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99140,Emergency anesthesia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99143,Mod sedat phys/qhp <5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99144,Mod sedat phys/qhp 5yrs/>,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99145,Mod sedat phys/qhp ea 15 min,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99148,Mod sed diff phys/qhp<5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99149,Mod sed diff phys/qhp 5/>yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99150,Mod sed diff phys/qhp add on,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99151,Mod sed same phys/qhp <5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99152,Mod sed same phys/qhp 5/>yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99153,Mod sed same phys/qhp ea,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99155,Mod sed oth phys/qhp <5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99156,Mod sed oth phys/qhp 5/>yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99157,Mod sed other phys/qhp ea,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99172,Ocular function screen,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99173,Visual acuity screen,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99174,Ocular instrumnt screen bil,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99175,Induction of vomiting,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99177,Ocular instrumnt screen bil,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99188,App topical fluoride varnish,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99238,Hospital discharge day,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99239,Hospital discharge day,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99363,Anticoagulant mgmt initial,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99364,Anticoagulant mgmt subseq,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99366,Team conf w/pat by hc prof,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99367,Team conf w/o pat by phys,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99368,Team conf w/o pat by hc pro,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99374,Home health care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99375,Home health care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99377,Hospice care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99378,Hospice care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99379,Nursing fac care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99380,Nursing fac care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99406,Behav chng smoking 3-10 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99407,Behav chng smoking > 10 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99408,Audit/dast 15-30 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99409,Audit/dast over 30 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99439,Chrnc care mgmt svc ea addl,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99453,Rem mntr physiol param setup,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99454,Rem mntr physiol param dev,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99457,Rem physiol mntr 1st 20 min,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99458,Rem physiol mntr ea addl 20,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99465,Nb resuscitation,General Medicine,Per Unit,$385.17 ,OP,$385.17 ,$385.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99473,Self-meas bp pt educaj/train,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99474,Self-meas bp 2 readg bid 30d,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99483,Assmt & care pln pt cog imp,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99484,Care mgmt svc bhvl hlth cond,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99487,Cplx chrnc care 1st 60 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99489,Cplx chrnc care ea addl 30,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99490,Chrnc care mgmt svc 1st 20,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99491,Chrnc care mgmt svc 30 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99492,1st psyc collab care mgmt,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99493,Sbsq psyc collab care mgmt,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99494,1st/sbsq psyc collab care,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99495,Trans care mgmt 14 day disch,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99496,Trans care mgmt 7 day disch,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99497,Advncd care plan 30 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99498,Advncd care plan addl 30 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99503,Home visit resp therapy,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,99504,Home visit mech ventilator,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0001A,Adm sarscov2 30mcg/0.3ml 1st,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0001M,Nfct ds chrnc hcv 6 assays,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0001U,Rbc dna hea 35 ag 11 bld grp,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0002A,Adm sarscov2 30mcg/0.3ml 2nd,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0002M,Liver dis 10 assays w/ash,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0002U,Onc clrct 3 ur metab alg plp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0003A,Fee covid-19 vac 1 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0003M,Liver dis 10 assays w/nash,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0003U,Onc ovar 5 prtn ser alg scor,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0004A,Fee covid-19 vac 1 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0004M,Scoliosis dna alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0004U,Nfct ds dna 27 resist genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0005U,Onco prst8 3 gene ur alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0006M,Onc hep gene risk classifier,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0006U,Detc ia meds 120+ analytes,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0007M,Onc gastro 51 gene nomogram,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0008M,Onc breast risk score,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0008U,Hpylori detcj abx rstnc dna,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0009M,Fetal aneuploidy trisom risk,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0009U,Onc brst ca erbb2 amp/nonamp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0010M,Onc prostate prob score,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0010U,Nfct ds strn typ whl gen seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0011A,Adm sarscov2 100mcg/0.5ml1st,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0011M,Onc prst8 ca mrna 12 gen alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0011U,Rx mntr lc-ms/ms oral fluid,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0012A,Adm sarscov2 100mcg/0.5ml2nd,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0012M,Onc mrna 5 gen rsk urthl ca,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0012U,Germln do gene reargmt detcj,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0013A,Fee covid-19 vac 2 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0013M,Onc mrna 5 gen recr urthl ca,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0013U,Onc sld org neo gene reargmt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0014A,Fee covid-19 vac 2 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0014M,Liver ds alys 3 bmrk srm alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0014U,Hem hmtlmf neo gene reargmt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0015M,Adrnl cortcl tum bchm asy 25,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0015U,Rx metab advrs rx rxn dna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0016M,Onc bladder mrna 209 gen alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0016U,Onc hmtlmf neo rna bcr/abl1,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0017M,Onc dlbcl mrna 20 genes alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0017U,Onc hmtlmf neo jak2 mut dna,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0018U,Onc thyr 10 microrna seq alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0019T,Extracorp shock wv tx ms nos,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0019U,Onc rna tiss predict alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0020U,Rx test prsmv ur w/def conf,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0021A,Fee covid-19 vac 3 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0021U,Onc prst8 detcj 8 autoantb,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0022A,Fee covid-19 vac 3 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0022U,Trgt gen seq dna&rna 23 gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0023A,Fee covid-19 vac 3 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0023U,Onc aml dna detcj/nondetcj,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0024A,Fee covid-19 vac 3 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0024U,Glyca nuc mr spectrsc quan,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0025U,Tenofovir liq chrom ur quan,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0026U,Onc thyr dna&mrna 112 genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0027U,Jak2 gene trgt seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0028U,Cyp2d6 gene cpy nmr cmn vrnt,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0029U,Rx metab advrs trgt seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0030U,Rx metab warf trgt seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0031A,Fee covid-19 vac 4 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0031U,Cyp1a2 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0032A,Fee covid-19 vac 4 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0032U,Comt gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0033A,Fee covid-19 vac 4 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0033U,Htr2a htr2c genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0034A,Fee covid-19 vac 4 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0034U,Tpmt nudt15 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0035U,Neuro csf prion prtn qual,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0036U,Xome tum & nml spec seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0037U,Trgt gen seq dna 324 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0038U,Vitamin d srm microsamp quan,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0039U,Dna antb 2strand hi avidity,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0040U,Bcr/abl1 gene major bp quan,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0041A,Fee covid-19 vac 5 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0041U,B brgdrferi antb 5 prtn igm,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0042A,Fee covid-19 vac 5 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0042T,Ct perfusion w/contrast cbf,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0042U,B brgdrferi antb 12 prtn igg,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0043A,Fee covid-19 vac 5 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0043U,Tbrf b grp antb 4 prtn igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0044A,Fee covid-19 vac 5 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0044U,Tbrf b grp antb 4 prtn igg,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0045U,Onc brst dux carc is 12 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0046U,Flt3 gene itd variants quan,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0047U,Onc prst8 mrna 17 gene alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0048U,Onc sld org neo dna 468 gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0049U,Npm1 gene analysis quan,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0050U,Trgt gen seq dna 194 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0051A,Fee covid-19 vac 6 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0051U,Rx mntr lc-ms/ms ur 31 pnl,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0052A,Fee covid-19 vac 6 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0052U,Lpoprtn bld w/5 maj classes,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0053A,Fee covid-19 vac 6 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0053U,Onc prst8 ca fish alys 4 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0054A,Fee covid-19 vac 6 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0054U,Rx mntr 14+ drugs & sbsts,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0055U,Card hrt trnspl 96 dna seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0056U,Hem aml dna gene reargmt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0057U,Onc sld org neo mrna 51 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0058T,Cryopreservation ovary tiss,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0058U,Onc merkel cll carc srm quan,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0059U,Onc merkel cll carc srm +/-,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0060U,Twn zyg gen seq alys chrms2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0061A,Fee covid-19 vac 7 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0061U,Tc meas 5 bmrk sfdi m-s alys,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0062A,Fee covid-19 vac 7 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0062U,Ai sle igg&igm alys 80 bmrk,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0063A,Fee covid-19 vac 7 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0063U,Neuro autism 32 amines alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0064A,Fee covid-19 vac 7 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0064U,Antb tp total&rpr ia qual,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0065U,Syfls tst nontreponemal antb,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0066U,Pamg-1 ia cervico-vag fluid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0067U,Onc brst imhchem prfl 4 bmrk,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0069U,Onc clrct microrna mir-31-3p,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0070U,Cyp2d6 gen com&slct rar vrnt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0071A,Fee covid-19 vac 8 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0071U,Cyp2d6 full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0072A,Fee covid-19 vac 8 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0072U,Cyp2d6 gen cyp2d6-2d7 hybrid,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0073A,Fee covid-19 vac 8 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0073U,Cyp2d6 gen cyp2d7-2d6 hybrid,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0074A,Fee covid-19 vac 8 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0074U,Cyp2d6 nonduplicated gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0075T,Perq stent/chest vert art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0075U,Cyp2d6 5' gene dup/mlt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0076T,S&i stent/chest vert art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0076U,Cyp2d6 3' gene dup/mlt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0077U,Ig paraprotein qual bld/ur,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0078U,Pain mgt opi use gnotyp pnl,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0079U,Cmprtv dna alys mlt snps,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0080U,Onc lng 5 clin rsk factr alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0081A,Fee covid-19 vac 9 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0081U,Onc uveal mlnma mrna 15 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0082A,Fee covid-19 vac 9 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0083A,Fee covid-19 vac 9 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0083U,Onc rspse chemo cntrst tomog,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0084A,Fee covid-19 vac 9 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0084U,Rbc dna gnotyp 10 bld groups,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0085T,Breath test heart reject,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0085U,Cdtb&vinculin igg antb ia,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0086U,Nfct ds bact&fng org id 6+,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0087U,Crd hrt trnspl mrna 1283 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0088U,Trnsplj kdn algrft rej 1494,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0089U,Onc mlnma prame & linc00518,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0090U,Onc cutan mlnma mrna 23 gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0091A,Fee covid-19 vac 10 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0091U,Onc clrct scr whl bld alg,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0092A,Fee covid-19 vac 10 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0092U,Onc lng 3 prtn bmrk plsm alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0093A,Fee covid-19 vac 10 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0093U,Rx mntr 65 com drugs urine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0094A,Fee covid-19 vac 10 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0094U,Genome rapid sequence alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0095U,Inflm ee elisa alys alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0096U,Hpv hi risk types male urine,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0099T,Implant corneal ring,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0100T,Prosth retina receive&gen,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0101A,Fee covid-19 vac 11 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0101T,Extracorp shockwv tx hi enrg,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0101U,Hered colon ca do 15 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0102A,Fee covid-19 vac 11 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0102U,Hered brst ca rltd do 17 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0103A,Fee covid-19 vac 11 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0103T,Holotranscobalamin,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0103U,Hered ova ca pnl 24 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0104A,Fee covid-19 vac 11 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0104U,Hered pan ca pnl 32 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0105U,Neph ckd mult eclia tum nec,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0106T,Touch quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0107T,Vibrate quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0107U,C diff tox ag detcj ia stool,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0108T,Cool quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0108U,Gi barrett esoph 9 prtn bmrk,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0109T,Heat quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0109U,Id aspergillus dna 4 species,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0110T,Nos quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0110U,Rx mntr 1+oral onc rx&sbsts,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0111T,Rbc membranes fatty acids,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0111U,Onc colon ca kras&nras alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0112U,Iadi 16s&18s rrna genes,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0113U,Onc prst8 pca3&tmprss2-erg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0114U,Gi barretts esoph vim&ccna1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0115U,Respir iadna 18 viral&2 bact,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0116U,Rx mntr nzm ia 35+oral flu,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0117U,Pain mgmt 11 endogenous anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0118U,Trnsplj don-drv cll-fr dna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0119U,Crd ceramides liq chrom plsm,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0120U,Onc b cll lymphm mrna 58 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0121U,Sc dis vcam-1 whole blood,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0122U,Sc dis p-selectin whl blood,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0123T,Scleral fistulization,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0123U,Mchnl fragility rbc prflg,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0124U,Ftl cgen abnor 3 analytes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0125U,Ftl cgen abnor prnt comp 5,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0126T,Chd risk imt study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0126U,Ftl cgen abnor prnt comp 5 y,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0127U,Ob pe 3 analytes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0128U,Ob pe 3 analytes y chrmsm,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0129U,Hered brst ca rltd do panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0130U,Hered colon ca do mrna pnl,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0131U,Hered brst ca rltd do pnl 13,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0132U,Hered ova ca rltd do pnl 17,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0133U,Hered prst8 ca rltd do 11,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0134U,Hered pan ca mrna pnl 18 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0135U,Hered gyn ca mrna pnl 12 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0136U,Atm mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0137U,Palb2 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0138U,Brca1 brca2 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0139U,Neuro austm meas 6 c metablt,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0140U,Nfct ds fungi dna 15 trgt,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0141U,Nfct ds bact&fng gram pos,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0142U,Nfct ds bact&fng gram neg,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0145U,Drug assay 65+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0146U,Drug assay 80+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0147U,Drug assay 85+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0148U,Drug assay 100+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0149U,Drug assay 60+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0151U,Nfct bct/vir resp nfctj 33,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0152U,Nfct ds dna untrgt ngnrj seq,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0153U,Onc breast mrna 101 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0154U,Onc urthl ca rna fgfr3 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0155U,Onc brst ca dna pik3ca gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0156U,Copy number sequence alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0157U,Apc mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0158U,Mlh1 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0159U,Msh2 mrna seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0160U,Msh6 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0161U,Pms2 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0162U,Hered colon ca trgt mrna pnl,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0163U,Onc clrct scr 3 prtn alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0164U,Gi ibs ia anti-cdtb&vinculin,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0165U,Peanut allg asmt epi,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0166U,Liver ds 10 biochem asy srm,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0167U,Chornc gonadotropin hcg ia,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0168U,Ftl aneuploidy dna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0169U,Nudt15&tpmt gene com vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0170U,Neuro asd rna next gen seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0171U,Trgt gen seq alys pnl dna 23,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0172T,Lumbar spine process addl,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0172U,Onc sld tum alys brca1 brca2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0173U,Psyc gen alys panel 14 genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0174U,Onc solid tumor 30 prtn trgt,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0175U,Psyc gen alys panel 15 genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0176U,Cdtb&vinculin igg antb ia,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0177U,Onc brst ca dna pik3ca 11,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0178T,64 lead ecg w/i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0178U,Peanut allg asmt epi clin rx,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0179T,64 lead ecg w/tracing,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0179U,Onc nonsm cll lng ca alys 23,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0180U,Abo gnotyp abo 7 exons,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0181U,Co gnotyp aqp1 exon 1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0182T,Hdr elect brachytherapy,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0182U,Crom gnotyp cd55 exons 1-10,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0183U,Di gnotyp slc4a1 exon 19,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0184T,Exc rectal tumor endoscopic,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0184U,Do gnotyp art4 exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0185U,Fut1 gnotyp fut1 exon 4,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0186U,Fut2 gnotyp fut2 exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0187U,Fy gnotyp ackr1 exons 1-2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0188U,Ge gnotyp gypc exons 1-4,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0189U,Gypa gnotyp ntrns 1 5 exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0190U,Gypb gnotyp ntrns 1 5 seux 3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0191T,Insert ant segment drain int,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0191U,In gnotyp cd44 exons 2 3 6,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0192U,Jk gnotyp slc14a1 exon 9,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0193U,Jr gnotyp abcg2 exons 2-26,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0194U,Kel gnotyp kel exon 8,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0195U,Klf1 targeted sequencing,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0196U,Lu gnotyp bcam exon 3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0197U,Lw gnotyp icam4 exon 1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0198T,Ocular blood flow measure,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0198U,Rhd&rhce gntyp rhd1-10&rhce5,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0199U,Sc gnotyp ermap exons 4 12,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0200U,Xk gnotyp xk exons 1-3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0201U,Yt gnotyp ache exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0203U,Ai ibd mrna xprsn prfl 17,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0204U,Onc thyr mrna xprsn alys 593,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0205T,Inirs each vessel add-on,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0205U,Oph amd alys 3 gene variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0206T,Cptr dbs alys car elec dta,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0206U,Neuro alzheimer cell aggregj,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0207T,Clear eyelid gland w/heat,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0207U,Neuro alzheimer quan imaging,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0208U,Onc mtc mrna xprsn alys 108,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0209U,Cytog const alys interrog,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0210U,Syphilis tst antb ia quan,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0211U,Onc pan-tum dna&rna gnrj seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0212T,Compre audiometry evaluation,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0212U,Rare ds gen dna alys proband,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0213U,Rare ds gen dna alys ea comp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0214U,Rare ds xom dna alys proband,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0215T,Njx paravert w/us cer/thor,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0215U,Rare ds xom dna alys ea comp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0216U,Neuro inh ataxia dna 12 com,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0217U,Neuro inh ataxia dna 51 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0218U,Neuro musc dys dmd seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0219U,Nfct agt hiv gnrj seq alys,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0220U,Onc brst ca ai assmt 12 feat,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0221U,Abo gnotyp next gnrj seq abo,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0222U,Rhd&rhce gntyp next gnrj seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0223T,Acoustic ecg w/i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0224T,Acoustic ecg 1+ analysis,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0224U,Antibody sars-cov-2 titer(s),Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0225T,Acoustic ecg analy & reprog,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0226U,Svnt sarscov2 elisa plsm srm,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0227U,Rx asy prsmv30+rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0228T,Njx tfrml eprl w/us cer/thor,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0228U,Onc prst8 ma molec prfl alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0229T,Njx tfrml eprl w/us cer/thor,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0229U,Bcat1 promoter mthyltn alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0230U,Ar full sequence analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0231U,Cacna1a full gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0232T,Njx platelet plasma,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0232U,Cstb full gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0233T,Skin glycation spectroscopy,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0233U,Fxn gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0234U,Mecp2 full gene analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0235T,Trluml perip athrc visceral,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0235U,Pten full gene analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0236T,Trluml perip athrc abd aorta,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0236U,Smn1&smn2 full gene analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0237T,Trluml perip athrc brchiocph,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0237U,Car ion chnlpthy gen seq pnl,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0238T,Trluml perip athrc iliac art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0238U,Onc lnch syn gen dna seq aly,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0239U,Trgt gen seq alys pnl 311+,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0240T,Esoph motility 3d topography,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0241T,Esoph motility w/stim/perf,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0243T,Intm msr bronchodil wheeze,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0244T,Cont msr bronchodil wheeze,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0249T,Ligation hemorrhoid w/us,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0253T,Insert aqueous drain device,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0255T,Evasc rpr iliac art bifr s&i,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0263T,Im b1 mrw cel ther cmpl,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0264T,Im b1 mrw cel ther xcl hrvst,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0265T,Im b1 mrw cel ther hrvst onl,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0266T,Implt/rpl crtd sns dev total,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0267T,Implt/rpl crtd sns dev lead,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0268T,Implt/rpl crtd sns dev gen,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0269T,Rev/remvl crtd sns dev total,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0270T,Rev/remvl crtd sns dev lead,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0271T,Rev/remvl crtd sns dev gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0272T,Interrogate crtd sns dev,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0273T,Interrogate crtd sns w/pgrmg,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0278T,Tempr,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0282T,Periph field stimul trial,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0283T,Periph field stimul perm,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0284T,Periph field stimul revise,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0285T,Periph field stimul analys,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0286T,Near ifr spectrsc of wounds,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0288T,Anoscopy w/rf delivery,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0289T,Laser inc for pkp/lkp donor,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0290T,Laser inc for pkp/lkp recip,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0294T,Ins lt atrl mont pres lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0295T,Ext ecg complete,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0296T,Ext ecg recording,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0297T,Ext ecg scan w/report,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0298T,Ext ecg review and interp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0301T,Mw therapy for breast tumor,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0302T,Icar ischm mntrng sys compl,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0303T,Icar ischm mntrng sys eltrd,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0304T,Icar ischm mntrng sys device,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0305T,Icar ischm mntrng prgrm eval,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0306T,Icar ischm mntr interr eval,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0307T,Rmvl icar ischm mntrng dvce,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0308T,Insj ocular telescope prosth,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0310T,Motor function mapping ntms,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0311T,Cal & alys cntrl artl press,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0312T,Laps impltj nstim vagus,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0313T,Laps rmvl nstim array vagus,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0314T,Laps rmvl vgl arry&pls gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0315T,Rmvl vagus nerve pls gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0316T,Replc vagus nerve pls gen,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0317T,Elec alys vagus nrv pls gen,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0329T,Mntr io press 24hrs/> uni/bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0330T,Tear film img uni/bi w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0331T,Heart symp image plnr,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0332T,Heart symp image plnr spect,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0333T,Visual ep scr acuity auto,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0335T,Insj sinus tarsi implant,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0337T,Endothel fxnassmnt non-invas,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0341T,Quant pupillometry w/ rprt,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0342T,Thxp apheresis w/hdl delip,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0346T,Ultrasound elastography,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0348T,Rsa spine exam,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0349T,Rsa upper extr exam,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0350T,Rsa lower extr exam,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0352T,Oct brst/node i&r per spec,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0354T,Oct breast surg cavity i&r,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0355T,Gi tract capsule endoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0356T,Insrt drug device for iop,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0357T,Cryopreservation oocyte(s),Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0358T,Bia whole body,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0362T,Bhv id suprt assmt ea 15 min,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0373T,Adapt bhv tx ea 15 min,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0376T,Insert ant segment drain int,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0377T,Anoscpy inj agent for incont,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0378T,Visual field assmnt rev/rprt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0379T,Vis field assmnt tech suppt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0380T,Comp animat ret imag series,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0381T,Ext h rate epi sz 14 days,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0382T,Ext h rate sz 14 day ri only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0383T,Ext h rate sz up to 30 days,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0384T,Ex h rate sz 30 day ri only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0385T,Ex h rate for sz ovr 30 day,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0386T,Ex h rate sz 30+ day ri only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0387T,Leadless c pm ins/rpl ventr,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0388T,Leadless c pm remove ventr,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0389T,Prog eval inper leadls pm,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0390T,Periproc eval inper ledls pm,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0391T,Intergt eval inper leadls pm,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0392T,Lap es sph augment dev place,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0393T,Es sph augmnt device removal,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0394T,Hdr elctrnc skn surf brchytx,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0395T,Hdr elctr ntrst/ntrcv brchtx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0398T,Mrgfus strtctc les abltj,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0399T,Myocardial strain imaging,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0400T,Mltispectrl digital les alys,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0401T,Mltispectrl digital les alys,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0402T,Colgn cross-link crn med sep,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0403T,Diabetes prev standard curr,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0406T,Sin ndsc plmt drg elut mplnt,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0407T,Sin ndsc plmt drg elut mplnt,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0408T,Insj/rplc cardiac modulj sys,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0409T,Insj/rplc car modulj pls gn,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0412T,Rmvl cardiac modulj pls gen,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0414T,Rmvl & rpl car modulj pls gn,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0417T,Prgrmg eval cardiac modulj,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0418T,Interro eval cardiac modulj,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0419T,Dstrj neurofibroma xtnsv,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0420T,Dstrj neurofibroma xtnsv,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0421T,Waterjet prostate abltj cmpl,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0422T,Tactile breast img uni/bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0423T,Assay secretory type ii pla2,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0424T,Insj/rplc nstim apnea compl,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0425T,Insj/rplc nstim apnea sen ld,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0426T,Insj/rplc nstim apnea stm ld,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0427T,Insj/rplc nstim apnea pls gn,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0428T,Rmvl nstim apnea pls gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0429T,Rmvl nstim apnea sen ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0430T,Rmvl nstim apnea stimj ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0431T,Rmvl/rplc nstim apnea pls gn,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0432T,Repos nstim apnea stimj ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0433T,Repos nstim apnea sensing ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0434T,Interro eval npgs apnea,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0435T,Prgrmg eval npgs apnea 1 ses,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0436T,Prgrmg eval npgs apnea study,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0437T,Impltj synth rnfcmt abdl wal,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0438T,Tprnl plmt biodegrdabl matrl,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0439T,Myocrd contrast prfuj echo,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0440T,Abltj perc uxtr/perph nrv,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0441T,Abltj perc lxtr/perph nrv,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0442T,Abltj perc plex/trncl nrv,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0443T,R-t spctrl alys prst8 tiss,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0446T,Insj impltbl glucose sensor,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0447T,Rmvl impltbl glucose sensor,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0448T,Remvl insj impltbl gluc sens,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0449T,Insj aqueous drain dev 1st,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0450T,Insj aqueous drain dev each,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0453T,Insj/rplcmt mech-elec ntrfce,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0457T,Remvl mech-elec skin ntrfce,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0462T,Prgrmg eval aortic ventr sys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0463T,Interrog aortic ventr sys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0464T,Visual ep test for glaucoma,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0466T,Insj ch wal respir eltrd/ra,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0467T,Revj/rplmnt ch respir eltrd,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0468T,Rmvl ch wal respir eltrd/ra,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0469T,Rta polarize scan oc scr bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0470T,Oct skn img acquisj i&r 1st,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0471T,Oct skn img acquisj i&r addl,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0472T,Prgrmg io rta eltrd ra,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0473T,Reprgrmg io rta eltrd ra,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0474T,Insj aqueous drg dev io rsvr,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0475T,Rec ftl car sgl 3 ch i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0476T,Rec ftl car sgl elec tr data,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0477T,Rec ftl car sgl xrtj alys,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0478T,Rec ftl car 3 ch rev i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0481T,Njx autol wbc concentrate,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0482T,Absl quan myocrd bld flo pet,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0485T,Oct mid ear i&r unilateral,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0486T,Oct mid ear i&r bilateral,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0487T,Trvg biomchn mapg w/reprt,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0488T,Diabetes prev online/elec,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0489T,Regn cell tx scldr hands,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0490T,Regn cell tx scldr h mlt inj,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0497T,Xtrnl pt act ecg in-off conn,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0498T,Xtrnl pt act ecg r&i pr 30 d,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0499T,Cysto f/urtl strix/stenosis,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0500T,Hpv 5+ hi risk hpv types,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0501T,Cor ffr derived cor cta data,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0502T,Cor ffr data prep & transmis,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0503T,Cor ffr alys gnrj ffr mdl,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0504T,Cor ffr data review i&r,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0505T,Ev fempop artl revsc,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0506T,Mac pgmt opt dns meas hfp,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0507T,Near ifr 2img mibmn glnd i&r,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0508T,Pls echo us b1 dns meas tib,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0509T,Pattern erg w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0510T,Rmvl sinus tarsi implant,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0511T,Rmvl&rinsj sinus tarsi implt,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0514T,Intraop vis axis id pt fixj,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0515T,Insj wcs lv compl sys,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0517T,Insj wcs lv pg compnt,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0518T,Rmvl pg compnt wcs,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0519T,Rmvl & rplcmt pg compnt wcs,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0520T,Rmvl&rplcmt pg wcs new eltrd,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0521T,Interrog dev eval wcs ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0522T,Prgrmg dev eval wcs ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0525T,Insj/rplcmt compl iims,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0527T,Insj/rplcmt iims implt mntr,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0528T,Prgrmg dev eval iims ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0529T,Interrog dev eval iims ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0530T,Removal complete iims,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0532T,Removal iims implt mntr only,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0533T,Cont rec mvmt do 6-10 days,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0534T,Cont rec mvmt do setup&train,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0535T,Cont rec mvmt do reprt cnfig,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0536T,Cont rec mvmt do dl w/i&r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0541T,Myocardial imaging mcg,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0542T,Myocardial imaging mcg i&r,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0546T,Rf spectrsc ntraop mrgn asmt,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0547T,B1 matrl qual tst mcrind tib,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0548T,Tprnl balo cntnc dev bi,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0549T,Tprnl balo cntnc dev uni,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0550T,Tprnl balo cntnc dev rmvl ea,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0551T,Tprnl balo cntnc dev adjmt,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0552T,Low-level laser therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0553T,Perq tcat iliac anast implt,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0554T,B1 str & fx rsk analysis,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0556T,B1 str & fx rsk assessment,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0558T,Ct scan f/biomchn ct alys,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0563T,Evac meibomian glnd heat bi,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0564T,Onc chemo rx cytotox csc 14,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0566T,Autol cell implt adps njx,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0568T,Intro mix saline&air f/ssg,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0571T,Insj/rplcmt icds ss eltrd,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0575T,Prgrmg dev eval icds ss ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0576T,Interrog dev eval icds ss ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0577T,Ephys eval icds ss,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0578T,Rem interrog dev icds phys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0579T,Rem interrog dev icds tech,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0581T,Abltj mal brst tum perq crtx,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0582T,Trurl abltj mal prst8 tiss,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0583T,Tmpst auto tube dlvr sys,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0587T,Perq impltj/rplcmt isdns ptn,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0588T,Revision/removal isdns ptn,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0589T,Elec alys smpl prgrmg iins,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0590T,Elec alys cplx prgrmg iins,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0591T,Hlth&wb coaching indiv 1st,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0592T,Hlth&wb coaching indiv f-up,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0593T,Hlth&wb coaching group,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0596T,Temp fml iu vlv-pmp 1st insj,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0597T,Temp fml iu valve-pmp rplcmt,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0602T,Transdermal gfr measurements,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0603T,Transdermal gfr monitoring,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0604T,Rem oct rta dev setup&educaj,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0605T,Rem oct rta techl sprt min 8,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0607T,Rem mntr pulm flu mntr setup,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0608T,Rem mntr pulm flu mntr alys,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0609T,Mrs disc pain acquisj data,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0610T,Mrs disc pain transmis data,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0611T,Mrs disc pain alg alys data,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0614T,Rmvl&rplcmt ss impl dfb pg,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0615T,Eye mvmt alys w/o calbrj i&r,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0616T,Insertion of iris prosthesis,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0617T,Insj iris prosth w/rmvl&insj,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0618T,Insj iris prosth sec io lens,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0619T,Cysto w/prst8 commissurotomy,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0620T,Evasc ven artlz tibl/prnl vn,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0621T,Trabeculostomy interno laser,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0622T,Trabeculostomy int lsr w/scp,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0623T,Auto quantification c plaque,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0632T,Perq tcat us abltj nrv p-art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,0633T,Ct breast w/3d uni c-,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0634T,Ct breast w/3d uni c+,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0635T,Ct breast w/3d uni c-/c+,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0636T,Ct breast w/3d bi c-,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0637T,Ct breast w/3d bi c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0638T,Ct breast w/3d bi c-/c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,0639T,Wrls skn snr anisotropy meas,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C1762,"Conn tiss, human(inc fascia)",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C1763,"Conn tiss, non-human",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C1849,"Skin substitute, synthetic",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C1878,Matrl for vocal cord,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C2615,"Sealant, pulmonary, liquid",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8900,"Mra w/cont, abd",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8901,"Mra w/o cont, abd",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8902,"Mra w/o fol w/cont, abd",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8903,"Mri w/cont, breast, uni",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8904,"Mri w/o cont, breast, uni",Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8905,"Mri w/o fol w/cont, brst, un",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8906,"Mri w/cont, breast, bi",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8907,"Mri w/o cont, breast, bi",Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8908,"Mri w/o fol w/cont, breast,",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8909,"Mra w/cont, chest",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8910,"Mra w/o cont, chest",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8911,"Mra w/o fol w/cont, chest",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8912,"Mra w/cont, lwr ext",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8913,"Mra w/o cont, lwr ext",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8914,"Mra w/o fol w/cont, lwr ext",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8918,"Mra w/cont, pelvis",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8919,"Mra w/o cont, pelvis",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8920,"Mra w/o fol w/cont, pelvis",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8921,"Tte w or w/o fol w/cont, com",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8922,"Tte w or w/o fol w/cont, f/u",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8923,"2d tte w or w/o fol w/con,co",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8924,"2d tte w or w/o fol w/con,fu",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8925,"2d tee w or w/o fol w/con,in",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8926,"Tee w or w/o fol w/cont,cong",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8927,"Tee w or w/o fol w/cont, mon",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8928,"Tte w or w/o fol w/con,stres",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8929,"Tte w or wo fol wcon,doppler",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8930,"Tte w or w/o contr, cont ecg",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8931,"Mra, w/dye, spinal canal",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8932,"Mra, w/o dye, spinal canal",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8933,"Mra, w/o&w/dye, spinal canal",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8934,"Mra, w/dye, upper extremity",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8935,"Mra, w/o dye, upper extr",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8936,"Mra, w/o&w/dye, upper extr",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C8957,"Prolonged iv inf, req pump",General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9014,"Injection, cerliponase alfa",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9015,"C-1 esterase, haegarda",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9016,"Inj, triptorelin ext rel",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9024,"Inj, daunorubicin-cytarabine",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9025,"Injection, ramucirumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9026,"Injection, vedolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9027,"Injection, pembrolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9028,Inj. inotuzumab ozogamicin,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9029,"Injection, guselkumab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9030,Inj copanlisib,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9031,"Lutetium Lu 177 dotatate, tx",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9032,Voretigene neparvovec-rzyl,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9033,"Inj, akynzeo",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9034,"Injection, dexamethasone 9%",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9035,"Injection, Aristada Initio",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9036,"Injection, patisiran",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9037,"Injection, risperidone",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9038,Inj mogamulizumab-kpkc,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9040,"Injection, fremanezumab-vfrm",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9041,"Inj, coagulation factor xa",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9042,"Inj., belrapzo 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9043,"Injection, levoleucovorin",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9044,"Injection, cemiplimab-rwlc",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9045,Moxetumomab pasudotox-tdfk,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9047,"Injection, caplacizumab-yhdp",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9048,Dexamethasone ophth insert,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9049,"Injection, tagraxofusp-erzs",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9050,"Injection, emapalumab-lzsg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9051,"Injection, omadacycline",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9052,"Injection, ravulizumab-cwv",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9053,"Inj, crizanlizumab-tmca",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9054,"Injection, lefamulin",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9055,"Inj, brexanolone",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9056,"Injection, givosiran",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9057,Inj cetirizine hydrochloride,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9058,"Injection,pegfilgrastim-bmez",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9059,"Injection, meloxicam",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9061,"Injection, teprotumumab-trbw",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9062,Daratumumab hyaluronidase,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9063,"Injection, eptinezumab-jjmr",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9064,Mitomycin pyelocalyceal inst,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9065,Romidepsin non-lyophilized,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9066,Sacituzumab govitecan-hziy,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9069,Belantamab mafodontin-blmf,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9070,"Injection, tafasitamab-cxix",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9071,"Injection, viltolarsen",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9072,"Inj, imm glob asceniv",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9121,"Injection, argatroban",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9122,Mometasone furoate (sinuva),Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9132,"Kcentra, per i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9137,Adynovate Factor VIII recom,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9138,Nuwiq Factor VIII recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9139,"Idelvion, 1 i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9140,Afstyla factor viii recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9141,Factor viii pegylated-aucl,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9248,"Inj, clevidipine butyrate",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9250,Artiss fibrin sealant,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9257,Bevacizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9293,"Injection, glucarpidase",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9349,"Puraply, puraply antimic",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9352,"Neuragen nerve guide, per cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9353,"Neurawrap nerve protector,cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9354,"Veritas collagen matrix, cm2",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9355,"Neuromatrix nerve cuff, cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9356,"Tenoglide tendon prot, cm2",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9358,"Surgimend, fetal",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9359,"Implnt,bon void filler-putty",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9360,"Surgimend, neonatal",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9361,Neuromend nerve wrap,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9362,"Implnt,bon void filler-strip",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9363,Integra meshed bil wound mat,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9364,"Porcine implant, permacol",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9408,"Iodine i-131 iobenguane, tx",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9442,"Injection, belinostat",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9443,"Injection, dalbavancin",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9444,"Injection, oritavancin",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9445,"C-1 esterase, Ruconest",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9446,"Inj, tedizolid phosphate",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9447,"Inj, phenylephrine ketorolac",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9448,Oral netupitant palonosetron,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9449,"Inj, blinatumomab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9450,Fluocinolone acetonide implt,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9451,"Injection, peramivir",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9452,"Inj, ceftolozane/tazobactam",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9453,"Injection, nivolumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9454,"Inj, pasireotide long acting",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9455,"Injection, siltuximab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9456,"Inj, isavuconazonium sulfate",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9460,"Injection, cangrelor",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9465,"Injection, Durolane",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9466,"Injection, benralizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9467,Inj rituximab hyaluronidase,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9468,"Inj, factor ix, Rebinyn",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9469,Inj triamcinolone acetonide,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9470,Aripiprazole lauroxil im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9471,"Hymovis, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9472,Inj talimogene laherparepvec,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9473,"Injection, mepolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9474,"Inj, irinotecan liposome",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9475,"Injection, necitumumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9476,"Injection, daratumumab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9477,"Injection, elotuzumab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9478,"Injection, sebelipase alfa",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9480,"Injection, trabectedin",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9481,"Injection, reslizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9482,Sotalol hydrochloride iv,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9483,"Injection, atezolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9484,"Injection, eteplirsen",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9485,"Injection, olaratumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9487,"Ustekinumab IV inj, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9488,Conivaptan hcl,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9489,"Injection, nusinersen",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9490,"Injection, bezlotoxumab",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9491,"Injection, avelumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9492,"Injection, durvalumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9493,"Injection, edaravone",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9494,"Injection, ocrelizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9497,"Loxapine, inhalation powder",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9600,Perc drug-el cor stent sing,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9601,Perc drug-el cor stent bran,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9602,Perc d-e cor stent ather s,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9603,Perc d-e cor stent ather br,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9604,Perc d-e cor revasc t cabg s,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9605,Perc d-e cor revasc t cabg b,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9606,Perc d-e cor revasc w ami s,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9607,Perc d-e cor revasc chro sin,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9608,Perc d-e cor revasc chro add,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9724,Eps stomach plic,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9726,Rxt breast appl place/remov,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9728,"Place device/marker, non pro",Therapeutic Radiology,Per Unit,$68.45 ,OP,$68.45 ,$68.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9734,"U/s trtmt, not leiomyomata",General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9737,Lap esoph augmentation,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9739,Cystoscopy prostatic imp 1-3,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9740,Cysto impl 4 or more,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9741,Impl pressure sensor w/angio,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9742,Laryngoscopy with injection,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9743,Bulking/spacer material impl,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9744,Abd us w/contrast,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9745,Nasal endo eustachian tube,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9747,"Ablation, hifu, prostate",Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9749,Repair nasal stenosis w/imp,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9750,Ins/rem-replace compl iims,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9762,Cardiac mri seg dys strain,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9763,Cardiac mri seg dys stress,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9765,Revasc intra lithotrip-stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9767,Revasc lithotrip-stent-ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9768,Endo us-guide hep porto grad,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,C9769,Cysto w/temp pros implant,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9770,"Vitrec/mech pars, subret inj",Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9771,Nsl/sins cryo post nasal tis,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9772,Revasc lithotrip tibi/perone,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9773,Revasc lithotr-stent tib/per,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9774,Revasc lithotr-ather tib/per,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9775,Revasc lith-sten-ath tib/per,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,C9803,Hopd covid-19 spec collect,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0120,Periodic oral evaluation,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0140,Limit oral eval problm focus,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0145,"Oral evaluation, pt < 3yrs",Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0150,Comprehensve oral evaluation,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0160,Extensv oral eval prob focus,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0170,"Re-eval,est pt,problem focus",Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0171,Re-eval post-op visit,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0180,Comp periodontal evaluation,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0190,Screening of a patient,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0191,Assessment of a patient,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0210,Intraor complete film series,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0220,Intraoral periapical first,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0230,Intraoral periapical ea add,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0240,Intraoral occlusal film,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0250,Extraoral 2d project image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0251,Extraoral posterior image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0260,Extraoral ea additional film,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0270,Dental bitewing single image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0272,Dental bitewings two images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0273,Bitewings - three images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0274,Bitewings four images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0277,Vert bitewings 7 to 8 images,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0290,Skull/facial bone image,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0310,Dental saliography,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0320,Dental tmj arthrogram incl i,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0321,Other tmj images by report,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0322,Dental tomographic survey,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0330,Panoramic image,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0340,2d cephalometric image,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0350,Oral/facial photo images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0351,3d photographic image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0364,Cone beam ct capt & interp,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0365,Cone beam ct interprete man,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0366,Cone beam ct interprete max,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0367,Cone beam ct interp both jaw,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0368,Cone beam ct interprete tmj,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0369,Max mri capture & interprete,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0370,Max ultrasound capt & interp,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0371,Sialoendoscopy capt & interp,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0380,Cone beam ct capture limited,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0381,Cone beam ct capt mandible,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0382,Cone beam ct capt maxilla,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0383,Cone beam ct both jaws,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0384,Cone beam ct capture tmj,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0385,Max mri image capture,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0386,Max ultrasound image capture,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0391,Imterprete diagnostic image,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0393,Trtmnt simulation 3d image,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0394,Digital sub 2 or more images,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0395,Fusion 2 or more 3d images,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0411,Hba1c in office testing,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0412,Blood glucose level test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0414,Lab process microbial spec,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0415,Collection of microorganisms,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0416,Viral culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0418,Analysis of saliva sample,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0419,Assess of salivary flow,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0421,Gen tst suscept oral disease,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0422,Collect & prep genetic samp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0423,Genetic test spec analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0425,Caries susceptibility test,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0431,Diag tst detect mucos abnorm,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0460,Pulp vitality test,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0470,Diagnostic casts,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0472,"Gross exam, prep & report",Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0473,"Micro exam, prep & report",Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0474,Micro w exam of surg margins,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0475,Decalcification procedure,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0476,Spec stains for microorganis,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0477,Spec stains not for microorg,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0478,Immunohistochemical stains,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0479,Tissue in-situ hybridization,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0480,Cytopath smear prep & report,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0481,Electron microscopy,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0482,Direct immunofluorescence,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0483,Indirect immunofluorescence,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0484,Consult slides prep elsewher,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0485,Consult inc prep of slides,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0486,Access of transep cytol samp,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0502,Other oral pathology procedu,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0600,Non-ionizing diag proc,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0601,Caries risk assess low risk,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0602,Caries risk assess mod risk,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0603,Caries risk assess high risk,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0604,Antigen test pub hlth pathog,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0605,Antibody test pub hlth path,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0701,Pano radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0702,2d cephal radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0703,2d oral/facial photo image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0704,3d photo image capture only,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0705,Extra oral post radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0706,Intraoral occlus radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0707,Intraoral periap radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0708,Intraoral bite radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0709,Intraoral cmplt radio images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D0999,Unspecified diagnostic proce,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1110,Dental prophylaxis adult,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1120,Dental prophylaxis child,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1206,Topical fluoride varnish,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1208,Topical app fluorid ex vrnsh,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1310,Nutri counsel-control caries,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1320,Tobacco counseling,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1321,Couns for high risk sub use,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1330,Oral hygiene instruction,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1351,Dental sealant per tooth,Dental,Per Unit,$24.50 ,OP,$24.50 ,$24.50 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1352,"Prev resin rest, perm tooth",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1353,Sealant repair per tooth,Dental,Per Unit,$24.50 ,OP,$24.50 ,$24.50 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1354,Int caries med app per tooth,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1355,Caries med app per tooth,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1510,Space maintainer fxd unilat,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1515,Fixed bilat space maintainer,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1516,"Fixed bilat space maint, max",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1517,"Fixed bilat space maint, man",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1520,Remove unilat space maintain,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1525,Remove bilat space maintain,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1526,"Remove bilat space main, max",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1527,"Remove bilat space main, man",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1550,Recement space maintainer,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1551,Recement space maint - max,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1552,Recement space maint - man,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1553,Recement unilat space maint,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1555,Remove fix space maintainer,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1556,Rem fixed unilat space maint,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1557,Remove fixed bilat maint max,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1558,Remove fixed bilat man,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1575,"Dist space maint, fixed unil",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D1999,Unspecified preventive proc,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2140,Amalgam one surface permanen,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2150,Amalgam two surfaces permane,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2160,Amalgam three surfaces perma,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2161,Amalgam 4 or > surfaces perm,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2330,Resin one surface-anterior,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2331,Resin two surfaces-anterior,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2332,Resin three surfaces-anterio,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2335,Resin 4/> surf or w incis an,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2390,Ant resin-based cmpst crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2391,Post 1 srfc resinbased cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2392,Post 2 srfc resinbased cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2393,Post 3 srfc resinbased cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2394,Post >=4srfc resinbase cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2410,Dental gold foil one surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2420,Dental gold foil two surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2430,Dental gold foil three surfa,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2510,Dental inlay metalic 1 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2520,Dental inlay metallic 2 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2530,Dental inlay metl 3/more sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2542,Dental onlay metallic 2 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2543,Dental onlay metallic 3 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2544,Dental onlay metl 4/more sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2610,Inlay porcelain/ceramic 1 su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2620,Inlay porcelain/ceramic 2 su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2630,Dental onlay porc 3/more sur,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2642,Dental onlay porcelin 2 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2643,Dental onlay porcelin 3 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2644,Dental onlay porc 4/more sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2650,Inlay composite/resin one su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2651,Inlay composite/resin two su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2652,Dental inlay resin 3/mre sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2662,Dental onlay resin 2 surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2663,Dental onlay resin 3 surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2664,Dental onlay resin 4/mre sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2710,Crown resin-based indirect,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2712,Crown 3/4 resin-based compos,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2720,Crown resin w/ high noble me,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2721,Crown resin w/ base metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2722,Crown resin w/ noble metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2740,Crown porcelain/ceramic,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2750,Crown porcelain w/ h noble m,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2751,Crown porcelain fused base m,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2752,Crown porcelain w/ noble met,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2753,Crown porc fused to titanium,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2780,Crown 3/4 cast hi noble met,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2781,Crown 3/4 cast base metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2782,Crown 3/4 cast noble metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2783,Crown 3/4 porcelain/ceramic,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2790,Crown full cast high noble m,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2791,Crown full cast base metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2792,Crown full cast noble metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2794,Crown-titanium,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2799,Provisional crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2910,Recement inlay onlay or part,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2915,Recement cast or prefab post,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2920,Re-cement or re-bond crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2921,Reattach tooth fragment,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2928,Prefab porc/cer crown perm,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2929,Prefab porc/ceram crown pri,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2930,Prefab stnlss steel crwn pri,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2931,Prefab stnlss steel crown pe,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2932,Prefabricated resin crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2933,Prefab stainless steel crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2934,Prefab steel crown primary,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2941,Int therapeutic restoration,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2950,Core build-up incl any pins,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2951,Tooth pin retention,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2952,Post and core cast + crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2953,Each addtnl cast post,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2954,Prefab post/core + crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2955,Post removal,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2957,Each addtnl prefab post,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,D2960,Labial veneer resin direct,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2961,Labial veneer resin indirect,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2962,Labial veneer porc indirect,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2970,Temp crown (fractured tooth),Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2971,Add proc construct new crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2975,Coping,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2980,Crown repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2981,Inlay repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2982,Onlay repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2983,Veneer repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2990,Resin infiltration of lesion,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D2999,Dental unspec restorative pr,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3110,Pulp cap direct,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3120,Pulp cap indirect,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3220,Therapeutic pulpotomy,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3221,Gross pulpal debridement,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3222,Part pulp for apexogenesis,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3230,Pulpal therapy anterior prim,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3240,Pulpal therapy posterior pri,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3310,"End thxpy, anterior tooth",Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3320,"End thxpy, premolar tooth",Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3330,"End thxpy, molar tooth",Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3331,Non-surg tx root canal obs,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3332,Incomplete endodontic tx,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3333,Internal root repair,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3346,Retreat root canal anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3347,Retreat root canal premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3348,Retreat root canal molar,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3351,Apexification/recalc initial,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3352,Apexification/recalc interim,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3353,Apexification/recalc final,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3355,Pulpal regeneration initial,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3356,Pulpal regeneration interim,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3357,Pulpal regeneration complete,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3410,Apicoectomy - anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3421,Root surgery premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3425,Root surgery molar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3426,Root surgery ea add root,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3427,Periradicular surgery,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3428,Bone graft peri per tooth,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3429,Bone graft peri each addl,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3430,Retrograde filling,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3431,Biological materials,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3432,Guided tissue regeneration,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3450,Root amputation,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3460,Endodontic endosseous implan,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3470,Intentional replantation,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3471,Surg rep root res anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3472,Surg rep root res premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3473,Surg rep root res molar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3501,Surg exp root surf anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3502,Surg exp root surf premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3503,Surg exp root surf molar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3910,Isolation- tooth w rubb dam,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3920,Tooth splitting,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3950,Canal prep/fitting of dowel,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D3999,Endodontic procedure,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4210,Gingivectomy/plasty 4 or mor,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4211,Gingivectomy/plasty 1 to 3,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4212,Gingivectomy/plasty rest,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4230,Ana crown exp 4 or> per quad,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4231,Ana crown exp 1-3 per quad,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4240,Gingival flap proc w/ planin,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4241,Gngvl flap w rootplan 1-3 th,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4245,Apically positioned flap,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4249,Crown lengthen hard tissue,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4260,Osseous surgery 4 or more,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4261,Osseous surg 1 to 3 teeth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4263,Bone replce graft first site,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4264,Bone replce graft each add,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4265,Bio mtrls to aid soft/os reg,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4266,Guided tiss regen resorble,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4267,Guided tiss regen nonresorb,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4268,Surgical revision procedure,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4270,Pedicle soft tissue graft pr,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4273,Auto tissue graft 1st tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4274,Mesial/distal wedge proc,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4275,Non-auto graft 1st tooth,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4276,Con tissue w dble ped graft,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4277,Soft tissue graft firsttooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4278,Soft tissue graft addl tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4283,Auto tissue graft addl tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4285,Non-auto graft addl tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4320,Provision splnt intracoronal,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4321,Provisional splint extracoro,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4341,Periodontal scaling & root,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4342,Periodontal scaling 1-3teeth,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4346,Scaling gingiv inflammation,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4355,Full mouth debridement,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4381,Localized delivery antimicro,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4910,Periodontal maint procedures,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4920,Unscheduled dressing change,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4921,Gingival irrigation per quad,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D4999,Unspecified periodontal proc,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5110,Dentures complete maxillary,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5120,Dentures complete mandible,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5130,Dentures immediat maxillary,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5140,Dentures immediat mandible,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5211,Dentures maxill part resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5212,Dentures mand part resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5213,Dentures maxill part metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5214,Dentures mandibl part metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5221,Immed max part denture resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5222,Immed man part denture resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5223,Immed max part dent metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5224,Immed mand part dent metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5225,Maxillary part denture flex,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5226,Mandibular part denture flex,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5281,Removable partial denture,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5282,"Remove unil part denture,max",Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5283,"Remove unil part denture,man",Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5284,Rem unilat dent flex base,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5286,Rem unilat dent 1 pc resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5410,Dentures adjust cmplt maxil,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5411,Dentures adjust cmplt mand,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5421,Dentures adjust part maxill,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5422,Dentures adjust part mandbl,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5510,Dentur repr broken compl bas,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5511,Rep broke comp dent base man,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5512,Rep broke comp dent base max,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5520,Replace denture teeth complt,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5610,Dentures repair resin base,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5611,Rep resin part dent base man,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5612,Rep resin part dent base max,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5620,Rep part denture cast frame,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5621,Rep cast part frame man,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5622,Rep cast part frame max,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5630,Rep partial denture clasp,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5640,Replace part denture teeth,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5650,Add tooth to partial denture,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5660,Add clasp to partial denture,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5670,Replc tth&acrlc on mtl frmwk,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5671,Replc tth&acrlc mandibular,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5710,Dentures rebase cmplt maxil,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5711,Dentures rebase cmplt mand,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5720,Dentures rebase part maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5721,Dentures rebase part mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5730,Denture reln cmplt max dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5731,Denture reln cmplt mand dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5740,Denture reln part max dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5741,Denture reln part mand dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5750,Denture reln cmplt max indir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5751,Denture reln cmplt mand ind,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5760,Denture reln part max indir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5761,Denture reln part mand indir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5810,Denture interm cmplt maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5811,Denture interm cmplt mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5820,Denture interm part maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5821,Denture interm part mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5850,Denture tiss conditn maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5851,Denture tiss condtin mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5862,Precision attachment,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5863,Overdenture complete max,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5864,Overdenture partial max,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5865,Overdenture complete mandib,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5866,Overdenture partial mandib,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5867,Replacement of precision att,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5875,Prosthesis modification,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5876,Add metal sub to acrylc dent,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5899,Removable prosthodontic proc,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5911,Facial moulage sectional,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5912,Facial moulage complete,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5913,Nasal prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5914,Auricular prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5915,Orbital prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5916,Ocular prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5919,Facial prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5922,Nasal septal prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5923,Ocular prosthesis interim,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5924,Cranial prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5925,Facial augmentation implant,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5926,Replacement nasal prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5927,Auricular replacement,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5928,Orbital replacement,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5929,Facial replacement,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5931,Surgical obturator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5932,Postsurgical obturator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5933,Refitting of obturator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5934,Mandibular flange prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5935,Mandibular denture prosth,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5936,Temp obturator prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5937,Trismus appliance,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5951,Feeding aid,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5952,Pediatric speech aid,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5953,Adult speech aid,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5954,Superimposed prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5955,Palatal lift prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5958,Intraoral con def inter plt,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5959,Intraoral con def mod palat,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5960,Modify speech aid prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5982,Surgical stent,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5983,Radiation applicator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5984,Radiation shield,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5985,Radiation cone locator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5986,Fluoride applicator,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5987,Commissure splint,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5988,Surgical splint,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5991,Vesiculobullous disease carr,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5992,Adjust max prost appliance,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5993,Main/clean max prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5994,Peridontal medicament,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5995,"Peri medicament w/seal, max",Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5996,"Peri medicament w/seal, mand",Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D5999,Maxillofacial prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6010,Odontics endosteal implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6011,Second stage implant surgery,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6012,Endosteal implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6013,Surgical place mini implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6040,Odontics eposteal implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6050,Odontics transosteal implnt,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6051,Interim abutment,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6055,Implant connecting bar,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6056,Prefabricated abutment,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6057,Custom abutment,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6058,Abutment supported crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6059,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6060,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6061,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6062,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6063,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6064,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6065,Implant supported crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6066,Implant supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6067,Implant supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6068,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6069,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6070,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6071,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6072,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6073,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6074,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6075,Implant supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6076,Implant supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6077,Implant supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6080,Implant maintenance,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6081,"Scale & debride, single imp",Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6082,Imp crown porc to base alloy,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6083,Imp crown porc to noble allo,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6084,Imp crown porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6085,Provisional implant crown,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6086,Imp crown base alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6087,Implant crown noble alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6088,Imp crown titanium alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6090,Repair implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6091,Repl semi/precision attach,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6092,Recement supp crown,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6093,Recement supp part denture,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6094,Abut support crown titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6095,Odontics repr abutment,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6096,Remove broken imp ret screw,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6097,Abut crown porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6098,Imp retain porc to base allo,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6099,Imp retainer for fpd,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6100,Removal of implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6101,Debridement of a periimplant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6102,Debridement & contouring,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6103,Bone graft repair perimplant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6104,Bone graft time of implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6110,Implnt/abut remov dent max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6111,Implnt/abut remov dent mand,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6112,Imp/abut rem dent part max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6113,Imp/abut rem dent part mand,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6114,Implnt/abut fixed dent max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6115,Implnt/abut fixed dent mand,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6116,Imp/abut fixed dent part max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6117,Imp/abut fixed dent part man,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6118,Imp/abut int fixed dent man,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6119,Int/abut int fixed dent max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6120,Imp retain porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6121,Retain metal fpd base alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6122,Retain metal fpd noble alloy,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6123,Retain metal fpd titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6190,Radio/surgical implant index,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6191,Semi precision abutment,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6192,Semi precision attachment,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6194,Abut support retainer titani,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6195,Abut retain porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6199,Implant procedure,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6205,Pontic-indirect resin based,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6210,Prosthodont high noble metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6211,Bridge base metal cast,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6212,Bridge noble metal cast,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6214,Pontic titanium,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6240,Bridge porcelain high noble,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6241,Bridge porcelain base metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6242,Bridge porcelain nobel metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6243,Pontic porcelain to titanium,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6245,Bridge porcelain/ceramic,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6250,Bridge resin w/high noble,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6251,Bridge resin base metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6252,Bridge resin w/noble metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6253,Provisional pontic,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6545,Dental retainr cast metl,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6548,Porcelain/ceramic retainer,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6549,Resin retainer,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6600,Porcelain/ceramic inlay 2srf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6601,Porc/ceram inlay >= 3 surfac,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6602,Cst hgh nble mtl inlay 2 srf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6603,Cst hgh nble mtl inlay >=3sr,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6604,Cst bse mtl inlay 2 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6605,Cst bse mtl inlay >= 3 surfa,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6606,Cast noble metal inlay 2 sur,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6607,Cst noble mtl inlay >=3 surf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6608,Onlay porc/crmc 2 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6609,Onlay porc/crmc >=3 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6610,Onlay cst hgh nbl mtl 2 srfc,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6611,Onlay cst hgh nbl mtl >=3srf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6612,Onlay cst base mtl 2 surface,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6613,Onlay cst base mtl >=3 surfa,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6614,Onlay cst nbl mtl 2 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6615,Onlay cst nbl mtl >=3 surfac,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6624,Inlay titanium,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6634,Onlay titanium,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6710,Crown-indirect resin based,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6720,Retain crown resin w hi nble,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6721,Crown resin w/base metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6722,Crown resin w/noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6740,Crown porcelain/ceramic,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6750,Crown porcelain high noble,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6751,Crown porcelain base metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6752,Crown porcelain noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6753,Retain crown porc to titaniu,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6780,Crown 3/4 high noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6781,Crown 3/4 cast based metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6782,Crown 3/4 cast noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6783,Crown 3/4 porcelain/ceramic,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6784,Retainer crown 3/4 titanium,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6790,Crown full high noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6791,Crown full base metal cast,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6792,Crown full noble metal cast,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6793,Provisional retainer crown,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6794,Crown titanium,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6920,Dental connector bar,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6930,Recement/bond part denture,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6940,Stress breaker,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6950,Precision attachment,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6980,Fixed partial repair,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6985,Pediatric partial denture fx,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D6999,Fixed prosthodontic proc,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7111,Extraction coronal remnants,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7140,Extraction erupted tooth/exr,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7210,Rem imp tooth w mucoper flp,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7220,Impact tooth remov soft tiss,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7230,Impact tooth remov part bony,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7240,Impact tooth remov comp bony,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7241,Impact tooth rem bony w/comp,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7250,Tooth root removal,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7251,Coronectomy,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7260,Oral antral fistula closure,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7261,Primary closure sinus perf,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7270,Tooth reimplantation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7272,Tooth transplantation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7280,Exposure of unerupted tooth,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7282,Mobilize erupted/malpos toot,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7283,Place device impacted tooth,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7285,Biopsy of oral tissue hard,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7286,Biopsy of oral tissue soft,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7287,Exfoliative cytolog collect,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7288,Brush biopsy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7290,Repositioning of teeth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7291,Transseptal fiberotomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7292,Screw retained plate,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7293,Temp anchorage dev w flap,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7294,Temp anchorage dev w/o flap,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7295,"Bone harvest,auto graft proc",Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7296,"Corticotomy, 1-3 teeth",Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7297,"Corticotomy, 4 or more teeth",Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7310,Alveoplasty w/ extraction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7311,Alveoloplasty w/extract 1-3,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7320,Alveoplasty w/o extraction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7321,Alveoloplasty not w/extracts,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7340,Vestibuloplasty ridge extens,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7350,Vestibuloplasty exten graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7410,Rad exc lesion up to 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7411,Excision benign lesion>1.25c,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7412,Excision benign lesion compl,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7413,Excision malig lesion<=1.25c,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7414,Excision malig lesion>1.25cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7415,Excision malig les complicat,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7440,Malig tumor exc to 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7441,Malig tumor > 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7450,Rem odontogen cyst to 1.25cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7451,Rem odontogen cyst > 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7460,Rem nonodonto cyst to 1.25cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7461,Rem nonodonto cyst > 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7465,Lesion destruction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7471,Rem exostosis any site,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7472,Removal of torus palatinus,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7473,Remove torus mandibularis,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7485,Surg reduct osseoustuberosit,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7490,Maxilla or mandible resectio,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7510,I&d absc intraoral soft tiss,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7511,Incision/drain abscess intra,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7520,I&d abscess extraoral,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7521,Incision/drain abscess extra,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7530,Removal fb skin/areolar tiss,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7540,Removal of fb reaction,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7550,Removal of sloughed off bone,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7560,Maxillary sinusotomy,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7610,Maxilla open reduct simple,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7620,Clsd reduct simpl maxilla fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7630,Open red simpl mandible fx,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7640,Clsd red simpl mandible fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7650,Open red simp malar/zygom fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7660,Clsd red simp malar/zygom fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7670,Closd rductn splint alveolus,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7671,Alveolus open reduction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7680,Reduct simple facial bone fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7710,Maxilla open reduct compound,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7720,Clsd reduct compd maxilla fx,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7730,Open reduct compd mandble fx,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7740,Clsd reduct compd mandble fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7750,Open red comp malar/zygma fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7760,Clsd red comp malar/zygma fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7770,Open reduc compd alveolus fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7771,Alveolus clsd reduc stblz te,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7780,Reduct compnd facial bone fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7810,Tmj open reduct-dislocation,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7820,Closed tmp manipulation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7830,Tmj manipulation under anest,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7840,Removal of tmj condyle,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7850,Tmj meniscectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7852,Tmj repair of joint disc,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7854,Tmj excisn of joint membrane,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7856,Tmj cutting of a muscle,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7858,Tmj reconstruction,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7860,Tmj cutting into joint,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7865,Tmj reshaping components,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7870,Tmj aspiration joint fluid,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7871,Lysis + lavage w catheters,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7872,Tmj diagnostic arthroscopy,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7873,Tmj arthroscopy lysis adhesn,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7874,Tmj arthroscopy disc reposit,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7875,Tmj arthroscopy synovectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7876,Tmj arthroscopy discectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7877,Tmj arthroscopy debridement,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7880,Occlusal orthotic appliance,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7881,Occ orthotic device adjust,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7899,Tmj unspecified therapy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7910,Dent sutur recent wnd to 5cm,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7911,Dental suture wound to 5 cm,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7912,Suture complicate wnd > 5 cm,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7920,Dental skin graft,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7921,Collect & appl blood product,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7922,Place intra-socket bio dress,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7940,Reshaping bone orthognathic,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7941,Bone cutting ramus closed,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7943,Cutting ramus open w/graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7944,Bone cutting segmented,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7945,Bone cutting body mandible,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7946,Reconstruction maxilla total,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7947,Reconstruct maxilla segment,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7948,Reconstruct midface no graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7949,Reconstruct midface w/graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7950,Mandible graft,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7951,Sinus aug w bone or bone sub,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7952,Sinus augmentation vertical,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7953,Bone replacement graft,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7955,Repair maxillofacial defects,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7960,Frenulectomy/frenectomy,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7961,Buccal/labial frenectomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7962,Lingual frenectomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7963,Frenuloplasty,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7970,Excision hyperplastic tissue,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7971,Excision pericoronal gingiva,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7972,Surg redct fibrous tuberosit,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7979,Non-surgical sialolithotomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7980,Surgical sialolithotomy,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7981,Excision of salivary gland,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7982,Sialodochoplasty,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7983,Closure of salivary fistula,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7990,Emergency tracheotomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7991,Dental coronoidectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7993,Surg place craniofacial impl,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7994,Surg place zygomatic impl,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7995,Synthetic graft facial bones,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7996,Implant mandible for augment,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7997,Appliance removal,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7998,Intraoral place of fix dev,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D7999,Oral surgery procedure,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8010,Limited dental tx primary,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8020,Limited dental tx transition,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8030,Limited dental tx adolescent,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8040,Limited dental tx adult,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8050,Intercep dental tx primary,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8060,Intercep dental tx transitn,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8070,Compre dental tx transition,Dental,Per Unit,$195.04 ,OP,$195.04 ,$195.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8080,Compre dental tx adolescent,Dental,Per Unit,$195.04 ,OP,$195.04 ,$195.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8090,Compre dental tx adult,Dental,Per Unit,$195.04 ,OP,$195.04 ,$195.04 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8210,Orthodontic rem appliance tx,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8220,Fixed appliance therapy habt,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8660,Preorthodontic tx visit,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8670,Periodic orthodontc tx visit,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8680,Orthodontic retention,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8681,Removable retainer adjust,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8690,Orthodontic treatment,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8691,Repair ortho appliance,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8692,Replacement retainer,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8693,Rebond/recement retainers,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8694,Repair fixed retainers,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8695,Remove fixed ortho appliance,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8696,Rep of ortho appliance max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8697,Rep of ortho appliance man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8698,Recement fixed retainer max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8699,Recement fixed retainer man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8701,Repair fixed retainer max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8702,Repair of fixed retainer man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8703,Replace broken retainer max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8704,Replace broken retainer man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D8999,Orthodontic procedure,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9110,Tx dental pain minor proc,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9120,Fix partial denture section,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9130,Temporomandibular joint dysf,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9210,Dent anesthesia w/o surgery,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9211,Regional block anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9212,Trigeminal block anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9215,Local anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9219,Eval mod/deep sed/gen anest,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9220,General anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9221,General anesthesia ea ad 15m,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9222,"Deep anest, 1st 15 min",Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9223,General anesth ea addl 15 mi,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9230,Analgesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9239,"Iv mod sedation, 1st 15 min",Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9241,Intravenous sedation,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9242,Iv sedation ea ad 15 m,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9243,Iv sedation ea addl 15m,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9248,Sedation (non-iv),Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9310,Dental consultation,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9311,Consult w/med hlth care prof,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9410,Dental house call,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9420,Hospital/asc call,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9430,Office visit during hours,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9440,Office visit after hours,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9450,Case presentation tx plan,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9610,Dent therapeutic drug inject,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9612,Thera par drugs 2 or > admin,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9613,Infiltration thera drug,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9630,Drugs/meds disp for home use,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9910,Dent appl desensitizing med,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9911,Appl desensitizing resin,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9920,Behavior management,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9930,Treatment of complications,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9931,Clean/inspect rem appliance,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9932,Clean & inspect rem dent max,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9933,Clean & inspect rem dent man,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9934,Clean rem part denture max,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9935,Clean rem part denture mand,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9940,Dental occlusal guard,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9941,Fabrication athletic guard,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9942,Repair/reline occlusal guard,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9943,Occlusal guard adjustment,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9944,"Occ guard, hard, full arch",Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9945,"Occ guard, soft, full arch",Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9946,"Occ guard, hard, part arch",Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9950,Occlusion analysis,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9951,Limited occlusal adjustment,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9952,Complete occlusal adjustment,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9970,Enamel microabrasion,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9971,Odontoplasty per tooth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9972,Extrnl bleaching per arch,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9973,Extrnl bleaching per tooth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9974,Intrnl bleaching per tooth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9975,External bleaching home app,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9991,"Case mgmt, appt barriers",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9992,"Case mgmt, care coordination",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9993,"Case mgmt, interviewing",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9994,"Case mgmt, pt education",Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9995,Teledentistry real-time,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9996,Teledentistry dent review,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9997,Dent case mgmt special needs,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,D9999,Adjunctive procedure,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0008,Admin influenza virus vac,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0009,Admin pneumococcal vaccine,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0010,Admin hepatitis b vaccine,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0027,Semen analysis,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0068,Adm iv infusion drug in home,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0069,Adm sq infusion drug in home,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0070,Adm of chemo drug in home,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0071,Comm svcs by rhc/fqhc 5 min,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0076,Care manag h vst new pt 20 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0077,Care manag h vst new pt 30 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0078,Care manag h vst new pt 45 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0079,Care manag h vst new pt 60 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0080,Care manag h vst new pt 75 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0081,Care man h v ext pt 20 mi,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0082,Care man h v ext pt 30 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0083,Care man h v ext pt 45 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0084,Care man h v ext pt 60 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0085,Care man h v ext pt 75 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0086,Care man home care plan 30 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0087,Care man home care plan 60 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0088,Adm iv drug 1st home visit,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0089,Adm subq drug 1st home visit,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0090,Adm iv chemo 1st home visit,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0103,Psa screening,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0104,Ca screen;flexi sigmoidscope,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0105,Colorectal scrn; hi risk ind,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0108,Diab manage trn per indiv,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0109,Diab manage trn ind/group,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0117,Glaucoma scrn hgh risk direc,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0118,Glaucoma scrn hgh risk direc,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0121,Colon ca scrn not hi rsk ind,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0122,Colon ca scrn; barium enema,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0123,Screen cerv/vag thin layer,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0124,Screen c/v thin layer by md,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0127,Trim nail(s),General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0128,Corf skilled nursing service,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0130,Single energy x-ray study,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0141,"Scr c/v cyto,autosys and md",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0143,"Scr c/v cyto,thinlayer,rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0144,"Scr c/v cyto,thinlayer,rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0145,"Scr c/v cyto,thinlayer,rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0147,"Scr c/v cyto, automated sys",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0148,"Scr c/v cyto, autosys, rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0151,"Hhcp-serv of pt,ea 15 min",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0152,"Hhcp-serv of ot,ea 15 min",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0153,"Hhcp-svs of s/l path,ea 15mn",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0155,"Hhcp-svs of csw,ea 15 min",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0157,Hhc pt assistant ea 15,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0158,Hhc ot assistant ea 15,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0159,Hhc pt maint ea 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0160,Hhc occup therapy ea 15,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0161,Hhc slp ea 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0162,"Hhc rn e&m plan svs, 15 min",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0166,"Extrnl counterpulse, per tx",Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0175,"Opps service,sched team conf",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0176,Opps/php;activity therapy,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0177,Opps/php; train & educ serv,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0179,Md recertification hha pt,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0180,Md certification hha patient,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0181,Home health care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0182,Hospice care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0186,"Dstry eye lesn,fdr vssl tech",Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0202,Scr mammo bi incl cad,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0204,Dx mammo incl cad bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0206,Dx mammo incl cad uni,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0219,Pet img wholbod melano nonco,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0235,Pet not otherwise specified,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0237,Therapeutic procd strg endur,Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0238,"Oth resp proc, indiv",Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0239,"Oth resp proc, group",Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0248,Demonstrate use home inr mon,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0252,Pet imaging initial dx,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0255,Current percep threshold tst,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0257,Unsched dialysis esrd pt hos,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0270,Mnt subs tx for change dx,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0271,Group mnt 2 or more 30 mins,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0278,"Iliac art angio,cardiac cath",Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0279,"Tomosynthesis, mammo",Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0283,Elec stim other than wound,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0289,"Arthro, loose body + chondro",Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0293,"Non-cov surg proc,clin trial",Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0297,Ldct for lung ca screen,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0306,Cbc/diffwbc w/o platelet,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0307,Cbc without platelet,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0328,Fecal blood scrn immunoassay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0339,"Robot lin-radsurg com, first",Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0340,Robt lin-radsurg fractx 2-5,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0365,Vessel mapping hemo access,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0378,Hospital observation per hr,Ancillary Services,Per Unit,$651.20 ,OP,$651.20 ,$651.20 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0389,Ultrasound exam aaa screen,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0396,Alcohol/subs interv 15-30mn,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0397,Alcohol/subs interv >30 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0403,Ekg for initial prevent exam,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0404,Ekg tracing for initial prev,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0405,Ekg interpret & report preve,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0409,Corf related serv 15 mins ea,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0410,Grp psych partial hosp 45-50,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0411,Inter active grp psych parti,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0412,Open tx iliac spine uni/bil,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0413,Pelvic ring fracture uni/bil,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0414,Pelvic ring fx treat int fix,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0415,Open tx post pelvic fxcture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0420,Ed svc ckd ind per session,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0421,Ed svc ckd grp per session,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0422,Intens cardiac rehab w/exerc,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0423,Intens cardiac rehab no exer,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0424,Pulmonary rehab w exer,Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0431,Drug screen multiple class,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0432,Eia hiv-1/hiv-2 screen,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0433,Elisa hiv-1/hiv-2 screen,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0434,Drug screen multi drug class,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0435,Oral hiv-1/hiv-2 screen,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0436,Tobacco-use counsel 3-10 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0437,Tobacco-use counsel>10min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0442,Annual alcohol screen 15 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0443,Brief alcohol misuse counsel,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0444,Depression screen annual,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0445,High inten beh couns std 30m,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0446,Intens behave ther cardio dx,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0447,Behavior counsel obesity 15m,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0448,Place perm pacing cardiovert,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G0451,Devlopment test interpt&rep,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0452,Molecular pathology interpr,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0459,Telehealth inpt pharm mgmt,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0464,"Colorec CA scr, sto bas DNA",Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0472,Hep c screen high risk/other,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0473,Group behave couns 2-10,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0475,Hiv combination assay,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0476,Hpv combo assay ca screen,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0477,Drug test presump optical,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0478,Drug test presump opt inst,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0479,Drug test presump not opt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0480,Drug test def 1-7 classes,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0491,Dialysis acu kidney no esrd,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0492,Md/oth eval acut kid no esrd,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0495,Rn care train/edu in hh,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0496,Lpn care train/edu in hh,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0498,Chemo extend iv infus w/pump,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0499,Hepb screen high risk indiv,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0500,Mod sedat endo service >5yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0502,"Init psych care manag, 70min",Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0503,"Subseq psych care man,60mi",Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0504,Init/sub psych care add 30 m,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0506,Comp asses care plan ccm svc,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0507,Care manage serv minimum 20,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0511,Ccm/bhi by rhc/fqhc 20min mo,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0512,Cocm by rhc/fqhc 60 min mo,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0515,Cognitive skills development,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0516,"Insert drug del implant, >=4",General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0517,Remove drug implant,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0518,Remove w insert drug implant,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G0659,Drug test def simple all cl,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2000,Blinded conv. tx mdd clin tr,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2010,Remot image submit by pt,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2011,Alcohol/sub misuse assess,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2012,Brief check in by md/qhp,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2014,Post-d/c care plan overs 30m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2015,Post-d/c care plan overs 60m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2058,Ccm add 20min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2064,Md mang high risk dx 30,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2065,Clin mang h risk dx 30,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2066,Inter devc remote 30d,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2082,Visit esketamine 56m or less,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2083,"Visit esketamine, > 56m",Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2168,Svs by pt in home health,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2169,Svs by ot in home health,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2213,Initiat med assist tx in er,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2214,Init/sub psych care m 1st 30,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2250,"Remot img sub by pt, non e/m",Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2251,"Brief chkin, 5-10, non-e/m",Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G2252,"Brief chkin by md/qhp, 11-20",Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G3001,"Admin + supply, tositumomab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6001,Echo guidance radiotherapy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6002,Stereoscopic x-ray guidance,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6003,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6004,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6005,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6006,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6007,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6008,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6009,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6010,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6011,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6012,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6013,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6014,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6015,Radiation tx delivery imrt,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6016,Delivery comp imrt,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6018,Ileoscopy w/stent,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,G6019,Colonoscopy lesion removal,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6020,Colonoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6021,Unlisted px small intestine,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6022,Sigmoidoscopy w/ablate tumr,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6023,Sigmoidoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6024,Lesion removal colonoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6025,Colonoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6027,Anoscopy hra w/spec collect,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6028,Anoscopy hra w/biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6030,Assay of amitriptyline,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6031,Assay of benzodiazepines,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6032,Assay of desipramine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6034,Assay of doxepin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6035,Assay of gold,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6036,Assay of Imipramine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6037,Assay of nortiptyline,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6038,Assay of salicylate,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6039,Assay of acetaminophen,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6040,Assay of ethanol,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6041,Assay of urine alkaloids,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6042,Assay of amphetamines,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6043,Assay of barbiturates,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6044,Assay of cocaine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6045,Assay of dihydrocodeinone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6046,Assay of dihydromorphinone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6047,Assay of dihydrotestosterone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6048,Assay of dimethadione,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6049,Assay of Epiandrosterone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6050,Assay of Ethchlorvynol,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6051,Assay of flurazepam,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6052,Assay of meprobamate,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6053,Assay of methadone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6054,Assay of methsuximide,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6055,Assay of nicotine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6056,Assay of opiates,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6057,Assay of phenothiazine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G6058,Drug confirmation,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9012,Other specified case mgmt,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9016,Demo-smoking cessation coun,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9020,Rimantadine hcl 100mg oral,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9034,"Zanamivir, inh pwdr, brand",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9035,"Oseltamivir phosp, brand",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9143,Warfarin respon genetic test,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9147,Outpt iv insulin tx any mea,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9157,Transesoph doppl cardiac mon,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9187,Bpci home visit,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9477,Care coord at hospice,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9686,Nursing facility conference,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9873,1 em core session,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9874,4 em core sessions,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9875,9 em core sessions,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9876,2 em core ms mo 7-9 no wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9877,2 em core ms mo 10-12 no wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9878,2 em core ms mo 7-9 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9879,2 em core ms mo 10-12 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9880,Em 5 percent wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9881,Em 9 percent wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9882,2 em ongoing ms mo 13-15 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9883,2 em ongoing ms mo 16-18 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9884,2 em ongoing ms mo 19-21 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9885,2 em ongoing ms mo 22-24 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9890,Em bridge payment,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,G9987,Bpci advanced in home visit,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0001,Alcohol and/or drug assess,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0002,Alcohol and/or drug screenin,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0003,Alcohol and/or drug screenin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0004,Alcohol and/or drug services,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0005,Alcohol and/or drug services,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0006,Alcohol and/or drug services,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0007,Alcohol and/or drug services,Behavioral Health,Per Unit,$135.70 ,OP,$135.70 ,$135.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0014,Alcohol and/or drug services,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0015,Alcohol and/or drug services,Behavioral Health,Per Unit,$339.88 ,OP,$339.88 ,$339.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0020,Alcohol and/or drug services,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0022,Alcohol and/or drug interven,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0031,Mh health assess by non-md,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0032,Mh svc plan dev by non-md,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0033,Oral med adm direct observe,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0034,Med trng & support per 15min,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0035,Mh partial hosp tx under 24h,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0037,Comm psy sup tx pgm per diem,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0046,"Mental health service, nos",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0047,Alcohol/drug abuse svc nos,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0049,Alcohol/drug screening,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H0050,Alcohol/drug service 15 min,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H1002,Carecoordination prenatal,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H1003,Prenatal at risk education,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H1011,Family assessment,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2000,Comp multidisipln evaluation,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2001,Rehabilitation program 1/2 d,Behavioral Health,Per Unit,$166.94 ,OP,$166.94 ,$166.94 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2010,Comprehensive med svc 15 min,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2011,"Crisis interven svc, 15 min",Behavioral Health,Per Unit,$135.70 ,OP,$135.70 ,$135.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2012,"Behav hlth day treat, per hr",Behavioral Health,Per Unit,$276.34 ,OP,$276.34 ,$276.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2014,"Skills train and dev, 15 min",Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2017,"Psysoc rehab svc, per 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2018,"Psysoc rehab svc, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2019,"Ther behav svc, per 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2020,"Ther behav svc, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2027,"Psychoed svc, per 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2028,"Sex offend tx svc, 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2029,"Sex offend tx svc, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2032,"Activity therapy, per 15 min",Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2033,Multisys ther/juvenile 15min,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2035,"A/d tx program, per hour",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,H2036,"A/d tx program, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0121,"Inj., omadacycline, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0122,"Inj., eravacycline, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0129,Abatacept injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0130,Abciximab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0135,Adalimumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0178,Aflibercept injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0179,"Inj, brolucizumab-dbll, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0180,Agalsidase beta injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0185,"Inj., aprepitant, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0202,"Injection, alemtuzumab",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0205,Alglucerase injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0207,Amifostine,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0210,Methyldopate hcl injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0215,Alefacept,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0220,Alglucosidase alfa injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0221,Lumizyme injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0222,"Inj., patisiran, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0223,Inj givosiran 0.5 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0256,Alpha 1 proteinase inhibitor,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0257,Glassia injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0287,Amphotericin b lipid complex,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0288,Ampho b cholesteryl sulfate,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0289,Amphotericin b liposome inj,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0291,"Inj., plazomicin, 5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0348,Anidulafungin injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0350,Injection anistreplase 30 u,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0364,Apomorphine hydrochloride,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0365,"Aprotonin, 10,000 kiu",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0401,Inj aripiprazole ext rel 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0475,Baclofen 10 mg injection,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0480,Basiliximab,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0485,Belatacept injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0490,Belimumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0517,"Inj., benralizumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0558,Peng benzathine/procaine inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0561,Penicillin g benzathine inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0565,"Inj, bezlotoxumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0567,"Inj., cerliponase alfa 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0570,Buprenorphine implant 74.2mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0583,Bivalirudin,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0584,"Injection, burosumab-twza 1m",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0585,"Injection,onabotulinumtoxina",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0586,Abobotulinumtoxina,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0587,"Inj, rimabotulinumtoxinb",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0588,Incobotulinumtoxin a,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0591,"Inj deoxycholic acid, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0593,"Inj., lanadelumab-flyo, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0594,Busulfan injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0596,"Injection, ruconest",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0597,"C-1 esterase, berinert",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0598,"C-1 esterase, cinryze",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0599,"Inj., haegarda 10 units",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0600,Edetate calcium disodium inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0604,"Cinacalcet, esrd on dialysis",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0606,"Inj, etelcalcetide, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0630,Calcitonin salmon injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0637,Caspofungin acetate,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0638,Canakinumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0641,Inj levoleucovorin nos 0.5mg,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0642,"Injection, khapzory, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0691,Inj lefamulin 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0693,"Inj., cefiderocol, 5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0695,Inj ceftolozane tazobactam,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0712,Ceftaroline fosamil inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0714,Ceftazidime and avibactam,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0716,Centruroides immune f(ab),Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0717,Certolizumab pegol inj 1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0740,Cidofovir injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0742,Inj imip 4 cilas 4 releb 2mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0775,"Collagenase, clost hist inj",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0791,Inj crizanlizumab-tmca 5mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0795,Corticorelin ovine triflutal,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0800,Corticotropin injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0833,Cosyntropin injection nos,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0840,Crotalidae poly immune fab,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0841,Inj crotalidae im f(ab')2 eq,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0850,Cytomegalovirus imm iv /vial,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0875,"Injection, dalbavancin",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0878,Daptomycin injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0881,"Darbepoetin alfa, non-esrd",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0882,"Darbepoetin alfa, esrd use",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0883,Argatroban nonesrd use 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0884,Argatroban esrd dialysis 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0885,"Epoetin alfa, non-esrd",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0886,Epoetin alfa 1000 units esrd,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0890,Peginesatide injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0894,Decitabine injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J0896,Inj luspatercept-aamt 0.25mg,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J0897,Denosumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1095,"Injection, dexamethasone 9%",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1096,Dexametha opth insert 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1097,Phenylep ketorolac opth soln,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1162,Digoxin immune fab (ovine),Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1190,Dexrazoxane hcl injection,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1201,Inj. cetirizine hcl 0.5mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1205,Chlorothiazide sodium inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1212,Dimethyl sulfoxide 50% 50 ml,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1267,Doripenem injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1290,Ecallantide injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1300,Eculizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1301,"Injection, edaravone, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1303,"Inj., ravulizumab-cwvz 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1322,"Elosulfase alfa, injection",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1327,Eptifibatide injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1410,Inj estrogen conjugate 25 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1428,"Inj, eteplirsen, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1429,Inj golodirsen 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1430,Ethanolamine oleate 100 mg,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1436,Etidronate disodium inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1437,Inj. fe derisomaltose 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1438,Etanercept injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1439,Inj ferric carboxymaltos 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1442,Inj filgrastim excl biosimil,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1446,"Inj, tbo-filgrastim, 5 mcg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1447,Inj tbo filgrastim 1 microg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1451,"Fomepizole, 15 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1452,Intraocular fomivirsen na,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1453,Fosaprepitant injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1454,"Inj fosnetupitant, palonoset",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1455,Foscarnet sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1457,Gallium nitrate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1458,Galsulfase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1459,Inj ivig privigen 500 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1460,Gamma globulin 1 cc inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1555,"Inj cuvitru, 100 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1556,"Inj, imm glob bivigam, 500mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1557,Gammaplex injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1558,"Inj. xembify, 100 mg",Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1559,Hizentra injection,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1560,Gamma globulin > 10 cc inj,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1561,Gamunex-c/gammaked,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1562,"Vivaglobin, inj",Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1566,"Immune globulin, powder",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1568,Octagam injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1569,Gammagard liquid injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1570,Ganciclovir sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1571,Hepagam b im injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1572,Flebogamma injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1573,"Hepagam b intravenous, inj",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1575,Hyqvia 100mg immuneglobulin,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1595,Injection glatiramer acetate,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1599,"Ivig non-lyophilized, nos",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1602,Golimumab for iv use 1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1610,Glucagon hydrochloride/1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1628,"Inj., guselkumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1632,"Inj., brexanolone, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1640,"Hemin, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1670,Tetanus immune globulin inj,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1675,Histrelin acetate,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1738,Inj. meloxicam 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1740,Ibandronate sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1742,Ibutilide fumarate injection,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1743,Idursulfase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1744,Icatibant injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1745,Infliximab not biosimil 10mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1746,"Inj., ibalizumab-uiyk, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1750,Inj iron dextran,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1756,Iron sucrose injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1786,Imuglucerase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1823,"Inj. inebilizumab-cdon, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1826,Interferon beta-1a inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1830,Interferon beta-1b / .25 mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1833,"Injection, isavuconazonium",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1930,Lanreotide injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1931,Laronidase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J1942,Aripiprazole lauroxil 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1943,"Inj., aristada initio, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1944,Aripirazole lauroxil 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1945,Lepirudin,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J1950,Leuprolide acetate /3.75 mg,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2062,Loxapine for inhalation 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2170,Mecasermin injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2182,"Injection, mepolizumab, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2186,"Inj., meropenem, vaborbactam",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2248,Micafungin sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2278,Ziconotide injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2315,"Naltrexone, depot form",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2323,Natalizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2325,Nesiritide injection,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2326,"Inj, nusinersen, 0.1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2350,"Injection, ocrelizumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2353,"Octreotide injection, depot",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2355,Oprelvekin injection,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2357,Omalizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2407,"Injection, oritavancin",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2425,Palifermin injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2426,Paliperidone palmitate inj,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2469,Palonosetron hcl,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2502,"Inj, pasireotide long acting",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2503,Pegaptanib sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2504,"Pegademase bovine, 25 iu",Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2505,"Injection, pegfilgrastim 6mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2507,Pegloticase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2513,Pentastarch 10% solution,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2515,Pentobarbital sodium inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2545,Pentamidine non-comp unit,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2547,"Injection, peramivir",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2562,Plerixafor injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2597,Inj desmopressin acetate,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2724,Protein c concentrate,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2730,Pralidoxime chloride inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2770,Quinupristin/dalfopristin,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2778,Ranibizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2783,Rasburicase,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2786,"Injection, reslizumab, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2790,Rho d immune globulin inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2791,Rhophylac injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2792,"Rho(d) immune globulin h, sd",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2793,Rilonacept injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2794,"Inj risperdal consta, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2796,Romiplostim injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2797,"Inj., rolapitant, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2798,"Inj., perseris, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2805,Sincalide injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2820,Sargramostim injection,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2840,Inj sebelipase alfa 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2850,Inj secretin synthetic human,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J2860,"Injection, siltuximab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2993,Reteplase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J2997,Alteplase recombinant,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3031,"Inj., fremanezumab-vfrm 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3032,Inj. eptinezumab-jjmr 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3060,"Inj, taliglucerase alfa 10 u",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3090,Inj tedizolid phosphate,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3095,Telavancin injection,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3101,Tenecteplase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3110,Teriparatide injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3111,Inj. romosozumab-aqqg 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3145,Testosterone undecanoate 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3240,Thyrotropin injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3241,Inj. teprotumumab-trbw 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3243,Tigecycline injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3245,"Inj., tildrakizumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3246,Tirofiban hcl,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3262,Tocilizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3285,Treprostinil injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3300,Triamcinolone a inj prs-free,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3304,Inj triamcinolone ace xr 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3315,Triptorelin pamoate,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3316,"Inj., triptorelin xr 3.75 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3355,"Urofollitropin, 75 iu",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3357,"Ustekinumab sub cu inj, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3358,"Ustekinumab, iv inject, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3365,"Urokinase 250,000 iu inj",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3380,"Injection, vedolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3385,Velaglucerase alfa,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3396,Verteporfin injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3397,"Inj., vestronidase alfa-vjbk",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3398,Inj luxturna 1 billion vec g,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3399,Inj onase abepar-xioi treat,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J3470,Hyaluronidase injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3471,"Ovine, up to 999 usp units",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3472,"Ovine, 1000 usp units",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J3473,Hyaluronidase recombinant,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7169,"Inj andexxa, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7170,"Inj., emicizumab-kxwh 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7175,"Inj, factor x, (human), 1iu",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7177,"Inj., fibryga, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7178,Inj human fibrinogen con nos,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7179,Vonvendi inj 1 iu vwf:rco,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7180,Factor xiii anti-hem factor,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7181,Factor xiii recomb a-subunit,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7182,Factor viii recomb novoeight,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7183,Wilate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7185,Xyntha inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7186,Antihemophilic viii/vwf comp,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7187,"Humate-p, inj",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7188,Factor viii recomb obizur,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7189,Factor viia recomb novoseven,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7190,Factor viii,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7191,Factor viii (porcine),Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7192,Factor viii recombinant nos,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7193,Factor ix non-recombinant,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7194,Factor ix complex,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7195,Factor ix recombinant nos,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7196,Antithrombin recombinant,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7197,Antithrombin iii injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7198,Anti-inhibitor,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7199,Hemophilia clot factor noc,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7200,Factor ix recombinan rixubis,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7201,Factor ix alprolix recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7202,Factor ix idelvion inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7203,Factor ix recomb gly rebinyn,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7204,Inj recombin esperoct per iu,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7205,Factor viii fc fusion recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7207,Factor viii pegylated recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7208,Inj. jivi 1 iu,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7209,Factor viii nuwiq recomb 1iu,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7210,"Inj, afstyla, 1 i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7211,"Inj, kovaltry, 1 i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7212,Factor viia recomb sevenfact,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7296,"Kyleena, 19.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7297,"Liletta, 52 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7298,"Mirena, 52 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7300,Intraut copper contraceptive,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7301,"Skyla, 13.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7302,Levonorgestrel iu 52 mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7303,Contraceptive vaginal ring,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7304,Contraceptive hormone patch,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7306,Levonorgestrel implant sys,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7307,Etonogestrel implant system,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7308,Aminolevulinic acid hcl top,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7309,"Methyl aminolevulinate, top",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7310,Ganciclovir long act implant,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7311,"Inj., retisert, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7312,Dexamethasone intra implant,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7313,"Inj., iluvien, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7314,"Inj., yutiq, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7315,Ophthalmic mitomycin,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7316,"Inj, ocriplasmin, 0.125 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7318,"Inj, durolane 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7320,"Genvisc 850, inj, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7321,Hyalgan or supartz inj dose,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7322,Hymovis injection 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7323,Euflexxa inj per dose,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7324,Orthovisc inj per dose,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7325,Synvisc or synvisc-one,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7326,Gel-one,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7327,Monovisc inj per dose,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7328,Gelsyn-3 injection 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7329,"Inj, trivisc 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7330,Cultured chondrocytes implnt,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7331,"Synojoynt, inj., 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7332,"Inj., triluron, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7333,Visco-3 inj dose,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7336,Capsaicin 8% patch,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7340,Carbidopa levodopa ent 100ml,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7345,"Aminolevulinic acid, 10% gel",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7351,Inj bimatoprost itc imp1mcg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7352,"Afamelanotide implant, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7401,Mometasone furoate sinus imp,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7501,Azathioprine parenteral,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7504,Lymphocyte immune globulin,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J7505,Monoclonal antibodies,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7511,Antithymocyte globuln rabbit,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7513,"Daclizumab, parenteral",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7525,Tacrolimus injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7639,Dornase alfa non-comp unit,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7685,Tobramycin comp unit,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J7686,"Treprostinil, non-comp unit",Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J8501,Oral aprepitant,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J8560,Etoposide oral 50 mg,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J8562,Oral fludarabine phosphate,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J8565,Gefitinib oral,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J8655,"Oral netupitant, palonosetro",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J8670,"Rolapitant, oral, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J8705,Topotecan oral,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9010,Alemtuzumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9015,Aldesleukin injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9017,Arsenic trioxide injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9019,Erwinaze injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9020,"Asparaginase, nos",Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9022,"Inj, atezolizumab,10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9023,"Injection, avelumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9025,Azacitidine injection,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9027,Clofarabine injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9030,Bcg live intravesical 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9031,Bcg live intravesical vac,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9032,"Injection, belinostat, 10mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9033,"Inj., treanda 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9034,"Inj., bendeka 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9035,Bevacizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9036,Inj. belrapzo/bendamustine,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9039,"Injection, blinatumomab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9040,Bleomycin sulfate injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9041,"Inj., velcade 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9042,Brentuximab vedotin inj,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9043,Cabazitaxel injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9044,"Inj, bortezomib, nos, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9047,"Injection, carfilzomib, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9050,Carmustine injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9055,Cetuximab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9057,"Inj., copanlisib, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9065,Inj cladribine per 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9070,Cyclophosphamide 100 mg inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9098,Cytarabine liposome inj,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9118,Inj. calaspargase pegol-mknl,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9119,"Inj., cemiplimab-rwlc, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9120,Dactinomycin injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9144,"Daratumumab, hyaluronidase",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9145,"Injection, daratumumab 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9150,Daunorubicin injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9151,Daunorubicin citrate inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9153,"Inj daunorubicin, cytarabine",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9155,Degarelix injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9160,Denileukin diftitox inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9171,Docetaxel injection,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9173,"Inj., durvalumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9176,"Injection, elotuzumab, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9177,Inj enfort vedo-ejfv 0.25mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9179,Eribulin mesylate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9185,Fludarabine phosphate inj,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9198,"Inj. infugem, 100 mg",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9199,"Injection, infugem, 200 mg",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9200,Floxuridine injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9202,Goserelin acetate implant,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9203,Gemtuzumab ozogamicin 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9204,"Inj mogamulizumab-kpkc, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9205,Inj irinotecan liposome 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9207,Ixabepilone injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9208,Ifosfamide injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9210,"Inj., emapalumab-lzsg, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9211,Idarubicin hcl injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9213,Interferon alfa-2a inj,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9214,Interferon alfa-2b inj,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9216,Interferon gamma 1-b inj,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9217,Leuprolide acetate suspnsion,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9219,Leuprolide acetate implant,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9223,"Inj. lurbinectedin, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9225,Vantas implant,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9226,Supprelin la implant,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9227,Inj. isatuximab-irfc 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9228,Ipilimumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9229,Inj inotuzumab ozogam 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9230,Mechlorethamine hcl inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9245,Inj melpha hydroch nos 50 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9246,"Inj., evomela, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9261,Nelarabine injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9262,"Inj, omacetaxine mep, 0.01mg",Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9264,Paclitaxel protein bound,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9266,Pegaspargase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9268,Pentostatin injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9269,Inj. tagraxofusp-erzs 10 mcg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9270,Plicamycin (mithramycin) inj,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9271,Inj pembrolizumab,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9280,Mitomycin injection,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9281,Mitomycin instillation,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9285,"Inj, olaratumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9293,Mitoxantrone hydrochl / 5 mg,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9295,"Injection, necitumumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9299,"Injection, nivolumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9300,Gemtuzumab ozogamicin inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9301,Obinutuzumab inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9302,Ofatumumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9303,Panitumumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9304,"Inj. pemetrexed, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9305,Inj. pemetrexed nos 10mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9306,"Injection, pertuzumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9307,Pralatrexate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9308,"Injection, ramucirumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9309,"Inj, polatuzumab vedotin 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9310,Rituximab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9311,"Inj rituximab, hyaluronidase",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9312,"Inj., rituximab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9313,"Inj., lumoxiti, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9315,Romidepsin injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9316,"Pertuzu, trastuzu, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9317,Sacituzumab govitecan-hziy,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9320,Streptozocin injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9325,Inj talimogene laherparepvec,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9328,Temozolomide injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9330,Temsirolimus injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9340,Thiotepa injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9352,Injection trabectedin 0.1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9354,"Inj, ado-trastuzumab emt 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9355,Inj trastuzumab excl biosimi,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9356,"Inj. herceptin hylecta, 10mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9357,Valrubicin injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9358,Inj fam-trastu deru-nxki 1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9371,"Inj, vincristine sul lip 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,J9395,"Injection, fulvestrant",Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9400,"Inj, ziv-aflibercept, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,J9600,Porfimer sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,L8604,Dextranomer/hyaluronic acid,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,L8605,Inj bulking agent anal canal,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,L8607,Inj vocal cord bulking agent,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,M0239,Bamlanivimab-xxxx infusion,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,M0243,Casirivi and imdevi infusion,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P2028,Cephalin floculation test,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P2029,Congo red blood test,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P2031,Hair analysis,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P2033,Blood thymol turbidity,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P2038,Blood mucoprotein,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P3000,Screen pap by tech w md supv,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P3001,Screening pap smear by phys,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P7001,Culture bacterial urine,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9010,Whole blood for transfusion,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9011,Blood split unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9012,Cryoprecipitate each unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9016,Rbc leukocytes reduced,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9017,Plasma 1 donor frz w/in 8 hr,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9019,"Platelets, each unit",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9020,Plaelet rich plasma unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9021,Red blood cells unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9022,Washed red blood cells unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9023,"Frozen plasma, pooled, sd",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9031,Platelets leukocytes reduced,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9032,"Platelets, irradiated",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9033,Platelets leukoreduced irrad,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9034,"Platelets, pheresis",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9035,Platelet pheres leukoreduced,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9036,Platelet pheresis irradiated,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9037,Plate pheres leukoredu irrad,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9038,Rbc irradiated,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9039,Rbc deglycerolized,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9040,Rbc leukoreduced irradiated,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9041,"Albumin (human),5%, 50ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9043,"Plasma protein fract,5%,50ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9044,Cryoprecipitatereducedplasma,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9045,"Albumin (human), 5%, 250 ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9046,"Albumin (human), 25%, 20 ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9047,"Albumin (human), 25%, 50ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9048,"Plasmaprotein fract,5%,250ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9050,"Granulocytes, pheresis unit",Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,P9051,"Blood, l/r, cmv-neg",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9052,"Platelets, hla-m, l/r, unit",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9053,"Plt, pher, l/r cmv-neg, irr",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9054,"Blood, l/r, froz/degly/wash",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9055,"Plt, aph/pher, l/r, cmv-neg",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9056,"Blood, l/r, irradiated",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9057,"Rbc, frz/deg/wsh, l/r, irrad",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9058,"Rbc, l/r, cmv-neg, irrad",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9059,"Plasma, frz between 8-24hour",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9060,Fr frz plasma donor retested,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9070,Pathogen reduced plasma pool,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9071,Pathogen reduced plasma sing,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9072,Plate path red/rapid bac tes,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9073,Platelets pheresis path redu,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9099,Blood component/product noc,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,P9100,Pathogen test for platelets,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0035,Cardiokymography,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0081,Infusion ther other than che,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0084,Chemotherapy by infusion,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0085,Chemo by both infusion and o,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0091,Obtaining screen pap smear,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0111,Wet mounts/ w preparations,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0112,Potassium hydroxide preps,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0113,Pinworm examinations,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0114,Fern test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0115,Post-coital mucous exam,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0138,"Ferumoxytol, non-esrd",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0139,"Ferumoxytol, esrd use",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0239,Bamlanivimab-xxxx,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0243,Casirivimab and imdevimab,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q0515,Sermorelin acetate injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2017,"Teniposide, 50 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2028,"Inj, sculptra, 0.5mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2034,Agriflu vaccine,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2035,"Afluria vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2036,"Flulaval vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2037,"Fluvirin vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2038,"Fluzone vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2039,"Influenza virus vaccine, nos",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2040,Tisagenlecleucel car-pos t,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2043,Sipuleucel-t auto cd54+,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2049,Imported lipodox inj,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q2050,Doxorubicin inj 10mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q3014,Telehealth facility fee,Ancillary Services,Per Unit,$8.33 ,OP,$8.33 ,$8.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q3027,Inj beta interferon im 1 mcg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q3028,Inj beta interferon sq 1 mcg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4074,Iloprost non-comp unit dose,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4081,"Epoetin alfa, 100 units esrd",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4100,"Skin substitute, nos",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4101,Apligraf,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4102,Oasis wound matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4103,Oasis burn matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4104,Integra bmwd,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4105,Integra drt or omnigraft,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4106,Dermagraft,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4107,Graftjacket,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4108,Integra matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4110,Primatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4111,Gammagraft,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4112,Cymetra injectable,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4113,Graftjacket xpress,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4114,Integra flowable wound matri,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4115,Alloskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4116,Alloderm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4117,Hyalomatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4118,Matristem micromatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4119,Matristem wound matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4120,Matristem burn matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4121,Theraskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4122,"Dermacell, awm, porous sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4123,Alloskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4124,Oasis tri-layer wound matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4125,Arthroflex,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4126,Memoderm/derma/tranz/integup,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4127,Talymed,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4128,Flexhd/allopatchhd/matrixhd,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4129,Unite biomatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4130,Strattice tm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4131,Epifix or epicord,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4132,"Grafix core, grafixpl core",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4133,Grafix stravix prime pl sqcm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4134,Hmatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4135,Mediskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4136,Ezderm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4137,Amnioexcel biodexcel 1sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4138,"Biodfence dryflex, 1cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4139,"Amnio or biodmatrix, inj 1cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4140,Biodfence 1cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4141,"Alloskin ac, 1 cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4142,Xcm biologic tiss matrix 1cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4143,"Repriza, 1cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4145,"Epifix, inj, 1mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4146,"Tensix, 1cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4147,Architect ecm px fx 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4148,Neox neox rt or clarix cord,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4149,"Excellagen, 0.1 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4150,Allowrap ds or dry 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4151,"Amnioband, guardian 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4152,Dermapure 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4153,"Dermavest, plurivest sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4154,Biovance 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4155,Neoxflo or clarixflo 1 mg,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4156,Neox 100 or clarix 100,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4157,Revitalon 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4158,"Kerecis omega3, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4159,Affinity1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4160,Nushield 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4161,Bio-connekt per square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4162,"Wndex flw, bioskn flw, 0.5cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4163,"Woundex, bioskin, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4164,"Helicoll, per square cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4165,"Keramatrix, kerasorb sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4166,"Cytal, per square centimeter",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4167,"Truskin, per sq centimeter",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4168,"Amnioband, 1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4169,"Artacent wound, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4170,"Cygnus, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4171,"Interfyl, 1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4172,Puraply or puraply am,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4173,Palingen or palingen xplus,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4174,Palingen or promatrx,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4175,Miroderm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4176,"Neopatch or therion, 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4177,"Floweramnioflo, 0.1 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4178,"Floweramniopatch, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4179,"Flowerderm, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4180,"Revita, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4181,"Amnio wound, per square cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4182,"Transcyte, per sq centimeter",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4183,"Surgigraft, 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4184,Cellesta or duo per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4185,Cellesta flowab amnion 0.5cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4186,Epifix 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4187,Epicord 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4188,Amnioarmor 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4189,"Artacent ac, 1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4190,Artacent ac 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4191,Restorigin 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4192,"Restorigin, 1 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4193,Coll-e-derm 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4194,Novachor 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4195,Puraply 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4196,Puraply am 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4197,Puraply xt 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4198,Genesis amnio membrane 1sqcm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4200,Skin te 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4201,Matrion 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4202,"Keroxx (2.5g/cc), 1cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4203,"Derma-gide, 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4204,Xwrap 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4205,Membrane graft or wrap sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4206,Fluid flow or fluid gf 1 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4208,Novafix per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4209,Surgraft per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4210,Axolotl graf dualgraf sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4211,Amnion bio or axobio sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4212,"Allogen, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4213,"Ascent, 0.5 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4214,Cellesta cord per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4215,"Axolotl ambient, cryo 0.1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4216,Artacent cord per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4217,Woundfix biowound plus xplus,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4218,Surgicord per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4219,Surgigraft dual per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4220,"Bellacell hd, surederm sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4221,Amniowrap2 per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4222,"Progenamatrix, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4226,Myown harv prep proc sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4227,Amniocore per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4228,"Bionextpatch, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4229,Cogenex amnio memb per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4230,Cogenex flow amnion 0.5 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4231,"Corplex p, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4232,"Corplex, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4233,Surfactor /nudyn per 0.5 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4234,"Xcellerate, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4235,Amniorepair or altiply sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4236,Carepatch per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4237,"Cryo-cord, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4238,"Derm-maxx, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4239,Amnio-maxx or lite per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4240,Corecyte topical only 0.5 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4241,"Polycyte, topical only 0.5cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4242,"Amniocyte plus, per 0.5 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4244,"Procenta, per 200 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4245,"Amniotext, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4246,"Coretext or protext, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4247,"Amniotext patch, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4248,Dermacyte amn mem allo sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4249,"Amniply, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4250,Amnioamp-mp per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4254,Novafix dl per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q4255,"Reguard, topical use per sq",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5101,"Injection, zarxio",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5102,"Inj., infliximab biosimilar",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5103,"Injection, inflectra",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5104,"Injection, renflexis",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5105,Inj retacrit esrd on dialysi,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5106,Inj retacrit non-esrd use,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5107,Inj mvasi 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5108,"Injection, fulphila",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5109,"Injection, ixifi, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5110,Nivestym,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5111,"Injection, udenyca 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5112,Inj ontruzant 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5113,Inj herzuma 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5114,Inj ogivri 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5115,Inj truxima 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5116,"Inj., trazimera, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5117,"Inj., kanjinti, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5118,"Inj., zirabev, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5119,"Inj ruxience, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5120,Inj pegfilgrastim-bmez 0.5mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5121,"Inj. avsola, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q5122,"Inj, nyvepria",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9975,Factor VIII FC Fusion Recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9979,"Injection, Alemtuzumab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9980,"Genvisc, inj, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9984,Kyleena,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9987,Pathogen test for platelets,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9988,Platelet pheresis path reduc,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9989,"Ustekinumab IV Inj, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9991,Buprenorph xr 100 mg or less,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9992,Buprenorphine xr over 100 mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9993,"Inj., triamcinolone ext rel",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,Q9995,"inj. emicizumab-kxwh, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S0013,"Esketamine, nasal spray",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0040,"Injection, ticarcillin disod",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0088,Imatinib 100 mg,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0126,Inj follitropin alfa 75 iu,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0132,Inj ganirelix acetat 250 mcg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0140,"Saquinavir, 200 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0142,Colistimethate inh sol mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0145,Peg interferon alfa-2a/180,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0148,Peg interferon alfa-2b/10,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0155,Epoprostenol dilutant,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0166,Inj olanzapine 2.5mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0175,Flutamide 125 mg,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0178,Lomustine 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0190,"Mifepristone, oral, 200 mg",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0195,Pneumo vaccine 5-9 yrs,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0199,Med abortion inc all ex drug,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0201,Partial hospitalization serv,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0220,Medical conference by physic,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0221,"Medical conference, 60 min",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0250,Comp geriatr assmt team,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0257,End of life counseling,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0271,Home hospice case 30 days,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0280,"Medical home, initial plan",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0281,"Medical home, maintenance",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0311,Comp mgmt care coord adv ill,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0315,Disease management program,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0316,Follow-up/reassessment,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0340,Lifestyle mod 1st stage,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0353,Cancer treatmentplan initial,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0354,Cancer treatment plan change,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0390,Rout foot care per visit,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0395,Impression casting ft,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0592,Comp cont lens eval,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0601,Screening proctoscopy,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0618,Audiometry for hearing aid,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0800,Laser in situ keratomileusis,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S0810,Photorefractive keratectomy,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S0812,Phototherap keratect,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2066,Breast gap flap reconst,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2067,"Breast ""stacked"" diep/gap",General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2068,Breast diep or siea flap,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2083,Adjustment gastric band,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2112,Knee arthroscp harv,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2202,Echosclerotherapy,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2225,Myringotomy laser-assist,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2230,Implant semi-imp hear,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2235,Implant auditory brain imp,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2260,Induced abortion 17-24 weeks,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2265,Induced abortion 25-28 wks,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2266,Induced abortion 29-31 wks,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2267,Induced abortion 32 or more,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2300,"Arthroscopy, shoulder, surgi",Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2340,Chemodenervation of abductor,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2341,Chemodenerv adduct vocal,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,S2342,Nasal endoscop po debrid,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2400,Fetal surg congen hernia,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2401,Fetal surg urin trac obstr,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2402,Fetal surg cong cyst malf,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2403,Fetal surg pulmon sequest,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2404,Fetal surg myelomeningo,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2405,Fetal surg sacrococ teratoma,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2409,Fetal surg noc,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S2411,Fetoscop laser ther ttts,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3620,Newborn metabolic screening,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3630,Eosinophil blood count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3645,Hiv-1 antibody testing of or,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3650,"Saliva test, hormone level;",Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3652,"Saliva test, hormone level;",Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3655,Antisperm antibodies test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3708,Gastrointestinal fat absorpt,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3721,Pca3 testing,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3722,Dose optimization auc - 5fu,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3800,Genetic testing als,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3840,Dna analysis ret-oncogene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3841,Gene test retinoblastoma,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3842,Gene test hippel-lindau,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3844,Dna analysis deafness,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3845,Gene test alpha-thalassemia,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3846,Gene test beta-thalassemia,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3849,Gene test niemann-pick,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3850,Gene test sickle cell,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3852,Dna analysis apoe alzheimer,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3853,Gene test myo musclr dyst,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3854,Gene profile panel breast,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3861,Genetic test brugada,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3865,Comp genet test hyp cardiomy,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3866,Spec gene test hyp cardiomy,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3870,Cgh test developmental delay,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3890,Fecal dna analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3900,Surface emg,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3902,Ballistocardiogram,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S3904,Masters two step,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4011,Ivf package,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4013,Compl gift case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4014,Compl zift case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4015,Complete ivf nos case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4016,Frozen ivf case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4017,Ivf canc a stim case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4018,F emb trns canc case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4020,Ivf canc a aspir case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4021,Ivf canc p aspir case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4022,Asst oocyte fert case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4023,Incompl donor egg case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4025,Donor serv ivf case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4026,Procure donor sperm,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4027,Store prev froz embryos,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4028,Microsurg epi sperm asp,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4030,Sperm procure init visit,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4031,Sperm procure subs visit,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4035,Stimulated iui case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4037,Cryo embryo transf case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4040,Monit store cryo embryo 30 d,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4042,Ovulation mgmt per cycle,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4981,Insert levonorgestrel ius,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S4989,Contracept iud,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S5180,Hh respiratory thrpy in eval,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S5181,Hh respiratory thrpy nos/day,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8032,Low dose CT lung screening,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8035,Magnetic source imaging,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8037,Mrcp,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8055,Us guidance fetal reduct,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8080,Scintimammography,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8092,Electron beam computed tomog,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8110,Peak expiratory flow rate (p,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8930,Auricular electrostimulation,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8940,Hippotherapy per session,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8948,Low-level laser trmt 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8950,"Complex lymphedema therapy,",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S8990,Pt or manip for maint,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9015,Automated eeg monitoring,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9024,Paranasal sinus ultrasound,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9061,Medical supplies and equipme,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9090,Vertebral axial decompressio,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9098,Home phototherapy visit,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9128,"Speech therapy, in the home,",Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9129,"Occupational therapy, in the",Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9131,Pt in the home per diem,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9140,"Diabetic management program,",Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9141,"Diabetic management program,",Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9145,Insulin pump initiation,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9152,"Speech therapy, re-eval",Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9211,Home mgmt gest hypertension,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9213,Hm preeclamp per diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9214,Hm gest dm per diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9335,Ht hemodialysis diem,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9339,Hit periton dialysis diem,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9370,Ht inj antiemetic diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9372,Ht inj anticoag diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9445,Pt education noc individ,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9446,Pt education noc group,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9452,Nutrition class,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9453,Smoking cessation class,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9455,"Diabetic management program,",Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9465,"Diabetic management program,",Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9470,"Nutritional counseling, diet",Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9472,Cardiac rehabilitation progr,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9473,Pulmonary rehabilitation pro,Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9475,Ambulatory setting substance,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9476,Vestibular rehab per diem,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9480,Intensive outpatient psychia,Behavioral Health,Per Unit,$339.88 ,OP,$339.88 ,$339.88 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9482,Family stabilization 15 min,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9484,Crisis intervention per hour,Behavioral Health,Per Unit,$135.70 ,OP,$135.70 ,$135.70 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9485,Crisis intervention mental h,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9537,Ht hem horm inj diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9538,Hit blood products diem,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9558,Ht inj growth horm diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9559,Hit inj interferon diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9560,Ht inj hormone diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,S9562,Ht inj palivizumab diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T1006,Family/couple counseling,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T1007,Treatment plan development,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T1012,Alcohol/substance abuse skil,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T1016,Case management,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T1017,Targeted case management,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T1023,Program intake assessment,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T1040,Comm bh clinic svc per diem,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T2022,"Case management, per month",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,T2023,Targeted case mgmt per month,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,U0001,2019-ncov diagnostic p,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,U0002,Covid-19 lab test non-cdc,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,U0005,Infec agen detec ampli probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,V2785,Corneal tissue processing,Ophthalmology,Per Unit,"$1,390.89 ",OP,"$1,390.89 ","$1,390.89 ",,,,,,,,,,,,,
Meridian Medicaid,CPT,V2790,Amniotic membrane,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,V5362,Speech screening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,V5363,Language screening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Meridian Medicaid,CPT,V5364,Dysphagia screening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,DRG,11,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$38,043.18 ",IP,"38,043.18","38,043.18",,,,,,,,,,,,,
Molina Medicaid,DRG,12,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$40,281.56 ",IP,"40,281.56","40,281.56",,,,,,,,,,,,,
Molina Medicaid,DRG,13,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$42,053.29 ",IP,"42,053.29","42,053.29",,,,,,,,,,,,,
Molina Medicaid,DRG,14,LIVER TRANSPLANT andOR INTESTINAL TRANSPLANT,,Relative Weights,"$78,175.26 ",IP,"78,175.26","78,175.26",,,,,,,,,,,,,
Molina Medicaid,DRG,21,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$45,599.51 ",IP,"45,599.51","45,599.51",,,,,,,,,,,,,
Molina Medicaid,DRG,22,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$58,026.75 ",IP,"58,026.75","58,026.75",,,,,,,,,,,,,
Molina Medicaid,DRG,23,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$74,400.53 ",IP,"74,400.53","74,400.53",,,,,,,,,,,,,
Molina Medicaid,DRG,24,HEART andOR LUNG TRANSPLANT,,Relative Weights,"$107,953.54 ",IP,"107,953.54","107,953.54",,,,,,,,,,,,,
Molina Medicaid,DRG,41,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$33,014.21 ",IP,"33,014.21","33,014.21",,,,,,,,,,,,,
Molina Medicaid,DRG,42,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$37,820.51 ",IP,"37,820.51","37,820.51",,,,,,,,,,,,,
Molina Medicaid,DRG,43,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$49,052.96 ",IP,"49,052.96","49,052.96",,,,,,,,,,,,,
Molina Medicaid,DRG,44,TRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURE,,Relative Weights,"$72,921.22 ",IP,"72,921.22","72,921.22",,,,,,,,,,,,,
Molina Medicaid,DRG,51,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$23,684.08 ",IP,"23,684.08","23,684.08",,,,,,,,,,,,,
Molina Medicaid,DRG,52,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$26,315.91 ",IP,"26,315.91","26,315.91",,,,,,,,,,,,,
Molina Medicaid,DRG,53,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$36,197.91 ",IP,"36,197.91","36,197.91",,,,,,,,,,,,,
Molina Medicaid,DRG,54,TRACHEOSTOMY W MV 96 HOURS WO EXTENSIVE PROCEDURE,,Relative Weights,"$48,934.75 ",IP,"48,934.75","48,934.75",,,,,,,,,,,,,
Molina Medicaid,DRG,61,PANCREAS TRANSPLANT,,Relative Weights,"$40,520.03 ",IP,"40,520.03","40,520.03",,,,,,,,,,,,,
Molina Medicaid,DRG,62,PANCREAS TRANSPLANT,,Relative Weights,"$45,022.22 ",IP,"45,022.22","45,022.22",,,,,,,,,,,,,
Molina Medicaid,DRG,63,PANCREAS TRANSPLANT,,Relative Weights,"$47,794.94 ",IP,"47,794.94","47,794.94",,,,,,,,,,,,,
Molina Medicaid,DRG,64,PANCREAS TRANSPLANT,,Relative Weights,"$66,459.33 ",IP,"66,459.33","66,459.33",,,,,,,,,,,,,
Molina Medicaid,DRG,71,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$38,434.91 ",IP,"38,434.91","38,434.91",,,,,,,,,,,,,
Molina Medicaid,DRG,72,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$48,059.19 ",IP,"48,059.19","48,059.19",,,,,,,,,,,,,
Molina Medicaid,DRG,73,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$59,827.69 ",IP,"59,827.69","59,827.69",,,,,,,,,,,,,
Molina Medicaid,DRG,74,ALLOGENEIC BONE MARROW TRANSPLANT,,Relative Weights,"$99,672.84 ",IP,"99,672.84","99,672.84",,,,,,,,,,,,,
Molina Medicaid,DRG,81,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$22,091.37 ",IP,"22,091.37","22,091.37",,,,,,,,,,,,,
Molina Medicaid,DRG,82,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$27,118.96 ",IP,"27,118.96","27,118.96",,,,,,,,,,,,,
Molina Medicaid,DRG,83,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$32,175.76 ",IP,"32,175.76","32,175.76",,,,,,,,,,,,,
Molina Medicaid,DRG,84,AUTOLOGOUS BONE MARROW TRANSPLANT,,Relative Weights,"$51,576.54 ",IP,"51,576.54","51,576.54",,,,,,,,,,,,,
Molina Medicaid,DRG,91,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$27,699.69 ",IP,"27,699.69","27,699.69",,,,,,,,,,,,,
Molina Medicaid,DRG,92,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$30,776.86 ",IP,"30,776.86","30,776.86",,,,,,,,,,,,,
Molina Medicaid,DRG,93,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$36,358.72 ",IP,"36,358.72","36,358.72",,,,,,,,,,,,,
Molina Medicaid,DRG,94,EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO),,Relative Weights,"$79,300.63 ",IP,"79,300.63","79,300.63",,,,,,,,,,,,,
Molina Medicaid,DRG,101,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$4,104.27 ",IP,"4,104.27","4,104.27",,,,,,,,,,,,,
Molina Medicaid,DRG,102,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$7,527.81 ",IP,"7,527.81","7,527.81",,,,,,,,,,,,,
Molina Medicaid,DRG,103,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$12,592.86 ",IP,"12,592.86","12,592.86",,,,,,,,,,,,,
Molina Medicaid,DRG,104,HEAD TRAUMA WITH DEEP COMA,,Relative Weights,"$37,584.09 ",IP,"37,584.09","37,584.09",,,,,,,,,,,,,
Molina Medicaid,DRG,201,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$9,991.61 ",IP,"9,991.61","9,991.61",,,,,,,,,,,,,
Molina Medicaid,DRG,202,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$11,868.15 ",IP,"11,868.15","11,868.15",,,,,,,,,,,,,
Molina Medicaid,DRG,203,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$16,002.32 ",IP,"16,002.32","16,002.32",,,,,,,,,,,,,
Molina Medicaid,DRG,204,CRANIOTOMY FOR TRAUMA,,Relative Weights,"$28,673.87 ",IP,"28,673.87","28,673.87",,,,,,,,,,,,,
Molina Medicaid,DRG,211,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$9,882.68 ",IP,"9,882.68","9,882.68",,,,,,,,,,,,,
Molina Medicaid,DRG,212,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$13,243.69 ",IP,"13,243.69","13,243.69",,,,,,,,,,,,,
Molina Medicaid,DRG,213,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$18,834.48 ",IP,"18,834.48","18,834.48",,,,,,,,,,,,,
Molina Medicaid,DRG,214,CRANIOTOMY EXCEPT FOR TRAUMA,,Relative Weights,"$27,671.86 ",IP,"27,671.86","27,671.86",,,,,,,,,,,,,
Molina Medicaid,DRG,221,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$6,449.86 ",IP,"6,449.86","6,449.86",,,,,,,,,,,,,
Molina Medicaid,DRG,222,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$7,492.76 ",IP,"7,492.76","7,492.76",,,,,,,,,,,,,
Molina Medicaid,DRG,223,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$10,628.01 ",IP,"10,628.01","10,628.01",,,,,,,,,,,,,
Molina Medicaid,DRG,224,VENTRICULAR SHUNT PROCEDURES,,Relative Weights,"$25,450.32 ",IP,"25,450.32","25,450.32",,,,,,,,,,,,,
Molina Medicaid,DRG,231,SPINAL PROCEDURES,,Relative Weights,"$7,646.71 ",IP,"7,646.71","7,646.71",,,,,,,,,,,,,
Molina Medicaid,DRG,232,SPINAL PROCEDURES,,Relative Weights,"$9,630.12 ",IP,"9,630.12","9,630.12",,,,,,,,,,,,,
Molina Medicaid,DRG,233,SPINAL PROCEDURES,,Relative Weights,"$16,000.26 ",IP,"16,000.26","16,000.26",,,,,,,,,,,,,
Molina Medicaid,DRG,234,SPINAL PROCEDURES,,Relative Weights,"$29,075.91 ",IP,"29,075.91","29,075.91",,,,,,,,,,,,,
Molina Medicaid,DRG,241,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$5,741.65 ",IP,"5,741.65","5,741.65",,,,,,,,,,,,,
Molina Medicaid,DRG,242,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$6,726.14 ",IP,"6,726.14","6,726.14",,,,,,,,,,,,,
Molina Medicaid,DRG,243,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$13,747.79 ",IP,"13,747.79","13,747.79",,,,,,,,,,,,,
Molina Medicaid,DRG,244,EXTRACRANIAL VASCULAR PROCEDURES,,Relative Weights,"$24,782.31 ",IP,"24,782.31","24,782.31",,,,,,,,,,,,,
Molina Medicaid,DRG,261,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$7,157.39 ",IP,"7,157.39","7,157.39",,,,,,,,,,,,,
Molina Medicaid,DRG,262,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$8,935.31 ",IP,"8,935.31","8,935.31",,,,,,,,,,,,,
Molina Medicaid,DRG,263,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$12,455.76 ",IP,"12,455.76","12,455.76",,,,,,,,,,,,,
Molina Medicaid,DRG,264,OTHER NERVOUS SYSTEM and RELATED PROCEDURES,,Relative Weights,"$22,781.03 ",IP,"22,781.03","22,781.03",,,,,,,,,,,,,
Molina Medicaid,DRG,401,SPINAL DISORDERS and INJURIES,,Relative Weights,"$5,482.55 ",IP,"5,482.55","5,482.55",,,,,,,,,,,,,
Molina Medicaid,DRG,402,SPINAL DISORDERS and INJURIES,,Relative Weights,"$5,877.72 ",IP,"5,877.72","5,877.72",,,,,,,,,,,,,
Molina Medicaid,DRG,403,SPINAL DISORDERS and INJURIES,,Relative Weights,"$8,545.98 ",IP,"8,545.98","8,545.98",,,,,,,,,,,,,
Molina Medicaid,DRG,404,SPINAL DISORDERS and INJURIES,,Relative Weights,"$17,945.87 ",IP,"17,945.87","17,945.87",,,,,,,,,,,,,
Molina Medicaid,DRG,411,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$4,340.00 ",IP,"4,340.00","4,340.00",,,,,,,,,,,,,
Molina Medicaid,DRG,412,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$4,441.02 ",IP,"4,441.02","4,441.02",,,,,,,,,,,,,
Molina Medicaid,DRG,413,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$5,802.81 ",IP,"5,802.81","5,802.81",,,,,,,,,,,,,
Molina Medicaid,DRG,414,NERVOUS SYSTEM MALIGNANCY,,Relative Weights,"$8,029.51 ",IP,"8,029.51","8,029.51",,,,,,,,,,,,,
Molina Medicaid,DRG,421,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$3,328.02 ",IP,"3,328.02","3,328.02",,,,,,,,,,,,,
Molina Medicaid,DRG,422,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$3,814.25 ",IP,"3,814.25","3,814.25",,,,,,,,,,,,,
Molina Medicaid,DRG,423,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$5,381.53 ",IP,"5,381.53","5,381.53",,,,,,,,,,,,,
Molina Medicaid,DRG,424,DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS,,Relative Weights,"$12,544.07 ",IP,"12,544.07","12,544.07",,,,,,,,,,,,,
Molina Medicaid,DRG,431,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$4,040.70 ",IP,"4,040.70","4,040.70",,,,,,,,,,,,,
Molina Medicaid,DRG,432,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$5,014.88 ",IP,"5,014.88","5,014.88",,,,,,,,,,,,,
Molina Medicaid,DRG,433,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$7,268.72 ",IP,"7,268.72","7,268.72",,,,,,,,,,,,,
Molina Medicaid,DRG,434,MULTIPLE SCLEROSIS and OTHER DEMYELINATING DISEASES,,Relative Weights,"$15,032.61 ",IP,"15,032.61","15,032.61",,,,,,,,,,,,,
Molina Medicaid,DRG,441,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$3,968.19 ",IP,"3,968.19","3,968.19",,,,,,,,,,,,,
Molina Medicaid,DRG,442,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$4,927.25 ",IP,"4,927.25","4,927.25",,,,,,,,,,,,,
Molina Medicaid,DRG,443,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$6,702.77 ",IP,"6,702.77","6,702.77",,,,,,,,,,,,,
Molina Medicaid,DRG,444,INTRACRANIAL HEMORRHAGE,,Relative Weights,"$9,326.01 ",IP,"9,326.01","9,326.01",,,,,,,,,,,,,
Molina Medicaid,DRG,451,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$3,612.20 ",IP,"3,612.20","3,612.20",,,,,,,,,,,,,
Molina Medicaid,DRG,452,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$4,429.34 ",IP,"4,429.34","4,429.34",,,,,,,,,,,,,
Molina Medicaid,DRG,453,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$5,951.60 ",IP,"5,951.60","5,951.60",,,,,,,,,,,,,
Molina Medicaid,DRG,454,CVA and PRECEREBRAL OCCLUSION W INFARCT,,Relative Weights,"$10,976.10 ",IP,"10,976.10","10,976.10",,,,,,,,,,,,,
Molina Medicaid,DRG,461,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$3,784.70 ",IP,"3,784.70","3,784.70",,,,,,,,,,,,,
Molina Medicaid,DRG,462,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$4,264.40 ",IP,"4,264.40","4,264.40",,,,,,,,,,,,,
Molina Medicaid,DRG,463,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$5,292.53 ",IP,"5,292.53","5,292.53",,,,,,,,,,,,,
Molina Medicaid,DRG,464,NONSPECIFIC CVA and PRECEREBRAL OCCLUSION WO INFARCT,,Relative Weights,"$10,621.82 ",IP,"10,621.82","10,621.82",,,,,,,,,,,,,
Molina Medicaid,DRG,471,TRANSIENT ISCHEMIA,,Relative Weights,"$3,321.15 ",IP,"3,321.15","3,321.15",,,,,,,,,,,,,
Molina Medicaid,DRG,472,TRANSIENT ISCHEMIA,,Relative Weights,"$3,597.42 ",IP,"3,597.42","3,597.42",,,,,,,,,,,,,
Molina Medicaid,DRG,473,TRANSIENT ISCHEMIA,,Relative Weights,"$4,242.41 ",IP,"4,242.41","4,242.41",,,,,,,,,,,,,
Molina Medicaid,DRG,474,TRANSIENT ISCHEMIA,,Relative Weights,"$7,719.21 ",IP,"7,719.21","7,719.21",,,,,,,,,,,,,
Molina Medicaid,DRG,481,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$3,400.87 ",IP,"3,400.87","3,400.87",,,,,,,,,,,,,
Molina Medicaid,DRG,482,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$3,627.32 ",IP,"3,627.32","3,627.32",,,,,,,,,,,,,
Molina Medicaid,DRG,483,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$4,545.48 ",IP,"4,545.48","4,545.48",,,,,,,,,,,,,
Molina Medicaid,DRG,484,PERIPHERAL CRANIAL and AUTONOMIC NERVE DISORDERS,,Relative Weights,"$10,429.39 ",IP,"10,429.39","10,429.39",,,,,,,,,,,,,
Molina Medicaid,DRG,491,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$5,943.01 ",IP,"5,943.01","5,943.01",,,,,,,,,,,,,
Molina Medicaid,DRG,492,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$9,716.03 ",IP,"9,716.03","9,716.03",,,,,,,,,,,,,
Molina Medicaid,DRG,493,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$11,066.13 ",IP,"11,066.13","11,066.13",,,,,,,,,,,,,
Molina Medicaid,DRG,494,BACTERIAL and TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM,,Relative Weights,"$20,732.33 ",IP,"20,732.33","20,732.33",,,,,,,,,,,,,
Molina Medicaid,DRG,501,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$3,211.53 ",IP,"3,211.53","3,211.53",,,,,,,,,,,,,
Molina Medicaid,DRG,502,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$6,688.34 ",IP,"6,688.34","6,688.34",,,,,,,,,,,,,
Molina Medicaid,DRG,503,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$10,165.49 ",IP,"10,165.49","10,165.49",,,,,,,,,,,,,
Molina Medicaid,DRG,504,NONBACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS,,Relative Weights,"$22,308.54 ",IP,"22,308.54","22,308.54",,,,,,,,,,,,,
Molina Medicaid,DRG,511,VIRAL MENINGITIS,,Relative Weights,"$2,048.35 ",IP,"2,048.35","2,048.35",,,,,,,,,,,,,
Molina Medicaid,DRG,512,VIRAL MENINGITIS,,Relative Weights,"$3,205.00 ",IP,"3,205.00","3,205.00",,,,,,,,,,,,,
Molina Medicaid,DRG,513,VIRAL MENINGITIS,,Relative Weights,"$5,993.52 ",IP,"5,993.52","5,993.52",,,,,,,,,,,,,
Molina Medicaid,DRG,514,VIRAL MENINGITIS,,Relative Weights,"$12,441.32 ",IP,"12,441.32","12,441.32",,,,,,,,,,,,,
Molina Medicaid,DRG,521,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$3,101.91 ",IP,"3,101.91","3,101.91",,,,,,,,,,,,,
Molina Medicaid,DRG,522,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$3,492.61 ",IP,"3,492.61","3,492.61",,,,,,,,,,,,,
Molina Medicaid,DRG,523,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$4,423.15 ",IP,"4,423.15","4,423.15",,,,,,,,,,,,,
Molina Medicaid,DRG,524,ALTERATION IN CONSCIOUSNESS,,Relative Weights,"$9,303.33 ",IP,"9,303.33","9,303.33",,,,,,,,,,,,,
Molina Medicaid,DRG,531,SEIZURE,,Relative Weights,"$2,710.87 ",IP,"2,710.87","2,710.87",,,,,,,,,,,,,
Molina Medicaid,DRG,532,SEIZURE,,Relative Weights,"$3,311.87 ",IP,"3,311.87","3,311.87",,,,,,,,,,,,,
Molina Medicaid,DRG,533,SEIZURE,,Relative Weights,"$4,410.44 ",IP,"4,410.44","4,410.44",,,,,,,,,,,,,
Molina Medicaid,DRG,534,SEIZURE,,Relative Weights,"$10,918.03 ",IP,"10,918.03","10,918.03",,,,,,,,,,,,,
Molina Medicaid,DRG,541,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$2,681.66 ",IP,"2,681.66","2,681.66",,,,,,,,,,,,,
Molina Medicaid,DRG,542,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$3,180.26 ",IP,"3,180.26","3,180.26",,,,,,,,,,,,,
Molina Medicaid,DRG,543,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$3,960.98 ",IP,"3,960.98","3,960.98",,,,,,,,,,,,,
Molina Medicaid,DRG,544,MIGRAINE and OTHER HEADACHES,,Relative Weights,"$6,681.46 ",IP,"6,681.46","6,681.46",,,,,,,,,,,,,
Molina Medicaid,DRG,551,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$3,376.47 ",IP,"3,376.47","3,376.47",,,,,,,,,,,,,
Molina Medicaid,DRG,552,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$4,570.57 ",IP,"4,570.57","4,570.57",,,,,,,,,,,,,
Molina Medicaid,DRG,553,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$6,561.54 ",IP,"6,561.54","6,561.54",,,,,,,,,,,,,
Molina Medicaid,DRG,554,HEAD TRAUMA W COMA 1 HR OR HEMORRHAGE,,Relative Weights,"$13,008.65 ",IP,"13,008.65","13,008.65",,,,,,,,,,,,,
Molina Medicaid,DRG,561,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$3,264.10 ",IP,"3,264.10","3,264.10",,,,,,,,,,,,,
Molina Medicaid,DRG,562,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$4,370.58 ",IP,"4,370.58","4,370.58",,,,,,,,,,,,,
Molina Medicaid,DRG,563,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$6,249.87 ",IP,"6,249.87","6,249.87",,,,,,,,,,,,,
Molina Medicaid,DRG,564,BRAIN CONTUSIONLACERATION and COMPLICATED SKULL FX COMA 1 HR OR NO COMA,,Relative Weights,"$13,974.93 ",IP,"13,974.93","13,974.93",,,,,,,,,,,,,
Molina Medicaid,DRG,571,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$2,653.48 ",IP,"2,653.48","2,653.48",,,,,,,,,,,,,
Molina Medicaid,DRG,572,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$3,996.71 ",IP,"3,996.71","3,996.71",,,,,,,,,,,,,
Molina Medicaid,DRG,573,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$5,550.25 ",IP,"5,550.25","5,550.25",,,,,,,,,,,,,
Molina Medicaid,DRG,574,CONCUSSION CLOSED SKULL FX NOSUNCOMPLICATED INTRACRANIAL INJURY COMA 1 HR OR NO COMA,,Relative Weights,"$10,437.98 ",IP,"10,437.98","10,437.98",,,,,,,,,,,,,
Molina Medicaid,DRG,581,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$3,385.75 ",IP,"3,385.75","3,385.75",,,,,,,,,,,,,
Molina Medicaid,DRG,582,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$4,062.35 ",IP,"4,062.35","4,062.35",,,,,,,,,,,,,
Molina Medicaid,DRG,583,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$5,313.15 ",IP,"5,313.15","5,313.15",,,,,,,,,,,,,
Molina Medicaid,DRG,584,OTHER DISORDERS OF NERVOUS SYSTEM,,Relative Weights,"$10,386.78 ",IP,"10,386.78","10,386.78",,,,,,,,,,,,,
Molina Medicaid,DRG,591,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$3,746.90 ",IP,"3,746.90","3,746.90",,,,,,,,,,,,,
Molina Medicaid,DRG,592,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$4,463.01 ",IP,"4,463.01","4,463.01",,,,,,,,,,,,,
Molina Medicaid,DRG,593,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$6,809.98 ",IP,"6,809.98","6,809.98",,,,,,,,,,,,,
Molina Medicaid,DRG,594,ANOXIC and OTHER SEVERE BRAIN DAMAGE,,Relative Weights,"$11,699.43 ",IP,"11,699.43","11,699.43",,,,,,,,,,,,,
Molina Medicaid,DRG,731,ORBIT AND EYE PROCEDURES,,Relative Weights,"$5,014.53 ",IP,"5,014.53","5,014.53",,,,,,,,,,,,,
Molina Medicaid,DRG,732,ORBIT AND EYE PROCEDURES,,Relative Weights,"$6,421.34 ",IP,"6,421.34","6,421.34",,,,,,,,,,,,,
Molina Medicaid,DRG,733,ORBIT AND EYE PROCEDURES,,Relative Weights,"$9,718.43 ",IP,"9,718.43","9,718.43",,,,,,,,,,,,,
Molina Medicaid,DRG,734,ORBIT AND EYE PROCEDURES,,Relative Weights,"$22,403.73 ",IP,"22,403.73","22,403.73",,,,,,,,,,,,,
Molina Medicaid,DRG,821,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$2,633.21 ",IP,"2,633.21","2,633.21",,,,,,,,,,,,,
Molina Medicaid,DRG,822,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$3,410.83 ",IP,"3,410.83","3,410.83",,,,,,,,,,,,,
Molina Medicaid,DRG,823,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$4,809.73 ",IP,"4,809.73","4,809.73",,,,,,,,,,,,,
Molina Medicaid,DRG,824,EYE INFECTIONS AND OTHER EYE DISORDERS,,Relative Weights,"$13,027.89 ",IP,"13,027.89","13,027.89",,,,,,,,,,,,,
Molina Medicaid,DRG,891,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$9,059.01 ",IP,"9,059.01","9,059.01",,,,,,,,,,,,,
Molina Medicaid,DRG,892,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$11,457.52 ",IP,"11,457.52","11,457.52",,,,,,,,,,,,,
Molina Medicaid,DRG,893,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$17,804.98 ",IP,"17,804.98","17,804.98",,,,,,,,,,,,,
Molina Medicaid,DRG,894,MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$32,041.75 ",IP,"32,041.75","32,041.75",,,,,,,,,,,,,
Molina Medicaid,DRG,911,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$6,729.57 ",IP,"6,729.57","6,729.57",,,,,,,,,,,,,
Molina Medicaid,DRG,912,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$9,964.47 ",IP,"9,964.47","9,964.47",,,,,,,,,,,,,
Molina Medicaid,DRG,913,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$16,613.29 ",IP,"16,613.29","16,613.29",,,,,,,,,,,,,
Molina Medicaid,DRG,914,OTHER MAJOR HEAD and NECK PROCEDURES,,Relative Weights,"$32,825.56 ",IP,"32,825.56","32,825.56",,,,,,,,,,,,,
Molina Medicaid,DRG,921,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$6,039.23 ",IP,"6,039.23","6,039.23",,,,,,,,,,,,,
Molina Medicaid,DRG,922,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$8,191.36 ",IP,"8,191.36","8,191.36",,,,,,,,,,,,,
Molina Medicaid,DRG,923,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$13,246.44 ",IP,"13,246.44","13,246.44",,,,,,,,,,,,,
Molina Medicaid,DRG,924,FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES,,Relative Weights,"$30,839.40 ",IP,"30,839.40","30,839.40",,,,,,,,,,,,,
Molina Medicaid,DRG,951,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$4,246.53 ",IP,"4,246.53","4,246.53",,,,,,,,,,,,,
Molina Medicaid,DRG,952,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$4,867.46 ",IP,"4,867.46","4,867.46",,,,,,,,,,,,,
Molina Medicaid,DRG,953,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$7,436.75 ",IP,"7,436.75","7,436.75",,,,,,,,,,,,,
Molina Medicaid,DRG,954,CLEFT LIP and PALATE REPAIR,,Relative Weights,"$14,987.25 ",IP,"14,987.25","14,987.25",,,,,,,,,,,,,
Molina Medicaid,DRG,971,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$2,853.47 ",IP,"2,853.47","2,853.47",,,,,,,,,,,,,
Molina Medicaid,DRG,972,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$3,981.59 ",IP,"3,981.59","3,981.59",,,,,,,,,,,,,
Molina Medicaid,DRG,973,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$6,406.56 ",IP,"6,406.56","6,406.56",,,,,,,,,,,,,
Molina Medicaid,DRG,974,TONSIL and ADENOID PROCEDURES,,Relative Weights,"$15,100.30 ",IP,"15,100.30","15,100.30",,,,,,,,,,,,,
Molina Medicaid,DRG,981,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$4,806.30 ",IP,"4,806.30","4,806.30",,,,,,,,,,,,,
Molina Medicaid,DRG,982,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$6,289.73 ",IP,"6,289.73","6,289.73",,,,,,,,,,,,,
Molina Medicaid,DRG,983,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$10,153.46 ",IP,"10,153.46","10,153.46",,,,,,,,,,,,,
Molina Medicaid,DRG,984,OTHER EAR NOSE MOUTH and THROAT PROCEDURES,,Relative Weights,"$19,630.32 ",IP,"19,630.32","19,630.32",,,,,,,,,,,,,
Molina Medicaid,DRG,1101,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$4,539.30 ",IP,"4,539.30","4,539.30",,,,,,,,,,,,,
Molina Medicaid,DRG,1102,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$4,571.26 ",IP,"4,571.26","4,571.26",,,,,,,,,,,,,
Molina Medicaid,DRG,1103,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$6,424.43 ",IP,"6,424.43","6,424.43",,,,,,,,,,,,,
Molina Medicaid,DRG,1104,EAR NOSE MOUTH THROAT CRANIALFACIAL MALIGNANCIES,,Relative Weights,"$10,388.84 ",IP,"10,388.84","10,388.84",,,,,,,,,,,,,
Molina Medicaid,DRG,1111,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$3,014.97 ",IP,"3,014.97","3,014.97",,,,,,,,,,,,,
Molina Medicaid,DRG,1112,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$3,232.83 ",IP,"3,232.83","3,232.83",,,,,,,,,,,,,
Molina Medicaid,DRG,1113,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$3,830.06 ",IP,"3,830.06","3,830.06",,,,,,,,,,,,,
Molina Medicaid,DRG,1114,VERTIGO and OTHER LABYRINTH DISORDERS,,Relative Weights,"$5,856.07 ",IP,"5,856.07","5,856.07",,,,,,,,,,,,,
Molina Medicaid,DRG,1131,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$1,710.57 ",IP,"1,710.57","1,710.57",,,,,,,,,,,,,
Molina Medicaid,DRG,1132,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$2,449.71 ",IP,"2,449.71","2,449.71",,,,,,,,,,,,,
Molina Medicaid,DRG,1133,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$3,709.10 ",IP,"3,709.10","3,709.10",,,,,,,,,,,,,
Molina Medicaid,DRG,1134,INFECTIONS OF UPPER RESPIRATORY TRACT,,Relative Weights,"$7,363.91 ",IP,"7,363.91","7,363.91",,,,,,,,,,,,,
Molina Medicaid,DRG,1141,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$2,233.23 ",IP,"2,233.23","2,233.23",,,,,,,,,,,,,
Molina Medicaid,DRG,1142,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$3,024.94 ",IP,"3,024.94","3,024.94",,,,,,,,,,,,,
Molina Medicaid,DRG,1143,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$4,392.57 ",IP,"4,392.57","4,392.57",,,,,,,,,,,,,
Molina Medicaid,DRG,1144,DENTAL DISEASES AND DISORDERS,,Relative Weights,"$11,476.08 ",IP,"11,476.08","11,476.08",,,,,,,,,,,,,
Molina Medicaid,DRG,1151,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$2,472.39 ",IP,"2,472.39","2,472.39",,,,,,,,,,,,,
Molina Medicaid,DRG,1152,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$3,380.25 ",IP,"3,380.25","3,380.25",,,,,,,,,,,,,
Molina Medicaid,DRG,1153,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$4,829.66 ",IP,"4,829.66","4,829.66",,,,,,,,,,,,,
Molina Medicaid,DRG,1154,OTHER EAR NOSE MOUTHTHROAT and CRANIALFACIAL DIAGNOSES,,Relative Weights,"$10,560.66 ",IP,"10,560.66","10,560.66",,,,,,,,,,,,,
Molina Medicaid,DRG,1201,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$8,978.60 ",IP,"8,978.60","8,978.60",,,,,,,,,,,,,
Molina Medicaid,DRG,1202,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$10,724.22 ",IP,"10,724.22","10,724.22",,,,,,,,,,,,,
Molina Medicaid,DRG,1203,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$15,096.86 ",IP,"15,096.86","15,096.86",,,,,,,,,,,,,
Molina Medicaid,DRG,1204,MAJOR RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$30,187.20 ",IP,"30,187.20","30,187.20",,,,,,,,,,,,,
Molina Medicaid,DRG,1211,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$6,647.79 ",IP,"6,647.79","6,647.79",,,,,,,,,,,,,
Molina Medicaid,DRG,1212,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$8,066.62 ",IP,"8,066.62","8,066.62",,,,,,,,,,,,,
Molina Medicaid,DRG,1213,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$12,267.10 ",IP,"12,267.10","12,267.10",,,,,,,,,,,,,
Molina Medicaid,DRG,1214,OTHER RESPIRATORY and CHEST PROCEDURES,,Relative Weights,"$23,708.13 ",IP,"23,708.13","23,708.13",,,,,,,,,,,,,
Molina Medicaid,DRG,1301,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$15,152.88 ",IP,"15,152.88","15,152.88",,,,,,,,,,,,,
Molina Medicaid,DRG,1302,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$17,209.82 ",IP,"17,209.82","17,209.82",,,,,,,,,,,,,
Molina Medicaid,DRG,1303,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$20,315.17 ",IP,"20,315.17","20,315.17",,,,,,,,,,,,,
Molina Medicaid,DRG,1304,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURS,,Relative Weights,"$28,326.47 ",IP,"28,326.47","28,326.47",,,,,,,,,,,,,
Molina Medicaid,DRG,1311,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$6,540.23 ",IP,"6,540.23","6,540.23",,,,,,,,,,,,,
Molina Medicaid,DRG,1312,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$9,797.46 ",IP,"9,797.46","9,797.46",,,,,,,,,,,,,
Molina Medicaid,DRG,1313,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$13,253.65 ",IP,"13,253.65","13,253.65",,,,,,,,,,,,,
Molina Medicaid,DRG,1314,CYSTIC FIBROSIS PULMONARY DISEASE,,Relative Weights,"$17,241.78 ",IP,"17,241.78","17,241.78",,,,,,,,,,,,,
Molina Medicaid,DRG,1321,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$2,377.20 ",IP,"2,377.20","2,377.20",,,,,,,,,,,,,
Molina Medicaid,DRG,1322,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$3,157.24 ",IP,"3,157.24","3,157.24",,,,,,,,,,,,,
Molina Medicaid,DRG,1323,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$5,204.90 ",IP,"5,204.90","5,204.90",,,,,,,,,,,,,
Molina Medicaid,DRG,1324,BPD and OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD,,Relative Weights,"$9,706.75 ",IP,"9,706.75","9,706.75",,,,,,,,,,,,,
Molina Medicaid,DRG,1331,RESPIRATORY FAILURE,,Relative Weights,"$2,072.41 ",IP,"2,072.41","2,072.41",,,,,,,,,,,,,
Molina Medicaid,DRG,1332,RESPIRATORY FAILURE,,Relative Weights,"$3,703.26 ",IP,"3,703.26","3,703.26",,,,,,,,,,,,,
Molina Medicaid,DRG,1333,RESPIRATORY FAILURE,,Relative Weights,"$5,064.70 ",IP,"5,064.70","5,064.70",,,,,,,,,,,,,
Molina Medicaid,DRG,1334,RESPIRATORY FAILURE,,Relative Weights,"$9,349.38 ",IP,"9,349.38","9,349.38",,,,,,,,,,,,,
Molina Medicaid,DRG,1341,PULMONARY EMBOLISM,,Relative Weights,"$2,977.18 ",IP,"2,977.18","2,977.18",,,,,,,,,,,,,
Molina Medicaid,DRG,1342,PULMONARY EMBOLISM,,Relative Weights,"$3,832.12 ",IP,"3,832.12","3,832.12",,,,,,,,,,,,,
Molina Medicaid,DRG,1343,PULMONARY EMBOLISM,,Relative Weights,"$5,276.03 ",IP,"5,276.03","5,276.03",,,,,,,,,,,,,
Molina Medicaid,DRG,1344,PULMONARY EMBOLISM,,Relative Weights,"$8,166.27 ",IP,"8,166.27","8,166.27",,,,,,,,,,,,,
Molina Medicaid,DRG,1351,MAJOR CHEST and RESPIRAZORY TRAUMA,,Relative Weights,"$3,792.26 ",IP,"3,792.26","3,792.26",,,,,,,,,,,,,
Molina Medicaid,DRG,1352,MAJOR CHEST and RESPIRATORY TRAUMA,,Relative Weights,"$3,955.48 ",IP,"3,955.48","3,955.48",,,,,,,,,,,,,
Molina Medicaid,DRG,1353,MAJOR CHEST and RESPIRATORY TRAUMA,,Relative Weights,"$5,683.92 ",IP,"5,683.92","5,683.92",,,,,,,,,,,,,
Molina Medicaid,DRG,1354,MAJOR CHEST and RESPIRATORY TRAUMA,,Relative Weights,"$10,178.89 ",IP,"10,178.89","10,178.89",,,,,,,,,,,,,
Molina Medicaid,DRG,1361,RESPIRATORY MALIGNANCY,,Relative Weights,"$4,244.47 ",IP,"4,244.47","4,244.47",,,,,,,,,,,,,
Molina Medicaid,DRG,1362,RESPIRATORY MALIGNANCY,,Relative Weights,"$4,742.73 ",IP,"4,742.73","4,742.73",,,,,,,,,,,,,
Molina Medicaid,DRG,1363,RESPIRATORY MALIGNANCY,,Relative Weights,"$6,049.19 ",IP,"6,049.19","6,049.19",,,,,,,,,,,,,
Molina Medicaid,DRG,1364,RESPIRATORY MALIGNANCY,,Relative Weights,"$9,049.05 ",IP,"9,049.05","9,049.05",,,,,,,,,,,,,
Molina Medicaid,DRG,1371,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$3,151.74 ",IP,"3,151.74","3,151.74",,,,,,,,,,,,,
Molina Medicaid,DRG,1372,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$3,930.39 ",IP,"3,930.39","3,930.39",,,,,,,,,,,,,
Molina Medicaid,DRG,1373,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$5,471.90 ",IP,"5,471.90","5,471.90",,,,,,,,,,,,,
Molina Medicaid,DRG,1374,MAJOR RESPIRATORY INFECTIONS and INFLAMMATIONS,,Relative Weights,"$8,758.68 ",IP,"8,758.68","8,758.68",,,,,,,,,,,,,
Molina Medicaid,DRG,1381,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$1,796.82 ",IP,"1,796.82","1,796.82",,,,,,,,,,,,,
Molina Medicaid,DRG,1382,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$2,575.82 ",IP,"2,575.82","2,575.82",,,,,,,,,,,,,
Molina Medicaid,DRG,1383,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$4,712.83 ",IP,"4,712.83","4,712.83",,,,,,,,,,,,,
Molina Medicaid,DRG,1384,BRONCHIOLITIS and RSV PNEUMONIA,,Relative Weights,"$9,865.85 ",IP,"9,865.85","9,865.85",,,,,,,,,,,,,
Molina Medicaid,DRG,1391,OTHER PNEUMONIA,,Relative Weights,"$2,182.71 ",IP,"2,182.71","2,182.71",,,,,,,,,,,,,
Molina Medicaid,DRG,1392,OTHER PNEUMONIA,,Relative Weights,"$3,016.35 ",IP,"3,016.35","3,016.35",,,,,,,,,,,,,
Molina Medicaid,DRG,1393,OTHER PNEUMONIA,,Relative Weights,"$4,342.75 ",IP,"4,342.75","4,342.75",,,,,,,,,,,,,
Molina Medicaid,DRG,1394,OTHER PNEUMONIA,,Relative Weights,"$7,186.59 ",IP,"7,186.59","7,186.59",,,,,,,,,,,,,
Molina Medicaid,DRG,1401,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$2,639.05 ",IP,"2,639.05","2,639.05",,,,,,,,,,,,,
Molina Medicaid,DRG,1402,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$3,167.20 ",IP,"3,167.20","3,167.20",,,,,,,,,,,,,
Molina Medicaid,DRG,1403,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$3,958.92 ",IP,"3,958.92","3,958.92",,,,,,,,,,,,,
Molina Medicaid,DRG,1404,CHRONIC OBSTRUCTIVE PULMONARY DISEASE,,Relative Weights,"$5,969.47 ",IP,"5,969.47","5,969.47",,,,,,,,,,,,,
Molina Medicaid,DRG,1411,ASTHMA,,Relative Weights,"$2,018.80 ",IP,"2,018.80","2,018.80",,,,,,,,,,,,,
Molina Medicaid,DRG,1412,ASTHMA,,Relative Weights,"$2,763.78 ",IP,"2,763.78","2,763.78",,,,,,,,,,,,,
Molina Medicaid,DRG,1413,ASTHMA,,Relative Weights,"$4,049.98 ",IP,"4,049.98","4,049.98",,,,,,,,,,,,,
Molina Medicaid,DRG,1414,ASTHMA,,Relative Weights,"$6,508.28 ",IP,"6,508.28","6,508.28",,,,,,,,,,,,,
Molina Medicaid,DRG,1421,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$3,358.26 ",IP,"3,358.26","3,358.26",,,,,,,,,,,,,
Molina Medicaid,DRG,1422,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$3,679.89 ",IP,"3,679.89","3,679.89",,,,,,,,,,,,,
Molina Medicaid,DRG,1423,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$4,888.08 ",IP,"4,888.08","4,888.08",,,,,,,,,,,,,
Molina Medicaid,DRG,1424,INTERSTITIAL and ALVEOLAR LUNG DISEASES,,Relative Weights,"$7,901.68 ",IP,"7,901.68","7,901.68",,,,,,,,,,,,,
Molina Medicaid,DRG,1431,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$2,504.69 ",IP,"2,504.69","2,504.69",,,,,,,,,,,,,
Molina Medicaid,DRG,1432,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$3,509.11 ",IP,"3,509.11","3,509.11",,,,,,,,,,,,,
Molina Medicaid,DRG,1433,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$5,145.11 ",IP,"5,145.11","5,145.11",,,,,,,,,,,,,
Molina Medicaid,DRG,1434,OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$8,358.70 ",IP,"8,358.70","8,358.70",,,,,,,,,,,,,
Molina Medicaid,DRG,1441,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$2,636.99 ",IP,"2,636.99","2,636.99",,,,,,,,,,,,,
Molina Medicaid,DRG,1442,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$3,405.68 ",IP,"3,405.68","3,405.68",,,,,,,,,,,,,
Molina Medicaid,DRG,1443,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$4,454.42 ",IP,"4,454.42","4,454.42",,,,,,,,,,,,,
Molina Medicaid,DRG,1444,RESPIRATORY SIGNS SYMPTOMS and MINOR DIAGNOSES,,Relative Weights,"$7,998.24 ",IP,"7,998.24","7,998.24",,,,,,,,,,,,,
Molina Medicaid,DRG,1451,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$2,478.23 ",IP,"2,478.23","2,478.23",,,,,,,,,,,,,
Molina Medicaid,DRG,1452,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$2,974.43 ",IP,"2,974.43","2,974.43",,,,,,,,,,,,,
Molina Medicaid,DRG,1453,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$3,820.09 ",IP,"3,820.09","3,820.09",,,,,,,,,,,,,
Molina Medicaid,DRG,1454,ACUTE BRONCHITIS AND RELATED SYMPTOMS,,Relative Weights,"$6,746.07 ",IP,"6,746.07","6,746.07",,,,,,,,,,,,,
Molina Medicaid,DRG,1601,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$19,007.33 ",IP,"19,007.33","19,007.33",,,,,,,,,,,,,
Molina Medicaid,DRG,1602,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$21,418.55 ",IP,"21,418.55","21,418.55",,,,,,,,,,,,,
Molina Medicaid,DRG,1603,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$29,897.52 ",IP,"29,897.52","29,897.52",,,,,,,,,,,,,
Molina Medicaid,DRG,1604,MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY,,Relative Weights,"$58,616.75 ",IP,"58,616.75","58,616.75",,,,,,,,,,,,,
Molina Medicaid,DRG,1611,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$21,623.70 ",IP,"21,623.70","21,623.70",,,,,,,,,,,,,
Molina Medicaid,DRG,1612,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$25,324.21 ",IP,"25,324.21","25,324.21",,,,,,,,,,,,,
Molina Medicaid,DRG,1613,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$37,168.99 ",IP,"37,168.99","37,168.99",,,,,,,,,,,,,
Molina Medicaid,DRG,1614,CARDIAC DEFIBRILLATOR and HEART ASSIST IMPLANT,,Relative Weights,"$84,952.59 ",IP,"84,952.59","84,952.59",,,,,,,,,,,,,
Molina Medicaid,DRG,1621,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$21,734.00 ",IP,"21,734.00","21,734.00",,,,,,,,,,,,,
Molina Medicaid,DRG,1622,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$25,647.21 ",IP,"25,647.21","25,647.21",,,,,,,,,,,,,
Molina Medicaid,DRG,1623,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$32,557.19 ",IP,"32,557.19","32,557.19",,,,,,,,,,,,,
Molina Medicaid,DRG,1624,CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX,,Relative Weights,"$51,493.39 ",IP,"51,493.39","51,493.39",,,,,,,,,,,,,
Molina Medicaid,DRG,1631,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$18,870.57 ",IP,"18,870.57","18,870.57",,,,,,,,,,,,,
Molina Medicaid,DRG,1632,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$20,678.38 ",IP,"20,678.38","20,678.38",,,,,,,,,,,,,
Molina Medicaid,DRG,1633,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$25,441.73 ",IP,"25,441.73","25,441.73",,,,,,,,,,,,,
Molina Medicaid,DRG,1634,CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX,,Relative Weights,"$42,290.40 ",IP,"42,290.40","42,290.40",,,,,,,,,,,,,
Molina Medicaid,DRG,1651,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$17,424.93 ",IP,"17,424.93","17,424.93",,,,,,,,,,,,,
Molina Medicaid,DRG,1652,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$20,592.13 ",IP,"20,592.13","20,592.13",,,,,,,,,,,,,
Molina Medicaid,DRG,1653,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$24,876.46 ",IP,"24,876.46","24,876.46",,,,,,,,,,,,,
Molina Medicaid,DRG,1654,CORONARY BYPASS W AMI OR COMPLEX PDX,,Relative Weights,"$37,414.00 ",IP,"37,414.00","37,414.00",,,,,,,,,,,,,
Molina Medicaid,DRG,1661,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$16,087.19 ",IP,"16,087.19","16,087.19",,,,,,,,,,,,,
Molina Medicaid,DRG,1662,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$17,173.40 ",IP,"17,173.40","17,173.40",,,,,,,,,,,,,
Molina Medicaid,DRG,1663,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$20,743.67 ",IP,"20,743.67","20,743.67",,,,,,,,,,,,,
Molina Medicaid,DRG,1664,CORONARY BYPASS WO AMI OR COMPLEX PDX,,Relative Weights,"$33,503.88 ",IP,"33,503.88","33,503.88",,,,,,,,,,,,,
Molina Medicaid,DRG,1671,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$15,753.88 ",IP,"15,753.88","15,753.88",,,,,,,,,,,,,
Molina Medicaid,DRG,1672,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$16,654.52 ",IP,"16,654.52","16,654.52",,,,,,,,,,,,,
Molina Medicaid,DRG,1673,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$20,943.66 ",IP,"20,943.66","20,943.66",,,,,,,,,,,,,
Molina Medicaid,DRG,1674,OTHER CARDIOTHORACIC and THORACIC VASCULAR PROCEDURES,,Relative Weights,"$39,564.41 ",IP,"39,564.41","39,564.41",,,,,,,,,,,,,
Molina Medicaid,DRG,1691,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$9,314.67 ",IP,"9,314.67","9,314.67",,,,,,,,,,,,,
Molina Medicaid,DRG,1692,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$12,244.08 ",IP,"12,244.08","12,244.08",,,,,,,,,,,,,
Molina Medicaid,DRG,1693,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$19,456.45 ",IP,"19,456.45","19,456.45",,,,,,,,,,,,,
Molina Medicaid,DRG,1694,MAJOR ABDOMINAL VASCULAR PROCEDURES,,Relative Weights,"$33,906.95 ",IP,"33,906.95","33,906.95",,,,,,,,,,,,,
Molina Medicaid,DRG,1701,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$10,265.14 ",IP,"10,265.14","10,265.14",,,,,,,,,,,,,
Molina Medicaid,DRG,1702,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$10,949.99 ",IP,"10,949.99","10,949.99",,,,,,,,,,,,,
Molina Medicaid,DRG,1703,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$13,975.61 ",IP,"13,975.61","13,975.61",,,,,,,,,,,,,
Molina Medicaid,DRG,1704,PERMANENT CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK,,Relative Weights,"$19,895.26 ",IP,"19,895.26","19,895.26",,,,,,,,,,,,,
Molina Medicaid,DRG,1711,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$8,272.45 ",IP,"8,272.45","8,272.45",,,,,,,,,,,,,
Molina Medicaid,DRG,1712,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$9,180.66 ",IP,"9,180.66","9,180.66",,,,,,,,,,,,,
Molina Medicaid,DRG,1713,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$10,971.29 ",IP,"10,971.29","10,971.29",,,,,,,,,,,,,
Molina Medicaid,DRG,1714,PERM CARDIAC PACEMAKER IMPLANT WO AMI HEART FAILURE OR SHOCK,,Relative Weights,"$17,965.80 ",IP,"17,965.80","17,965.80",,,,,,,,,,,,,
Molina Medicaid,DRG,1741,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$9,597.47 ",IP,"9,597.47","9,597.47",,,,,,,,,,,,,
Molina Medicaid,DRG,1742,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$10,364.10 ",IP,"10,364.10","10,364.10",,,,,,,,,,,,,
Molina Medicaid,DRG,1743,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$12,874.29 ",IP,"12,874.29","12,874.29",,,,,,,,,,,,,
Molina Medicaid,DRG,1744,PERCUTANEOUS CORONARY INTERVENTION W AMI,,Relative Weights,"$19,364.01 ",IP,"19,364.01","19,364.01",,,,,,,,,,,,,
Molina Medicaid,DRG,1751,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$11,256.84 ",IP,"11,256.84","11,256.84",,,,,,,,,,,,,
Molina Medicaid,DRG,1752,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$12,009.39 ",IP,"12,009.39","12,009.39",,,,,,,,,,,,,
Molina Medicaid,DRG,1753,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$14,253.95 ",IP,"14,253.95","14,253.95",,,,,,,,,,,,,
Molina Medicaid,DRG,1754,PERCUTANEOUS CORONARY INTERVENTION WO AMI,,Relative Weights,"$25,147.58 ",IP,"25,147.58","25,147.58",,,,,,,,,,,,,
Molina Medicaid,DRG,1761,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$9,268.97 ",IP,"9,268.97","9,268.97",,,,,,,,,,,,,
Molina Medicaid,DRG,1762,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$10,537.63 ",IP,"10,537.63","10,537.63",,,,,,,,,,,,,
Molina Medicaid,DRG,1763,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$15,961.08 ",IP,"15,961.08","15,961.08",,,,,,,,,,,,,
Molina Medicaid,DRG,1764,CARDIAC PACEMAKER and DEFIBRILLATOR DEVICE REPLACEMENT,,Relative Weights,"$25,961.29 ",IP,"25,961.29","25,961.29",,,,,,,,,,,,,
Molina Medicaid,DRG,1771,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$6,530.96 ",IP,"6,530.96","6,530.96",,,,,,,,,,,,,
Molina Medicaid,DRG,1772,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$9,029.80 ",IP,"9,029.80","9,029.80",,,,,,,,,,,,,
Molina Medicaid,DRG,1773,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$11,280.21 ",IP,"11,280.21","11,280.21",,,,,,,,,,,,,
Molina Medicaid,DRG,1774,CARDIAC PACEMAKER and DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT,,Relative Weights,"$17,033.20 ",IP,"17,033.20","17,033.20",,,,,,,,,,,,,
Molina Medicaid,DRG,1801,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$6,351.58 ",IP,"6,351.58","6,351.58",,,,,,,,,,,,,
Molina Medicaid,DRG,1802,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$7,715.78 ",IP,"7,715.78","7,715.78",,,,,,,,,,,,,
Molina Medicaid,DRG,1803,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$10,872.33 ",IP,"10,872.33","10,872.33",,,,,,,,,,,,,
Molina Medicaid,DRG,1804,OTHER CIRCULATORY SYSTEM PROCEDURES,,Relative Weights,"$20,062.95 ",IP,"20,062.95","20,062.95",,,,,,,,,,,,,
Molina Medicaid,DRG,1811,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$9,268.28 ",IP,"9,268.28","9,268.28",,,,,,,,,,,,,
Molina Medicaid,DRG,1812,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$11,438.97 ",IP,"11,438.97","11,438.97",,,,,,,,,,,,,
Molina Medicaid,DRG,1813,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$16,303.68 ",IP,"16,303.68","16,303.68",,,,,,,,,,,,,
Molina Medicaid,DRG,1814,LOWER EXTREMITY ARTERIAL PROCEDURES,,Relative Weights,"$27,105.22 ",IP,"27,105.22","27,105.22",,,,,,,,,,,,,
Molina Medicaid,DRG,1821,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$9,585.79 ",IP,"9,585.79","9,585.79",,,,,,,,,,,,,
Molina Medicaid,DRG,1822,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$11,451.68 ",IP,"11,451.68","11,451.68",,,,,,,,,,,,,
Molina Medicaid,DRG,1823,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$12,966.73 ",IP,"12,966.73","12,966.73",,,,,,,,,,,,,
Molina Medicaid,DRG,1824,OTHER PERIPHERAL VASCULAR PROCEDURES,,Relative Weights,"$25,526.94 ",IP,"25,526.94","25,526.94",,,,,,,,,,,,,
Molina Medicaid,DRG,1901,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$3,454.82 ",IP,"3,454.82","3,454.82",,,,,,,,,,,,,
Molina Medicaid,DRG,1902,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$4,023.17 ",IP,"4,023.17","4,023.17",,,,,,,,,,,,,
Molina Medicaid,DRG,1903,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$5,278.78 ",IP,"5,278.78","5,278.78",,,,,,,,,,,,,
Molina Medicaid,DRG,1904,ACUTE MYOCARDIAL INFARCTION,,Relative Weights,"$8,568.66 ",IP,"8,568.66","8,568.66",,,,,,,,,,,,,
Molina Medicaid,DRG,1911,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$4,795.99 ",IP,"4,795.99","4,795.99",,,,,,,,,,,,,
Molina Medicaid,DRG,1912,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$5,349.23 ",IP,"5,349.23","5,349.23",,,,,,,,,,,,,
Molina Medicaid,DRG,1913,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$6,652.26 ",IP,"6,652.26","6,652.26",,,,,,,,,,,,,
Molina Medicaid,DRG,1914,CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE,,Relative Weights,"$10,568.22 ",IP,"10,568.22","10,568.22",,,,,,,,,,,,,
Molina Medicaid,DRG,1921,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$5,126.56 ",IP,"5,126.56","5,126.56",,,,,,,,,,,,,
Molina Medicaid,DRG,1922,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$5,995.59 ",IP,"5,995.59","5,995.59",,,,,,,,,,,,,
Molina Medicaid,DRG,1923,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$8,192.04 ",IP,"8,192.04","8,192.04",,,,,,,,,,,,,
Molina Medicaid,DRG,1924,CARDIAC CATHETERIZATION FOR OTHER NONCORONARY CONDITIONS,,Relative Weights,"$14,030.25 ",IP,"14,030.25","14,030.25",,,,,,,,,,,,,
Molina Medicaid,DRG,1931,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$4,156.16 ",IP,"4,156.16","4,156.16",,,,,,,,,,,,,
Molina Medicaid,DRG,1932,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$5,201.81 ",IP,"5,201.81","5,201.81",,,,,,,,,,,,,
Molina Medicaid,DRG,1933,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$7,472.15 ",IP,"7,472.15","7,472.15",,,,,,,,,,,,,
Molina Medicaid,DRG,1934,ACUTE and SUBACUTE ENDOCARDITIS,,Relative Weights,"$12,655.75 ",IP,"12,655.75","12,655.75",,,,,,,,,,,,,
Molina Medicaid,DRG,1941,HEART FAILURE,,Relative Weights,"$2,590.60 ",IP,"2,590.60","2,590.60",,,,,,,,,,,,,
Molina Medicaid,DRG,1942,HEART FAILURE,,Relative Weights,"$3,135.24 ",IP,"3,135.24","3,135.24",,,,,,,,,,,,,
Molina Medicaid,DRG,1943,HEART FAILURE,,Relative Weights,"$4,368.86 ",IP,"4,368.86","4,368.86",,,,,,,,,,,,,
Molina Medicaid,DRG,1944,HEART FAILURE,,Relative Weights,"$7,070.79 ",IP,"7,070.79","7,070.79",,,,,,,,,,,,,
Molina Medicaid,DRG,1961,CARDIAC ARREST and SHOCK,,Relative Weights,"$2,365.52 ",IP,"2,365.52","2,365.52",,,,,,,,,,,,,
Molina Medicaid,DRG,1962,CARDIAC ARREST and SHOCK,,Relative Weights,"$2,596.44 ",IP,"2,596.44","2,596.44",,,,,,,,,,,,,
Molina Medicaid,DRG,1963,CARDIAC ARREST and SHOCK,,Relative Weights,"$4,010.12 ",IP,"4,010.12","4,010.12",,,,,,,,,,,,,
Molina Medicaid,DRG,1964,CARDIAC ARREST and SHOCK,,Relative Weights,"$8,325.03 ",IP,"8,325.03","8,325.03",,,,,,,,,,,,,
Molina Medicaid,DRG,1971,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$2,758.63 ",IP,"2,758.63","2,758.63",,,,,,,,,,,,,
Molina Medicaid,DRG,1972,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$3,488.49 ",IP,"3,488.49","3,488.49",,,,,,,,,,,,,
Molina Medicaid,DRG,1973,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$4,794.61 ",IP,"4,794.61","4,794.61",,,,,,,,,,,,,
Molina Medicaid,DRG,1974,PERIPHERAL and OTHER VASCULAR DISORDERS,,Relative Weights,"$9,053.51 ",IP,"9,053.51","9,053.51",,,,,,,,,,,,,
Molina Medicaid,DRG,1981,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$2,680.28 ",IP,"2,680.28","2,680.28",,,,,,,,,,,,,
Molina Medicaid,DRG,1982,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$2,985.77 ",IP,"2,985.77","2,985.77",,,,,,,,,,,,,
Molina Medicaid,DRG,1983,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$3,628.00 ",IP,"3,628.00","3,628.00",,,,,,,,,,,,,
Molina Medicaid,DRG,1984,ANGINA PECTORIS and CORONARY ATHEROSCLEROSIS,,Relative Weights,"$6,763.25 ",IP,"6,763.25","6,763.25",,,,,,,,,,,,,
Molina Medicaid,DRG,1991,HYPERTENSION,,Relative Weights,"$2,662.41 ",IP,"2,662.41","2,662.41",,,,,,,,,,,,,
Molina Medicaid,DRG,1992,HYPERTENSION,,Relative Weights,"$2,956.56 ",IP,"2,956.56","2,956.56",,,,,,,,,,,,,
Molina Medicaid,DRG,1993,HYPERTENSION,,Relative Weights,"$3,736.93 ",IP,"3,736.93","3,736.93",,,,,,,,,,,,,
Molina Medicaid,DRG,1994,HYPERTENSION,,Relative Weights,"$6,634.39 ",IP,"6,634.39","6,634.39",,,,,,,,,,,,,
Molina Medicaid,DRG,2001,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$2,919.45 ",IP,"2,919.45","2,919.45",,,,,,,,,,,,,
Molina Medicaid,DRG,2002,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$3,565.12 ",IP,"3,565.12","3,565.12",,,,,,,,,,,,,
Molina Medicaid,DRG,2003,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$4,853.03 ",IP,"4,853.03","4,853.03",,,,,,,,,,,,,
Molina Medicaid,DRG,2004,CARDIAC STRUCTURAL and VALVULAR DISORDERS,,Relative Weights,"$10,524.92 ",IP,"10,524.92","10,524.92",,,,,,,,,,,,,
Molina Medicaid,DRG,2011,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$2,322.91 ",IP,"2,322.91","2,322.91",,,,,,,,,,,,,
Molina Medicaid,DRG,2012,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$2,865.50 ",IP,"2,865.50","2,865.50",,,,,,,,,,,,,
Molina Medicaid,DRG,2013,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$3,988.81 ",IP,"3,988.81","3,988.81",,,,,,,,,,,,,
Molina Medicaid,DRG,2014,CARDIAC ARRHYTHMIA and CONDUCTION DISORDERS,,Relative Weights,"$7,490.70 ",IP,"7,490.70","7,490.70",,,,,,,,,,,,,
Molina Medicaid,DRG,2031,CHEST PAIN,,Relative Weights,"$2,896.08 ",IP,"2,896.08","2,896.08",,,,,,,,,,,,,
Molina Medicaid,DRG,2032,CHEST PAIN,,Relative Weights,"$3,156.55 ",IP,"3,156.55","3,156.55",,,,,,,,,,,,,
Molina Medicaid,DRG,2033,CHEST PAIN,,Relative Weights,"$3,647.25 ",IP,"3,647.25","3,647.25",,,,,,,,,,,,,
Molina Medicaid,DRG,2034,CHEST PAIN,,Relative Weights,"$5,656.08 ",IP,"5,656.08","5,656.08",,,,,,,,,,,,,
Molina Medicaid,DRG,2041,SYNCOPE and COLLAPSE,,Relative Weights,"$3,210.15 ",IP,"3,210.15","3,210.15",,,,,,,,,,,,,
Molina Medicaid,DRG,2042,SYNCOPE and COLLAPSE,,Relative Weights,"$3,469.25 ",IP,"3,469.25","3,469.25",,,,,,,,,,,,,
Molina Medicaid,DRG,2043,SYNCOPE and COLLAPSE,,Relative Weights,"$3,913.56 ",IP,"3,913.56","3,913.56",,,,,,,,,,,,,
Molina Medicaid,DRG,2044,SYNCOPE and COLLAPSE,,Relative Weights,"$6,621.67 ",IP,"6,621.67","6,621.67",,,,,,,,,,,,,
Molina Medicaid,DRG,2051,CARDIOMYOPATHY,,Relative Weights,"$3,094.70 ",IP,"3,094.70","3,094.70",,,,,,,,,,,,,
Molina Medicaid,DRG,2052,CARDIOMYOPATHY,,Relative Weights,"$3,108.78 ",IP,"3,108.78","3,108.78",,,,,,,,,,,,,
Molina Medicaid,DRG,2053,CARDIOMYOPATHY,,Relative Weights,"$4,834.47 ",IP,"4,834.47","4,834.47",,,,,,,,,,,,,
Molina Medicaid,DRG,2054,CARDIOMYOPATHY,,Relative Weights,"$12,099.76 ",IP,"12,099.76","12,099.76",,,,,,,,,,,,,
Molina Medicaid,DRG,2061,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$3,915.62 ",IP,"3,915.62","3,915.62",,,,,,,,,,,,,
Molina Medicaid,DRG,2062,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$4,064.41 ",IP,"4,064.41","4,064.41",,,,,,,,,,,,,
Molina Medicaid,DRG,2063,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$5,616.22 ",IP,"5,616.22","5,616.22",,,,,,,,,,,,,
Molina Medicaid,DRG,2064,MALFUNCTIONREACTIONCOMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE,,Relative Weights,"$11,629.68 ",IP,"11,629.68","11,629.68",,,,,,,,,,,,,
Molina Medicaid,DRG,2071,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$2,947.97 ",IP,"2,947.97","2,947.97",,,,,,,,,,,,,
Molina Medicaid,DRG,2072,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$3,511.17 ",IP,"3,511.17","3,511.17",,,,,,,,,,,,,
Molina Medicaid,DRG,2073,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$4,590.50 ",IP,"4,590.50","4,590.50",,,,,,,,,,,,,
Molina Medicaid,DRG,2074,OTHER CIRCULATORY SYSTEM DIAGNOSES,,Relative Weights,"$8,837.72 ",IP,"8,837.72","8,837.72",,,,,,,,,,,,,
Molina Medicaid,DRG,2201,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$7,004.47 ",IP,"7,004.47","7,004.47",,,,,,,,,,,,,
Molina Medicaid,DRG,2202,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$10,124.94 ",IP,"10,124.94","10,124.94",,,,,,,,,,,,,
Molina Medicaid,DRG,2203,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$15,446.33 ",IP,"15,446.33","15,446.33",,,,,,,,,,,,,
Molina Medicaid,DRG,2204,MAJOR STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$29,728.80 ",IP,"29,728.80","29,728.80",,,,,,,,,,,,,
Molina Medicaid,DRG,2221,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$3,629.38 ",IP,"3,629.38","3,629.38",,,,,,,,,,,,,
Molina Medicaid,DRG,2222,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$5,962.94 ",IP,"5,962.94","5,962.94",,,,,,,,,,,,,
Molina Medicaid,DRG,2223,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$9,116.74 ",IP,"9,116.74","9,116.74",,,,,,,,,,,,,
Molina Medicaid,DRG,2224,OTHER STOMACH ESOPHAGEAL and DUODENAL PROCEDURES,,Relative Weights,"$19,946.46 ",IP,"19,946.46","19,946.46",,,,,,,,,,,,,
Molina Medicaid,DRG,2231,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$5,180.51 ",IP,"5,180.51","5,180.51",,,,,,,,,,,,,
Molina Medicaid,DRG,2232,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$7,107.90 ",IP,"7,107.90","7,107.90",,,,,,,,,,,,,
Molina Medicaid,DRG,2233,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$10,759.27 ",IP,"10,759.27","10,759.27",,,,,,,,,,,,,
Molina Medicaid,DRG,2234,OTHER SMALL and LARGE BOWEL PROCEDURES,,Relative Weights,"$20,449.53 ",IP,"20,449.53","20,449.53",,,,,,,,,,,,,
Molina Medicaid,DRG,2241,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$6,143.69 ",IP,"6,143.69","6,143.69",,,,,,,,,,,,,
Molina Medicaid,DRG,2242,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$7,746.36 ",IP,"7,746.36","7,746.36",,,,,,,,,,,,,
Molina Medicaid,DRG,2243,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$11,242.41 ",IP,"11,242.41","11,242.41",,,,,,,,,,,,,
Molina Medicaid,DRG,2244,PERITONEAL ADHESIOLYSIS,,Relative Weights,"$20,422.04 ",IP,"20,422.04","20,422.04",,,,,,,,,,,,,
Molina Medicaid,DRG,2261,ANAL PROCEDURES,,Relative Weights,"$4,263.71 ",IP,"4,263.71","4,263.71",,,,,,,,,,,,,
Molina Medicaid,DRG,2262,ANAL PROCEDURES,,Relative Weights,"$5,861.92 ",IP,"5,861.92","5,861.92",,,,,,,,,,,,,
Molina Medicaid,DRG,2263,ANAL PROCEDURES,,Relative Weights,"$7,950.47 ",IP,"7,950.47","7,950.47",,,,,,,,,,,,,
Molina Medicaid,DRG,2264,ANAL PROCEDURES,,Relative Weights,"$17,017.73 ",IP,"17,017.73","17,017.73",,,,,,,,,,,,,
Molina Medicaid,DRG,2271,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$5,689.07 ",IP,"5,689.07","5,689.07",,,,,,,,,,,,,
Molina Medicaid,DRG,2272,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$6,795.89 ",IP,"6,795.89","6,795.89",,,,,,,,,,,,,
Molina Medicaid,DRG,2273,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$10,114.97 ",IP,"10,114.97","10,114.97",,,,,,,,,,,,,
Molina Medicaid,DRG,2274,HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL and UMBILICAL,,Relative Weights,"$20,038.21 ",IP,"20,038.21","20,038.21",,,,,,,,,,,,,
Molina Medicaid,DRG,2281,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$4,335.53 ",IP,"4,335.53","4,335.53",,,,,,,,,,,,,
Molina Medicaid,DRG,2282,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$5,502.48 ",IP,"5,502.48","5,502.48",,,,,,,,,,,,,
Molina Medicaid,DRG,2283,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$7,788.28 ",IP,"7,788.28","7,788.28",,,,,,,,,,,,,
Molina Medicaid,DRG,2284,INGUINAL FEMORAL and UMBILICAL HERNIA PROCEDURES,,Relative Weights,"$16,501.95 ",IP,"16,501.95","16,501.95",,,,,,,,,,,,,
Molina Medicaid,DRG,2291,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$5,564.34 ",IP,"5,564.34","5,564.34",,,,,,,,,,,,,
Molina Medicaid,DRG,2292,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$7,117.87 ",IP,"7,117.87","7,117.87",,,,,,,,,,,,,
Molina Medicaid,DRG,2293,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$10,259.30 ",IP,"10,259.30","10,259.30",,,,,,,,,,,,,
Molina Medicaid,DRG,2294,OTHER DIGESTIVE SYSTEM and ABDOMINAL PROCEDURES,,Relative Weights,"$20,018.28 ",IP,"20,018.28","20,018.28",,,,,,,,,,,,,
Molina Medicaid,DRG,2301,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$6,770.12 ",IP,"6,770.12","6,770.12",,,,,,,,,,,,,
Molina Medicaid,DRG,2302,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$8,787.20 ",IP,"8,787.20","8,787.20",,,,,,,,,,,,,
Molina Medicaid,DRG,2303,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$13,506.56 ",IP,"13,506.56","13,506.56",,,,,,,,,,,,,
Molina Medicaid,DRG,2304,MAJOR SMALL BOWEL PROCEDURES,,Relative Weights,"$27,168.10 ",IP,"27,168.10","27,168.10",,,,,,,,,,,,,
Molina Medicaid,DRG,2311,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$6,900.01 ",IP,"6,900.01","6,900.01",,,,,,,,,,,,,
Molina Medicaid,DRG,2312,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$8,451.83 ",IP,"8,451.83","8,451.83",,,,,,,,,,,,,
Molina Medicaid,DRG,2313,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$12,656.43 ",IP,"12,656.43","12,656.43",,,,,,,,,,,,,
Molina Medicaid,DRG,2314,MAJOR LARGE BOWEL PROCEDURES,,Relative Weights,"$23,212.62 ",IP,"23,212.62","23,212.62",,,,,,,,,,,,,
Molina Medicaid,DRG,2321,GASTRIC FUNDOPLICATION,,Relative Weights,"$5,317.96 ",IP,"5,317.96","5,317.96",,,,,,,,,,,,,
Molina Medicaid,DRG,2322,GASTRIC FUNDOPLICATION,,Relative Weights,"$6,619.27 ",IP,"6,619.27","6,619.27",,,,,,,,,,,,,
Molina Medicaid,DRG,2323,GASTRIC FUNDOPLICATION,,Relative Weights,"$9,668.60 ",IP,"9,668.60","9,668.60",,,,,,,,,,,,,
Molina Medicaid,DRG,2324,GASTRIC FUNDOPLICATION,,Relative Weights,"$26,510.06 ",IP,"26,510.06","26,510.06",,,,,,,,,,,,,
Molina Medicaid,DRG,2331,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$5,328.61 ",IP,"5,328.61","5,328.61",,,,,,,,,,,,,
Molina Medicaid,DRG,2332,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$6,525.46 ",IP,"6,525.46","6,525.46",,,,,,,,,,,,,
Molina Medicaid,DRG,2333,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$9,426.35 ",IP,"9,426.35","9,426.35",,,,,,,,,,,,,
Molina Medicaid,DRG,2334,APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$16,969.28 ",IP,"16,969.28","16,969.28",,,,,,,,,,,,,
Molina Medicaid,DRG,2341,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$3,837.96 ",IP,"3,837.96","3,837.96",,,,,,,,,,,,,
Molina Medicaid,DRG,2342,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$4,853.72 ",IP,"4,853.72","4,853.72",,,,,,,,,,,,,
Molina Medicaid,DRG,2343,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$7,767.67 ",IP,"7,767.67","7,767.67",,,,,,,,,,,,,
Molina Medicaid,DRG,2344,APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS,,Relative Weights,"$15,153.91 ",IP,"15,153.91","15,153.91",,,,,,,,,,,,,
Molina Medicaid,DRG,2401,DIGESTIVE MALIGNANCY,,Relative Weights,"$4,130.38 ",IP,"4,130.38","4,130.38",,,,,,,,,,,,,
Molina Medicaid,DRG,2402,DIGESTIVE MALIGNANCY,,Relative Weights,"$4,471.61 ",IP,"4,471.61","4,471.61",,,,,,,,,,,,,
Molina Medicaid,DRG,2403,DIGESTIVE MALIGNANCY,,Relative Weights,"$5,940.95 ",IP,"5,940.95","5,940.95",,,,,,,,,,,,,
Molina Medicaid,DRG,2404,DIGESTIVE MALIGNANCY,,Relative Weights,"$10,480.94 ",IP,"10,480.94","10,480.94",,,,,,,,,,,,,
Molina Medicaid,DRG,2411,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$3,142.46 ",IP,"3,142.46","3,142.46",,,,,,,,,,,,,
Molina Medicaid,DRG,2412,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$3,833.49 ",IP,"3,833.49","3,833.49",,,,,,,,,,,,,
Molina Medicaid,DRG,2413,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$5,293.90 ",IP,"5,293.90","5,293.90",,,,,,,,,,,,,
Molina Medicaid,DRG,2414,PEPTIC ULCER and GASTRITIS,,Relative Weights,"$11,497.38 ",IP,"11,497.38","11,497.38",,,,,,,,,,,,,
Molina Medicaid,DRG,2421,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$2,834.23 ",IP,"2,834.23","2,834.23",,,,,,,,,,,,,
Molina Medicaid,DRG,2422,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$3,630.75 ",IP,"3,630.75","3,630.75",,,,,,,,,,,,,
Molina Medicaid,DRG,2423,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$5,095.29 ",IP,"5,095.29","5,095.29",,,,,,,,,,,,,
Molina Medicaid,DRG,2424,MAJOR ESOPHAGEAL DISORDERS,,Relative Weights,"$11,235.54 ",IP,"11,235.54","11,235.54",,,,,,,,,,,,,
Molina Medicaid,DRG,2431,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$2,619.12 ",IP,"2,619.12","2,619.12",,,,,,,,,,,,,
Molina Medicaid,DRG,2432,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$3,394.34 ",IP,"3,394.34","3,394.34",,,,,,,,,,,,,
Molina Medicaid,DRG,2433,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$4,672.28 ",IP,"4,672.28","4,672.28",,,,,,,,,,,,,
Molina Medicaid,DRG,2434,OTHER ESOPHAGEAL DISORDERS,,Relative Weights,"$10,028.72 ",IP,"10,028.72","10,028.72",,,,,,,,,,,,,
Molina Medicaid,DRG,2441,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$2,541.46 ",IP,"2,541.46","2,541.46",,,,,,,,,,,,,
Molina Medicaid,DRG,2442,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$3,268.57 ",IP,"3,268.57","3,268.57",,,,,,,,,,,,,
Molina Medicaid,DRG,2443,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$4,670.91 ",IP,"4,670.91","4,670.91",,,,,,,,,,,,,
Molina Medicaid,DRG,2444,DIVERTICULITIS and DIVERTICULOSIS,,Relative Weights,"$10,075.80 ",IP,"10,075.80","10,075.80",,,,,,,,,,,,,
Molina Medicaid,DRG,2451,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$3,109.82 ",IP,"3,109.82","3,109.82",,,,,,,,,,,,,
Molina Medicaid,DRG,2452,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$3,884.35 ",IP,"3,884.35","3,884.35",,,,,,,,,,,,,
Molina Medicaid,DRG,2453,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$5,370.53 ",IP,"5,370.53","5,370.53",,,,,,,,,,,,,
Molina Medicaid,DRG,2454,INFLAMMATORY BOWEL DISEASE,,Relative Weights,"$12,127.25 ",IP,"12,127.25","12,127.25",,,,,,,,,,,,,
Molina Medicaid,DRG,2461,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$3,009.82 ",IP,"3,009.82","3,009.82",,,,,,,,,,,,,
Molina Medicaid,DRG,2462,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$3,644.84 ",IP,"3,644.84","3,644.84",,,,,,,,,,,,,
Molina Medicaid,DRG,2463,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$5,068.14 ",IP,"5,068.14","5,068.14",,,,,,,,,,,,,
Molina Medicaid,DRG,2464,GASTROINTESTINAL VASCULAR INSUFFICIENCY,,Relative Weights,"$9,550.40 ",IP,"9,550.40","9,550.40",,,,,,,,,,,,,
Molina Medicaid,DRG,2471,INTESTINAL OBSTRUCTION,,Relative Weights,"$2,323.60 ",IP,"2,323.60","2,323.60",,,,,,,,,,,,,
Molina Medicaid,DRG,2472,INTESTINAL OBSTRUCTION,,Relative Weights,"$2,999.17 ",IP,"2,999.17","2,999.17",,,,,,,,,,,,,
Molina Medicaid,DRG,2473,INTESTINAL OBSTRUCTION,,Relative Weights,"$4,431.74 ",IP,"4,431.74","4,431.74",,,,,,,,,,,,,
Molina Medicaid,DRG,2474,INTESTINAL OBSTRUCTION,,Relative Weights,"$9,108.15 ",IP,"9,108.15","9,108.15",,,,,,,,,,,,,
Molina Medicaid,DRG,2481,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$2,573.42 ",IP,"2,573.42","2,573.42",,,,,,,,,,,,,
Molina Medicaid,DRG,2482,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$3,590.89 ",IP,"3,590.89","3,590.89",,,,,,,,,,,,,
Molina Medicaid,DRG,2483,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$4,839.63 ",IP,"4,839.63","4,839.63",,,,,,,,,,,,,
Molina Medicaid,DRG,2484,MAJOR GASTROINTESTINAL and PERITONEAL INFECTIONS,,Relative Weights,"$10,133.19 ",IP,"10,133.19","10,133.19",,,,,,,,,,,,,
Molina Medicaid,DRG,2491,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$2,187.52 ",IP,"2,187.52","2,187.52",,,,,,,,,,,,,
Molina Medicaid,DRG,2492,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$2,797.80 ",IP,"2,797.80","2,797.80",,,,,,,,,,,,,
Molina Medicaid,DRG,2493,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$3,754.80 ",IP,"3,754.80","3,754.80",,,,,,,,,,,,,
Molina Medicaid,DRG,2494,OTHER GASTROENTERITIS NAUSEA and VOMITING,,Relative Weights,"$8,298.22 ",IP,"8,298.22","8,298.22",,,,,,,,,,,,,
Molina Medicaid,DRG,2511,ABDOMINAL PAIN,,Relative Weights,"$2,520.84 ",IP,"2,520.84","2,520.84",,,,,,,,,,,,,
Molina Medicaid,DRG,2512,ABDOMINAL PAIN,,Relative Weights,"$3,175.79 ",IP,"3,175.79","3,175.79",,,,,,,,,,,,,
Molina Medicaid,DRG,2513,ABDOMINAL PAIN,,Relative Weights,"$4,112.86 ",IP,"4,112.86","4,112.86",,,,,,,,,,,,,
Molina Medicaid,DRG,2514,ABDOMINAL PAIN,,Relative Weights,"$7,334.01 ",IP,"7,334.01","7,334.01",,,,,,,,,,,,,
Molina Medicaid,DRG,2521,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$2,913.26 ",IP,"2,913.26","2,913.26",,,,,,,,,,,,,
Molina Medicaid,DRG,2522,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$3,639.34 ",IP,"3,639.34","3,639.34",,,,,,,,,,,,,
Molina Medicaid,DRG,2523,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$5,172.60 ",IP,"5,172.60","5,172.60",,,,,,,,,,,,,
Molina Medicaid,DRG,2524,MALFUNCTION REACTION and COMPLICATION OF GI DEVICE OR PROCEDURE,,Relative Weights,"$11,168.53 ",IP,"11,168.53","11,168.53",,,,,,,,,,,,,
Molina Medicaid,DRG,2531,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$2,890.24 ",IP,"2,890.24","2,890.24",,,,,,,,,,,,,
Molina Medicaid,DRG,2532,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$3,602.23 ",IP,"3,602.23","3,602.23",,,,,,,,,,,,,
Molina Medicaid,DRG,2533,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$5,054.39 ",IP,"5,054.39","5,054.39",,,,,,,,,,,,,
Molina Medicaid,DRG,2534,OTHER and UNSPECIFIED GASTROINTESTINAL HEMORRHAGE,,Relative Weights,"$9,586.48 ",IP,"9,586.48","9,586.48",,,,,,,,,,,,,
Molina Medicaid,DRG,2541,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$2,614.99 ",IP,"2,614.99","2,614.99",,,,,,,,,,,,,
Molina Medicaid,DRG,2542,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$3,386.43 ",IP,"3,386.43","3,386.43",,,,,,,,,,,,,
Molina Medicaid,DRG,2543,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$4,771.93 ",IP,"4,771.93","4,771.93",,,,,,,,,,,,,
Molina Medicaid,DRG,2544,OTHER DIGESTIVE SYSTEM DIAGNOSES,,Relative Weights,"$9,778.91 ",IP,"9,778.91","9,778.91",,,,,,,,,,,,,
Molina Medicaid,DRG,2601,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$9,438.72 ",IP,"9,438.72","9,438.72",,,,,,,,,,,,,
Molina Medicaid,DRG,2602,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$11,500.13 ",IP,"11,500.13","11,500.13",,,,,,,,,,,,,
Molina Medicaid,DRG,2603,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$16,312.61 ",IP,"16,312.61","16,312.61",,,,,,,,,,,,,
Molina Medicaid,DRG,2604,MAJOR PANCREAS LIVER and SHUNT PROCEDURES,,Relative Weights,"$34,324.11 ",IP,"34,324.11","34,324.11",,,,,,,,,,,,,
Molina Medicaid,DRG,2611,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$6,801.05 ",IP,"6,801.05","6,801.05",,,,,,,,,,,,,
Molina Medicaid,DRG,2612,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$10,119.10 ",IP,"10,119.10","10,119.10",,,,,,,,,,,,,
Molina Medicaid,DRG,2613,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$14,491.05 ",IP,"14,491.05","14,491.05",,,,,,,,,,,,,
Molina Medicaid,DRG,2614,MAJOR BILIARY TRACT PROCEDURES,,Relative Weights,"$28,576.97 ",IP,"28,576.97","28,576.97",,,,,,,,,,,,,
Molina Medicaid,DRG,2631,CHOLECYSTECTOMY,,Relative Weights,"$5,153.36 ",IP,"5,153.36","5,153.36",,,,,,,,,,,,,
Molina Medicaid,DRG,2632,CHOLECYSTECTOMY,,Relative Weights,"$6,574.60 ",IP,"6,574.60","6,574.60",,,,,,,,,,,,,
Molina Medicaid,DRG,2633,CHOLECYSTECTOMY,,Relative Weights,"$8,823.28 ",IP,"8,823.28","8,823.28",,,,,,,,,,,,,
Molina Medicaid,DRG,2634,CHOLECYSTECTOMY,,Relative Weights,"$16,983.37 ",IP,"16,983.37","16,983.37",,,,,,,,,,,,,
Molina Medicaid,DRG,2641,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$6,826.47 ",IP,"6,826.47","6,826.47",,,,,,,,,,,,,
Molina Medicaid,DRG,2642,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$7,584.86 ",IP,"7,584.86","7,584.86",,,,,,,,,,,,,
Molina Medicaid,DRG,2643,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$11,612.15 ",IP,"11,612.15","11,612.15",,,,,,,,,,,,,
Molina Medicaid,DRG,2644,OTHER HEPATOBILIARY PANCREAS and ABDOMINAL PROCEDURES,,Relative Weights,"$29,218.86 ",IP,"29,218.86","29,218.86",,,,,,,,,,,,,
Molina Medicaid,DRG,2791,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$2,567.92 ",IP,"2,567.92","2,567.92",,,,,,,,,,,,,
Molina Medicaid,DRG,2792,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$3,323.89 ",IP,"3,323.89","3,323.89",,,,,,,,,,,,,
Molina Medicaid,DRG,2793,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$4,704.93 ",IP,"4,704.93","4,704.93",,,,,,,,,,,,,
Molina Medicaid,DRG,2794,HEPATIC COMA and OTHER MAJOR ACUTE LIVER DISORDERS,,Relative Weights,"$11,290.86 ",IP,"11,290.86","11,290.86",,,,,,,,,,,,,
Molina Medicaid,DRG,2801,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$2,499.54 ",IP,"2,499.54","2,499.54",,,,,,,,,,,,,
Molina Medicaid,DRG,2802,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$3,093.32 ",IP,"3,093.32","3,093.32",,,,,,,,,,,,,
Molina Medicaid,DRG,2803,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$4,638.26 ",IP,"4,638.26","4,638.26",,,,,,,,,,,,,
Molina Medicaid,DRG,2804,ALCOHOLIC LIVER DISEASE,,Relative Weights,"$10,324.24 ",IP,"10,324.24","10,324.24",,,,,,,,,,,,,
Molina Medicaid,DRG,2811,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$3,619.41 ",IP,"3,619.41","3,619.41",,,,,,,,,,,,,
Molina Medicaid,DRG,2812,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$4,564.04 ",IP,"4,564.04","4,564.04",,,,,,,,,,,,,
Molina Medicaid,DRG,2813,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$5,844.73 ",IP,"5,844.73","5,844.73",,,,,,,,,,,,,
Molina Medicaid,DRG,2814,MALIGNANCY OF HEPATOBILIARY SYSTEM and PANCREAS,,Relative Weights,"$9,186.50 ",IP,"9,186.50","9,186.50",,,,,,,,,,,,,
Molina Medicaid,DRG,2821,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$2,462.42 ",IP,"2,462.42","2,462.42",,,,,,,,,,,,,
Molina Medicaid,DRG,2822,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$3,135.24 ",IP,"3,135.24","3,135.24",,,,,,,,,,,,,
Molina Medicaid,DRG,2823,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$4,746.16 ",IP,"4,746.16","4,746.16",,,,,,,,,,,,,
Molina Medicaid,DRG,2824,DISORDERS OF PANCREAS EXCEPT MALIGNANCY,,Relative Weights,"$12,503.18 ",IP,"12,503.18","12,503.18",,,,,,,,,,,,,
Molina Medicaid,DRG,2831,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$2,720.83 ",IP,"2,720.83","2,720.83",,,,,,,,,,,,,
Molina Medicaid,DRG,2832,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$3,349.67 ",IP,"3,349.67","3,349.67",,,,,,,,,,,,,
Molina Medicaid,DRG,2833,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$4,885.67 ",IP,"4,885.67","4,885.67",,,,,,,,,,,,,
Molina Medicaid,DRG,2834,OTHER DISORDERS OF THE LIVER,,Relative Weights,"$10,248.65 ",IP,"10,248.65","10,248.65",,,,,,,,,,,,,
Molina Medicaid,DRG,2841,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$3,351.73 ",IP,"3,351.73","3,351.73",,,,,,,,,,,,,
Molina Medicaid,DRG,2842,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$4,147.57 ",IP,"4,147.57","4,147.57",,,,,,,,,,,,,
Molina Medicaid,DRG,2843,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$5,552.31 ",IP,"5,552.31","5,552.31",,,,,,,,,,,,,
Molina Medicaid,DRG,2844,DISORDERS OF GALLBLADDER and BILIARY TRACT,,Relative Weights,"$10,788.48 ",IP,"10,788.48","10,788.48",,,,,,,,,,,,,
Molina Medicaid,DRG,3011,HIP JOINT REPLACEMENT,,Relative Weights,"$7,771.10 ",IP,"7,771.10","7,771.10",,,,,,,,,,,,,
Molina Medicaid,DRG,3012,HIP JOINT REPLACEMENT,,Relative Weights,"$8,122.29 ",IP,"8,122.29","8,122.29",,,,,,,,,,,,,
Molina Medicaid,DRG,3013,HIP JOINT REPLACEMENT,,Relative Weights,"$10,480.59 ",IP,"10,480.59","10,480.59",,,,,,,,,,,,,
Molina Medicaid,DRG,3014,HIP JOINT REPLACEMENT,,Relative Weights,"$16,617.41 ",IP,"16,617.41","16,617.41",,,,,,,,,,,,,
Molina Medicaid,DRG,3021,KNEE JOINT REPLACEMENT,,Relative Weights,"$7,208.24 ",IP,"7,208.24","7,208.24",,,,,,,,,,,,,
Molina Medicaid,DRG,3022,KNEE JOINT REPLACEMENT,,Relative Weights,"$7,702.03 ",IP,"7,702.03","7,702.03",,,,,,,,,,,,,
Molina Medicaid,DRG,3023,KNEE JOINT REPLACEMENT,,Relative Weights,"$9,864.13 ",IP,"9,864.13","9,864.13",,,,,,,,,,,,,
Molina Medicaid,DRG,3024,KNEE JOINT REPLACEMENT,,Relative Weights,"$17,075.12 ",IP,"17,075.12","17,075.12",,,,,,,,,,,,,
Molina Medicaid,DRG,3031,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$22,622.27 ",IP,"22,622.27","22,622.27",,,,,,,,,,,,,
Molina Medicaid,DRG,3032,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$26,401.82 ",IP,"26,401.82","26,401.82",,,,,,,,,,,,,
Molina Medicaid,DRG,3033,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$36,462.15 ",IP,"36,462.15","36,462.15",,,,,,,,,,,,,
Molina Medicaid,DRG,3034,DORSAL and LUMBAR FUSION PROC FOR CURVATURE OF BACK,,Relative Weights,"$46,680.22 ",IP,"46,680.22","46,680.22",,,,,,,,,,,,,
Molina Medicaid,DRG,3041,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$13,662.91 ",IP,"13,662.91","13,662.91",,,,,,,,,,,,,
Molina Medicaid,DRG,3042,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$15,568.66 ",IP,"15,568.66","15,568.66",,,,,,,,,,,,,
Molina Medicaid,DRG,3043,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$23,409.86 ",IP,"23,409.86","23,409.86",,,,,,,,,,,,,
Molina Medicaid,DRG,3044,DORSAL and LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK,,Relative Weights,"$37,522.24 ",IP,"37,522.24","37,522.24",,,,,,,,,,,,,
Molina Medicaid,DRG,3051,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$4,866.09 ",IP,"4,866.09","4,866.09",,,,,,,,,,,,,
Molina Medicaid,DRG,3052,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$6,637.82 ",IP,"6,637.82","6,637.82",,,,,,,,,,,,,
Molina Medicaid,DRG,3053,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$10,080.61 ",IP,"10,080.61","10,080.61",,,,,,,,,,,,,
Molina Medicaid,DRG,3054,AMPUTATION OF LOWER LIMB EXCEPT TOES,,Relative Weights,"$19,786.33 ",IP,"19,786.33","19,786.33",,,,,,,,,,,,,
Molina Medicaid,DRG,3081,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$6,633.70 ",IP,"6,633.70","6,633.70",,,,,,,,,,,,,
Molina Medicaid,DRG,3082,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$7,529.88 ",IP,"7,529.88","7,529.88",,,,,,,,,,,,,
Molina Medicaid,DRG,3083,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$9,249.72 ",IP,"9,249.72","9,249.72",,,,,,,,,,,,,
Molina Medicaid,DRG,3084,HIP and FEMUR FRACTURE REPAIR,,Relative Weights,"$14,744.30 ",IP,"14,744.30","14,744.30",,,,,,,,,,,,,
Molina Medicaid,DRG,3091,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$7,238.83 ",IP,"7,238.83","7,238.83",,,,,,,,,,,,,
Molina Medicaid,DRG,3092,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$9,130.83 ",IP,"9,130.83","9,130.83",,,,,,,,,,,,,
Molina Medicaid,DRG,3093,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$12,063.33 ",IP,"12,063.33","12,063.33",,,,,,,,,,,,,
Molina Medicaid,DRG,3094,OTHER SIGNIFICANT HIP and FEMUR SURGERY,,Relative Weights,"$21,019.95 ",IP,"21,019.95","21,019.95",,,,,,,,,,,,,
Molina Medicaid,DRG,3101,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$5,634.78 ",IP,"5,634.78","5,634.78",,,,,,,,,,,,,
Molina Medicaid,DRG,3102,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$6,775.27 ",IP,"6,775.27","6,775.27",,,,,,,,,,,,,
Molina Medicaid,DRG,3103,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$9,328.07 ",IP,"9,328.07","9,328.07",,,,,,,,,,,,,
Molina Medicaid,DRG,3104,INTERVERTEBRAL DISC EXCISION and DECOMPRESSION,,Relative Weights,"$18,301.18 ",IP,"18,301.18","18,301.18",,,,,,,,,,,,,
Molina Medicaid,DRG,3121,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$6,515.49 ",IP,"6,515.49","6,515.49",,,,,,,,,,,,,
Molina Medicaid,DRG,3122,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$8,587.21 ",IP,"8,587.21","8,587.21",,,,,,,,,,,,,
Molina Medicaid,DRG,3123,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$12,636.50 ",IP,"12,636.50","12,636.50",,,,,,,,,,,,,
Molina Medicaid,DRG,3124,SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$31,602.60 ",IP,"31,602.60","31,602.60",,,,,,,,,,,,,
Molina Medicaid,DRG,3131,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$5,906.59 ",IP,"5,906.59","5,906.59",,,,,,,,,,,,,
Molina Medicaid,DRG,3132,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$7,791.03 ",IP,"7,791.03","7,791.03",,,,,,,,,,,,,
Molina Medicaid,DRG,3133,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$10,674.40 ",IP,"10,674.40","10,674.40",,,,,,,,,,,,,
Molina Medicaid,DRG,3134,KNEE and LOWER LEG PROCEDURES EXCEPT FOOT,,Relative Weights,"$18,704.94 ",IP,"18,704.94","18,704.94",,,,,,,,,,,,,
Molina Medicaid,DRG,3141,FOOT and TOE PROCEDURES,,Relative Weights,"$5,184.29 ",IP,"5,184.29","5,184.29",,,,,,,,,,,,,
Molina Medicaid,DRG,3142,FOOT and TOE PROCEDURES,,Relative Weights,"$5,760.89 ",IP,"5,760.89","5,760.89",,,,,,,,,,,,,
Molina Medicaid,DRG,3143,FOOT and TOE PROCEDURES,,Relative Weights,"$7,587.61 ",IP,"7,587.61","7,587.61",,,,,,,,,,,,,
Molina Medicaid,DRG,3144,FOOT and TOE PROCEDURES,,Relative Weights,"$15,541.86 ",IP,"15,541.86","15,541.86",,,,,,,,,,,,,
Molina Medicaid,DRG,3151,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$4,407.35 ",IP,"4,407.35","4,407.35",,,,,,,,,,,,,
Molina Medicaid,DRG,3152,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$7,204.46 ",IP,"7,204.46","7,204.46",,,,,,,,,,,,,
Molina Medicaid,DRG,3153,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$9,814.99 ",IP,"9,814.99","9,814.99",,,,,,,,,,,,,
Molina Medicaid,DRG,3154,SHOULDER UPPER ARM and FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT,,Relative Weights,"$17,630.42 ",IP,"17,630.42","17,630.42",,,,,,,,,,,,,
Molina Medicaid,DRG,3161,HAND and WRIST PROCEDURES,,Relative Weights,"$4,228.66 ",IP,"4,228.66","4,228.66",,,,,,,,,,,,,
Molina Medicaid,DRG,3162,HAND and WRIST PROCEDURES,,Relative Weights,"$5,513.82 ",IP,"5,513.82","5,513.82",,,,,,,,,,,,,
Molina Medicaid,DRG,3163,HAND and WRIST PROCEDURES,,Relative Weights,"$8,327.78 ",IP,"8,327.78","8,327.78",,,,,,,,,,,,,
Molina Medicaid,DRG,3164,HAND and WRIST PROCEDURES,,Relative Weights,"$17,742.44 ",IP,"17,742.44","17,742.44",,,,,,,,,,,,,
Molina Medicaid,DRG,3171,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$4,914.20 ",IP,"4,914.20","4,914.20",,,,,,,,,,,,,
Molina Medicaid,DRG,3172,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$6,410.69 ",IP,"6,410.69","6,410.69",,,,,,,,,,,,,
Molina Medicaid,DRG,3173,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$9,611.56 ",IP,"9,611.56","9,611.56",,,,,,,,,,,,,
Molina Medicaid,DRG,3174,TENDON MUSCLE and OTHER SOFT TISSUE PROCEDURES,,Relative Weights,"$20,290.08 ",IP,"20,290.08","20,290.08",,,,,,,,,,,,,
Molina Medicaid,DRG,3201,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$5,415.55 ",IP,"5,415.55","5,415.55",,,,,,,,,,,,,
Molina Medicaid,DRG,3202,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$6,995.19 ",IP,"6,995.19","6,995.19",,,,,,,,,,,,,
Molina Medicaid,DRG,3203,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$10,390.22 ",IP,"10,390.22","10,390.22",,,,,,,,,,,,,
Molina Medicaid,DRG,3204,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE PROCEDURES,,Relative Weights,"$19,965.01 ",IP,"19,965.01","19,965.01",,,,,,,,,,,,,
Molina Medicaid,DRG,3211,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$8,441.17 ",IP,"8,441.17","8,441.17",,,,,,,,,,,,,
Molina Medicaid,DRG,3212,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$10,023.57 ",IP,"10,023.57","10,023.57",,,,,,,,,,,,,
Molina Medicaid,DRG,3213,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$14,027.50 ",IP,"14,027.50","14,027.50",,,,,,,,,,,,,
Molina Medicaid,DRG,3214,CERVICAL SPINAL FUSION and OTHER BACKNECK PROC EXC DISC EXCISDECOMP,,Relative Weights,"$25,569.90 ",IP,"25,569.90","25,569.90",,,,,,,,,,,,,
Molina Medicaid,DRG,3221,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$8,466.60 ",IP,"8,466.60","8,466.60",,,,,,,,,,,,,
Molina Medicaid,DRG,3222,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$8,949.40 ",IP,"8,949.40","8,949.40",,,,,,,,,,,,,
Molina Medicaid,DRG,3223,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$11,526.59 ",IP,"11,526.59","11,526.59",,,,,,,,,,,,,
Molina Medicaid,DRG,3224,SHOULDER and ELBOW JOINT REPLACEMENT,,Relative Weights,"$17,494.69 ",IP,"17,494.69","17,494.69",,,,,,,,,,,,,
Molina Medicaid,DRG,3401,FRACTURE OF FEMUR,,Relative Weights,"$2,284.43 ",IP,"2,284.43","2,284.43",,,,,,,,,,,,,
Molina Medicaid,DRG,3402,FRACTURE OF FEMUR,,Relative Weights,"$2,649.70 ",IP,"2,649.70","2,649.70",,,,,,,,,,,,,
Molina Medicaid,DRG,3403,FRACTURE OF FEMUR,,Relative Weights,"$3,664.08 ",IP,"3,664.08","3,664.08",,,,,,,,,,,,,
Molina Medicaid,DRG,3404,FRACTURE OF FEMUR,,Relative Weights,"$6,893.48 ",IP,"6,893.48","6,893.48",,,,,,,,,,,,,
Molina Medicaid,DRG,3411,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$2,584.41 ",IP,"2,584.41","2,584.41",,,,,,,,,,,,,
Molina Medicaid,DRG,3412,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$2,958.62 ",IP,"2,958.62","2,958.62",,,,,,,,,,,,,
Molina Medicaid,DRG,3413,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$3,751.71 ",IP,"3,751.71","3,751.71",,,,,,,,,,,,,
Molina Medicaid,DRG,3414,FRACTURE OF PELVIS OR DISLOCATION OF HIP,,Relative Weights,"$8,259.05 ",IP,"8,259.05","8,259.05",,,,,,,,,,,,,
Molina Medicaid,DRG,3421,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$2,677.53 ",IP,"2,677.53","2,677.53",,,,,,,,,,,,,
Molina Medicaid,DRG,3422,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$3,262.04 ",IP,"3,262.04","3,262.04",,,,,,,,,,,,,
Molina Medicaid,DRG,3423,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$4,236.57 ",IP,"4,236.57","4,236.57",,,,,,,,,,,,,
Molina Medicaid,DRG,3424,FRACTURES and DISLOCATIONS EXCEPT FEMUR PELVIS and BACK,,Relative Weights,"$8,410.59 ",IP,"8,410.59","8,410.59",,,,,,,,,,,,,
Molina Medicaid,DRG,3431,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$4,528.30 ",IP,"4,528.30","4,528.30",,,,,,,,,,,,,
Molina Medicaid,DRG,3432,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$4,916.60 ",IP,"4,916.60","4,916.60",,,,,,,,,,,,,
Molina Medicaid,DRG,3433,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$6,907.57 ",IP,"6,907.57","6,907.57",,,,,,,,,,,,,
Molina Medicaid,DRG,3434,MUSCULOSKELETAL MALIGNANCY and PATHOL FRACTURE DT MUSCSKEL MALIG,,Relative Weights,"$11,710.09 ",IP,"11,710.09","11,710.09",,,,,,,,,,,,,
Molina Medicaid,DRG,3441,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$3,603.61 ",IP,"3,603.61","3,603.61",,,,,,,,,,,,,
Molina Medicaid,DRG,3442,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$4,272.99 ",IP,"4,272.99","4,272.99",,,,,,,,,,,,,
Molina Medicaid,DRG,3443,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$5,859.85 ",IP,"5,859.85","5,859.85",,,,,,,,,,,,,
Molina Medicaid,DRG,3444,OSTEOMYELITIS SEPTIC ARTHRITIS and OTHER MUSCULOSKELETAL INFECTIONS,,Relative Weights,"$10,885.73 ",IP,"10,885.73","10,885.73",,,,,,,,,,,,,
Molina Medicaid,DRG,3461,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$3,601.54 ",IP,"3,601.54","3,601.54",,,,,,,,,,,,,
Molina Medicaid,DRG,3462,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$4,539.99 ",IP,"4,539.99","4,539.99",,,,,,,,,,,,,
Molina Medicaid,DRG,3463,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$6,445.74 ",IP,"6,445.74","6,445.74",,,,,,,,,,,,,
Molina Medicaid,DRG,3464,CONNECTIVE TISSUE DISORDERS,,Relative Weights,"$15,116.11 ",IP,"15,116.11","15,116.11",,,,,,,,,,,,,
Molina Medicaid,DRG,3471,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$3,279.91 ",IP,"3,279.91","3,279.91",,,,,,,,,,,,,
Molina Medicaid,DRG,3472,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$3,772.33 ",IP,"3,772.33","3,772.33",,,,,,,,,,,,,
Molina Medicaid,DRG,3473,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$4,894.95 ",IP,"4,894.95","4,894.95",,,,,,,,,,,,,
Molina Medicaid,DRG,3474,OTHER BACK and NECK DISORDERS FRACTURES and INJURIES,,Relative Weights,"$9,864.13 ",IP,"9,864.13","9,864.13",,,,,,,,,,,,,
Molina Medicaid,DRG,3491,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$2,603.31 ",IP,"2,603.31","2,603.31",,,,,,,,,,,,,
Molina Medicaid,DRG,3492,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$3,535.91 ",IP,"3,535.91","3,535.91",,,,,,,,,,,,,
Molina Medicaid,DRG,3493,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$5,006.97 ",IP,"5,006.97","5,006.97",,,,,,,,,,,,,
Molina Medicaid,DRG,3494,MALFUNCTION REACTION COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE,,Relative Weights,"$9,666.89 ",IP,"9,666.89","9,666.89",,,,,,,,,,,,,
Molina Medicaid,DRG,3511,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$2,708.80 ",IP,"2,708.80","2,708.80",,,,,,,,,,,,,
Molina Medicaid,DRG,3512,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$3,066.17 ",IP,"3,066.17","3,066.17",,,,,,,,,,,,,
Molina Medicaid,DRG,3513,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$4,449.61 ",IP,"4,449.61","4,449.61",,,,,,,,,,,,,
Molina Medicaid,DRG,3514,OTHER MUSCULOSKELETAL SYSTEM and CONNECTIVE TISSUE DIAGNOSES,,Relative Weights,"$8,785.14 ",IP,"8,785.14","8,785.14",,,,,,,,,,,,,
Molina Medicaid,DRG,3611,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$5,861.92 ",IP,"5,861.92","5,861.92",,,,,,,,,,,,,
Molina Medicaid,DRG,3612,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$6,759.47 ",IP,"6,759.47","6,759.47",,,,,,,,,,,,,
Molina Medicaid,DRG,3613,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$10,411.18 ",IP,"10,411.18","10,411.18",,,,,,,,,,,,,
Molina Medicaid,DRG,3614,SKIN GRAFT FOR SKIN and SUBCUTANEOUS TISSUE DIAGNOSES,,Relative Weights,"$23,051.12 ",IP,"23,051.12","23,051.12",,,,,,,,,,,,,
Molina Medicaid,DRG,3621,MASTECTOMY PROCEDURES,,Relative Weights,"$5,733.06 ",IP,"5,733.06","5,733.06",,,,,,,,,,,,,
Molina Medicaid,DRG,3622,MASTECTOMY PROCEDURES,,Relative Weights,"$6,783.86 ",IP,"6,783.86","6,783.86",,,,,,,,,,,,,
Molina Medicaid,DRG,3623,MASTECTOMY PROCEDURES,,Relative Weights,"$8,730.85 ",IP,"8,730.85","8,730.85",,,,,,,,,,,,,
Molina Medicaid,DRG,3624,MASTECTOMY PROCEDURES,,Relative Weights,"$15,662.13 ",IP,"15,662.13","15,662.13",,,,,,,,,,,,,
Molina Medicaid,DRG,3631,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$5,772.23 ",IP,"5,772.23","5,772.23",,,,,,,,,,,,,
Molina Medicaid,DRG,3632,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$7,919.20 ",IP,"7,919.20","7,919.20",,,,,,,,,,,,,
Molina Medicaid,DRG,3633,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$10,641.07 ",IP,"10,641.07","10,641.07",,,,,,,,,,,,,
Molina Medicaid,DRG,3634,BREAST PROCEDURES EXCEPT MASTECTOMY,,Relative Weights,"$13,007.96 ",IP,"13,007.96","13,007.96",,,,,,,,,,,,,
Molina Medicaid,DRG,3641,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$3,659.27 ",IP,"3,659.27","3,659.27",,,,,,,,,,,,,
Molina Medicaid,DRG,3642,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$5,232.39 ",IP,"5,232.39","5,232.39",,,,,,,,,,,,,
Molina Medicaid,DRG,3643,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$8,152.18 ",IP,"8,152.18","8,152.18",,,,,,,,,,,,,
Molina Medicaid,DRG,3644,OTHER SKIN SUBCUTANEOUS TISSUE and RELATED PROCEDURES,,Relative Weights,"$16,685.79 ",IP,"16,685.79","16,685.79",,,,,,,,,,,,,
Molina Medicaid,DRG,3801,SKIN ULCERS,,Relative Weights,"$2,950.72 ",IP,"2,950.72","2,950.72",,,,,,,,,,,,,
Molina Medicaid,DRG,3802,SKIN ULCERS,,Relative Weights,"$3,415.64 ",IP,"3,415.64","3,415.64",,,,,,,,,,,,,
Molina Medicaid,DRG,3803,SKIN ULCERS,,Relative Weights,"$4,667.13 ",IP,"4,667.13","4,667.13",,,,,,,,,,,,,
Molina Medicaid,DRG,3804,SKIN ULCERS,,Relative Weights,"$9,197.15 ",IP,"9,197.15","9,197.15",,,,,,,,,,,,,
Molina Medicaid,DRG,3811,MAJOR SKIN DISORDERS,,Relative Weights,"$2,135.64 ",IP,"2,135.64","2,135.64",,,,,,,,,,,,,
Molina Medicaid,DRG,3812,MAJOR SKIN DISORDERS,,Relative Weights,"$3,426.98 ",IP,"3,426.98","3,426.98",,,,,,,,,,,,,
Molina Medicaid,DRG,3813,MAJOR SKIN DISORDERS,,Relative Weights,"$6,058.47 ",IP,"6,058.47","6,058.47",,,,,,,,,,,,,
Molina Medicaid,DRG,3814,MAJOR SKIN DISORDERS,,Relative Weights,"$15,997.51 ",IP,"15,997.51","15,997.51",,,,,,,,,,,,,
Molina Medicaid,DRG,3821,MALIGNANT BREAST DISORDERS,,Relative Weights,"$3,708.41 ",IP,"3,708.41","3,708.41",,,,,,,,,,,,,
Molina Medicaid,DRG,3822,MALIGNANT BREAST DISORDERS,,Relative Weights,"$3,837.96 ",IP,"3,837.96","3,837.96",,,,,,,,,,,,,
Molina Medicaid,DRG,3823,MALIGNANT BREAST DISORDERS,,Relative Weights,"$5,221.05 ",IP,"5,221.05","5,221.05",,,,,,,,,,,,,
Molina Medicaid,DRG,3824,MALIGNANT BREAST DISORDERS,,Relative Weights,"$8,582.75 ",IP,"8,582.75","8,582.75",,,,,,,,,,,,,
Molina Medicaid,DRG,3831,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$2,128.08 ",IP,"2,128.08","2,128.08",,,,,,,,,,,,,
Molina Medicaid,DRG,3832,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$2,886.11 ",IP,"2,886.11","2,886.11",,,,,,,,,,,,,
Molina Medicaid,DRG,3833,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$4,151.00 ",IP,"4,151.00","4,151.00",,,,,,,,,,,,,
Molina Medicaid,DRG,3834,CELLULITIS and OTHER SKIN INFECTIONS,,Relative Weights,"$8,552.16 ",IP,"8,552.16","8,552.16",,,,,,,,,,,,,
Molina Medicaid,DRG,3841,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$2,690.94 ",IP,"2,690.94","2,690.94",,,,,,,,,,,,,
Molina Medicaid,DRG,3842,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$3,464.09 ",IP,"3,464.09","3,464.09",,,,,,,,,,,,,
Molina Medicaid,DRG,3843,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$4,737.92 ",IP,"4,737.92","4,737.92",,,,,,,,,,,,,
Molina Medicaid,DRG,3844,CONTUSION OPEN WOUND and OTHER TRAUMA TO SKIN and SUBCUTANEOUS TISSUE,,Relative Weights,"$9,439.41 ",IP,"9,439.41","9,439.41",,,,,,,,,,,,,
Molina Medicaid,DRG,3851,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$2,189.24 ",IP,"2,189.24","2,189.24",,,,,,,,,,,,,
Molina Medicaid,DRG,3852,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$2,880.96 ",IP,"2,880.96","2,880.96",,,,,,,,,,,,,
Molina Medicaid,DRG,3853,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$4,186.05 ",IP,"4,186.05","4,186.05",,,,,,,,,,,,,
Molina Medicaid,DRG,3854,OTHER SKIN SUBCUTANEOUS TISSUE and BREAST DISORDERS,,Relative Weights,"$8,871.05 ",IP,"8,871.05","8,871.05",,,,,,,,,,,,,
Molina Medicaid,DRG,4011,ADRENAL PROCEDURES,,Relative Weights,"$6,855.68 ",IP,"6,855.68","6,855.68",,,,,,,,,,,,,
Molina Medicaid,DRG,4012,ADRENAL PROCEDURES,,Relative Weights,"$10,778.52 ",IP,"10,778.52","10,778.52",,,,,,,,,,,,,
Molina Medicaid,DRG,4013,ADRENAL PROCEDURES,,Relative Weights,"$13,300.04 ",IP,"13,300.04","13,300.04",,,,,,,,,,,,,
Molina Medicaid,DRG,4014,ADRENAL PROCEDURES,,Relative Weights,"$24,027.70 ",IP,"24,027.70","24,027.70",,,,,,,,,,,,,
Molina Medicaid,DRG,4031,PROCEDURES FOR OBESITY,,Relative Weights,"$5,110.06 ",IP,"5,110.06","5,110.06",,,,,,,,,,,,,
Molina Medicaid,DRG,4032,PROCEDURES FOR OBESITY,,Relative Weights,"$6,108.30 ",IP,"6,108.30","6,108.30",,,,,,,,,,,,,
Molina Medicaid,DRG,4033,PROCEDURES FOR OBESITY,,Relative Weights,"$9,074.13 ",IP,"9,074.13","9,074.13",,,,,,,,,,,,,
Molina Medicaid,DRG,4034,PROCEDURES FOR OBESITY,,Relative Weights,"$26,392.19 ",IP,"26,392.19","26,392.19",,,,,,,,,,,,,
Molina Medicaid,DRG,4041,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$4,728.64 ",IP,"4,728.64","4,728.64",,,,,,,,,,,,,
Molina Medicaid,DRG,4042,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$6,537.48 ",IP,"6,537.48","6,537.48",,,,,,,,,,,,,
Molina Medicaid,DRG,4043,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$10,989.85 ",IP,"10,989.85","10,989.85",,,,,,,,,,,,,
Molina Medicaid,DRG,4044,THYROID PARATHYROID and THYROGLOSSAL PROCEDURES,,Relative Weights,"$24,206.39 ",IP,"24,206.39","24,206.39",,,,,,,,,,,,,
Molina Medicaid,DRG,4051,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$7,505.82 ",IP,"7,505.82","7,505.82",,,,,,,,,,,,,
Molina Medicaid,DRG,4052,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$8,475.19 ",IP,"8,475.19","8,475.19",,,,,,,,,,,,,
Molina Medicaid,DRG,4053,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$12,612.79 ",IP,"12,612.79","12,612.79",,,,,,,,,,,,,
Molina Medicaid,DRG,4054,OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL and METABOLIC DISORDERS,,Relative Weights,"$26,164.03 ",IP,"26,164.03","26,164.03",,,,,,,,,,,,,
Molina Medicaid,DRG,4201,DIABETES,,Relative Weights,"$2,259.68 ",IP,"2,259.68","2,259.68",,,,,,,,,,,,,
Molina Medicaid,DRG,4202,DIABETES,,Relative Weights,"$2,723.24 ",IP,"2,723.24","2,723.24",,,,,,,,,,,,,
Molina Medicaid,DRG,4203,DIABETES,,Relative Weights,"$3,776.79 ",IP,"3,776.79","3,776.79",,,,,,,,,,,,,
Molina Medicaid,DRG,4204,DIABETES,,Relative Weights,"$8,028.82 ",IP,"8,028.82","8,028.82",,,,,,,,,,,,,
Molina Medicaid,DRG,4211,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$2,343.53 ",IP,"2,343.53","2,343.53",,,,,,,,,,,,,
Molina Medicaid,DRG,4212,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$3,329.74 ",IP,"3,329.74","3,329.74",,,,,,,,,,,,,
Molina Medicaid,DRG,4213,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$5,181.88 ",IP,"5,181.88","5,181.88",,,,,,,,,,,,,
Molina Medicaid,DRG,4214,MALNUTRITION FAILURE TO THRIVE and OTHER NUTRITIONAL DISORDERS,,Relative Weights,"$10,295.72 ",IP,"10,295.72","10,295.72",,,,,,,,,,,,,
Molina Medicaid,DRG,4221,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$1,870.01 ",IP,"1,870.01","1,870.01",,,,,,,,,,,,,
Molina Medicaid,DRG,4222,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$2,609.84 ",IP,"2,609.84","2,609.84",,,,,,,,,,,,,
Molina Medicaid,DRG,4223,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$3,459.28 ",IP,"3,459.28","3,459.28",,,,,,,,,,,,,
Molina Medicaid,DRG,4224,HYPOVOLEMIA and RELATED ELECTROLYTE DISORDERS,,Relative Weights,"$7,038.84 ",IP,"7,038.84","7,038.84",,,,,,,,,,,,,
Molina Medicaid,DRG,4231,INBORN ERRORS OF METABOLISM,,Relative Weights,"$5,529.29 ",IP,"5,529.29","5,529.29",,,,,,,,,,,,,
Molina Medicaid,DRG,4232,INBORN ERRORS OF METABOLISM,,Relative Weights,"$5,948.85 ",IP,"5,948.85","5,948.85",,,,,,,,,,,,,
Molina Medicaid,DRG,4233,INBORN ERRORS OF METABOLISM,,Relative Weights,"$8,447.01 ",IP,"8,447.01","8,447.01",,,,,,,,,,,,,
Molina Medicaid,DRG,4234,INBORN ERRORS OF METABOLISM,,Relative Weights,"$27,194.91 ",IP,"27,194.91","27,194.91",,,,,,,,,,,,,
Molina Medicaid,DRG,4241,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$2,869.62 ",IP,"2,869.62","2,869.62",,,,,,,,,,,,,
Molina Medicaid,DRG,4242,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$3,662.02 ",IP,"3,662.02","3,662.02",,,,,,,,,,,,,
Molina Medicaid,DRG,4243,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$5,028.28 ",IP,"5,028.28","5,028.28",,,,,,,,,,,,,
Molina Medicaid,DRG,4244,OTHER ENDOCRINE DISORDERS,,Relative Weights,"$10,807.73 ",IP,"10,807.73","10,807.73",,,,,,,,,,,,,
Molina Medicaid,DRG,4251,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$2,221.89 ",IP,"2,221.89","2,221.89",,,,,,,,,,,,,
Molina Medicaid,DRG,4252,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$2,908.79 ",IP,"2,908.79","2,908.79",,,,,,,,,,,,,
Molina Medicaid,DRG,4253,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$3,943.11 ",IP,"3,943.11","3,943.11",,,,,,,,,,,,,
Molina Medicaid,DRG,4254,OTHER NONHYPOVOLEMIC ELECTROLYTE DISORDERS,,Relative Weights,"$7,662.17 ",IP,"7,662.17","7,662.17",,,,,,,,,,,,,
Molina Medicaid,DRG,4261,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$2,409.16 ",IP,"2,409.16","2,409.16",,,,,,,,,,,,,
Molina Medicaid,DRG,4262,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$2,941.78 ",IP,"2,941.78","2,941.78",,,,,,,,,,,,,
Molina Medicaid,DRG,4263,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$4,191.21 ",IP,"4,191.21","4,191.21",,,,,,,,,,,,,
Molina Medicaid,DRG,4264,NONHYPOVOLEMIC SODIUM DISORDERS,,Relative Weights,"$8,224.69 ",IP,"8,224.69","8,224.69",,,,,,,,,,,,,
Molina Medicaid,DRG,4271,THYROID DISORDERS,,Relative Weights,"$2,411.91 ",IP,"2,411.91","2,411.91",,,,,,,,,,,,,
Molina Medicaid,DRG,4272,THYROID DISORDERS,,Relative Weights,"$3,208.44 ",IP,"3,208.44","3,208.44",,,,,,,,,,,,,
Molina Medicaid,DRG,4273,THYROID DISORDERS,,Relative Weights,"$4,621.77 ",IP,"4,621.77","4,621.77",,,,,,,,,,,,,
Molina Medicaid,DRG,4274,THYROID DISORDERS,,Relative Weights,"$9,834.92 ",IP,"9,834.92","9,834.92",,,,,,,,,,,,,
Molina Medicaid,DRG,4401,KIDNEY TRANSPLANT,,Relative Weights,"$26,376.39 ",IP,"26,376.39","26,376.39",,,,,,,,,,,,,
Molina Medicaid,DRG,4402,KIDNEY TRANSPLANT,,Relative Weights,"$28,441.58 ",IP,"28,441.58","28,441.58",,,,,,,,,,,,,
Molina Medicaid,DRG,4403,KIDNEY TRANSPLANT,,Relative Weights,"$31,863.75 ",IP,"31,863.75","31,863.75",,,,,,,,,,,,,
Molina Medicaid,DRG,4404,KIDNEY TRANSPLANT,,Relative Weights,"$48,433.40 ",IP,"48,433.40","48,433.40",,,,,,,,,,,,,
Molina Medicaid,DRG,4411,MAJOR BLADDER PROCEDURES,,Relative Weights,"$7,124.74 ",IP,"7,124.74","7,124.74",,,,,,,,,,,,,
Molina Medicaid,DRG,4412,MAJOR BLADDER PROCEDURES,,Relative Weights,"$11,337.94 ",IP,"11,337.94","11,337.94",,,,,,,,,,,,,
Molina Medicaid,DRG,4413,MAJOR BLADDER PROCEDURES,,Relative Weights,"$14,853.23 ",IP,"14,853.23","14,853.23",,,,,,,,,,,,,
Molina Medicaid,DRG,4414,MAJOR BLADDER PROCEDURES,,Relative Weights,"$32,299.47 ",IP,"32,299.47","32,299.47",,,,,,,,,,,,,
Molina Medicaid,DRG,4421,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$7,007.22 ",IP,"7,007.22","7,007.22",,,,,,,,,,,,,
Molina Medicaid,DRG,4422,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$7,784.16 ",IP,"7,784.16","7,784.16",,,,,,,,,,,,,
Molina Medicaid,DRG,4423,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$11,551.33 ",IP,"11,551.33","11,551.33",,,,,,,,,,,,,
Molina Medicaid,DRG,4424,KIDNEY and URINARY TRACT PROCEDURES FOR MALIGNANCY,,Relative Weights,"$20,973.56 ",IP,"20,973.56","20,973.56",,,,,,,,,,,,,
Molina Medicaid,DRG,4431,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$5,745.77 ",IP,"5,745.77","5,745.77",,,,,,,,,,,,,
Molina Medicaid,DRG,4432,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$6,928.19 ",IP,"6,928.19","6,928.19",,,,,,,,,,,,,
Molina Medicaid,DRG,4433,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$10,300.53 ",IP,"10,300.53","10,300.53",,,,,,,,,,,,,
Molina Medicaid,DRG,4434,KIDNEY and URINARY TRACT PROCEDURES FOR NONMALIGNANCY,,Relative Weights,"$21,259.80 ",IP,"21,259.80","21,259.80",,,,,,,,,,,,,
Molina Medicaid,DRG,4441,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$6,643.67 ",IP,"6,643.67","6,643.67",,,,,,,,,,,,,
Molina Medicaid,DRG,4442,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$8,351.49 ",IP,"8,351.49","8,351.49",,,,,,,,,,,,,
Molina Medicaid,DRG,4443,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$12,840.62 ",IP,"12,840.62","12,840.62",,,,,,,,,,,,,
Molina Medicaid,DRG,4444,RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR,,Relative Weights,"$25,251.70 ",IP,"25,251.70","25,251.70",,,,,,,,,,,,,
Molina Medicaid,DRG,4451,OTHER BLADDER PROCEDURES,,Relative Weights,"$4,867.46 ",IP,"4,867.46","4,867.46",,,,,,,,,,,,,
Molina Medicaid,DRG,4452,OTHER BLADDER PROCEDURES,,Relative Weights,"$6,607.93 ",IP,"6,607.93","6,607.93",,,,,,,,,,,,,
Molina Medicaid,DRG,4453,OTHER BLADDER PROCEDURES,,Relative Weights,"$8,634.63 ",IP,"8,634.63","8,634.63",,,,,,,,,,,,,
Molina Medicaid,DRG,4454,OTHER BLADDER PROCEDURES,,Relative Weights,"$17,913.22 ",IP,"17,913.22","17,913.22",,,,,,,,,,,,,
Molina Medicaid,DRG,4461,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$4,096.37 ",IP,"4,096.37","4,096.37",,,,,,,,,,,,,
Molina Medicaid,DRG,4462,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$5,093.91 ",IP,"5,093.91","5,093.91",,,,,,,,,,,,,
Molina Medicaid,DRG,4463,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$7,454.97 ",IP,"7,454.97","7,454.97",,,,,,,,,,,,,
Molina Medicaid,DRG,4464,URETHRAL and TRANSURETHRAL PROCEDURES,,Relative Weights,"$15,279.67 ",IP,"15,279.67","15,279.67",,,,,,,,,,,,,
Molina Medicaid,DRG,4471,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$6,383.54 ",IP,"6,383.54","6,383.54",,,,,,,,,,,,,
Molina Medicaid,DRG,4472,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$7,988.27 ",IP,"7,988.27","7,988.27",,,,,,,,,,,,,
Molina Medicaid,DRG,4473,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$11,578.48 ",IP,"11,578.48","11,578.48",,,,,,,,,,,,,
Molina Medicaid,DRG,4474,OTHER KIDNEY URINARY TRACT and RELATED PROCEDURES,,Relative Weights,"$26,335.15 ",IP,"26,335.15","26,335.15",,,,,,,,,,,,,
Molina Medicaid,DRG,4611,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$4,213.89 ",IP,"4,213.89","4,213.89",,,,,,,,,,,,,
Molina Medicaid,DRG,4612,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$4,354.09 ",IP,"4,354.09","4,354.09",,,,,,,,,,,,,
Molina Medicaid,DRG,4613,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$5,833.40 ",IP,"5,833.40","5,833.40",,,,,,,,,,,,,
Molina Medicaid,DRG,4614,KIDNEY and URINARY TRACT MALIGNANCY,,Relative Weights,"$10,495.71 ",IP,"10,495.71","10,495.71",,,,,,,,,,,,,
Molina Medicaid,DRG,4621,NEPHRITIS and NEPHROSIS,,Relative Weights,"$2,361.40 ",IP,"2,361.40","2,361.40",,,,,,,,,,,,,
Molina Medicaid,DRG,4622,NEPHRITIS and NEPHROSIS,,Relative Weights,"$3,007.07 ",IP,"3,007.07","3,007.07",,,,,,,,,,,,,
Molina Medicaid,DRG,4623,NEPHRITIS and NEPHROSIS,,Relative Weights,"$5,343.04 ",IP,"5,343.04","5,343.04",,,,,,,,,,,,,
Molina Medicaid,DRG,4624,NEPHRITIS and NEPHROSIS,,Relative Weights,"$14,645.34 ",IP,"14,645.34","14,645.34",,,,,,,,,,,,,
Molina Medicaid,DRG,4631,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$2,386.48 ",IP,"2,386.48","2,386.48",,,,,,,,,,,,,
Molina Medicaid,DRG,4632,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$2,925.29 ",IP,"2,925.29","2,925.29",,,,,,,,,,,,,
Molina Medicaid,DRG,4633,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$3,755.49 ",IP,"3,755.49","3,755.49",,,,,,,,,,,,,
Molina Medicaid,DRG,4634,KIDNEY and URINARY TRACT INFECTIONS,,Relative Weights,"$6,746.75 ",IP,"6,746.75","6,746.75",,,,,,,,,,,,,
Molina Medicaid,DRG,4651,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$2,676.16 ",IP,"2,676.16","2,676.16",,,,,,,,,,,,,
Molina Medicaid,DRG,4652,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$3,212.22 ",IP,"3,212.22","3,212.22",,,,,,,,,,,,,
Molina Medicaid,DRG,4653,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$4,385.36 ",IP,"4,385.36","4,385.36",,,,,,,,,,,,,
Molina Medicaid,DRG,4654,URINARY STONES and ACQUIRED UPPER URINARY TRACT OBSTRUCTION,,Relative Weights,"$8,949.40 ",IP,"8,949.40","8,949.40",,,,,,,,,,,,,
Molina Medicaid,DRG,4661,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$2,602.62 ",IP,"2,602.62","2,602.62",,,,,,,,,,,,,
Molina Medicaid,DRG,4662,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$3,336.61 ",IP,"3,336.61","3,336.61",,,,,,,,,,,,,
Molina Medicaid,DRG,4663,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$4,821.07 ",IP,"4,821.07","4,821.07",,,,,,,,,,,,,
Molina Medicaid,DRG,4664,MALFUNCTION REACTION COMPLIC OF GENITOURINARY DEVICE OR PROC,,Relative Weights,"$8,281.73 ",IP,"8,281.73","8,281.73",,,,,,,,,,,,,
Molina Medicaid,DRG,4681,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$2,645.58 ",IP,"2,645.58","2,645.58",,,,,,,,,,,,,
Molina Medicaid,DRG,4682,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$3,341.08 ",IP,"3,341.08","3,341.08",,,,,,,,,,,,,
Molina Medicaid,DRG,4683,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$4,559.92 ",IP,"4,559.92","4,559.92",,,,,,,,,,,,,
Molina Medicaid,DRG,4684,OTHER KIDNEY and URINARY TRACT DIAGNOSES SIGNS and SYMPTOMS,,Relative Weights,"$9,588.20 ",IP,"9,588.20","9,588.20",,,,,,,,,,,,,
Molina Medicaid,DRG,4691,ACUTE KIDNEY INJURY,,Relative Weights,"$2,379.95 ",IP,"2,379.95","2,379.95",,,,,,,,,,,,,
Molina Medicaid,DRG,4692,ACUTE KIDNEY INJURY,,Relative Weights,"$3,050.71 ",IP,"3,050.71","3,050.71",,,,,,,,,,,,,
Molina Medicaid,DRG,4693,ACUTE KIDNEY INJURY,,Relative Weights,"$4,563.35 ",IP,"4,563.35","4,563.35",,,,,,,,,,,,,
Molina Medicaid,DRG,4694,ACUTE KIDNEY INJURY,,Relative Weights,"$9,568.95 ",IP,"9,568.95","9,568.95",,,,,,,,,,,,,
Molina Medicaid,DRG,4701,CHRONIC KIDNEY DISEASE,,Relative Weights,"$2,503.66 ",IP,"2,503.66","2,503.66",,,,,,,,,,,,,
Molina Medicaid,DRG,4702,CHRONIC KIDNEY DISEASE,,Relative Weights,"$3,283.35 ",IP,"3,283.35","3,283.35",,,,,,,,,,,,,
Molina Medicaid,DRG,4703,CHRONIC KIDNEY DISEASE,,Relative Weights,"$4,530.02 ",IP,"4,530.02","4,530.02",,,,,,,,,,,,,
Molina Medicaid,DRG,4704,CHRONIC KIDNEY DISEASE,,Relative Weights,"$8,193.42 ",IP,"8,193.42","8,193.42",,,,,,,,,,,,,
Molina Medicaid,DRG,4801,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$6,131.66 ",IP,"6,131.66","6,131.66",,,,,,,,,,,,,
Molina Medicaid,DRG,4802,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$6,485.60 ",IP,"6,485.60","6,485.60",,,,,,,,,,,,,
Molina Medicaid,DRG,4803,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$10,188.85 ",IP,"10,188.85","10,188.85",,,,,,,,,,,,,
Molina Medicaid,DRG,4804,MAJOR MALE PELVIC PROCEDURES,,Relative Weights,"$21,900.66 ",IP,"21,900.66","21,900.66",,,,,,,,,,,,,
Molina Medicaid,DRG,4821,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$4,027.30 ",IP,"4,027.30","4,027.30",,,,,,,,,,,,,
Molina Medicaid,DRG,4822,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$4,459.58 ",IP,"4,459.58","4,459.58",,,,,,,,,,,,,
Molina Medicaid,DRG,4823,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$7,759.08 ",IP,"7,759.08","7,759.08",,,,,,,,,,,,,
Molina Medicaid,DRG,4824,TRANSURETHRAL PROSTATECTOMY,,Relative Weights,"$15,069.03 ",IP,"15,069.03","15,069.03",,,,,,,,,,,,,
Molina Medicaid,DRG,4831,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$5,523.10 ",IP,"5,523.10","5,523.10",,,,,,,,,,,,,
Molina Medicaid,DRG,4832,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$6,593.84 ",IP,"6,593.84","6,593.84",,,,,,,,,,,,,
Molina Medicaid,DRG,4833,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$8,503.71 ",IP,"8,503.71","8,503.71",,,,,,,,,,,,,
Molina Medicaid,DRG,4834,PENIS TESTES and SCROTAL PROCEDURES,,Relative Weights,"$16,764.14 ",IP,"16,764.14","16,764.14",,,,,,,,,,,,,
Molina Medicaid,DRG,4841,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$6,414.47 ",IP,"6,414.47","6,414.47",,,,,,,,,,,,,
Molina Medicaid,DRG,4842,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$6,893.48 ",IP,"6,893.48","6,893.48",,,,,,,,,,,,,
Molina Medicaid,DRG,4843,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$7,922.98 ",IP,"7,922.98","7,922.98",,,,,,,,,,,,,
Molina Medicaid,DRG,4844,OTHER MALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$22,148.41 ",IP,"22,148.41","22,148.41",,,,,,,,,,,,,
Molina Medicaid,DRG,5001,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$3,471.31 ",IP,"3,471.31","3,471.31",,,,,,,,,,,,,
Molina Medicaid,DRG,5002,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$3,960.98 ",IP,"3,960.98","3,960.98",,,,,,,,,,,,,
Molina Medicaid,DRG,5003,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$5,381.18 ",IP,"5,381.18","5,381.18",,,,,,,,,,,,,
Molina Medicaid,DRG,5004,MALIGNANCY MALE REPRODUCTIVE SYSTEM,,Relative Weights,"$8,653.88 ",IP,"8,653.88","8,653.88",,,,,,,,,,,,,
Molina Medicaid,DRG,5011,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$2,269.65 ",IP,"2,269.65","2,269.65",,,,,,,,,,,,,
Molina Medicaid,DRG,5012,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$2,988.52 ",IP,"2,988.52","2,988.52",,,,,,,,,,,,,
Molina Medicaid,DRG,5013,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$4,126.95 ",IP,"4,126.95","4,126.95",,,,,,,,,,,,,
Molina Medicaid,DRG,5014,MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY,,Relative Weights,"$8,519.52 ",IP,"8,519.52","8,519.52",,,,,,,,,,,,,
Molina Medicaid,DRG,5101,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$6,667.03 ",IP,"6,667.03","6,667.03",,,,,,,,,,,,,
Molina Medicaid,DRG,5102,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$7,636.06 ",IP,"7,636.06","7,636.06",,,,,,,,,,,,,
Molina Medicaid,DRG,5103,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$12,159.55 ",IP,"12,159.55","12,159.55",,,,,,,,,,,,,
Molina Medicaid,DRG,5104,PELVIC EVISCERATION RADICAL HYSTERECTOMY and OTHER RADICAL GYN PROCS,,Relative Weights,"$22,308.54 ",IP,"22,308.54","22,308.54",,,,,,,,,,,,,
Molina Medicaid,DRG,5111,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$6,477.69 ",IP,"6,477.69","6,477.69",,,,,,,,,,,,,
Molina Medicaid,DRG,5112,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$7,830.89 ",IP,"7,830.89","7,830.89",,,,,,,,,,,,,
Molina Medicaid,DRG,5113,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$10,746.90 ",IP,"10,746.90","10,746.90",,,,,,,,,,,,,
Molina Medicaid,DRG,5114,UTERINE and ADNEXA PROCEDURES FOR OVARIAN and ADNEXAL MALIGNANCY,,Relative Weights,"$23,120.88 ",IP,"23,120.88","23,120.88",,,,,,,,,,,,,
Molina Medicaid,DRG,5121,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$6,341.62 ",IP,"6,341.62","6,341.62",,,,,,,,,,,,,
Molina Medicaid,DRG,5122,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$7,038.84 ",IP,"7,038.84","7,038.84",,,,,,,,,,,,,
Molina Medicaid,DRG,5123,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$9,937.66 ",IP,"9,937.66","9,937.66",,,,,,,,,,,,,
Molina Medicaid,DRG,5124,UTERINE and ADNEXA PROCEDURES FOR NONOVARIAN and NONADNEXAL MALIG,,Relative Weights,"$20,453.99 ",IP,"20,453.99","20,453.99",,,,,,,,,,,,,
Molina Medicaid,DRG,5131,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$4,384.67 ",IP,"4,384.67","4,384.67",,,,,,,,,,,,,
Molina Medicaid,DRG,5132,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$5,107.31 ",IP,"5,107.31","5,107.31",,,,,,,,,,,,,
Molina Medicaid,DRG,5133,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$8,107.86 ",IP,"8,107.86","8,107.86",,,,,,,,,,,,,
Molina Medicaid,DRG,5134,UTERINE and ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA,,Relative Weights,"$16,632.53 ",IP,"16,632.53","16,632.53",,,,,,,,,,,,,
Molina Medicaid,DRG,5141,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$3,945.51 ",IP,"3,945.51","3,945.51",,,,,,,,,,,,,
Molina Medicaid,DRG,5142,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$5,893.19 ",IP,"5,893.19","5,893.19",,,,,,,,,,,,,
Molina Medicaid,DRG,5143,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$10,581.96 ",IP,"10,581.96","10,581.96",,,,,,,,,,,,,
Molina Medicaid,DRG,5144,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,,Relative Weights,"$22,849.41 ",IP,"22,849.41","22,849.41",,,,,,,,,,,,,
Molina Medicaid,DRG,5171,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$3,258.61 ",IP,"3,258.61","3,258.61",,,,,,,,,,,,,
Molina Medicaid,DRG,5172,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$4,494.28 ",IP,"4,494.28","4,494.28",,,,,,,,,,,,,
Molina Medicaid,DRG,5173,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$6,942.62 ",IP,"6,942.62","6,942.62",,,,,,,,,,,,,
Molina Medicaid,DRG,5174,DILATION and CURETTAGE FOR NONOBSTETRIC DIAGNOSES,,Relative Weights,"$14,767.33 ",IP,"14,767.33","14,767.33",,,,,,,,,,,,,
Molina Medicaid,DRG,5181,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$4,123.51 ",IP,"4,123.51","4,123.51",,,,,,,,,,,,,
Molina Medicaid,DRG,5182,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$5,436.16 ",IP,"5,436.16","5,436.16",,,,,,,,,,,,,
Molina Medicaid,DRG,5183,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$9,420.16 ",IP,"9,420.16","9,420.16",,,,,,,,,,,,,
Molina Medicaid,DRG,5184,OTHER FEMALE REPRODUCTIVE SYSTEM and RELATED PROCEDURES,,Relative Weights,"$21,115.47 ",IP,"21,115.47","21,115.47",,,,,,,,,,,,,
Molina Medicaid,DRG,5191,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$3,160.33 ",IP,"3,160.33","3,160.33",,,,,,,,,,,,,
Molina Medicaid,DRG,5192,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$3,849.30 ",IP,"3,849.30","3,849.30",,,,,,,,,,,,,
Molina Medicaid,DRG,5193,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$7,527.81 ",IP,"7,527.81","7,527.81",,,,,,,,,,,,,
Molina Medicaid,DRG,5194,UTERINE and ADNEXA PROCEDURES FOR LEIOMYOMA,,Relative Weights,"$15,622.96 ",IP,"15,622.96","15,622.96",,,,,,,,,,,,,
Molina Medicaid,DRG,5301,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$3,382.31 ",IP,"3,382.31","3,382.31",,,,,,,,,,,,,
Molina Medicaid,DRG,5302,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$3,815.97 ",IP,"3,815.97","3,815.97",,,,,,,,,,,,,
Molina Medicaid,DRG,5303,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$5,327.23 ",IP,"5,327.23","5,327.23",,,,,,,,,,,,,
Molina Medicaid,DRG,5304,FEMALE REPRODUCTIVE SYSTEM MALIGNANCY,,Relative Weights,"$9,039.08 ",IP,"9,039.08","9,039.08",,,,,,,,,,,,,
Molina Medicaid,DRG,5311,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$2,096.46 ",IP,"2,096.46","2,096.46",,,,,,,,,,,,,
Molina Medicaid,DRG,5312,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$2,868.93 ",IP,"2,868.93","2,868.93",,,,,,,,,,,,,
Molina Medicaid,DRG,5313,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$4,503.56 ",IP,"4,503.56","4,503.56",,,,,,,,,,,,,
Molina Medicaid,DRG,5314,FEMALE REPRODUCTIVE SYSTEM INFECTIONS,,Relative Weights,"$9,958.97 ",IP,"9,958.97","9,958.97",,,,,,,,,,,,,
Molina Medicaid,DRG,5321,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$2,302.29 ",IP,"2,302.29","2,302.29",,,,,,,,,,,,,
Molina Medicaid,DRG,5322,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$2,696.78 ",IP,"2,696.78","2,696.78",,,,,,,,,,,,,
Molina Medicaid,DRG,5323,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$4,143.44 ",IP,"4,143.44","4,143.44",,,,,,,,,,,,,
Molina Medicaid,DRG,5324,MENSTRUAL and OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS,,Relative Weights,"$9,044.24 ",IP,"9,044.24","9,044.24",,,,,,,,,,,,,
Molina Medicaid,DRG,5401,CESAREAN DELIVERY,,Relative Weights,"$2,493.69 ",IP,"2,493.69","2,493.69",,,,,,,,,,,,,
Molina Medicaid,DRG,5402,CESAREAN DELIVERY,,Relative Weights,"$2,909.48 ",IP,"2,909.48","2,909.48",,,,,,,,,,,,,
Molina Medicaid,DRG,5403,CESAREAN DELIVERY,,Relative Weights,"$4,140.35 ",IP,"4,140.35","4,140.35",,,,,,,,,,,,,
Molina Medicaid,DRG,5404,CESAREAN DELIVERY,,Relative Weights,"$8,525.02 ",IP,"8,525.02","8,525.02",,,,,,,,,,,,,
Molina Medicaid,DRG,5411,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$2,683.03 ",IP,"2,683.03","2,683.03",,,,,,,,,,,,,
Molina Medicaid,DRG,5412,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$2,694.03 ",IP,"2,694.03","2,694.03",,,,,,,,,,,,,
Molina Medicaid,DRG,5413,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$3,800.85 ",IP,"3,800.85","3,800.85",,,,,,,,,,,,,
Molina Medicaid,DRG,5414,VAGINAL DELIVERY W STERILIZATION andOR DandC,,Relative Weights,"$9,356.59 ",IP,"9,356.59","9,356.59",,,,,,,,,,,,,
Molina Medicaid,DRG,5421,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$1,729.81 ",IP,"1,729.81","1,729.81",,,,,,,,,,,,,
Molina Medicaid,DRG,5422,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$1,962.10 ",IP,"1,962.10","1,962.10",,,,,,,,,,,,,
Molina Medicaid,DRG,5423,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$2,979.24 ",IP,"2,979.24","2,979.24",,,,,,,,,,,,,
Molina Medicaid,DRG,5424,VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION andOR DandC,,Relative Weights,"$11,346.53 ",IP,"11,346.53","11,346.53",,,,,,,,,,,,,
Molina Medicaid,DRG,5441,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$1,946.30 ",IP,"1,946.30","1,946.30",,,,,,,,,,,,,
Molina Medicaid,DRG,5442,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$2,595.06 ",IP,"2,595.06","2,595.06",,,,,,,,,,,,,
Molina Medicaid,DRG,5443,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$3,856.51 ",IP,"3,856.51","3,856.51",,,,,,,,,,,,,
Molina Medicaid,DRG,5444,DandC ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES,,Relative Weights,"$14,310.30 ",IP,"14,310.30","14,310.30",,,,,,,,,,,,,
Molina Medicaid,DRG,5451,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$2,785.09 ",IP,"2,785.09","2,785.09",,,,,,,,,,,,,
Molina Medicaid,DRG,5452,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$3,114.63 ",IP,"3,114.63","3,114.63",,,,,,,,,,,,,
Molina Medicaid,DRG,5453,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$3,214.96 ",IP,"3,214.96","3,214.96",,,,,,,,,,,,,
Molina Medicaid,DRG,5454,ECTOPIC PREGNANCY PROCEDURE,,Relative Weights,"$4,812.48 ",IP,"4,812.48","4,812.48",,,,,,,,,,,,,
Molina Medicaid,DRG,5461,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$2,385.45 ",IP,"2,385.45","2,385.45",,,,,,,,,,,,,
Molina Medicaid,DRG,5462,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$4,587.41 ",IP,"4,587.41","4,587.41",,,,,,,,,,,,,
Molina Medicaid,DRG,5463,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$5,857.79 ",IP,"5,857.79","5,857.79",,,,,,,,,,,,,
Molina Medicaid,DRG,5464,OTHER OR PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES,,Relative Weights,"$11,895.30 ",IP,"11,895.30","11,895.30",,,,,,,,,,,,,
Molina Medicaid,DRG,5601,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$1,539.10 ",IP,"1,539.10","1,539.10",,,,,,,,,,,,,
Molina Medicaid,DRG,5602,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$1,659.37 ",IP,"1,659.37","1,659.37",,,,,,,,,,,,,
Molina Medicaid,DRG,5603,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$2,337.34 ",IP,"2,337.34","2,337.34",,,,,,,,,,,,,
Molina Medicaid,DRG,5604,VAGINAL DELIVERY,VAGINAL DELIVERY,Relative Weights,"$4,292.23 ",IP,"4,292.23","4,292.23",,,,,,,,,,,,,
Molina Medicaid,DRG,5611,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$1,236.71 ",IP,"1,236.71","1,236.71",,,,,,,,,,,,,
Molina Medicaid,DRG,5612,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$1,778.26 ",IP,"1,778.26","1,778.26",,,,,,,,,,,,,
Molina Medicaid,DRG,5613,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$2,747.29 ",IP,"2,747.29","2,747.29",,,,,,,,,,,,,
Molina Medicaid,DRG,5614,POSTPARTUM and POST ABORTION DIAGNOSES WO PROCEDURE,,Relative Weights,"$5,898.34 ",IP,"5,898.34","5,898.34",,,,,,,,,,,,,
Molina Medicaid,DRG,5631,PRETERM LABOR,,Relative Weights,"$1,387.56 ",IP,"1,387.56","1,387.56",,,,,,,,,,,,,
Molina Medicaid,DRG,5632,PRETERM LABOR,,Relative Weights,"$1,719.85 ",IP,"1,719.85","1,719.85",,,,,,,,,,,,,
Molina Medicaid,DRG,5633,PRETERM LABOR,,Relative Weights,"$2,634.92 ",IP,"2,634.92","2,634.92",,,,,,,,,,,,,
Molina Medicaid,DRG,5634,PRETERM LABOR,,Relative Weights,"$4,637.23 ",IP,"4,637.23","4,637.23",,,,,,,,,,,,,
Molina Medicaid,DRG,5641,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$1,463.85 ",IP,"1,463.85","1,463.85",,,,,,,,,,,,,
Molina Medicaid,DRG,5642,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$1,520.55 ",IP,"1,520.55","1,520.55",,,,,,,,,,,,,
Molina Medicaid,DRG,5643,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$2,435.62 ",IP,"2,435.62","2,435.62",,,,,,,,,,,,,
Molina Medicaid,DRG,5644,ABORTION WO DandC ASPIRATION CURETTAGE OR HYSTEROTOMY,,Relative Weights,"$3,935.55 ",IP,"3,935.55","3,935.55",,,,,,,,,,,,,
Molina Medicaid,DRG,5651,FALSE LABOR,FALSE LABOR,Relative Weights,$992.39 ,IP,992.39,992.39,,,,,,,,,,,,,
Molina Medicaid,DRG,5652,FALSE LABOR,FALSE LABOR,Relative Weights,"$1,254.23 ",IP,"1,254.23","1,254.23",,,,,,,,,,,,,
Molina Medicaid,DRG,5653,FALSE LABOR,FALSE LABOR,Relative Weights,"$2,123.61 ",IP,"2,123.61","2,123.61",,,,,,,,,,,,,
Molina Medicaid,DRG,5654,FALSE LABOR,FALSE LABOR,Relative Weights,"$2,123.61 ",IP,"2,123.61","2,123.61",,,,,,,,,,,,,
Molina Medicaid,DRG,5661,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$1,462.82 ",IP,"1,462.82","1,462.82",,,,,,,,,,,,,
Molina Medicaid,DRG,5662,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$1,906.44 ",IP,"1,906.44","1,906.44",,,,,,,,,,,,,
Molina Medicaid,DRG,5663,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$2,718.08 ",IP,"2,718.08","2,718.08",,,,,,,,,,,,,
Molina Medicaid,DRG,5664,OTHER ANTEPARTUM DIAGNOSES,,Relative Weights,"$5,715.19 ",IP,"5,715.19","5,715.19",,,,,,,,,,,,,
Molina Medicaid,DRG,5801,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$1,625.35 ",IP,"1,625.35","1,625.35",,,,,,,,,,,,,
Molina Medicaid,DRG,5802,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$2,301.61 ",IP,"2,301.61","2,301.61",,,,,,,,,,,,,
Molina Medicaid,DRG,5803,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$3,477.84 ",IP,"3,477.84","3,477.84",,,,,,,,,,,,,
Molina Medicaid,DRG,5804,NEONATE TRANSFERRED 5 DAYS OLD NOT BORN HERE,,Relative Weights,"$6,537.48 ",IP,"6,537.48","6,537.48",,,,,,,,,,,,,
Molina Medicaid,DRG,5811,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,$559.42 ,IP,559.42,559.42,,,,,,,,,,,,,
Molina Medicaid,DRG,5812,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,$716.80 ,IP,716.8,716.8,,,,,,,,,,,,,
Molina Medicaid,DRG,5813,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,"$1,204.41 ",IP,"1,204.41","1,204.41",,,,,,,,,,,,,
Molina Medicaid,DRG,5814,NEONATE TRANSFERRED 5 DAYS OLD BORN HERE,,Relative Weights,"$2,109.52 ",IP,"2,109.52","2,109.52",,,,,,,,,,,,,
Molina Medicaid,DRG,5831,NEONATE W ECMO,,Relative Weights,"$87,271.04 ",IP,"87,271.04","87,271.04",,,,,,,,,,,,,
Molina Medicaid,DRG,5832,NEONATE W ECMO,,Relative Weights,"$87,459.00 ",IP,"87,459.00","87,459.00",,,,,,,,,,,,,
Molina Medicaid,DRG,5833,NEONATE W ECMO,,Relative Weights,"$148,358.12 ",IP,"148,358.12","148,358.12",,,,,,,,,,,,,
Molina Medicaid,DRG,5834,NEONATE W ECMO,,Relative Weights,"$163,193.83 ",IP,"163,193.83","163,193.83",,,,,,,,,,,,,
Molina Medicaid,DRG,5881,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$67,852.39 ",IP,"67,852.39","67,852.39",,,,,,,,,,,,,
Molina Medicaid,DRG,5882,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$75,391.54 ",IP,"75,391.54","75,391.54",,,,,,,,,,,,,
Molina Medicaid,DRG,5883,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$83,636.16 ",IP,"83,636.16","83,636.16",,,,,,,,,,,,,
Molina Medicaid,DRG,5884,NEONATE BWT 1500G W MAJOR PROCEDURE,,Relative Weights,"$133,619.66 ",IP,"133,619.66","133,619.66",,,,,,,,,,,,,
Molina Medicaid,DRG,5891,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$98,896.59 ",IP,"98,896.59","98,896.59",,,,,,,,,,,,,
Molina Medicaid,DRG,5892,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$69,370.87 ",IP,"69,370.87","69,370.87",,,,,,,,,,,,,
Molina Medicaid,DRG,5893,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$63,064.65 ",IP,"63,064.65","63,064.65",,,,,,,,,,,,,
Molina Medicaid,DRG,5894,NEONATE BWT 500G OR GA 24 WEEKS,,Relative Weights,"$11,889.12 ",IP,"11,889.12","11,889.12",,,,,,,,,,,,,
Molina Medicaid,DRG,5911,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$57,344.65 ",IP,"57,344.65","57,344.65",,,,,,,,,,,,,
Molina Medicaid,DRG,5912,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$79,559.04 ",IP,"79,559.04","79,559.04",,,,,,,,,,,,,
Molina Medicaid,DRG,5913,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$85,488.65 ",IP,"85,488.65","85,488.65",,,,,,,,,,,,,
Molina Medicaid,DRG,5914,NEONATE BIRTHWT 500749G WO MAJOR PROCEDURE,,Relative Weights,"$110,417.00 ",IP,"110,417.00","110,417.00",,,,,,,,,,,,,
Molina Medicaid,DRG,5931,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$37,781.34 ",IP,"37,781.34","37,781.34",,,,,,,,,,,,,
Molina Medicaid,DRG,5932,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$59,330.12 ",IP,"59,330.12","59,330.12",,,,,,,,,,,,,
Molina Medicaid,DRG,5933,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$71,323.01 ",IP,"71,323.01","71,323.01",,,,,,,,,,,,,
Molina Medicaid,DRG,5934,NEONATE BIRTHWT 750999G WO MAJOR PROCEDURE,,Relative Weights,"$96,423.52 ",IP,"96,423.52","96,423.52",,,,,,,,,,,,,
Molina Medicaid,DRG,6021,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$36,367.31 ",IP,"36,367.31","36,367.31",,,,,,,,,,,,,
Molina Medicaid,DRG,6022,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$43,081.42 ",IP,"43,081.42","43,081.42",,,,,,,,,,,,,
Molina Medicaid,DRG,6023,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$56,708.94 ",IP,"56,708.94","56,708.94",,,,,,,,,,,,,
Molina Medicaid,DRG,6024,NEONATE BWT 10001249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$82,218.02 ",IP,"82,218.02","82,218.02",,,,,,,,,,,,,
Molina Medicaid,DRG,6031,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$21,131.62 ",IP,"21,131.62","21,131.62",,,,,,,,,,,,,
Molina Medicaid,DRG,6032,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$31,760.66 ",IP,"31,760.66","31,760.66",,,,,,,,,,,,,
Molina Medicaid,DRG,6033,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$45,733.18 ",IP,"45,733.18","45,733.18",,,,,,,,,,,,,
Molina Medicaid,DRG,6034,NEONATE BIRTHWT 10001249G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$71,521.63 ",IP,"71,521.63","71,521.63",,,,,,,,,,,,,
Molina Medicaid,DRG,6071,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$24,973.02 ",IP,"24,973.02","24,973.02",,,,,,,,,,,,,
Molina Medicaid,DRG,6072,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$31,699.15 ",IP,"31,699.15","31,699.15",,,,,,,,,,,,,
Molina Medicaid,DRG,6073,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$41,632.01 ",IP,"41,632.01","41,632.01",,,,,,,,,,,,,
Molina Medicaid,DRG,6074,NEONATE BWT 12501499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM,,Relative Weights,"$64,492.07 ",IP,"64,492.07","64,492.07",,,,,,,,,,,,,
Molina Medicaid,DRG,6081,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$16,607.44 ",IP,"16,607.44","16,607.44",,,,,,,,,,,,,
Molina Medicaid,DRG,6082,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$23,967.23 ",IP,"23,967.23","23,967.23",,,,,,,,,,,,,
Molina Medicaid,DRG,6083,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$34,646.09 ",IP,"34,646.09","34,646.09",,,,,,,,,,,,,
Molina Medicaid,DRG,6084,NEONATE BWT 12501499G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$60,788.81 ",IP,"60,788.81","60,788.81",,,,,,,,,,,,,
Molina Medicaid,DRG,6091,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$25,499.11 ",IP,"25,499.11","25,499.11",,,,,,,,,,,,,
Molina Medicaid,DRG,6092,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$27,431.32 ",IP,"27,431.32","27,431.32",,,,,,,,,,,,,
Molina Medicaid,DRG,6093,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$47,002.54 ",IP,"47,002.54","47,002.54",,,,,,,,,,,,,
Molina Medicaid,DRG,6094,NEONATE BWT 15002499G W MAJOR PROCEDURE,,Relative Weights,"$99,687.62 ",IP,"99,687.62","99,687.62",,,,,,,,,,,,,
Molina Medicaid,DRG,6111,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$12,585.30 ",IP,"12,585.30","12,585.30",,,,,,,,,,,,,
Molina Medicaid,DRG,6112,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$19,393.91 ",IP,"19,393.91","19,393.91",,,,,,,,,,,,,
Molina Medicaid,DRG,6113,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$32,347.92 ",IP,"32,347.92","32,347.92",,,,,,,,,,,,,
Molina Medicaid,DRG,6114,NEONATE BIRTHWT 15001999G W MAJOR ANOMALY,,Relative Weights,"$58,174.51 ",IP,"58,174.51","58,174.51",,,,,,,,,,,,,
Molina Medicaid,DRG,6121,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$16,224.65 ",IP,"16,224.65","16,224.65",,,,,,,,,,,,,
Molina Medicaid,DRG,6122,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$21,637.79 ",IP,"21,637.79","21,637.79",,,,,,,,,,,,,
Molina Medicaid,DRG,6123,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$29,186.22 ",IP,"29,186.22","29,186.22",,,,,,,,,,,,,
Molina Medicaid,DRG,6124,NEONATE BWT 15001999G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$42,407.23 ",IP,"42,407.23","42,407.23",,,,,,,,,,,,,
Molina Medicaid,DRG,6131,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$13,196.61 ",IP,"13,196.61","13,196.61",,,,,,,,,,,,,
Molina Medicaid,DRG,6132,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$21,189.35 ",IP,"21,189.35","21,189.35",,,,,,,,,,,,,
Molina Medicaid,DRG,6133,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$27,656.40 ",IP,"27,656.40","27,656.40",,,,,,,,,,,,,
Molina Medicaid,DRG,6134,NEONATE BIRTHWT 15001999G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$47,731.03 ",IP,"47,731.03","47,731.03",,,,,,,,,,,,,
Molina Medicaid,DRG,6141,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$8,925.34 ",IP,"8,925.34","8,925.34",,,,,,,,,,,,,
Molina Medicaid,DRG,6142,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$15,030.54 ",IP,"15,030.54","15,030.54",,,,,,,,,,,,,
Molina Medicaid,DRG,6143,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$25,580.55 ",IP,"25,580.55","25,580.55",,,,,,,,,,,,,
Molina Medicaid,DRG,6144,NEONATE BWT 15001999G W OR WO OTHER SIGNIFICANT CONDITION,,Relative Weights,"$45,341.79 ",IP,"45,341.79","45,341.79",,,,,,,,,,,,,
Molina Medicaid,DRG,6211,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$6,929.91 ",IP,"6,929.91","6,929.91",,,,,,,,,,,,,
Molina Medicaid,DRG,6212,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$14,367.69 ",IP,"14,367.69","14,367.69",,,,,,,,,,,,,
Molina Medicaid,DRG,6213,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$26,320.72 ",IP,"26,320.72","26,320.72",,,,,,,,,,,,,
Molina Medicaid,DRG,6214,NEONATE BWT 20002499G W MAJOR ANOMALY,,Relative Weights,"$49,514.79 ",IP,"49,514.79","49,514.79",,,,,,,,,,,,,
Molina Medicaid,DRG,6221,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$10,129.06 ",IP,"10,129.06","10,129.06",,,,,,,,,,,,,
Molina Medicaid,DRG,6222,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$13,681.47 ",IP,"13,681.47","13,681.47",,,,,,,,,,,,,
Molina Medicaid,DRG,6223,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$17,417.03 ",IP,"17,417.03","17,417.03",,,,,,,,,,,,,
Molina Medicaid,DRG,6224,NEONATE BWT 20002499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$32,501.52 ",IP,"32,501.52","32,501.52",,,,,,,,,,,,,
Molina Medicaid,DRG,6231,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$7,947.73 ",IP,"7,947.73","7,947.73",,,,,,,,,,,,,
Molina Medicaid,DRG,6232,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$11,704.59 ",IP,"11,704.59","11,704.59",,,,,,,,,,,,,
Molina Medicaid,DRG,6233,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$18,604.26 ",IP,"18,604.26","18,604.26",,,,,,,,,,,,,
Molina Medicaid,DRG,6234,NEONATE BWT 20002499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$29,470.40 ",IP,"29,470.40","29,470.40",,,,,,,,,,,,,
Molina Medicaid,DRG,6251,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$8,481.72 ",IP,"8,481.72","8,481.72",,,,,,,,,,,,,
Molina Medicaid,DRG,6252,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$12,056.81 ",IP,"12,056.81","12,056.81",,,,,,,,,,,,,
Molina Medicaid,DRG,6253,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$17,253.12 ",IP,"17,253.12","17,253.12",,,,,,,,,,,,,
Molina Medicaid,DRG,6254,NEONATE BWT 20002499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$25,500.83 ",IP,"25,500.83","25,500.83",,,,,,,,,,,,,
Molina Medicaid,DRG,6261,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$1,026.75 ",IP,"1,026.75","1,026.75",,,,,,,,,,,,,
Molina Medicaid,DRG,6262,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$1,832.56 ",IP,"1,832.56","1,832.56",,,,,,,,,,,,,
Molina Medicaid,DRG,6263,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$5,129.99 ",IP,"5,129.99","5,129.99",,,,,,,,,,,,,
Molina Medicaid,DRG,6264,NEONATE BWT 20002499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$14,511.67 ",IP,"14,511.67","14,511.67",,,,,,,,,,,,,
Molina Medicaid,DRG,6301,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$14,642.59 ",IP,"14,642.59","14,642.59",,,,,,,,,,,,,
Molina Medicaid,DRG,6302,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$26,499.41 ",IP,"26,499.41","26,499.41",,,,,,,,,,,,,
Molina Medicaid,DRG,6303,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$44,508.84 ",IP,"44,508.84","44,508.84",,,,,,,,,,,,,
Molina Medicaid,DRG,6304,NEONATE BIRTHWT 2499G W MAJOR CARDIOVASCULAR PROCEDURE,,Relative Weights,"$79,154.59 ",IP,"79,154.59","79,154.59",,,,,,,,,,,,,
Molina Medicaid,DRG,6311,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$11,884.65 ",IP,"11,884.65","11,884.65",,,,,,,,,,,,,
Molina Medicaid,DRG,6312,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$19,077.77 ",IP,"19,077.77","19,077.77",,,,,,,,,,,,,
Molina Medicaid,DRG,6313,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$33,764.00 ",IP,"33,764.00","33,764.00",,,,,,,,,,,,,
Molina Medicaid,DRG,6314,NEONATE BIRTHWT 2499G W OTHER MAJOR PROCEDURE,,Relative Weights,"$74,464.79 ",IP,"74,464.79","74,464.79",,,,,,,,,,,,,
Molina Medicaid,DRG,6331,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$2,688.87 ",IP,"2,688.87","2,688.87",,,,,,,,,,,,,
Molina Medicaid,DRG,6332,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$7,851.51 ",IP,"7,851.51","7,851.51",,,,,,,,,,,,,
Molina Medicaid,DRG,6333,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$17,713.92 ",IP,"17,713.92","17,713.92",,,,,,,,,,,,,
Molina Medicaid,DRG,6334,NEONATE BIRTHWT 2499G W MAJOR ANOMALY,,Relative Weights,"$44,843.19 ",IP,"44,843.19","44,843.19",,,,,,,,,,,,,
Molina Medicaid,DRG,6341,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$4,461.64 ",IP,"4,461.64","4,461.64",,,,,,,,,,,,,
Molina Medicaid,DRG,6342,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$7,881.41 ",IP,"7,881.41","7,881.41",,,,,,,,,,,,,
Molina Medicaid,DRG,6343,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$11,444.81 ",IP,"11,444.81","11,444.81",,,,,,,,,,,,,
Molina Medicaid,DRG,6344,NEONATE BIRTHWT 2499G W RESP DIST SYNDOTH MAJ RESP COND,,Relative Weights,"$28,806.17 ",IP,"28,806.17","28,806.17",,,,,,,,,,,,,
Molina Medicaid,DRG,6361,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$4,375.39 ",IP,"4,375.39","4,375.39",,,,,,,,,,,,,
Molina Medicaid,DRG,6362,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$6,615.83 ",IP,"6,615.83","6,615.83",,,,,,,,,,,,,
Molina Medicaid,DRG,6363,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$13,140.60 ",IP,"13,140.60","13,140.60",,,,,,,,,,,,,
Molina Medicaid,DRG,6364,NEONATE BIRTHWT 2499G W CONGENITALPERINATAL INFECTION,,Relative Weights,"$22,289.30 ",IP,"22,289.30","22,289.30",,,,,,,,,,,,,
Molina Medicaid,DRG,6391,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$4,122.14 ",IP,"4,122.14","4,122.14",,,,,,,,,,,,,
Molina Medicaid,DRG,6392,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$7,440.19 ",IP,"7,440.19","7,440.19",,,,,,,,,,,,,
Molina Medicaid,DRG,6393,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$11,681.22 ",IP,"11,681.22","11,681.22",,,,,,,,,,,,,
Molina Medicaid,DRG,6394,NEONATE BIRTHWT 2499G W OTHER SIGNIFICANT CONDITION,,Relative Weights,"$20,735.08 ",IP,"20,735.08","20,735.08",,,,,,,,,,,,,
Molina Medicaid,DRG,6401,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,$571.11 ,IP,571.11,571.11,,,,,,,,,,,,,
Molina Medicaid,DRG,6402,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,$900.64 ,IP,900.64,900.64,,,,,,,,,,,,,
Molina Medicaid,DRG,6403,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$2,228.41 ",IP,"2,228.41","2,228.41",,,,,,,,,,,,,
Molina Medicaid,DRG,6404,NEONATE BIRTHWT 2499G NORMAL NEWBORN OR NEONATE W OTHER PROBLEM,,Relative Weights,"$13,890.74 ",IP,"13,890.74","13,890.74",,,,,,,,,,,,,
Molina Medicaid,DRG,6501,SPLENECTOMY,,Relative Weights,"$6,304.16 ",IP,"6,304.16","6,304.16",,,,,,,,,,,,,
Molina Medicaid,DRG,6502,SPLENECTOMY,,Relative Weights,"$8,491.69 ",IP,"8,491.69","8,491.69",,,,,,,,,,,,,
Molina Medicaid,DRG,6503,SPLENECTOMY,,Relative Weights,"$13,332.00 ",IP,"13,332.00","13,332.00",,,,,,,,,,,,,
Molina Medicaid,DRG,6504,SPLENECTOMY,,Relative Weights,"$23,483.06 ",IP,"23,483.06","23,483.06",,,,,,,,,,,,,
Molina Medicaid,DRG,6511,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$5,293.90 ",IP,"5,293.90","5,293.90",,,,,,,,,,,,,
Molina Medicaid,DRG,6512,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$7,236.76 ",IP,"7,236.76","7,236.76",,,,,,,,,,,,,
Molina Medicaid,DRG,6513,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$10,916.31 ",IP,"10,916.31","10,916.31",,,,,,,,,,,,,
Molina Medicaid,DRG,6514,OTHER PROCEDURES OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$33,538.24 ",IP,"33,538.24","33,538.24",,,,,,,,,,,,,
Molina Medicaid,DRG,6601,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$3,747.59 ",IP,"3,747.59","3,747.59",,,,,,,,,,,,,
Molina Medicaid,DRG,6602,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$4,287.77 ",IP,"4,287.77","4,287.77",,,,,,,,,,,,,
Molina Medicaid,DRG,6603,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$6,366.70 ",IP,"6,366.70","6,366.70",,,,,,,,,,,,,
Molina Medicaid,DRG,6604,MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS and COAGUL,,Relative Weights,"$16,194.41 ",IP,"16,194.41","16,194.41",,,,,,,,,,,,,
Molina Medicaid,DRG,6611,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$3,902.56 ",IP,"3,902.56","3,902.56",,,,,,,,,,,,,
Molina Medicaid,DRG,6612,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$5,668.11 ",IP,"5,668.11","5,668.11",,,,,,,,,,,,,
Molina Medicaid,DRG,6613,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$9,739.74 ",IP,"9,739.74","9,739.74",,,,,,,,,,,,,
Molina Medicaid,DRG,6614,COAGULATION and PLATELET DISORDERS,,Relative Weights,"$15,545.30 ",IP,"15,545.30","15,545.30",,,,,,,,,,,,,
Molina Medicaid,DRG,6621,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$2,821.17 ",IP,"2,821.17","2,821.17",,,,,,,,,,,,,
Molina Medicaid,DRG,6622,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$3,681.27 ",IP,"3,681.27","3,681.27",,,,,,,,,,,,,
Molina Medicaid,DRG,6623,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$5,206.96 ",IP,"5,206.96","5,206.96",,,,,,,,,,,,,
Molina Medicaid,DRG,6624,SICKLE CELL ANEMIA CRISIS,,Relative Weights,"$10,694.33 ",IP,"10,694.33","10,694.33",,,,,,,,,,,,,
Molina Medicaid,DRG,6631,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$2,701.59 ",IP,"2,701.59","2,701.59",,,,,,,,,,,,,
Molina Medicaid,DRG,6632,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$3,327.33 ",IP,"3,327.33","3,327.33",,,,,,,,,,,,,
Molina Medicaid,DRG,6633,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$4,391.20 ",IP,"4,391.20","4,391.20",,,,,,,,,,,,,
Molina Medicaid,DRG,6634,OTHER ANEMIA and DISORDERS OF BLOOD and BLOODFORMING ORGANS,,Relative Weights,"$8,007.52 ",IP,"8,007.52","8,007.52",,,,,,,,,,,,,
Molina Medicaid,DRG,6801,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$7,740.52 ",IP,"7,740.52","7,740.52",,,,,,,,,,,,,
Molina Medicaid,DRG,6802,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$10,236.62 ",IP,"10,236.62","10,236.62",,,,,,,,,,,,,
Molina Medicaid,DRG,6803,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$16,199.56 ",IP,"16,199.56","16,199.56",,,,,,,,,,,,,
Molina Medicaid,DRG,6804,MAJOR OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$34,974.94 ",IP,"34,974.94","34,974.94",,,,,,,,,,,,,
Molina Medicaid,DRG,6811,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$6,220.66 ",IP,"6,220.66","6,220.66",,,,,,,,,,,,,
Molina Medicaid,DRG,6812,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$7,805.46 ",IP,"7,805.46","7,805.46",,,,,,,,,,,,,
Molina Medicaid,DRG,6813,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$13,731.30 ",IP,"13,731.30","13,731.30",,,,,,,,,,,,,
Molina Medicaid,DRG,6814,OTHER OR PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS,,Relative Weights,"$32,311.50 ",IP,"32,311.50","32,311.50",,,,,,,,,,,,,
Molina Medicaid,DRG,6901,ACUTE LEUKEMIA,,Relative Weights,"$8,376.23 ",IP,"8,376.23","8,376.23",,,,,,,,,,,,,
Molina Medicaid,DRG,6902,ACUTE LEUKEMIA,,Relative Weights,"$11,965.06 ",IP,"11,965.06","11,965.06",,,,,,,,,,,,,
Molina Medicaid,DRG,6903,ACUTE LEUKEMIA,,Relative Weights,"$18,264.07 ",IP,"18,264.07","18,264.07",,,,,,,,,,,,,
Molina Medicaid,DRG,6904,ACUTE LEUKEMIA,,Relative Weights,"$33,495.63 ",IP,"33,495.63","33,495.63",,,,,,,,,,,,,
Molina Medicaid,DRG,6911,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$6,184.92 ",IP,"6,184.92","6,184.92",,,,,,,,,,,,,
Molina Medicaid,DRG,6912,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$6,251.93 ",IP,"6,251.93","6,251.93",,,,,,,,,,,,,
Molina Medicaid,DRG,6913,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$9,090.97 ",IP,"9,090.97","9,090.97",,,,,,,,,,,,,
Molina Medicaid,DRG,6914,LYMPHOMA MYELOMA and NONACUTE LEUKEMIA,,Relative Weights,"$18,806.65 ",IP,"18,806.65","18,806.65",,,,,,,,,,,,,
Molina Medicaid,DRG,6921,RADIOTHERAPY,,Relative Weights,"$5,028.28 ",IP,"5,028.28","5,028.28",,,,,,,,,,,,,
Molina Medicaid,DRG,6922,RADIOTHERAPY,,Relative Weights,"$8,603.36 ",IP,"8,603.36","8,603.36",,,,,,,,,,,,,
Molina Medicaid,DRG,6923,RADIOTHERAPY,,Relative Weights,"$11,232.45 ",IP,"11,232.45","11,232.45",,,,,,,,,,,,,
Molina Medicaid,DRG,6924,RADIOTHERAPY,,Relative Weights,"$22,232.95 ",IP,"22,232.95","22,232.95",,,,,,,,,,,,,
Molina Medicaid,DRG,6941,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$3,669.93 ",IP,"3,669.93","3,669.93",,,,,,,,,,,,,
Molina Medicaid,DRG,6942,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$4,230.04 ",IP,"4,230.04","4,230.04",,,,,,,,,,,,,
Molina Medicaid,DRG,6943,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$5,867.41 ",IP,"5,867.41","5,867.41",,,,,,,,,,,,,
Molina Medicaid,DRG,6944,LYMPHATIC and OTHER MALIGNANCIES and NEOPLASMS OF UNCERTAIN BEHAVIOR,,Relative Weights,"$11,092.25 ",IP,"11,092.25","11,092.25",,,,,,,,,,,,,
Molina Medicaid,DRG,6951,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$3,844.14 ",IP,"3,844.14","3,844.14",,,,,,,,,,,,,
Molina Medicaid,DRG,6952,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$4,908.70 ",IP,"4,908.70","4,908.70",,,,,,,,,,,,,
Molina Medicaid,DRG,6953,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$11,375.74 ",IP,"11,375.74","11,375.74",,,,,,,,,,,,,
Molina Medicaid,DRG,6954,CHEMOTHERAPY FOR ACUTE LEUKEMIA,,Relative Weights,"$32,868.17 ",IP,"32,868.17","32,868.17",,,,,,,,,,,,,
Molina Medicaid,DRG,6961,OTHER CHEMOTHERAPY,,Relative Weights,"$4,174.03 ",IP,"4,174.03","4,174.03",,,,,,,,,,,,,
Molina Medicaid,DRG,6962,OTHER CHEMOTHERAPY,,Relative Weights,"$5,397.68 ",IP,"5,397.68","5,397.68",,,,,,,,,,,,,
Molina Medicaid,DRG,6963,OTHER CHEMOTHERAPY,,Relative Weights,"$7,757.01 ",IP,"7,757.01","7,757.01",,,,,,,,,,,,,
Molina Medicaid,DRG,6964,OTHER CHEMOTHERAPY,,Relative Weights,"$17,845.53 ",IP,"17,845.53","17,845.53",,,,,,,,,,,,,
Molina Medicaid,DRG,7101,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$5,318.64 ",IP,"5,318.64","5,318.64",,,,,,,,,,,,,
Molina Medicaid,DRG,7102,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$7,922.30 ",IP,"7,922.30","7,922.30",,,,,,,,,,,,,
Molina Medicaid,DRG,7103,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$12,117.63 ",IP,"12,117.63","12,117.63",,,,,,,,,,,,,
Molina Medicaid,DRG,7104,INFECTIOUS and PARASITIC DISEASES INCLUDING HIV W OR PROCEDURE,,Relative Weights,"$24,582.32 ",IP,"24,582.32","24,582.32",,,,,,,,,,,,,
Molina Medicaid,DRG,7111,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$5,432.73 ",IP,"5,432.73","5,432.73",,,,,,,,,,,,,
Molina Medicaid,DRG,7112,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$7,124.05 ",IP,"7,124.05","7,124.05",,,,,,,,,,,,,
Molina Medicaid,DRG,7113,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$12,166.42 ",IP,"12,166.42","12,166.42",,,,,,,,,,,,,
Molina Medicaid,DRG,7114,POSTOP POSTTRAUMA OTHER DEVICE INFECTIONS W OR PROCEDURE,,Relative Weights,"$25,010.82 ",IP,"25,010.82","25,010.82",,,,,,,,,,,,,
Molina Medicaid,DRG,7201,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$2,801.24 ",IP,"2,801.24","2,801.24",,,,,,,,,,,,,
Molina Medicaid,DRG,7202,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$3,678.52 ",IP,"3,678.52","3,678.52",,,,,,,,,,,,,
Molina Medicaid,DRG,7203,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$5,399.74 ",IP,"5,399.74","5,399.74",,,,,,,,,,,,,
Molina Medicaid,DRG,7204,SEPTICEMIA and DISSEMINATED INFECTIONS,,Relative Weights,"$10,740.72 ",IP,"10,740.72","10,740.72",,,,,,,,,,,,,
Molina Medicaid,DRG,7211,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$2,917.38 ",IP,"2,917.38","2,917.38",,,,,,,,,,,,,
Molina Medicaid,DRG,7212,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$3,837.27 ",IP,"3,837.27","3,837.27",,,,,,,,,,,,,
Molina Medicaid,DRG,7213,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$6,182.18 ",IP,"6,182.18","6,182.18",,,,,,,,,,,,,
Molina Medicaid,DRG,7214,POSTOPERATIVE POSTTRAUMATIC OTHER DEVICE INFECTIONS,,Relative Weights,"$12,158.86 ",IP,"12,158.86","12,158.86",,,,,,,,,,,,,
Molina Medicaid,DRG,7221,FEVER,,Relative Weights,"$1,952.14 ",IP,"1,952.14","1,952.14",,,,,,,,,,,,,
Molina Medicaid,DRG,7222,FEVER,,Relative Weights,"$2,920.13 ",IP,"2,920.13","2,920.13",,,,,,,,,,,,,
Molina Medicaid,DRG,7223,FEVER,,Relative Weights,"$3,952.39 ",IP,"3,952.39","3,952.39",,,,,,,,,,,,,
Molina Medicaid,DRG,7224,FEVER,,Relative Weights,"$6,941.25 ",IP,"6,941.25","6,941.25",,,,,,,,,,,,,
Molina Medicaid,DRG,7231,VIRAL ILLNESS,,Relative Weights,"$1,908.50 ",IP,"1,908.50","1,908.50",,,,,,,,,,,,,
Molina Medicaid,DRG,7232,VIRAL ILLNESS,,Relative Weights,"$2,685.44 ",IP,"2,685.44","2,685.44",,,,,,,,,,,,,
Molina Medicaid,DRG,7233,VIRAL ILLNESS,,Relative Weights,"$4,131.07 ",IP,"4,131.07","4,131.07",,,,,,,,,,,,,
Molina Medicaid,DRG,7234,VIRAL ILLNESS,,Relative Weights,"$10,429.39 ",IP,"10,429.39","10,429.39",,,,,,,,,,,,,
Molina Medicaid,DRG,7241,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$3,048.31 ",IP,"3,048.31","3,048.31",,,,,,,,,,,,,
Molina Medicaid,DRG,7242,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$3,655.49 ",IP,"3,655.49","3,655.49",,,,,,,,,,,,,
Molina Medicaid,DRG,7243,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$5,820.68 ",IP,"5,820.68","5,820.68",,,,,,,,,,,,,
Molina Medicaid,DRG,7244,OTHER INFECTIOUS and PARASITIC DISEASES,,Relative Weights,"$13,099.02 ",IP,"13,099.02","13,099.02",,,,,,,,,,,,,
Molina Medicaid,DRG,7401,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$6,032.70 ",IP,"6,032.70","6,032.70",,,,,,,,,,,,,
Molina Medicaid,DRG,7402,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$6,703.46 ",IP,"6,703.46","6,703.46",,,,,,,,,,,,,
Molina Medicaid,DRG,7403,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$13,324.79 ",IP,"13,324.79","13,324.79",,,,,,,,,,,,,
Molina Medicaid,DRG,7404,MENTAL ILLNESS DIAGNOSIS W OR PROCEDURE,,Relative Weights,"$26,668.81 ",IP,"26,668.81","26,668.81",,,,,,,,,,,,,
Molina Medicaid,DRG,7501,SCHIZOPHRENIA,,Relative Weights,"$2,530.12 ",IP,"2,530.12","2,530.12",,,,,,,,,,,,,
Molina Medicaid,DRG,7502,SCHIZOPHRENIA,,Relative Weights,"$2,708.80 ",IP,"2,708.80","2,708.80",,,,,,,,,,,,,
Molina Medicaid,DRG,7503,SCHIZOPHRENIA,,Relative Weights,"$4,799.08 ",IP,"4,799.08","4,799.08",,,,,,,,,,,,,
Molina Medicaid,DRG,7504,SCHIZOPHRENIA,,Relative Weights,"$13,473.58 ",IP,"13,473.58","13,473.58",,,,,,,,,,,,,
Molina Medicaid,DRG,7511,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$1,760.40 ",IP,"1,760.40","1,760.40",,,,,,,,,,,,,
Molina Medicaid,DRG,7512,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$2,237.01 ",IP,"2,237.01","2,237.01",,,,,,,,,,,,,
Molina Medicaid,DRG,7513,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$3,773.70 ",IP,"3,773.70","3,773.70",,,,,,,,,,,,,
Molina Medicaid,DRG,7514,MAJOR DEPRESSIVE DISORDERS and OTHERUNSPECIFIED PSYCHOSES,,Relative Weights,"$8,518.14 ",IP,"8,518.14","8,518.14",,,,,,,,,,,,,
Molina Medicaid,DRG,7521,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$1,687.20 ",IP,"1,687.20","1,687.20",,,,,,,,,,,,,
Molina Medicaid,DRG,7522,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$2,102.30 ",IP,"2,102.30","2,102.30",,,,,,,,,,,,,
Molina Medicaid,DRG,7523,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$3,885.72 ",IP,"3,885.72","3,885.72",,,,,,,,,,,,,
Molina Medicaid,DRG,7524,DISORDERS OF PERSONALITY and IMPULSE CONTROL,,Relative Weights,"$13,737.14 ",IP,"13,737.14","13,737.14",,,,,,,,,,,,,
Molina Medicaid,DRG,7531,BIPOLAR DISORDERS,,Relative Weights,"$1,873.11 ",IP,"1,873.11","1,873.11",,,,,,,,,,,,,
Molina Medicaid,DRG,7532,BIPOLAR DISORDERS,,Relative Weights,"$2,183.40 ",IP,"2,183.40","2,183.40",,,,,,,,,,,,,
Molina Medicaid,DRG,7533,BIPOLAR DISORDERS,,Relative Weights,"$3,541.07 ",IP,"3,541.07","3,541.07",,,,,,,,,,,,,
Molina Medicaid,DRG,7534,BIPOLAR DISORDERS,,Relative Weights,"$10,043.84 ",IP,"10,043.84","10,043.84",,,,,,,,,,,,,
Molina Medicaid,DRG,7541,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$1,523.64 ",IP,"1,523.64","1,523.64",,,,,,,,,,,,,
Molina Medicaid,DRG,7542,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$2,007.46 ",IP,"2,007.46","2,007.46",,,,,,,,,,,,,
Molina Medicaid,DRG,7543,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$3,012.23 ",IP,"3,012.23","3,012.23",,,,,,,,,,,,,
Molina Medicaid,DRG,7544,DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER,,Relative Weights,"$7,979.68 ",IP,"7,979.68","7,979.68",,,,,,,,,,,,,
Molina Medicaid,DRG,7551,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$1,532.57 ",IP,"1,532.57","1,532.57",,,,,,,,,,,,,
Molina Medicaid,DRG,7552,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$2,506.06 ",IP,"2,506.06","2,506.06",,,,,,,,,,,,,
Molina Medicaid,DRG,7553,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$3,538.32 ",IP,"3,538.32","3,538.32",,,,,,,,,,,,,
Molina Medicaid,DRG,7554,ADJUSTMENT DISORDERS and NEUROSES EXCEPT DEPRESSIVE DIAGNOSES,,Relative Weights,"$6,118.26 ",IP,"6,118.26","6,118.26",,,,,,,,,,,,,
Molina Medicaid,DRG,7561,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$2,496.79 ",IP,"2,496.79","2,496.79",,,,,,,,,,,,,
Molina Medicaid,DRG,7562,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$3,057.58 ",IP,"3,057.58","3,057.58",,,,,,,,,,,,,
Molina Medicaid,DRG,7563,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$3,397.43 ",IP,"3,397.43","3,397.43",,,,,,,,,,,,,
Molina Medicaid,DRG,7564,ACUTE ANXIETY and DELIRIUM STATES,,Relative Weights,"$7,384.52 ",IP,"7,384.52","7,384.52",,,,,,,,,,,,,
Molina Medicaid,DRG,7571,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$2,504.35 ",IP,"2,504.35","2,504.35",,,,,,,,,,,,,
Molina Medicaid,DRG,7572,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$3,161.02 ",IP,"3,161.02","3,161.02",,,,,,,,,,,,,
Molina Medicaid,DRG,7573,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$5,750.24 ",IP,"5,750.24","5,750.24",,,,,,,,,,,,,
Molina Medicaid,DRG,7574,ORGANIC MENTAL HEALTH DISTURBANCES,,Relative Weights,"$15,933.94 ",IP,"15,933.94","15,933.94",,,,,,,,,,,,,
Molina Medicaid,DRG,7581,BEHAVIORAL DISORDERS,,Relative Weights,"$2,326.35 ",IP,"2,326.35","2,326.35",,,,,,,,,,,,,
Molina Medicaid,DRG,7582,BEHAVIORAL DISORDERS,,Relative Weights,"$2,881.65 ",IP,"2,881.65","2,881.65",,,,,,,,,,,,,
Molina Medicaid,DRG,7583,BEHAVIORAL DISORDERS,,Relative Weights,"$4,037.26 ",IP,"4,037.26","4,037.26",,,,,,,,,,,,,
Molina Medicaid,DRG,7584,BEHAVIORAL DISORDERS,,Relative Weights,"$5,464.00 ",IP,"5,464.00","5,464.00",,,,,,,,,,,,,
Molina Medicaid,DRG,7591,EATING DISORDERS,,Relative Weights,"$4,564.04 ",IP,"4,564.04","4,564.04",,,,,,,,,,,,,
Molina Medicaid,DRG,7592,EATING DISORDERS,,Relative Weights,"$5,955.04 ",IP,"5,955.04","5,955.04",,,,,,,,,,,,,
Molina Medicaid,DRG,7593,EATING DISORDERS,,Relative Weights,"$9,440.78 ",IP,"9,440.78","9,440.78",,,,,,,,,,,,,
Molina Medicaid,DRG,7594,EATING DISORDERS,,Relative Weights,"$12,954.01 ",IP,"12,954.01","12,954.01",,,,,,,,,,,,,
Molina Medicaid,DRG,7601,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$2,553.48 ",IP,"2,553.48","2,553.48",,,,,,,,,,,,,
Molina Medicaid,DRG,7602,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$3,467.19 ",IP,"3,467.19","3,467.19",,,,,,,,,,,,,
Molina Medicaid,DRG,7603,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$6,902.07 ",IP,"6,902.07","6,902.07",,,,,,,,,,,,,
Molina Medicaid,DRG,7604,OTHER MENTAL HEALTH DISORDERS,,Relative Weights,"$12,546.82 ",IP,"12,546.82","12,546.82",,,,,,,,,,,,,
Molina Medicaid,DRG,7701,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$1,041.53 ",IP,"1,041.53","1,041.53",,,,,,,,,,,,,
Molina Medicaid,DRG,7702,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$1,522.95 ",IP,"1,522.95","1,522.95",,,,,,,,,,,,,
Molina Medicaid,DRG,7703,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$2,633.89 ",IP,"2,633.89","2,633.89",,,,,,,,,,,,,
Molina Medicaid,DRG,7704,DRUG and ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE,,Relative Weights,"$6,153.65 ",IP,"6,153.65","6,153.65",,,,,,,,,,,,,
Molina Medicaid,DRG,7721,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$2,743.85 ",IP,"2,743.85","2,743.85",,,,,,,,,,,,,
Molina Medicaid,DRG,7722,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$3,502.58 ",IP,"3,502.58","3,502.58",,,,,,,,,,,,,
Molina Medicaid,DRG,7723,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$4,241.72 ",IP,"4,241.72","4,241.72",,,,,,,,,,,,,
Molina Medicaid,DRG,7724,ALCOHOL and DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY,,Relative Weights,"$9,550.40 ",IP,"9,550.40","9,550.40",,,,,,,,,,,,,
Molina Medicaid,DRG,7731,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$1,275.88 ",IP,"1,275.88","1,275.88",,,,,,,,,,,,,
Molina Medicaid,DRG,7732,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$1,881.01 ",IP,"1,881.01","1,881.01",,,,,,,,,,,,,
Molina Medicaid,DRG,7733,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$3,476.12 ",IP,"3,476.12","3,476.12",,,,,,,,,,,,,
Molina Medicaid,DRG,7734,OPIOID ABUSE and DEPENDENCE,,Relative Weights,"$9,565.86 ",IP,"9,565.86","9,565.86",,,,,,,,,,,,,
Molina Medicaid,DRG,7741,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$1,761.43 ",IP,"1,761.43","1,761.43",,,,,,,,,,,,,
Molina Medicaid,DRG,7742,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$1,956.95 ",IP,"1,956.95","1,956.95",,,,,,,,,,,,,
Molina Medicaid,DRG,7743,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$3,314.62 ",IP,"3,314.62","3,314.62",,,,,,,,,,,,,
Molina Medicaid,DRG,7744,COCAINE ABUSE and DEPENDENCE,,Relative Weights,"$9,105.40 ",IP,"9,105.40","9,105.40",,,,,,,,,,,,,
Molina Medicaid,DRG,7751,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$1,741.50 ",IP,"1,741.50","1,741.50",,,,,,,,,,,,,
Molina Medicaid,DRG,7752,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$2,441.81 ",IP,"2,441.81","2,441.81",,,,,,,,,,,,,
Molina Medicaid,DRG,7753,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$3,986.06 ",IP,"3,986.06","3,986.06",,,,,,,,,,,,,
Molina Medicaid,DRG,7754,ALCOHOL ABUSE and DEPENDENCE,,Relative Weights,"$10,751.37 ",IP,"10,751.37","10,751.37",,,,,,,,,,,,,
Molina Medicaid,DRG,7761,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$2,414.66 ",IP,"2,414.66","2,414.66",,,,,,,,,,,,,
Molina Medicaid,DRG,7762,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$2,653.48 ",IP,"2,653.48","2,653.48",,,,,,,,,,,,,
Molina Medicaid,DRG,7763,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$4,175.40 ",IP,"4,175.40","4,175.40",,,,,,,,,,,,,
Molina Medicaid,DRG,7764,OTHER DRUG ABUSE and DEPENDENCE,,Relative Weights,"$7,699.28 ",IP,"7,699.28","7,699.28",,,,,,,,,,,,,
Molina Medicaid,DRG,7921,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$7,773.51 ",IP,"7,773.51","7,773.51",,,,,,,,,,,,,
Molina Medicaid,DRG,7922,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$8,931.53 ",IP,"8,931.53","8,931.53",,,,,,,,,,,,,
Molina Medicaid,DRG,7923,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$13,005.21 ",IP,"13,005.21","13,005.21",,,,,,,,,,,,,
Molina Medicaid,DRG,7924,EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$27,591.45 ",IP,"27,591.45","27,591.45",,,,,,,,,,,,,
Molina Medicaid,DRG,7931,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$4,608.37 ",IP,"4,608.37","4,608.37",,,,,,,,,,,,,
Molina Medicaid,DRG,7932,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$6,350.90 ",IP,"6,350.90","6,350.90",,,,,,,,,,,,,
Molina Medicaid,DRG,7933,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$9,808.12 ",IP,"9,808.12","9,808.12",,,,,,,,,,,,,
Molina Medicaid,DRG,7934,MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$20,177.03 ",IP,"20,177.03","20,177.03",,,,,,,,,,,,,
Molina Medicaid,DRG,7941,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$3,990.87 ",IP,"3,990.87","3,990.87",,,,,,,,,,,,,
Molina Medicaid,DRG,7942,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$5,327.92 ",IP,"5,327.92","5,327.92",,,,,,,,,,,,,
Molina Medicaid,DRG,7943,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$7,911.30 ",IP,"7,911.30","7,911.30",,,,,,,,,,,,,
Molina Medicaid,DRG,7944,NONEXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$16,457.28 ",IP,"16,457.28","16,457.28",,,,,,,,,,,,,
Molina Medicaid,DRG,8101,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$2,594.03 ",IP,"2,594.03","2,594.03",,,,,,,,,,,,,
Molina Medicaid,DRG,8102,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$3,420.11 ",IP,"3,420.11","3,420.11",,,,,,,,,,,,,
Molina Medicaid,DRG,8103,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$5,351.98 ",IP,"5,351.98","5,351.98",,,,,,,,,,,,,
Molina Medicaid,DRG,8104,HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION,,Relative Weights,"$10,772.68 ",IP,"10,772.68","10,772.68",,,,,,,,,,,,,
Molina Medicaid,DRG,8111,ALLERGIC REACTIONS,,Relative Weights,"$1,582.40 ",IP,"1,582.40","1,582.40",,,,,,,,,,,,,
Molina Medicaid,DRG,8112,ALLERGIC REACTIONS,,Relative Weights,"$2,325.66 ",IP,"2,325.66","2,325.66",,,,,,,,,,,,,
Molina Medicaid,DRG,8113,ALLERGIC REACTIONS,,Relative Weights,"$4,003.24 ",IP,"4,003.24","4,003.24",,,,,,,,,,,,,
Molina Medicaid,DRG,8114,ALLERGIC REACTIONS,,Relative Weights,"$9,358.65 ",IP,"9,358.65","9,358.65",,,,,,,,,,,,,
Molina Medicaid,DRG,8121,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$1,778.95 ",IP,"1,778.95","1,778.95",,,,,,,,,,,,,
Molina Medicaid,DRG,8122,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$2,471.70 ",IP,"2,471.70","2,471.70",,,,,,,,,,,,,
Molina Medicaid,DRG,8123,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$3,713.91 ",IP,"3,713.91","3,713.91",,,,,,,,,,,,,
Molina Medicaid,DRG,8124,POISONING OF MEDICINAL AGENTS,,Relative Weights,"$7,487.95 ",IP,"7,487.95","7,487.95",,,,,,,,,,,,,
Molina Medicaid,DRG,8131,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$2,963.09 ",IP,"2,963.09","2,963.09",,,,,,,,,,,,,
Molina Medicaid,DRG,8132,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$3,546.91 ",IP,"3,546.91","3,546.91",,,,,,,,,,,,,
Molina Medicaid,DRG,8133,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$5,048.90 ",IP,"5,048.90","5,048.90",,,,,,,,,,,,,
Molina Medicaid,DRG,8134,OTHER COMPLICATIONS OF TREATMENT,,Relative Weights,"$10,108.45 ",IP,"10,108.45","10,108.45",,,,,,,,,,,,,
Molina Medicaid,DRG,8151,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$2,225.32 ",IP,"2,225.32","2,225.32",,,,,,,,,,,,,
Molina Medicaid,DRG,8152,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$3,062.74 ",IP,"3,062.74","3,062.74",,,,,,,,,,,,,
Molina Medicaid,DRG,8153,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$5,006.29 ",IP,"5,006.29","5,006.29",,,,,,,,,,,,,
Molina Medicaid,DRG,8154,OTHER INJURY POISONING and TOXIC EFFECT DIAGNOSES,,Relative Weights,"$14,243.99 ",IP,"14,243.99","14,243.99",,,,,,,,,,,,,
Molina Medicaid,DRG,8161,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$2,832.85 ",IP,"2,832.85","2,832.85",,,,,,,,,,,,,
Molina Medicaid,DRG,8162,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$3,147.27 ",IP,"3,147.27","3,147.27",,,,,,,,,,,,,
Molina Medicaid,DRG,8163,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$3,543.13 ",IP,"3,543.13","3,543.13",,,,,,,,,,,,,
Molina Medicaid,DRG,8164,TOXIC EFFECTS OF NONMEDICINAL SUBSTANCES,,Relative Weights,"$7,485.21 ",IP,"7,485.21","7,485.21",,,,,,,,,,,,,
Molina Medicaid,DRG,8171,OVERDOSE,,Relative Weights,"$1,970.70 ",IP,"1,970.70","1,970.70",,,,,,,,,,,,,
Molina Medicaid,DRG,8172,OVERDOSE,,Relative Weights,"$2,320.16 ",IP,"2,320.16","2,320.16",,,,,,,,,,,,,
Molina Medicaid,DRG,8173,OVERDOSE,,Relative Weights,"$3,714.94 ",IP,"3,714.94","3,714.94",,,,,,,,,,,,,
Molina Medicaid,DRG,8174,OVERDOSE,,Relative Weights,"$7,902.37 ",IP,"7,902.37","7,902.37",,,,,,,,,,,,,
Molina Medicaid,DRG,8411,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$22,662.13 ",IP,"22,662.13","22,662.13",,,,,,,,,,,,,
Molina Medicaid,DRG,8412,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$23,053.18 ",IP,"23,053.18","23,053.18",,,,,,,,,,,,,
Molina Medicaid,DRG,8413,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$35,475.26 ",IP,"35,475.26","35,475.26",,,,,,,,,,,,,
Molina Medicaid,DRG,8414,EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT,,Relative Weights,"$76,935.80 ",IP,"76,935.80","76,935.80",,,,,,,,,,,,,
Molina Medicaid,DRG,8421,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$7,378.34 ",IP,"7,378.34","7,378.34",,,,,,,,,,,,,
Molina Medicaid,DRG,8422,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$11,298.08 ",IP,"11,298.08","11,298.08",,,,,,,,,,,,,
Molina Medicaid,DRG,8423,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$20,251.94 ",IP,"20,251.94","20,251.94",,,,,,,,,,,,,
Molina Medicaid,DRG,8424,BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS,,Relative Weights,"$47,998.02 ",IP,"47,998.02","47,998.02",,,,,,,,,,,,,
Molina Medicaid,DRG,8431,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$3,499.14 ",IP,"3,499.14","3,499.14",,,,,,,,,,,,,
Molina Medicaid,DRG,8432,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$3,888.47 ",IP,"3,888.47","3,888.47",,,,,,,,,,,,,
Molina Medicaid,DRG,8433,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$4,320.07 ",IP,"4,320.07","4,320.07",,,,,,,,,,,,,
Molina Medicaid,DRG,8434,EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$12,575.34 ",IP,"12,575.34","12,575.34",,,,,,,,,,,,,
Molina Medicaid,DRG,8441,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$2,201.96 ",IP,"2,201.96","2,201.96",,,,,,,,,,,,,
Molina Medicaid,DRG,8442,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$3,652.06 ",IP,"3,652.06","3,652.06",,,,,,,,,,,,,
Molina Medicaid,DRG,8443,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$7,050.86 ",IP,"7,050.86","7,050.86",,,,,,,,,,,,,
Molina Medicaid,DRG,8444,PARTIAL THICKNESS BURNS WO SKIN GRAFT,,Relative Weights,"$19,183.95 ",IP,"19,183.95","19,183.95",,,,,,,,,,,,,
Molina Medicaid,DRG,8501,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$9,879.93 ",IP,"9,879.93","9,879.93",,,,,,,,,,,,,
Molina Medicaid,DRG,8502,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$12,498.36 ",IP,"12,498.36","12,498.36",,,,,,,,,,,,,
Molina Medicaid,DRG,8503,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$15,265.59 ",IP,"15,265.59","15,265.59",,,,,,,,,,,,,
Molina Medicaid,DRG,8504,PROCEDURE W DIAG OF REHAB AFTERCARE OR OTH CONTACT W HEALTH SERVICE,,Relative Weights,"$33,306.29 ",IP,"33,306.29","33,306.29",,,,,,,,,,,,,
Molina Medicaid,DRG,8601,REHABILITATION,REHABILITATION,Relative Weights,"$2,725.99 ",IP,"2,725.99","2,725.99",,,,,,,,,,,,,
Molina Medicaid,DRG,8602,REHABILITATION,REHABILITATION,Relative Weights,"$2,784.40 ",IP,"2,784.40","2,784.40",,,,,,,,,,,,,
Molina Medicaid,DRG,8603,REHABILITATION,REHABILITATION,Relative Weights,"$4,569.88 ",IP,"4,569.88","4,569.88",,,,,,,,,,,,,
Molina Medicaid,DRG,8604,REHABILITATION,REHABILITATION,Relative Weights,"$7,353.25 ",IP,"7,353.25","7,353.25",,,,,,,,,,,,,
Molina Medicaid,DRG,8611,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$2,528.74 ",IP,"2,528.74","2,528.74",,,,,,,,,,,,,
Molina Medicaid,DRG,8612,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$3,061.36 ",IP,"3,061.36","3,061.36",,,,,,,,,,,,,
Molina Medicaid,DRG,8613,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$4,043.10 ",IP,"4,043.10","4,043.10",,,,,,,,,,,,,
Molina Medicaid,DRG,8614,SIGNS SYMPTOMS and OTHER FACTORS INFLUENCING HEALTH STATUS,,Relative Weights,"$7,783.47 ",IP,"7,783.47","7,783.47",,,,,,,,,,,,,
Molina Medicaid,DRG,8621,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$2,738.70 ",IP,"2,738.70","2,738.70",,,,,,,,,,,,,
Molina Medicaid,DRG,8622,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$3,392.96 ",IP,"3,392.96","3,392.96",,,,,,,,,,,,,
Molina Medicaid,DRG,8623,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$4,971.92 ",IP,"4,971.92","4,971.92",,,,,,,,,,,,,
Molina Medicaid,DRG,8624,OTHER AFTERCARE and CONVALESCENCE,,Relative Weights,"$9,845.92 ",IP,"9,845.92","9,845.92",,,,,,,,,,,,,
Molina Medicaid,DRG,8631,NEONATAL AFTERCARE,,Relative Weights,"$4,260.96 ",IP,"4,260.96","4,260.96",,,,,,,,,,,,,
Molina Medicaid,DRG,8632,NEONATAL AFTERCARE,,Relative Weights,"$10,340.39 ",IP,"10,340.39","10,340.39",,,,,,,,,,,,,
Molina Medicaid,DRG,8633,NEONATAL AFTERCARE,,Relative Weights,"$23,505.05 ",IP,"23,505.05","23,505.05",,,,,,,,,,,,,
Molina Medicaid,DRG,8634,NEONATAL AFTERCARE,,Relative Weights,"$48,982.51 ",IP,"48,982.51","48,982.51",,,,,,,,,,,,,
Molina Medicaid,DRG,8901,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$3,464.78 ",IP,"3,464.78","3,464.78",,,,,,,,,,,,,
Molina Medicaid,DRG,8902,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$4,475.73 ",IP,"4,475.73","4,475.73",,,,,,,,,,,,,
Molina Medicaid,DRG,8903,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$6,306.22 ",IP,"6,306.22","6,306.22",,,,,,,,,,,,,
Molina Medicaid,DRG,8904,HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS,,Relative Weights,"$13,523.40 ",IP,"13,523.40","13,523.40",,,,,,,,,,,,,
Molina Medicaid,DRG,8921,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$3,450.69 ",IP,"3,450.69","3,450.69",,,,,,,,,,,,,
Molina Medicaid,DRG,8922,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$4,178.15 ",IP,"4,178.15","4,178.15",,,,,,,,,,,,,
Molina Medicaid,DRG,8923,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$4,816.26 ",IP,"4,816.26","4,816.26",,,,,,,,,,,,,
Molina Medicaid,DRG,8924,HIV W MAJOR HIV RELATED CONDITION,,Relative Weights,"$8,453.20 ",IP,"8,453.20","8,453.20",,,,,,,,,,,,,
Molina Medicaid,DRG,8931,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$2,817.73 ",IP,"2,817.73","2,817.73",,,,,,,,,,,,,
Molina Medicaid,DRG,8932,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$4,010.80 ",IP,"4,010.80","4,010.80",,,,,,,,,,,,,
Molina Medicaid,DRG,8933,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$5,201.12 ",IP,"5,201.12","5,201.12",,,,,,,,,,,,,
Molina Medicaid,DRG,8934,HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS,,Relative Weights,"$9,134.61 ",IP,"9,134.61","9,134.61",,,,,,,,,,,,,
Molina Medicaid,DRG,8941,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$2,969.96 ",IP,"2,969.96","2,969.96",,,,,,,,,,,,,
Molina Medicaid,DRG,8942,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$3,496.05 ",IP,"3,496.05","3,496.05",,,,,,,,,,,,,
Molina Medicaid,DRG,8943,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$4,518.34 ",IP,"4,518.34","4,518.34",,,,,,,,,,,,,
Molina Medicaid,DRG,8944,HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND,,Relative Weights,"$6,751.91 ",IP,"6,751.91","6,751.91",,,,,,,,,,,,,
Molina Medicaid,DRG,9101,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$13,920.63 ",IP,"13,920.63","13,920.63",,,,,,,,,,,,,
Molina Medicaid,DRG,9102,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$15,317.47 ",IP,"15,317.47","15,317.47",,,,,,,,,,,,,
Molina Medicaid,DRG,9103,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$18,619.37 ",IP,"18,619.37","18,619.37",,,,,,,,,,,,,
Molina Medicaid,DRG,9104,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$36,457.00 ",IP,"36,457.00","36,457.00",,,,,,,,,,,,,
Molina Medicaid,DRG,9111,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$7,838.80 ",IP,"7,838.80","7,838.80",,,,,,,,,,,,,
Molina Medicaid,DRG,9112,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$10,303.63 ",IP,"10,303.63","10,303.63",,,,,,,,,,,,,
Molina Medicaid,DRG,9113,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$13,414.47 ",IP,"13,414.47","13,414.47",,,,,,,,,,,,,
Molina Medicaid,DRG,9114,EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA,,Relative Weights,"$32,085.73 ",IP,"32,085.73","32,085.73",,,,,,,,,,,,,
Molina Medicaid,DRG,9121,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$8,688.93 ",IP,"8,688.93","8,688.93",,,,,,,,,,,,,
Molina Medicaid,DRG,9122,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$9,567.24 ",IP,"9,567.24","9,567.24",,,,,,,,,,,,,
Molina Medicaid,DRG,9123,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$14,948.76 ",IP,"14,948.76","14,948.76",,,,,,,,,,,,,
Molina Medicaid,DRG,9124,MUSCULOSKELETAL and OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,,Relative Weights,"$30,211.60 ",IP,"30,211.60","30,211.60",,,,,,,,,,,,,
Molina Medicaid,DRG,9301,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$3,875.76 ",IP,"3,875.76","3,875.76",,,,,,,,,,,,,
Molina Medicaid,DRG,9302,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$4,609.06 ",IP,"4,609.06","4,609.06",,,,,,,,,,,,,
Molina Medicaid,DRG,9303,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$7,139.17 ",IP,"7,139.17","7,139.17",,,,,,,,,,,,,
Molina Medicaid,DRG,9304,MULTIPLE SIGNIFICANT TRAUMA WO OR PROCEDURE,,Relative Weights,"$15,709.89 ",IP,"15,709.89","15,709.89",,,,,,,,,,,,,
Molina Medicaid,DRG,9501,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$7,265.63 ",IP,"7,265.63","7,265.63",,,,,,,,,,,,,
Molina Medicaid,DRG,9502,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$9,410.20 ",IP,"9,410.20","9,410.20",,,,,,,,,,,,,
Molina Medicaid,DRG,9503,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$12,679.80 ",IP,"12,679.80","12,679.80",,,,,,,,,,,,,
Molina Medicaid,DRG,9504,EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$27,388.02 ",IP,"27,388.02","27,388.02",,,,,,,,,,,,,
Molina Medicaid,DRG,9511,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$5,641.31 ",IP,"5,641.31","5,641.31",,,,,,,,,,,,,
Molina Medicaid,DRG,9512,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$7,394.49 ",IP,"7,394.49","7,394.49",,,,,,,,,,,,,
Molina Medicaid,DRG,9513,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$11,184.68 ",IP,"11,184.68","11,184.68",,,,,,,,,,,,,
Molina Medicaid,DRG,9514,MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$22,584.13 ",IP,"22,584.13","22,584.13",,,,,,,,,,,,,
Molina Medicaid,DRG,9521,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$4,663.69 ",IP,"4,663.69","4,663.69",,,,,,,,,,,,,
Molina Medicaid,DRG,9522,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$6,212.76 ",IP,"6,212.76","6,212.76",,,,,,,,,,,,,
Molina Medicaid,DRG,9523,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$9,852.10 ",IP,"9,852.10","9,852.10",,,,,,,,,,,,,
Molina Medicaid,DRG,9524,NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS,,Relative Weights,"$20,519.28 ",IP,"20,519.28","20,519.28",,,,,,,,,,,,,
Molina Medicaid,CPT,100,Anesth salivary gland,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,102,Anesth repair of cleft lip,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,103,Anesth blepharoplasty,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,104,Anesth electroshock,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,120,Anesth ear surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,124,Anesth ear exam,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,126,Anesth tympanotomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,140,Anesth procedures on eye,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,142,Anesth lens surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,144,Anesth corneal transplant,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,145,Anesth vitreoretinal surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,147,Anesth iridectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,148,Anesth eye exam,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,160,Anesth nose/sinus surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,162,Anesth nose/sinus surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,164,Anesth biopsy of nose,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,170,Anesth procedure on mouth,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,172,Anesth cleft palate repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,174,Anesth pharyngeal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,176,Anesth pharyngeal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,190,Anesth face/skull bone surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,192,Anesth facial bone surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,210,Anesth cranial surg nos,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,211,Anesth cran surg hemotoma,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,212,Anesth skull drainage,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,214,Anesth skull drainage,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,215,Anesth skull repair/fract,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,216,Anesth head vessel surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,218,Anesth special head surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,220,Anesth intrcrn nerve,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,222,Anesth head nerve surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,300,Anesth head/neck/ptrunk,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,320,Anesth neck organ 1yr/>,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,322,Anesth biopsy of thyroid,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,326,Anesth larynx/trach < 1 yr,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,350,Anesth neck vessel surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,352,Anesth neck vessel surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,400,Anesth skin ext/per/atrunk,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,402,Anesth surgery of breast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,404,Anesth surgery of breast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,406,Anesth surgery of breast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,410,Anesth correct heart rhythm,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,450,Anesth surgery of shoulder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,454,Anesth collar bone biopsy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,470,Anesth removal of rib,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,472,Anesth chest wall repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,474,Anesth surgery of rib,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,500,Anesth esophageal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,520,Anesth chest procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,522,Anesth chest lining biopsy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,524,Anesth chest drainage,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,528,Anes mediascpy & dx thorscpy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,529,Anes medscpy&thorscpy 1 lung,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,530,Anesth pacemaker insertion,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,532,Anesth vascular access,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,534,Anesth cardioverter/defib,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,537,Anesth cardiac electrophys,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,539,Anesth trach-bronch reconst,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,540,Anesth chest surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,541,Anesth one lung ventilation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,542,Anesthesia removal pleura,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,546,Anesth lung chest wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,548,Anesth trachea bronchi surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,550,Anesth sternal debridement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,560,Anesth heart surg w/o pump,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,561,Anesth heart surg <1 yr,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,562,Anesth hrt surg w/pmp age 1+,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,563,Anesth heart surg w/arrest,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,566,Anesth cabg w/o pump,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,567,Anesth cabg w/pump,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,580,Anesth heart/lung transplnt,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,600,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,604,Anesth sitting procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,620,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,625,Anes spine tranthor w/o vent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,626,Anes spine transthor w/vent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,630,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,632,Anesth removal of nerves,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,635,Anesth lumbar puncture,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,640,Anesth spine manipulation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,670,Anesth spine cord surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,700,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,702,Anesth for liver biopsy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,730,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,731,Anes upr gi ndsc px nos,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,732,Anes upr gi ndsc px ercp,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,740,Anesth upper gi visualize,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,750,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,752,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,754,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,756,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,770,Anesth blood vessel repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,790,Anesth surg upper abdomen,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,792,Anesth hemorr/excise liver,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,794,Anesth pancreas removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,796,Anesth for liver transplant,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,797,Anesth surgery for obesity,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,800,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,802,Anesth fat layer removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,810,Anesth low intestine scope,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,811,Anes lwr intst ndsc nos,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,812,Anes lwr intst scr colsc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,813,Anes upr lwr gi ndsc px,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,820,Anesth abdominal wall surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,830,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,832,Anesth repair of hernia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,834,Anesth hernia repair < 1 yr,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,836,Anesth hernia repair preemie,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,840,Anesth surg lower abdomen,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,842,Anesth amniocentesis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,844,Anesth pelvis surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,846,Anesth hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,848,Anesth pelvic organ surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,851,Anesth tubal ligation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,860,Anesth surgery of abdomen,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,862,Anesth kidney/ureter surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,864,Anesth removal of bladder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,865,Anesth removal of prostate,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,866,Anesth removal of adrenal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,868,Anesth kidney transplant,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,870,Anesth bladder stone surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,872,Anesth kidney stone destruct,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,873,Anesth kidney stone destruct,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,880,Anesth abdomen vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,882,Anesth major vein ligation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,902,Anesth anorectal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,904,Anesth perineal surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,906,Anesth removal of vulva,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,908,Anesth removal of prostate,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,910,Anesth bladder surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,912,Anesth bladder tumor surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,914,Anesth removal of prostate,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,916,Anesth bleeding control,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,918,Anesth stone removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,920,Anesth genitalia surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,921,Anesth vasectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,922,Anesth sperm duct surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,924,Anesth testis exploration,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,926,Anesth removal of testis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,928,Anesth removal of testis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,930,Anesth testis suspension,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,932,Anesth amputation of penis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,934,Anesth penis nodes removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,936,Anesth penis nodes removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,938,Anesth insert penis device,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,940,Anesth vaginal procedures,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,942,Anesth surg on vag/urethral,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,944,Anesth vaginal hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,948,Anesth repair of cervix,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,950,Anesth vaginal endoscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,952,Anesth hysteroscope/graph,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1112,Anesth bone aspirate/bx,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1120,Anesth pelvis surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1130,Anesth body cast procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1140,Anesth amputation at pelvis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1150,Anesth pelvic tumor surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1160,Anesth pelvis procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1170,Anesth pelvis surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1173,Anesth fx repair pelvis,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1180,Anesth pelvis nerve removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1190,Anesth pelvis nerve removal,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1200,Anesth hip joint procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1202,Anesth arthroscopy of hip,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1210,Anesth hip joint surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1212,Anesth hip disarticulation,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1214,Anesth hip arthroplasty,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1215,Anesth revise hip repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1220,Anesth procedure on femur,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1230,Anesth surgery of femur,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1232,Anesth amputation of femur,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1234,Anesth radical femur surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1250,Anesth upper leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1260,Anesth upper leg veins surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1270,Anesth thigh arteries surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1272,Anesth femoral artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1274,Anesth femoral embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1320,Anesth knee area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1340,Anesth knee area procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1360,Anesth knee area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1380,Anesth knee joint procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1382,Anesth dx knee arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1390,Anesth knee area procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1392,Anesth knee area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1400,Anesth knee joint surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1402,Anesth knee arthroplasty,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1404,Anesth amputation at knee,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1420,Anesth knee joint casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1430,Anesth knee veins surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1432,Anesth knee vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1440,Anesth knee arteries surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1442,Anesth knee artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1444,Anesth knee artery repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1462,Anesth lower leg procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1464,Anesth ankle/ft arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1470,Anesth lower leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1472,Anesth achilles tendon surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1474,Anesth lower leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1480,Anesth lower leg bone surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1482,Anesth radical leg surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1484,Anesth lower leg revision,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1486,Anesth ankle replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1490,Anesth lower leg casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1500,Anesth leg arteries surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1502,Anesth lwr leg embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1520,Anesth lower leg vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1522,Anesth lower leg vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1610,Anesth surgery of shoulder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1620,Anesth shoulder procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1622,Anes dx shoulder arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1630,Anesth surgery of shoulder,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1634,Anesth shoulder joint amput,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1636,Anesth forequarter amput,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1638,Anesth shoulder replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1650,Anesth shoulder artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1652,Anesth shoulder vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1654,Anesth shoulder vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1656,Anesth arm-leg vessel surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1670,Anesth shoulder vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1680,Anesth shoulder casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1682,Anesth airplane cast,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1710,Anesth elbow area surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1712,Anesth uppr arm tendon surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1714,Anesth uppr arm tendon surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1716,Anesth biceps tendon repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1730,Anesth uppr arm procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1732,Anesth dx elbow arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1740,Anesth upper arm surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1742,Anesth humerus surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1744,Anesth humerus repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1756,Anesth radical humerus surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1758,Anesth humeral lesion surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1760,Anesth elbow replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1770,Anesth uppr arm artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1772,Anesth uppr arm embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1780,Anesth upper arm vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1782,Anesth uppr arm vein repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1810,Anesth lower arm surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1820,Anesth lower arm procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1829,Anesth dx wrist arthroscopy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1830,Anesth lower arm surgery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1832,Anesth wrist replacement,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1840,Anesth lwr arm artery surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1842,Anesth lwr arm embolectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1844,Anesth vascular shunt surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1850,Anesth lower arm vein surg,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1852,Anesth lwr arm vein repair,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1860,Anesth lower arm casting,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1916,Anesth dx arteriography,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1920,Anesth catheterize heart,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1922,Anesth cat or mri scan,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1924,Anes ther interven rad artrl,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1925,Anes ther interven rad card,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1926,Anes tx interv rad hrt/cran,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1930,Anes ther interven rad vein,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1931,Anes ther interven rad tips,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1932,Anes tx interv rad th vein,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1933,Anes tx interv rad cran vein,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1935,Anesth perc img dx sp proc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1936,Anesth perc img tx sp proc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1951,Anesth burn less 4 percent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1952,Anesth burn 4-9 percent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1953,Anesth burn each 9 percent,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1958,Anesth antepartum manipul,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1960,Anesth vaginal delivery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1961,Anesth cs delivery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1962,Anesth emer hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1963,Anesth cs hysterectomy,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1965,Anesth inc/missed ab proc,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1966,Anesth induced ab procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1967,Anesth/analg vag delivery,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1968,Anes/analg cs deliver add-on,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1969,Anesth/analg cs hyst add-on,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1991,Anesth nerve block/inj,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1992,Anesth n block/inj prone,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1996,Hosp manage cont drug admin,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,1999,Unlisted anesth procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10004,Fna bx w/o img gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10005,Fna bx w/us gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10006,Fna bx w/us gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10007,Fna bx w/fluor gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10008,Fna bx w/fluor gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10009,Fna bx w/ct gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10010,Fna bx w/ct gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10011,Fna bx w/mr gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10012,Fna bx w/mr gdn ea addl,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10021,Fna bx w/o img gdn 1st les,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10022,Fna w/image,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10030,Guide cathet fluid drainage,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10040,Acne surgery,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10060,Drainage of skin abscess,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10061,Drainage of skin abscess,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10080,Drainage of pilonidal cyst,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10081,Drainage of pilonidal cyst,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10120,Remove foreign body,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10121,Remove foreign body,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10140,Drainage of hematoma/fluid,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,10160,Puncture drainage of lesion,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11055,Trim skin lesion,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11056,Trim skin lesions 2 to 4,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11057,Trim skin lesions over 4,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11100,Biopsy skin lesion,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11101,Biopsy skin add-on,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11102,Tangntl bx skin single les,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11103,Tangntl bx skin ea sep/addl,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11104,Punch bx skin single lesion,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11105,Punch bx skin ea sep/addl,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11106,Incal bx skn single les,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11107,Incal bx skn ea sep/addl,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11200,Removal of skin tags 2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11305,Shave skin lesion 0.5 cm/<,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11306,Shave skin lesion 0.6-1.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11307,Shave skin lesion 1.1-2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11308,Shave skin lesion >2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11310,Shave skin lesion 0.5 cm/<,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11311,Shave skin lesion 0.6-1.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11312,Shave skin lesion 1.1-2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11313,Shave skin lesion >2.0 cm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11400,Exc tr-ext b9+marg 0.5 cm<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11401,Exc tr-ext b9+marg 0.6-1 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11402,Exc tr-ext b9+marg 1.1-2 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11403,Exc tr-ext b9+marg 2.1-3cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11404,Exc tr-ext b9+marg 3.1-4 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11406,Exc tr-ext b9+marg >4.0 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11420,Exc h-f-nk-sp b9+marg 0.5/<,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11421,Exc h-f-nk-sp b9+marg 0.6-1,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11422,Exc h-f-nk-sp b9+marg 1.1-2,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11423,Exc h-f-nk-sp b9+marg 2.1-3,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11424,Exc h-f-nk-sp b9+marg 3.1-4,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11426,Exc h-f-nk-sp b9+marg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11440,Exc face-mm b9+marg 0.5 cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11441,Exc face-mm b9+marg 0.6-1 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11442,Exc face-mm b9+marg 1.1-2 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11443,Exc face-mm b9+marg 2.1-3 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11444,Exc face-mm b9+marg 3.1-4 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11446,Exc face-mm b9+marg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11450,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11451,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11462,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11463,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11470,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11471,Removal sweat gland lesion,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11600,Exc tr-ext mal+marg 0.5 cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11601,Exc tr-ext mal+marg 0.6-1 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11602,Exc tr-ext mal+marg 1.1-2 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11603,Exc tr-ext mal+marg 2.1-3 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11604,Exc tr-ext mal+marg 3.1-4 cm,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11606,Exc tr-ext mal+marg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11620,Exc h-f-nk-sp mal+marg 0.5/<,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11621,Exc s/n/h/f/g mal+mrg 0.6-1,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11622,Exc s/n/h/f/g mal+mrg 1.1-2,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11623,Exc s/n/h/f/g mal+mrg 2.1-3,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11624,Exc s/n/h/f/g mal+mrg 3.1-4,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11626,Exc s/n/h/f/g mal+mrg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11640,Exc f/e/e/n/l mal+mrg 0.5cm<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11641,Exc f/e/e/n/l mal+mrg 0.6-1,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11642,Exc f/e/e/n/l mal+mrg 1.1-2,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11643,Exc f/e/e/n/l mal+mrg 2.1-3,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11644,Exc f/e/e/n/l mal+mrg 3.1-4,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11646,Exc f/e/e/n/l mal+mrg >4 cm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11719,Trim nail(s) any number,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11720,Debride nail 1-5,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11721,Debride nail 6 or more,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11730,Removal of nail plate,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11732,Remove nail plate add-on,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11740,Drain blood from under nail,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11750,Removal of nail bed,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11752,Remove nail bed/tip,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11755,Biopsy nail unit,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11760,Repair of nail bed,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11762,Reconstruction of nail bed,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11765,Excision of nail fold toe,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11770,Remove pilonidal cyst simple,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11771,Remove pilonidal cyst exten,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11772,Remove pilonidal cyst compl,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11900,Inject skin lesions 7,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11920,Correct skin color 6.0 cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11921,Correct skn color 6.1-20.0cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11922,Correct skin color ea 20.0cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11950,Tx contour defects 1 cc/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11951,Tx contour defects 1.1-5.0cc,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11952,Tx contour defects 5.1-10cc,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11954,Tx contour defects >10.0 cc,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11960,Insert tissue expander(s),General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,11971,Rmvl tis xpndr wo insj implt,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11976,Remove contraceptive capsule,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11980,Implant hormone pellet(s),General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11981,Insert drug implant device,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11982,Remove drug implant device,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,11983,Remove/insert drug implant,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13100,Cmplx rpr trunk 1.1-2.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13101,Cmplx rpr trunk 2.6-7.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13102,Cmplx rpr trunk addl 5cm/<,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13120,Cmplx rpr s/a/l 1.1-2.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13121,Cmplx rpr s/a/l 2.6-7.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13122,Cmplx rpr s/a/l addl 5 cm/>,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13131,Cmplx rpr f/c/c/m/n/ax/g/h/f,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13132,Cmplx rpr f/c/c/m/n/ax/g/h/f,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13133,Cmplx rpr f/c/c/m/n/ax/g/h/f,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13151,Cmplx rpr e/n/e/l 1.1-2.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13152,Cmplx rpr e/n/e/l 2.6-7.5 cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,13153,Cmplx rpr e/n/e/l addl 5cm/<,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15050,Skin pinch graft,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15775,Hair trnspl 1-15 punch grfts,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15776,Hair trnspl >15 punch grafts,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15780,Dermabrasion total face,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15781,Dermabrasion segmental face,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15782,Dermabrasion other than face,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15783,Dermabrasion suprfl any site,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15786,Abrasion lesion single,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15787,Abrasion lesions add-on,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15788,Chemical peel face epiderm,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15789,Chemical peel face dermal,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15792,Chemical peel nonfacial,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15793,Chemical peel nonfacial,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15819,Plastic surgery neck,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15820,Revision of lower eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15821,Revision of lower eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15822,Revision of upper eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15823,Revision of upper eyelid,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15824,Removal of forehead wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15825,Removal of neck wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15826,Removal of brow wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15828,Removal of face wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15829,Removal of skin wrinkles,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15830,Exc skin abd,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15832,Excise excessive skin thigh,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15833,Excise excessive skin leg,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15834,Excise excessive skin hip,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15835,Excise excessive skin buttck,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15836,Excise excessive skin arm,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15837,Excise excess skin arm/hand,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15838,Excise excess skin fat pad,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15839,Excise excess skin & tissue,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15847,Exc skin abd add-on,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15850,Remove sutures same surgeon,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15851,Remove sutures diff surgeon,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,15876,Suction lipectomy head&neck,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15877,Suction lipectomy trunk,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15878,Suction lipectomy upr extrem,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,15879,Suction lipectomy lwr extrem,General Surgery,Per Unit,"$1,792.83 ",OP,"$1,792.83 ","$1,792.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,17000,Destruct premalg lesion,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17003,Destruct premalg les 2-14,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17004,Destroy premal lesions 15/>,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17106,Destruction of skin lesions,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17107,Destruction of skin lesions,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17108,Destruction of skin lesions,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17110,Destruct b9 lesion 1-14,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17111,Destruct lesion 15 or more,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17250,Chem caut of granltj tissue,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17260,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17261,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17262,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17263,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17264,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17266,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17270,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17271,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17272,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17273,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17274,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17276,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17280,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17281,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17282,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17283,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17284,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17286,Destruction of skin lesions,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17340,Cryotherapy of skin,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17360,Skin peel therapy,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17380,Hair removal by electrolysis,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,17999,Skin tissue procedure,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19000,Drainage of breast lesion,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19001,Drain breast lesion add-on,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19020,Incision of breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19081,Bx breast 1st lesion strtctc,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19082,Bx breast add lesion strtctc,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19083,Bx breast 1st lesion us imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19084,Bx breast add lesion us imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19085,Bx breast 1st lesion mr imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19086,Bx breast add lesion mr imag,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19100,Bx breast percut w/o image,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19101,Biopsy of breast open,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19105,Cryosurg ablate fa each,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19110,Nipple exploration,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19112,Excise breast duct fistula,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19120,Removal of breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19125,Excision breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19126,Excision addl breast lesion,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19294,Prep tum cav iort prtl mast,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19297,Place breast cath for rad,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19298,Place breast rad tube/caths,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19300,Removal of breast tissue,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19301,Partial mastectomy,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19302,P-mastectomy w/ln removal,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19303,Mast simple complete,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19304,Mast subq,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19305,Mast radical,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19306,Mast rad urban type,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19307,Mast mod rad,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19316,Suspension of breast,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19318,Breast reduction,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19324,Enlarge breast,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19325,Breast augmentation w/implt,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19328,Rmvl intact breast implant,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19330,Rmvl ruptured breast implant,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19340,Insj breast implt sm d mast,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19342,Insj/rplcmt brst implt sep d,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19350,Breast reconstruction,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19355,Correct inverted nipple(s),General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19357,Tiss xpndr plmt brst rcnstj,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19361,Brst rcnstj latsms drsi flap,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19364,Brst rcnstj free flap,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19366,Breast reconstruction,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19367,Brst rcnstj 1 pdcl tram flap,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19368,Brst rcnstj 1pdcl tram anast,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19369,Brst rcnstj 2 pdcl tram flap,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19370,Revj peri-implt capsule brst,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19371,Peri-implt capslc brst compl,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19380,Revj reconstructed breast,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,19396,Design custom breast implant,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,19499,Breast surgery procedure,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20206,Needle biopsy muscle,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20220,Bone biopsy trocar/needle,General Surgery,Per Unit,$346.87 ,OP,$346.87 ,$346.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20500,Injection of sinus tract,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20526,Ther injection carp tunnel,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20527,Inj dupuytren cord w/enzyme,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20550,Inj tendon sheath/ligament,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20551,Inj tendon origin/insertion,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20552,Inj trigger point 1/2 muscl,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20553,Inject trigger points 3/>,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20560,Ndl insj w/o njx 1 or 2 musc,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20561,Ndl insj w/o njx 3+ musc,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20600,Drain/inj joint/bursa w/o us,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20605,Drain/inj joint/bursa w/o us,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20610,Drain/inj joint/bursa w/o us,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20612,Aspirate/inj ganglion cyst,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,20822,Replantation digit complete,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,20824,Replantation thumb complete,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,20827,Replantation thumb complete,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,20957,Mt bone graft microvasc,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,20972,Bone/skin graft metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,20973,Bone/skin graft great toe,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,20999,Musculoskeletal surgery,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21010,Incision of jaw joint,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21025,Excision of bone lower jaw,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21030,Excise max/zygoma b9 tumor,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21031,Remove exostosis mandible,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21032,Remove exostosis maxilla,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21034,Excise max/zygoma mal tumor,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21040,Excise mandible lesion,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21044,Removal of jaw bone lesion,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21045,Extensive jaw surgery,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21046,Remove mandible cyst complex,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21047,Excise lwr jaw cyst w/repair,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21048,Remove maxilla cyst complex,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21049,Excis uppr jaw cyst w/repair,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21050,Removal of jaw joint,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21060,Remove jaw joint cartilage,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21070,Remove coronoid process,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21073,Mnpj of tmj w/anesth,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21076,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21077,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21079,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21080,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21081,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21082,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21083,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21084,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21085,Prepare face/oral prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21086,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21087,Prepare face/oral prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21088,Prepare face/oral prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21089,Prepare face/oral prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21100,Maxillofacial fixation,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21110,Interdental fixation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21120,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21121,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21122,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21123,Reconstruction of chin,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21125,Augmentation lower jaw bone,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21127,Augmentation lower jaw bone,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21138,Reduction of forehead,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21172,Reconstruct orbit/forehead,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21175,Reconstruct orbit/forehead,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21193,Reconst lwr jaw w/o graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21195,Reconst lwr jaw w/o fixation,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21196,Reconst lwr jaw w/fixation,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21198,Reconstr lwr jaw segment,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21199,Reconstr lwr jaw w/advance,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21206,Reconstruct upper jaw bone,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21215,Lower jaw bone graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21235,Ear cartilage graft,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21240,Reconstruction of jaw joint,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21242,Reconstruction of jaw joint,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21243,Reconstruction of jaw joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21244,Reconstruction of lower jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21245,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21246,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21248,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21249,Reconstruction of jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21270,Augmentation cheek bone,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21280,Revision of eyelid,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21282,Revision of eyelid,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21295,Revision of jaw muscle/bone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21296,Revision of jaw muscle/bone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21315,Closed tx nose fx w/o stablj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21320,Closed tx nose fx w/ stablj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21336,Open tx septal fx w/wo stabj,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21337,Closed tx septal&nose fx,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21345,Closed tx nose/jaw fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21346,Opn tx nasomax fx w/fixj,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21400,Closed tx orbit w/o manipulj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21401,Closed tx orbit w/manipulj,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21421,Treat mouth roof fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21422,Treat mouth roof fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21440,Treat dental ridge fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21445,Treat dental ridge fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21450,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21451,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21452,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21453,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21454,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21461,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21462,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21465,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21470,Treat lower jaw fracture,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21485,Reset dislocated jaw,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21490,Repair dislocated jaw,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21495,Treat hyoid bone fracture,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21497,Interdental wiring,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21685,Hyoid myotomy & suspension,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21805,Treatment of rib fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21811,Optx of rib fx w/fixj scope,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21812,Treatment of rib fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21813,Treatment of rib fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,21820,Treat sternum fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,21825,Treat sternum fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,22305,Closed tx spine process fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,22310,Closed tx vert fx w/o manj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,22315,Closed tx vert fx w/manj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,22505,Manipulation of spine,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,22515,Perq vertebral augmentation,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,22999,Abdomen surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23470,Reconstruct shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23472,Reconstruct shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23473,Revis reconst shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23474,Revis reconst shoulder joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23500,Treat clavicle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23505,Treat clavicle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23515,Treat clavicle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23520,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23525,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23530,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23532,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23540,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23545,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23550,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23552,Treat clavicle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23570,Treat shoulder blade fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23575,Treat shoulder blade fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23585,Treat scapula fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23600,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23605,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23615,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23616,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23620,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23625,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23630,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23650,Treat shoulder dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23655,Treat shoulder dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23660,Treat shoulder dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23665,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23670,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23675,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23680,Treat dislocation/fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,23700,Fixation of shoulder,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,23929,Shoulder surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24300,Manipulate elbow w/anesth,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24360,Reconstruct elbow joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24361,Reconstruct elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24362,Reconstruct elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24363,Replace elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24365,Reconstruct head of radius,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24366,Reconstruct head of radius,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24370,Revise reconst elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24371,Revise reconst elbow joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24500,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24505,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24515,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24516,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24530,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24535,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24538,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24545,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24546,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24560,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24565,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24566,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24575,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24576,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24577,Treat humerus fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24579,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24582,Treat humerus fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24586,Treat elbow fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24587,Treat elbow fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24600,Treat elbow dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24605,Treat elbow dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24615,Treat elbow dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24620,Treat elbow fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24635,Treat elbow fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24640,Treat elbow dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24650,Treat radius fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24655,Treat radius fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24665,Treat radius fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24666,Treat radius fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24670,Treat ulnar fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24675,Treat ulnar fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,24685,Treat ulnar fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,24999,Upper arm/elbow surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25001,Incise flexor carpi radialis,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25111,Remove wrist tendon lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25112,Reremove wrist tendon lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25136,Remove & graft wrist lesion,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25210,Removal of wrist bone,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25215,Removal of wrist bones,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25259,Manipulate wrist w/anesthes,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25315,Revise palsy hand tendon(s),Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25316,Revise palsy hand tendon(s),Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25332,Revise wrist joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25394,Repair carpal bone shorten,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25430,Vasc graft into carpal bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25431,Repair nonunion carpal bone,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25441,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25442,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25443,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25444,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25445,Reconstruct wrist joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25446,Wrist replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25447,Repair wrist joints,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25449,Remove wrist joint implant,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25500,Treat fracture of radius,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25505,Treat fracture of radius,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25515,Treat fracture of radius,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25520,Treat fracture of radius,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25525,Treat fracture of radius,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25526,Treat fracture of radius,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25530,Treat fracture of ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25535,Treat fracture of ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25545,Treat fracture of ulna,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25560,Treat fracture radius & ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25565,Treat fracture radius & ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25574,Treat fracture radius & ulna,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25575,Treat fracture radius/ulna,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25600,Treat fracture radius/ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25605,Treat fracture radius/ulna,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25606,Treat fx distal radial,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25607,Treat fx rad extra-articul,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25608,Treat fx rad intra-articul,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25609,Treat fx radial 3+ frag,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25622,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25624,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25628,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25630,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25635,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25645,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25650,Treat wrist bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25651,Pin ulnar styloid fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25652,Treat fracture ulnar styloid,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25660,Treat wrist dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25670,Treat wrist dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25671,Pin radioulnar dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25675,Treat wrist dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25676,Treat wrist dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25680,Treat wrist fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25685,Treat wrist fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25690,Treat wrist dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25695,Treat wrist dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25820,Fusion of hand bones,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25825,Fuse hand bones with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,25929,Amputation follow-up surgery,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,25999,Forearm or wrist surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26010,Drainage of finger abscess,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26011,Drainage of finger abscess,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26020,Drain hand tendon sheath,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26025,Drainage of palm bursa,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26030,Drainage of palm bursas,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26034,Treat hand bone lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26035,Decompress fingers/hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26037,Decompress fingers/hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26040,Release palm contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26045,Release palm contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26055,Incise finger tendon sheath,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26060,Incision of finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26070,Explore/treat hand joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26075,Explore/treat finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26080,Explore/treat finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26100,Biopsy hand joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26105,Biopsy finger joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26110,Biopsy finger joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26111,Exc hand les sc 1.5 cm/>,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26113,Exc hand tum deep 1.5 cm/>,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26115,Exc hand les sc < 1.5 cm,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26116,Exc hand tum deep < 1.5 cm,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26117,Rad resect hand tumor < 3 cm,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26118,Rad resect hand tumor 3 cm/>,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26121,Release palm contracture,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26123,Release palm contracture,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26125,Release palm contracture,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26130,Remove wrist joint lining,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26135,Revise finger joint each,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26140,Revise finger joint each,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26145,Tendon excision palm/finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26160,Remove tendon sheath lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26170,Removal of palm tendon each,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26180,Removal of finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26185,Remove finger bone,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26200,Remove hand bone lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26205,Remove/graft bone lesion,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26210,Removal of finger lesion,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26215,Remove/graft finger lesion,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26230,Partial removal of hand bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26235,Partial removal finger bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26236,Partial removal finger bone,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26250,Extensive hand surgery,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26260,Resect prox finger tumor,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26262,Resect distal finger tumor,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26320,Removal of implant from hand,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26340,Manipulate finger w/anesth,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26341,Manipulat palm cord post inj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26350,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26352,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26356,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26357,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26358,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26370,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26372,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26373,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26390,Revise hand/finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26392,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26410,Repair hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26412,Repair/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26415,Excision hand/finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26416,Graft hand or finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26418,Repair finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26420,Repair/graft finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26426,Repair finger/hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26428,Repair/graft finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26432,Repair finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26433,Repair finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26434,Repair/graft finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26437,Realignment of tendons,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26440,Release palm/finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26442,Release palm & finger tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26445,Release hand/finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26449,Release forearm/hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26450,Incision of palm tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26455,Incision of finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26460,Incise hand/finger tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26471,Fusion of finger tendons,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26474,Fusion of finger tendons,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26476,Tendon lengthening,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26477,Tendon shortening,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26478,Lengthening of hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26479,Shortening of hand tendon,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26480,Transplant hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26483,Transplant/graft hand tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26485,Transplant palm tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26489,Transplant/graft palm tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26490,Revise thumb tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26492,Tendon transfer with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26494,Hand tendon/muscle transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26496,Revise thumb tendon,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26497,Finger tendon transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26498,Finger tendon transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26499,Revision of finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26500,Hand tendon reconstruction,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26502,Hand tendon reconstruction,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26508,Release thumb contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26510,Thumb tendon transfer,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26516,Fusion of knuckle joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26517,Fusion of knuckle joints,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26518,Fusion of knuckle joints,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26520,Release knuckle contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26525,Release finger contracture,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26530,Revise knuckle joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26531,Revise knuckle with implant,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26535,Revise finger joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26536,Revise/implant finger joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26540,Repair hand joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26541,Repair hand joint with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26542,Repair hand joint with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26545,Reconstruct finger joint,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26546,Repair nonunion hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26548,Reconstruct finger joint,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26550,Construct thumb replacement,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26555,Positional change of finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26560,Repair of web finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26561,Repair of web finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26562,Repair of web finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26565,Correct metacarpal flaw,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26567,Correct finger deformity,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26568,Lengthen metacarpal/finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26580,Repair hand deformity,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26587,Reconstruct extra finger,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26590,Repair finger deformity,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26591,Repair muscles of hand,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26593,Release muscles of hand,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26596,Excision constricting tissue,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26600,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26605,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26607,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26608,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26615,Treat metacarpal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26641,Treat thumb dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26645,Treat thumb fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26650,Treat thumb fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26665,Treat thumb fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26670,Treat hand dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26675,Treat hand dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26676,Pin hand dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26685,Treat hand dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26686,Treat hand dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26700,Treat knuckle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26705,Treat knuckle dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26706,Pin knuckle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26715,Treat knuckle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26720,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26725,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26727,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26735,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26740,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26742,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26746,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26750,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26755,Treat finger fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26756,Pin finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26765,Treat finger fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26770,Treat finger dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26775,Treat finger dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26776,Pin finger dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26785,Treat finger dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26820,Thumb fusion with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26841,Fusion of thumb,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26842,Thumb fusion with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26843,Fusion of hand joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26844,Fusion/graft of hand joint,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26850,Fusion of knuckle,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26852,Fusion of knuckle with graft,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26860,Fusion of finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26861,Fusion of finger jnt add-on,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26862,Fusion/graft of finger joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26863,Fuse/graft added joint,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26910,Amputate metacarpal bone,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26951,Amputation of finger/thumb,Orthopedic Surgery,Per Unit,$661.08 ,OP,$661.08 ,$661.08 ,,,,,,,,,,,,,
Molina Medicaid,CPT,26952,Amputation of finger/thumb,Orthopedic Surgery,Per Unit,"$1,085.51 ",OP,"$1,085.51 ","$1,085.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,26989,Hand/finger surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27125,Partial hip replacement,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27130,Total hip arthroplasty,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27132,Total hip arthroplasty,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27134,Revise hip joint replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27137,Revise hip joint replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27138,Revise hip joint replacement,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27175,Treat slipped epiphysis,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27178,Treat slipped epiphysis,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27181,Treat slipped epiphysis,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27193,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27194,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27197,Clsd tx pelvic ring fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27198,Clsd tx pelvic ring fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27200,Treat tail bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27202,Treat tail bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27215,Treat pelvic fracture(s),Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27216,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27217,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27218,Treat pelvic ring fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27220,Treat hip socket fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27222,Treat hip socket fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27226,Treat hip wall fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27227,Treat hip fracture(s),Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27230,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27232,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27235,Treat thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27236,Treat thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27238,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27240,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27246,Treat thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27248,Treat thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27250,Treat hip dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27252,Treat hip dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27253,Treat hip dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27256,Treat hip dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27257,Treat hip dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27265,Treat hip dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27266,Treat hip dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27267,Cltx thigh fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27268,Cltx thigh fx w/mnpj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27269,Optx thigh fx,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27275,Manipulation of hip joint,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27299,Pelvis/hip joint surgery,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27412,Autochondrocyte implant knee,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27415,Osteochondral knee allograft,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27437,Revise kneecap,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27438,Revise kneecap with implant,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27440,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27441,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27442,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27443,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27445,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27446,Revision of knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27447,Total knee arthroplasty,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27486,Revise/replace knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27487,Revise/replace knee joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27500,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27501,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27502,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27503,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27507,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27508,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27509,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27510,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27511,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27513,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27514,Treatment of thigh fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27516,Treat thigh fx growth plate,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27517,Treat thigh fx growth plate,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27520,Treat kneecap fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27524,Treat kneecap fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27530,Treat knee fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27532,Treat knee fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27535,Treat knee fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27536,Treat knee fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27538,Treat knee fracture(s),Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27540,Treat knee fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27550,Treat knee dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27552,Treat knee dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27560,Treat kneecap dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27562,Treat kneecap dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27566,Treat kneecap dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27570,Fixation of knee joint,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27599,Leg surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27605,Incision of achilles tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27700,Revision of ankle joint,Orthopedic Surgery,Per Unit,"$1,410.56 ",OP,"$1,410.56 ","$1,410.56 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27702,Reconstruct ankle joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27703,Reconstruction ankle joint,Orthopedic Surgery,Per Unit,"$4,978.29 ",OP,"$4,978.29 ","$4,978.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27720,Repair of tibia,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27722,Repair/graft of tibia,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27724,Repair/graft of tibia,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27726,Repair fibula nonunion,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27750,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27752,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27756,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27758,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27759,Treatment of tibia fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27760,Cltx medial ankle fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27762,Cltx med ankle fx w/mnpj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27766,Optx medial ankle fx,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27767,Cltx post ankle fx,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27768,Cltx post ankle fx w/mnpj,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27769,Optx post ankle fx,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27780,Treatment of fibula fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27781,Treatment of fibula fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27784,Treatment of fibula fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27786,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27788,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27792,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27808,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27810,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27814,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27816,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27818,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27822,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27823,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27824,Treat lower leg fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27825,Treat lower leg fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27826,Treat lower leg fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27827,Treat lower leg fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27828,Treat lower leg fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27829,Treat lower leg joint,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27830,Treat lower leg dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27831,Treat lower leg dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27832,Treat lower leg dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27840,Treat ankle dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27842,Treat ankle dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27846,Treat ankle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27848,Treat ankle dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,27860,Fixation of ankle joint,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,27899,Leg/ankle surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28001,Drainage of bursa of foot,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28002,Treatment of foot infection,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28005,Treat foot bone lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28008,Incision of foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28010,Incision of toe tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28011,Incision of toe tendons,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28020,Exploration of foot joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28022,Exploration of foot joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28024,Exploration of toe joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28039,Exc foot/toe tum sc 1.5 cm/>,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28041,Exc foot/toe tum dep 1.5cm/>,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28045,Exc foot/toe tum deep <1.5cm,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28046,Resect foot/toe tumor < 3 cm,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28047,Resect foot/toe tumor 3 cm/>,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28050,Biopsy of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28052,Biopsy of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28054,Biopsy of toe joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28055,Neurectomy foot,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28060,Partial removal foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28062,Removal of foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28070,Removal of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28072,Removal of foot joint lining,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28080,Removal of foot lesion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28086,Excise foot tendon sheath,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28088,Excise foot tendon sheath,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28090,Removal of foot lesion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28092,Removal of toe lesions,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28100,Removal of ankle/heel lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28102,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28103,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28104,Removal of foot lesion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28106,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28107,Remove/graft foot lesion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28108,Removal of toe lesions,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28110,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28111,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28112,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28113,Part removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28114,Removal of metatarsal heads,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28116,Revision of foot,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28118,Removal of heel bone,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28119,Removal of heel spur,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28120,Part removal of ankle/heel,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28122,Partial removal of foot bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28124,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28126,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28130,Removal of ankle bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28140,Removal of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28150,Removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28153,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28160,Partial removal of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28171,Resect tarsal tumor,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28173,Resect metatarsal tumor,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28175,Resect phalanx of toe tumor,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28190,Removal of foot foreign body,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28193,Removal of foot foreign body,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28200,Repair of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28202,Repair/graft of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28208,Repair of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28210,Repair/graft of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28220,Release of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28222,Release of foot tendons,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28225,Release of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28226,Release of foot tendons,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28230,Incision of foot tendon(s),Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28232,Incision of toe tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28234,Incision of foot tendon,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28238,Revision of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28240,Release of big toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28250,Revision of foot fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28260,Release of midfoot joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28261,Revision of foot tendon,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28262,Revision of foot and ankle,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28264,Release of midfoot joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28270,Release of foot contracture,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28272,Release of toe joint each,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28280,Fusion of toes,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28285,Repair of hammertoe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28286,Repair of hammertoe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28288,Partial removal of foot bone,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28289,Corrj halux rigdus w/o implt,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28290,Correction of bunion,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28291,Corrj halux rigdus w/implt,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28292,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28293,Correction of bunion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28294,Correction of bunion,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28295,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28296,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28297,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28298,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28299,Correction hallux valgus,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28300,Incision of heel bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28302,Incision of ankle bone,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28304,Incision of midfoot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28305,Incise/graft midfoot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28306,Incision of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28307,Incision of metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28308,Incision of metatarsal,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28309,Incision of metatarsals,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28310,Revision of big toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28312,Revision of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28313,Repair deformity of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28315,Removal of sesamoid bone,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28320,Repair of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28322,Repair of metatarsals,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28340,Resect enlarged toe tissue,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28341,Resect enlarged toe,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28344,Repair extra toe(s),Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28345,Repair webbed toe(s),Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28360,Reconstruct cleft foot,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28400,Treatment of heel fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28405,Treatment of heel fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28406,Treatment of heel fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28415,Treat heel fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28420,Treat/graft heel fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28430,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28435,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28436,Treatment of ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28445,Treat ankle fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28446,Osteochondral talus autogrft,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28450,Treat midfoot fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28455,Treat midfoot fracture each,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28456,Treat midfoot fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28465,Treat midfoot fracture each,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28470,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28475,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28476,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28485,Treat metatarsal fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28490,Treat big toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28495,Treat big toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28496,Treat big toe fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28505,Treat big toe fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28510,Treatment of toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28515,Treatment of toe fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28525,Treat toe fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28530,Treat sesamoid bone fracture,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28531,Treat sesamoid bone fracture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28540,Treat foot dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28545,Treat foot dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28546,Treat foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28555,Repair foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28570,Treat foot dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28575,Treat foot dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28576,Treat foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28585,Repair foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28600,Treat foot dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28605,Treat foot dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28606,Treat foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28615,Repair foot dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28630,Treat toe dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28635,Treat toe dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28636,Treat toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28645,Repair toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28660,Treat toe dislocation,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28665,Treat toe dislocation,Orthopedic Surgery,Per Unit,$578.65 ,OP,$578.65 ,$578.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,28666,Treat toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28675,Repair of toe dislocation,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28705,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28715,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28725,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28730,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28735,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28737,Revision of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28740,Fusion of foot bones,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28750,Fusion of big toe joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28755,Fusion of big toe joint,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28760,Fusion of big toe joint,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28805,Amputation thru metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28810,Amputation toe & metatarsal,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28820,Amputation of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28825,Partial amputation of toe,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28890,Hi enrgy eswt plantar fascia,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,28899,Foot/toes surgery procedure,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29000,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29010,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29015,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29035,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29040,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29044,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29046,Application of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29049,Application of figure eight,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29055,Application of shoulder cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29058,Application of shoulder cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29065,Application of long arm cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29075,Application of forearm cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29085,Apply hand/wrist cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29086,Apply finger cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29105,Apply long arm splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29125,Apply forearm splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29126,Apply forearm splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29130,Application of finger splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29131,Application of finger splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29200,Strapping of chest,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29240,Strapping of shoulder,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29260,Strapping of elbow or wrist,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29280,Strapping of hand or finger,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29305,Application of hip cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29325,Application of hip casts,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29345,Application of long leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29355,Application of long leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29358,Apply long leg cast brace,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29365,Application of long leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29405,Apply short leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29425,Apply short leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29435,Apply short leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29440,Addition of walker to cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29445,Apply rigid leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29450,Application of leg cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29505,Application long leg splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29515,Application lower leg splint,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29520,Strapping of hip,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29530,Strapping of knee,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29540,Strapping of ankle and/or ft,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29550,Strapping of toes,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29580,Application of paste boot,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29581,Apply multlay comprs lwr leg,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29582,Apply multlay comprs upr leg,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29583,Apply multlay comprs upr arm,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29584,Appl multlay comprs arm/hand,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29700,Removal/revision of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29705,Removal/revision of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29710,Removal/revision of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29720,Repair of body cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29730,Windowing of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29740,Wedging of cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29750,Wedging of clubfoot cast,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29799,Casting/strapping procedure,Orthopedics,Per Unit,$143.71 ,OP,$143.71 ,$143.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,29800,Jaw arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29804,Jaw arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29805,Sho arthrs dx +- synovial bx,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29806,Sho arthrs srg capsulorpaphy,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29807,Sho arthrs srg rpr slap les,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29819,Sho arthrs srg rmvl loose/fb,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29820,Sho arthrs srg prtl synvct,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29821,Sho arthrs srg compl synvct,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29822,Sho arthrs srg lmtd dbrdmt,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29823,Sho arthrs srg xtnsv dbrdmt,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29824,Sho arthrs srg dstl claviclc,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29825,Sho arthrs srg lss&rescj ads,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29826,Sho arthrs srg decompression,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29827,Sho arthrs srg rt8tr cuf rpr,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29828,Sho arthrs srg bicp tenodsis,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29830,Elbow arthroscopy,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29834,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29835,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29836,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29837,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29838,Elbow arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29840,Wrist arthroscopy,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29843,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29844,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29845,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29846,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29847,Wrist arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29848,Wrist endoscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29850,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29851,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29855,Tibial arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29856,Tibial arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29860,Hip arthroscopy dx,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29861,Hip arthro w/fb removal,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29862,Hip arthr0 w/debridement,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29863,Hip arthr0 w/synovectomy,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29866,Autgrft implnt knee w/scope,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29867,Allgrft implnt knee w/scope,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29868,Meniscal trnspl knee w/scpe,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29870,Knee arthroscopy dx,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29871,Knee arthroscopy/drainage,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29873,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29874,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29875,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29876,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29877,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29879,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29880,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29881,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29882,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29883,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29884,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29885,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29886,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29887,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29888,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29889,Knee arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29891,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29892,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29893,Scope plantar fasciotomy,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29894,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29895,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29897,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29898,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29899,Ankle arthroscopy/surgery,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29900,Mcp joint arthroscopy dx,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29901,Mcp joint arthroscopy surg,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29902,Mcp joint arthroscopy surg,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29904,Subtalar arthro w/fb rmvl,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29905,Subtalar arthro w/exc,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29906,Subtalar arthro w/deb,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29907,Subtalar arthro w/fusion,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29914,Hip arthro w/femoroplasty,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29915,Hip arthro acetabuloplasty,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29916,Hip arthro w/labral repair,Orthopedic Surgery,Per Unit,"$2,793.83 ",OP,"$2,793.83 ","$2,793.83 ",,,,,,,,,,,,,
Molina Medicaid,CPT,29999,Arthroscopy of joint,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30020,Drainage of nose lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30100,Intranasal biopsy,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30110,Removal of nose polyp(s),Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30115,Removal of nose polyp(s),Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30117,Removal of intranasal lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30118,Removal of intranasal lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30120,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30124,Removal of nose lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30125,Removal of nose lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30130,Excise inferior turbinate,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30140,Resect inferior turbinate,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30150,Partial removal of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30160,Removal of nose,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30200,Injection treatment of nose,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30220,Insert nasal septal button,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30310,Remove nasal foreign body,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30320,Remove nasal foreign body,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30400,Reconstruction of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30410,Reconstruction of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30420,Reconstruction of nose,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30430,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30435,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30450,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30460,Revision of nose,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30462,Revision of nose,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30465,Repair nasal stenosis,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30468,Rpr nsl vlv collapse w/implt,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30520,Repair of nasal septum,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30540,Repair nasal defect,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30560,Release of nasal adhesions,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30580,Repair upper jaw fistula,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30600,Repair mouth/nose fistula,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30620,Intranasal reconstruction,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30630,Repair nasal septum defect,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30801,Ablate inf turbinate superf,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30802,Ablate inf turbinate submuc,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,30915,Ligation nasal sinus artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30920,Ligation upper jaw artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30930,Ther fx nasal inf turbinate,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,30999,Nasal surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31000,Irrigation maxillary sinus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31002,Irrigation sphenoid sinus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31020,Exploration maxillary sinus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31030,Exploration maxillary sinus,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31032,Explore sinus remove polyps,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31050,Exploration sphenoid sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31051,Sphenoid sinus surgery,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31070,Exploration of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31075,Exploration of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31080,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31081,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31084,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31085,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31086,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31087,Removal of frontal sinus,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31090,Exploration of sinuses,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31200,Removal of ethmoid sinus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31201,Removal of ethmoid sinus,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31205,Removal of ethmoid sinus,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31225,Removal of upper jaw,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31233,Nsl/sins ndsc dx max sinusc,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31235,Nsl/sins ndsc dx sphn sinusc,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31237,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31238,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31239,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31240,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31241,Nsl/sins ndsc w/artery lig,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31253,Nsl/sins ndsc total,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31254,Nsl/sins ndsc w/prtl ethmdct,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31255,Nsl/sins ndsc w/tot ethmdct,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31256,Exploration maxillary sinus,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31257,Nsl/sins ndsc tot w/sphendt,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31259,Nsl/sins ndsc sphn tiss rmvl,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31267,Endoscopy maxillary sinus,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31276,Nsl/sins ndsc frnt tiss rmvl,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31287,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31288,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31290,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31291,Nasal/sinus endoscopy surg,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31292,Nsl/sins ndsc med/inf dcmprn,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31293,Nsl/sins ndsc med&inf dcmprn,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31294,Nsl/sins ndsc surg on dcmprn,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31295,Nsl/sins ndsc surg max sins,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31296,Nsl/sins ndsc surg frnt sins,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31297,Nsl/sins ndsc surg sphn sins,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31298,Nsl/sins ndsc surg frnt&sphn,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31299,Sinus surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31300,Removal of larynx lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31320,Diagnostic incision larynx,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31375,Partial removal of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31400,Revision of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31420,Removal of epiglottis,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31500,Insert emergency airway,General Medicine,Per Unit,$385.17 ,OP,$385.17 ,$385.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31510,Laryngoscopy with biopsy,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31512,Removal of larynx lesion,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31513,Injection into vocal cord,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31515,Laryngoscopy for aspiration,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31520,Dx laryngoscopy newborn,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31525,Dx laryngoscopy excl nb,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31526,Dx laryngoscopy w/oper scope,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31527,Laryngoscopy for treatment,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31528,Laryngoscopy and dilation,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31529,Laryngoscopy and dilation,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31530,Laryngoscopy w/fb removal,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31531,Laryngoscopy w/fb & op scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31535,Laryngoscopy w/biopsy,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31536,Laryngoscopy w/bx & op scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31540,Laryngoscopy w/exc of tumor,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31541,Larynscop w/tumr exc + scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31545,Remove vc lesion w/scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31546,Remove vc lesion scope/graft,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31551,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31552,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31553,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31554,Laryngoplasty laryngeal sten,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31560,Laryngoscop w/arytenoidectom,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31561,Larynscop remve cart + scop,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31570,Laryngoscope w/vc inj,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31571,Laryngoscop w/vc inj + scope,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31572,Largsc w/laser dstrj les,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31573,Largsc w/ther injection,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31574,Largsc w/njx augmentation,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31576,Laryngoscopy with biopsy,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31577,Largsc w/rmvl foreign bdy(s),Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31578,Largsc w/removal lesion,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31579,Laryngoscopy telescopic,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31580,Laryngoplasty laryngeal web,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31582,Revision of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31584,Laryngoplasty fx rdctj fixj,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31587,Laryngoplasty cricoid split,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31588,Revision of larynx,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31590,Reinnervate larynx,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31591,Laryngoplasty medialization,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31595,Larynx nerve surgery,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,31599,Larynx surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31615,Visualization of windpipe,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31622,Dx bronchoscope/wash,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31623,Dx bronchoscope/brush,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31624,Dx bronchoscope/lavage,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31625,Bronchoscopy w/biopsy(s),Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31626,Bronchoscopy w/markers,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31627,Navigational bronchoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31628,Bronchoscopy/lung bx each,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31629,Bronchoscopy/needle bx each,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31632,Bronchoscopy/lung bx addl,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31633,Bronchoscopy/needle bx addl,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31635,Bronchoscopy w/fb removal,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31643,Diag bronchoscope/catheter,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31645,Brnchsc w/ther aspir 1st,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31646,Brnchsc w/ther aspir sbsq,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31720,Clearance of airways,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31725,Clearance of airways,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,31899,Airways surgical procedure,Pulmonary,Per Unit,$987.23 ,OP,$987.23 ,$987.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,33206,Insert heart pm atrial,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33207,Insert heart pm ventricular,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33208,Insrt heart pm atrial & vent,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33212,Insert pulse gen sngl lead,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33213,Insert pulse gen dual leads,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33214,Upgrade of pacemaker system,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33221,Insert pulse gen mult leads,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33224,Insert pacing lead & connect,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33225,L ventric pacing lead add-on,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33226,Reposition l ventric lead,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33227,Remove&replace pm gen singl,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33228,Remv&replc pm gen dual lead,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33229,Remv&replc pm gen mult leads,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33230,Insrt pulse gen w/dual leads,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33231,Insrt pulse gen w/mult leads,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33233,Removal of pm generator,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33240,Insrt pulse gen w/singl lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33241,Remove pulse generator,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33249,Insj/rplcmt defib w/lead(s),Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33262,Rmvl& replc pulse gen 1 lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33263,Rmvl & rplcmt dfb gen 2 lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33264,Rmvl & rplcmt dfb gen mlt ld,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33270,Ins/rep subq defibrillator,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33274,Tcat insj/rpl perm ldls pm,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33275,Tcat rmvl perm ldls pm w/img,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33282,Implant pat-active ht record,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33285,Insj subq car rhythm mntr,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33289,Tcat impl wrls p-art prs snr,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33889,Artery transpose/endovas taa,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33967,Insert i-aort percut device,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33968,Remove aortic assist device,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33990,Insj perq vad l hrt arterial,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33991,Insj perq vad l hrt artl&ven,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33992,Rmvl perq left heart vad,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33993,Reposg perq r/l hrt vad,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33995,Insj perq vad r hrt venous,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33997,Rmvl perq right heart vad,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,33999,Cardiac surgery procedure,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34001,Removal of artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34101,Removal of artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34111,Removal of arm artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34201,Removal of artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34203,Removal of leg artery clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34421,Removal of vein clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34471,Removal of vein clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34490,Removal of vein clot,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34501,Repair valve femoral vein,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34510,Transposition of vein valve,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34520,Cross-over vein graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34530,Leg vein fusion,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34714,Opn fem art expos cndt crtj,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34715,Opn ax/subcla art expos,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34716,Opn ax/subcla art expos cndt,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34812,Opn fem art expos,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,34834,Opn brach art expos,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35011,Repair defect of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35013,Repair artery rupture arm,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35045,Repair defect of arm artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35180,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35184,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35188,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35190,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35201,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35206,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35207,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35226,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35231,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35236,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35256,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35261,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35266,Repair blood vessel lesion,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35301,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35302,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35303,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35304,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35305,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35306,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35321,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35355,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35371,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35372,Rechanneling of artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35390,Reoperation carotid add-on,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35400,Angioscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,35452,Repair arterial blockage,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35472,Repair arterial blockage,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35694,Art trnsposj subclav carotid,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35697,Reimplant artery each,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35700,Reoperation bypass graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35701,Expl n/flwd surg neck art,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35702,Expl n/flwd surg uxtr art,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35703,Expl n/flwd surg lxtr art,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35721,Exploration femoral artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35741,Exploration popliteal artery,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35761,Exploration of artery/vein,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35800,Explore neck vessels,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35820,Explore chest vessels,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35860,Explore limb vessels,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35875,Removal of clot in graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35876,Removal of clot in graft,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35901,Excision graft neck,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,35903,Excision graft extremity,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36005,Injection ext venography,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36010,Place catheter in vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36011,Place catheter in vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36012,Place catheter in vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36013,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36014,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36015,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36100,Establish access to artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36120,Establish access to artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36140,Intro ndl icath upr/lxtr art,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36160,Establish access to aorta,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36200,Place catheter in aorta,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36215,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36216,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36217,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36218,Place catheter in artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36221,Place cath thoracic aorta,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36222,Place cath carotid/inom art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36223,Place cath carotid/inom art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36224,Place cath carotd art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36225,Place cath subclavian art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36226,Place cath vertebral art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36227,Place cath xtrnl carotid,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36228,Place cath intracranial art,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36245,Ins cath abd/l-ext art 1st,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36246,Ins cath abd/l-ext art 2nd,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36247,Ins cath abd/l-ext art 3rd,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36248,Ins cath abd/l-ext art addl,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36251,Ins cath ren art 1st unilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36252,Ins cath ren art 1st bilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36253,Ins cath ren art 2nd+ unilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36254,Ins cath ren art 2nd+ bilat,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36260,Insertion of infusion pump,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36299,Vessel injection procedure,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36430,Blood transfusion service,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36440,Bl push transfuse 2 yr/<,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36450,Bl exchange/transfuse nb,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36455,Bl exchange/transfuse non-nb,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36456,Prtl exchange transfuse nb,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36460,Transfusion service fetal,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36465,Njx noncmpnd sclrsnt 1 vein,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36466,Njx noncmpnd sclrsnt mlt vn,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36468,Njx sclrsnt spider veins,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36470,Njx sclrsnt 1 incmptnt vein,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36471,Njx sclrsnt mlt incmptnt vn,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36481,Insertion of catheter vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36500,Insertion of catheter vein,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36511,Apheresis wbc,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36512,Apheresis rbc,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36513,Apheresis platelets,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36514,Apheresis plasma,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36515,Apheresis adsorp/reinfuse,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36516,Apheresis immunoads slctv,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36522,Photopheresis,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36557,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36558,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36560,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36561,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36563,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36565,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36566,Insert tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36581,Replace tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36582,Replace tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36583,Replace tunneled cv cath,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36593,Declot vascular device,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36620,Insertion catheter artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36625,Insertion catheter artery,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36640,Insertion catheter artery,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36680,Insert needle bone cavity,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36800,Insertion of cannula,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36810,Insertion of cannula,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36815,Insertion of cannula,Interventional Radiology,Per Unit,$970.64 ,OP,$970.64 ,$970.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36823,Insertion of cannula(s),Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36838,Dist revas ligation hemo,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36860,External cannula declotting,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,36903,Intro cath dialysis circuit,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36905,Thrmbc/nfs dialysis circuit,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36906,Thrmbc/nfs dialysis circuit,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36907,Balo angiop ctr dialysis seg,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36908,Stent plmt ctr dialysis seg,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,36909,Dialysis circuit embolj,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37145,Revision of circulation,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37182,Insert hepatic shunt (tips),Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37183,Remove hepatic shunt (tips),Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37184,Prim art m-thrmbc 1st vsl,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37185,Prim art m-thrmbc sbsq vsl,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37186,Sec art thrombectomy add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37195,Thrombolytic therapy stroke,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,37202,Transcatheter therapy infuse,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,37215,Transcath stent cca w/eps,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37216,Transcath stent cca w/o eps,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37217,Stent placemt retro carotid,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37218,Stent placemt ante carotid,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37220,Iliac revasc,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37221,Iliac revasc w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37222,Iliac revasc add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37223,Iliac revasc w/stent add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37224,Fem/popl revas w/tla,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37225,Fem/popl revas w/ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37226,Fem/popl revasc w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37227,Fem/popl revasc stnt & ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37228,Tib/per revasc w/tla,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37229,Tib/per revasc w/ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37230,Tib/per revasc w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37231,Tib/per revasc stent & ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37232,Tib/per revasc add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37233,Tibper revasc w/ather add-on,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37234,Revsc opn/prq tib/pero stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37235,Tib/per revasc stnt & ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37236,Open/perq place stent 1st,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37237,Open/perq place stent ea add,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37238,Open/perq place stent same,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37239,Open/perq place stent ea add,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37241,Vasc embolize/occlude venous,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37242,Vasc embolize/occlude artery,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37243,Vasc embolize/occlude organ,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37244,Vasc embolize/occlude bleed,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37247,Trluml balo angiop addl art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37249,Trluml balo angiop addl vein,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37250,Iv us first vessel add-on,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,37251,Iv us each add vessel add-on,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,37500,Endoscopy ligate perf veins,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37501,Vascular endoscopy procedure,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,37565,Ligation of neck vein,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37600,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37605,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37606,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37607,Ligation of a-v fistula,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37609,Temporal artery procedure,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37615,Ligation of neck artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37618,Ligation of extremity artery,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37619,Ligation of inf vena cava,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37650,Revision of major vein,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37790,Penile venous occlusion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,37799,Vascular surgery procedure,Vascular Surgery,Per Unit,"$1,174.75 ",OP,"$1,174.75 ","$1,174.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38102,Removal of spleen total,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38120,Laparoscopy splenectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38129,Laparoscope proc spleen,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38205,Harvest allogeneic stem cell,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38206,Harvest auto stem cells,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38207,Cryopreserve stem cells,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38208,Thaw preserved stem cells,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38209,Wash harvest stem cells,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38210,T-cell depletion of harvest,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38211,Tumor cell deplete of harvst,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38212,Rbc depletion of harvest,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38213,Platelet deplete of harvest,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38214,Volume deplete of harvest,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38215,Harvest stem cell concentrte,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38230,Bone marrow harvest allogen,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38232,Bone marrow harvest autolog,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38240,Transplt allo hct/donor,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38241,Transplt autol hct/donor,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38242,Transplt allo lymphocytes,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38243,Transplj hematopoietic boost,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38300,Drainage lymph node lesion,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38305,Drainage lymph node lesion,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38308,Incision of lymph channels,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38380,Thoracic duct procedure,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38500,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38505,Needle biopsy lymph nodes,General Surgery,Per Unit,$734.97 ,OP,$734.97 ,$734.97 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38510,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38520,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38525,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38530,Biopsy/removal lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38531,Open bx/exc inguinofem nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38542,Explore deep node(s) neck,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38550,Removal neck/armpit lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38555,Removal neck/armpit lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38562,Removal pelvic lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38570,Laparoscopy lymph node biop,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38571,Laparoscopy lymphadenectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38572,Laparoscopy lymphadenectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38573,Laps pelvic lymphadec,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38589,Laparoscope proc lymphatic,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38700,Removal of lymph nodes neck,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38720,Removal of lymph nodes neck,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38724,Removal of lymph nodes neck,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38740,Remove armpit lymph nodes,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38745,Remove armpit lymph nodes,General Surgery,Per Unit,"$1,609.30 ",OP,"$1,609.30 ","$1,609.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38747,Remove abdominal lymph nodes,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38760,Remove groin lymph nodes,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,38792,Ra tracer id of sentinl node,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38794,Access thoracic lymph duct,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,38999,Blood/lymph system procedure,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,39545,Revision of diaphragm,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,39599,Diaphragm surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40490,Biopsy of lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40500,Partial excision of lip,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40510,Partial excision of lip,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40520,Partial excision of lip,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40525,Reconstruct lip with flap,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40527,Reconstruct lip with flap,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40530,Partial removal of lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40650,Repair lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40652,Repair lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40654,Repair lip,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40799,Lip surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40801,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40805,Removal foreign body mouth,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40806,Incision of lip fold,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40808,Biopsy of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40810,Excision of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40812,Excise/repair mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40814,Excise/repair mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40816,Excision of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40818,Excise oral mucosa for graft,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40819,Excise lip or cheek fold,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40820,Treatment of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40830,Repair mouth laceration,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40831,Repair mouth laceration,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,40840,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40842,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40843,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40844,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40845,Reconstruction of mouth,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,40899,Mouth surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41000,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41005,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41006,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41007,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41008,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41009,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41010,Incision of tongue fold,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41015,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41016,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41017,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41018,Drainage of mouth lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41100,Biopsy of tongue,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41105,Biopsy of tongue,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41108,Biopsy of floor of mouth,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41110,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41112,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41113,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41114,Excision of tongue lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41115,Excision of tongue fold,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41116,Excision of mouth lesion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41120,Partial removal of tongue,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41130,Partial removal of tongue,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41135,Tongue and neck surgery,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41150,Tongue mouth jaw surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41500,Fixation of tongue,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41510,Tongue to lip surgery,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41512,Tongue suspension,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41520,Reconstruction tongue fold,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41530,Tongue base vol reduction,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41599,Tongue and mouth surgery,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41805,Removal foreign body gum,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41806,Removal foreign body jawbone,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41820,Excision gum each quadrant,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41821,Excision of gum flap,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41822,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41823,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41825,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41826,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41827,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41828,Excision of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41830,Removal of gum tissue,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41850,Treatment of gum lesion,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41870,Gum graft,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,41872,Repair gum,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41874,Repair tooth socket,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,41899,Dental surgery procedure,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42100,Biopsy roof of mouth,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42104,Excision lesion mouth roof,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42106,Excision lesion mouth roof,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42107,Excision lesion mouth roof,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42120,Remove palate/lesion,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42140,Excision of uvula,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42160,Treatment mouth roof lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42180,Repair palate,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42182,Repair palate,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42260,Repair nose to lip fistula,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42280,Preparation palate mold,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42281,Insertion palate prosthesis,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42299,Palate/uvula surgery,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42300,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42305,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42310,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42320,Drainage of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42330,Removal of salivary stone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42335,Removal of salivary stone,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42340,Removal of salivary stone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42400,Biopsy of salivary gland,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42405,Biopsy of salivary gland,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42408,Excision of salivary cyst,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42409,Drainage of salivary cyst,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42410,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42415,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42420,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42425,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42426,Excise parotid gland/lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42440,Excise submaxillary gland,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42450,Excise sublingual gland,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42500,Repair salivary duct,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42505,Repair salivary duct,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42507,Parotid duct diversion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42509,Parotid duct diversion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42510,Parotid duct diversion,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42600,Closure of salivary fistula,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42650,Dilation of salivary duct,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42660,Dilation of salivary duct,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42665,Ligation of salivary duct,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42699,Salivary surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42720,Drainage of throat abscess,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42725,Drainage of throat abscess,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42800,Biopsy of throat,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42804,Biopsy of upper nose/throat,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42806,Biopsy of upper nose/throat,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42808,Excise pharynx lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42810,Excision of neck cyst,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42815,Excision of neck cyst,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42820,Remove tonsils and adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42821,Remove tonsils and adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42825,Removal of tonsils,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42826,Removal of tonsils,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42830,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42831,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42835,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42836,Removal of adenoids,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42842,Extensive surgery of throat,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42844,Extensive surgery of throat,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42860,Excision of tonsil tags,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42870,Excision of lingual tonsil,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42890,Partial removal of pharynx,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42892,Revision of pharyngeal walls,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42900,Repair throat wound,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42950,Reconstruction of throat,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42953,Repair throat esophagus,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42955,Surgical opening of throat,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42960,Control throat bleeding,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42962,Control throat bleeding,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,42970,Control nose/throat bleeding,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42972,Control nose/throat bleeding,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,42999,Throat surgery procedure,Otolaryngology Surgery,Per Unit,"$1,027.68 ",OP,"$1,027.68 ","$1,027.68 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43020,Incision of esophagus,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43030,Throat muscle surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43100,Excision of esophagus lesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43130,Removal of esophagus pouch,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43191,Esophagoscopy rigid trnso dx,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43192,Esophagoscp rig trnso inject,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43193,Esophagoscp rig trnso biopsy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43194,Esophagoscp rig trnso rem fb,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43196,Esophagoscp guide wire dilat,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43197,Esophagoscopy flex dx brush,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43198,Esophagosc flex trnsn biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43200,Esophagoscopy flexible brush,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43201,Esoph scope w/submucous inj,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43202,Esophagoscopy flex biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43204,Esoph scope w/sclerosis inj,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43205,Esophagus endoscopy/ligation,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43206,Esoph optical endomicroscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43211,Esophagoscop mucosal resect,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43213,Esophagoscopy retro balloon,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43214,Esophagosc dilate balloon 30,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43215,Esophagoscopy flex remove fb,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43216,Esophagoscopy lesion removal,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43217,Esophagoscopy snare les remv,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43220,Esophagoscopy balloon <30mm,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43226,Esoph endoscopy dilation,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43227,Esophagoscopy control bleed,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43229,Esophagoscopy lesion ablate,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43231,Esophagoscop ultrasound exam,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43232,Esophagoscopy w/us needle bx,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43233,Egd balloon dil esoph30 mm/>,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43235,Egd diagnostic brush wash,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43236,Uppr gi scope w/submuc inj,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43237,Endoscopic us exam esoph,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43238,Egd us fine needle bx/aspir,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43239,Egd biopsy single/multiple,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43241,Egd tube/cath insertion,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43242,Egd us fine needle bx/aspir,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43243,Egd injection varices,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43244,Egd varices ligation,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43245,Egd dilate stricture,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43246,Egd place gastrostomy tube,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43247,Egd remove foreign body,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43248,Egd guide wire insertion,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43249,Esoph egd dilation <30 mm,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43250,Egd cautery tumor polyp,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43251,Egd remove lesion snare,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43253,Egd us transmural injxn/mark,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43254,Egd endo mucosal resection,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43255,Egd control bleeding any,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43257,Egd w/thrml txmnt gerd,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43259,Egd us exam duodenum/jejunum,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43260,Ercp w/specimen collection,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43261,Endo cholangiopancreatograph,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43262,Endo cholangiopancreatograph,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43263,Ercp sphincter pressure meas,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43270,Egd lesion ablation,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43275,Ercp remove forgn body duct,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43276,Ercp stent exchange w/dilate,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43277,Ercp ea duct/ampulla dilate,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43279,Lap myotomy heller,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43280,Laparoscopy fundoplasty,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43281,Lap paraesophag hern repair,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43282,Lap paraesoph her rpr w/mesh,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43283,Lap esoph lengthening,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43284,Laps esophgl sphnctr agmntj,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43285,Rmvl esophgl sphnctr dev,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43289,Laparoscope proc esoph,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43300,Repair of esophagus,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43305,Repair esophagus and fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43320,Fuse esophagus & stomach,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43332,Transab esoph hiat hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43333,Transab esoph hiat hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43334,Transthor diaphrag hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43335,Transthor diaphrag hern rpr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43336,Thorabd diaphr hern repair,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43337,Thorabd diaphr hern repair,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43338,Esoph lengthening,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43401,Esophagus surgery for veins,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43410,Repair esophagus wound,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43420,Repair esophagus opening,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43450,Dilate esophagus 1/mult pass,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43453,Dilate esophagus,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43499,Esophagus surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43500,Surgical opening of stomach,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43510,Surgical opening of stomach,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43520,Incision of pyloric muscle,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43610,Excision of stomach lesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43644,Lap gastric bypass/roux-en-y,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43645,Lap gastr bypass incl smll i,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43647,Lap impl electrode antrum,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43648,Lap revise/remv eltrd antrum,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43651,Laparoscopy vagus nerve,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43652,Laparoscopy vagus nerve,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43653,Laparoscopy gastrostomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43659,Laparoscope proc stom,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43752,Nasal/orogastric w/tube plmt,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43753,Tx gastro intub w/asp,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43754,Dx gastr intub w/asp spec,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43755,Dx gastr intub w/asp specs,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43756,Dx duod intub w/asp spec,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43757,Dx duod intub w/asp specs,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43760,Change gastrostomy tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43761,Reposition gastrostomy tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43762,Rplc gtube no revj trc,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43763,Rplc gtube revj gstrst trc,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43770,Lap place gastr adj device,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43771,Lap revise gastr adj device,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43772,Lap rmvl gastr adj device,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43773,Lap replace gastr adj device,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43774,Lap rmvl gastr adj all parts,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43775,Lap sleeve gastrectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43830,Place gastrostomy tube,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43831,Place gastrostomy tube,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43832,Place gastrostomy tube,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43842,V-band gastroplasty,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43843,Gastroplasty w/o v-band,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43848,Revision gastroplasty,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43860,Revise stomach-bowel fusion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43870,Repair stomach opening,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43880,Repair stomach-bowel fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43881,Impl/redo electrd antrum,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43882,Revise/remove electrd antrum,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,43886,Revise gastric port open,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43887,Remove gastric port open,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43888,Change gastric port open,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,43999,Stomach surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44005,Freeing of bowel adhesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44015,Insert needle cath bowel,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44020,Explore small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44050,Reduce bowel obstruction,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44055,Correct malrotation of bowel,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44100,Biopsy of bowel,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44110,Excise intestine lesion(s),General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44111,Excision of bowel lesion(s),General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44125,Removal of small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44130,Bowel to bowel fusion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44139,Mobilization of colon,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44141,Partial removal of colon,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44143,Partial removal of colon,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44180,Lap enterolysis,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44186,Lap jejunostomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44187,Lap ileo/jejuno-stomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44188,Lap colostomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44204,Laparo partial colectomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44206,Lap part colectomy w/stoma,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44207,L colectomy/coloproctostomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44208,L colectomy/coloproctostomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44213,Lap mobil splenic fl add-on,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44238,Laparoscope proc intestine,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44300,Open bowel to skin,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44312,Revision of ileostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44320,Colostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44340,Revision of colostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44346,Revision of colostomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44360,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44361,Small bowel endoscopy/biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44363,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44364,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44365,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44366,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44369,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44370,Small bowel endoscopy/stent,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44372,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44373,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44376,Small bowel endoscopy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44377,Small bowel endoscopy/biopsy,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44378,Small bowel endoscopy,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44379,S bowel endoscope w/stent,Gastroenterology,Per Unit,$446.31 ,OP,$446.31 ,$446.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44380,Small bowel endoscopy br/wa,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44381,Small bowel endoscopy br/wa,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44382,Small bowel endoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44384,Small bowel endoscopy,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44385,Endoscopy of bowel pouch,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44386,Endoscopy bowel pouch/biop,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44388,Colonoscopy thru stoma spx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44389,Colonoscopy with biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44390,Colonoscopy for foreign body,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44391,Colonoscopy for bleeding,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44392,Colonoscopy & polypectomy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44394,Colonoscopy w/snare,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44401,Colonoscopy with ablation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44402,Colonoscopy w/stent plcmt,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44403,Colonoscopy w/resection,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44404,Colonoscopy w/injection,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44405,Colonoscopy w/dilation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44406,Colonoscopy w/ultrasound,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44407,Colonoscopy w/ndl aspir/bx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44408,Colonoscopy w/decompression,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44500,Intro gastrointestinal tube,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44602,Suture small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44603,Suture small intestine,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44615,Intestinal stricturoplasty,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44620,Repair bowel opening,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44640,Repair bowel-skin fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44650,Repair bowel fistula,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44799,Unlisted px small intestine,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44800,Excision of bowel pouch,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44820,Excision of mesentery lesion,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44850,Repair of mesentery,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44899,Bowel surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,44900,Drain appendix abscess open,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44950,Appendectomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44955,Appendectomy add-on,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44960,Appendectomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44970,Laparoscopy appendectomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,44979,Laparoscope proc app,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45000,Drainage of pelvic abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45005,Drainage of rectal abscess,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45020,Drainage of rectal abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45100,Biopsy of rectum,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45108,Removal of anorectal lesion,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45113,Partial proctectomy,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45123,Partial proctectomy,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45130,Excision of rectal prolapse,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45136,Excise ileoanal reservior,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45150,Excision of rectal stricture,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45160,Excision of rectal lesion,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45171,Exc rect tum transanal part,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45172,Exc rect tum transanal full,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45190,Destruction rectal tumor,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45300,Proctosigmoidoscopy dx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45303,Proctosigmoidoscopy dilate,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45305,Proctosigmoidoscopy w/bx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45307,Proctosigmoidoscopy fb,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45308,Proctosigmoidoscopy removal,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45309,Proctosigmoidoscopy removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45315,Proctosigmoidoscopy removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45317,Proctosigmoidoscopy bleed,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45320,Proctosigmoidoscopy ablate,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45321,Proctosigmoidoscopy volvul,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45327,Proctosigmoidoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45330,Diagnostic sigmoidoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45331,Sigmoidoscopy and biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45332,Sigmoidoscopy w/fb removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45333,Sigmoidoscopy & polypectomy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45334,Sigmoidoscopy for bleeding,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45335,Sigmoidoscopy w/submuc inj,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45337,Sigmoidoscopy & decompress,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45338,Sigmoidoscopy w/tumr remove,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45340,Sig w/tndsc balloon dilation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45341,Sigmoidoscopy w/ultrasound,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45342,Sigmoidoscopy w/us guide bx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45346,Sigmoidoscopy w/ablation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45347,Sigmoidoscopy w/plcmt stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45349,Sigmoidoscopy w/resection,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45350,Sgmdsc w/band ligation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45378,Diagnostic colonoscopy,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45379,Colonoscopy w/fb removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45380,Colonoscopy and biopsy,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45381,Colonoscopy submucous njx,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45382,Colonoscopy w/control bleed,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45384,Colonoscopy w/lesion removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45385,Colonoscopy w/lesion removal,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45386,Colonoscopy w/balloon dilat,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45388,Colonoscopy w/ablation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45389,Colonoscopy w/stent plcmt,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45390,Colonoscopy w/resection,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45391,Colonoscopy w/endoscope us,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45392,Colonoscopy w/endoscopic fnb,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45393,Colonoscopy w/decompression,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45398,Colonoscopy w/band ligation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45399,Unlisted procedure colon,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45400,Laparoscopic proc,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45402,Lap proctopexy w/sig resect,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45499,Laparoscope proc rectum,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45500,Repair of rectum,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45505,Repair of rectum,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45520,Treatment of rectal prolapse,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45541,Correct rectal prolapse,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45560,Repair of rectocele,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45562,Exploration/repair of rectum,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45800,Repair rect/bladder fistula,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45820,Repair rectourethral fistula,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,45900,Reduction of rectal prolapse,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45905,Dilation of anal sphincter,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45910,Dilation of rectal narrowing,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45915,Remove rectal obstruction,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45990,Surg dx exam anorectal,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,45999,Rectum surgery procedure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46020,Placement of seton,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46030,Removal of rectal marker,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46040,Incision of rectal abscess,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46045,Incision of rectal abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46050,Incision of anal abscess,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46060,Incision of rectal abscess,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46070,Incision of anal septum,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46080,Incision of anal sphincter,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46083,Incise external hemorrhoid,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46200,Removal of anal fissure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46220,Excise anal ext tag/papilla,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46221,Ligation of hemorrhoid(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46230,Removal of anal tags,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46250,Remove ext hem groups 2+,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46255,Remove int/ext hem 1 group,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46257,Remove in/ex hem grp & fiss,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46258,Remove in/ex hem grp w/fistu,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46260,Remove in/ex hem groups 2+,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46261,Remove in/ex hem grps & fiss,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46262,Remove in/ex hem grps w/fist,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46270,Remove anal fist subq,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46275,Remove anal fist inter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46280,Remove anal fist complex,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46285,Remove anal fist 2 stage,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46288,Repair anal fistula,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46320,Removal of hemorrhoid clot,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46500,Injection into hemorrhoid(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46505,Chemodenervation anal musc,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46600,Diagnostic anoscopy spx,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46601,Diagnostic anoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46604,Anoscopy and dilation,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46606,Anoscopy and biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46607,Diagnostic anoscopy & biopsy,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46608,Anoscopy remove for body,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46610,Anoscopy remove lesion,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46611,Anoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46612,Anoscopy remove lesions,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46614,Anoscopy control bleeding,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46615,Anoscopy,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46700,Repair of anal stricture,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46705,Repair of anal stricture,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46706,Repr of anal fistula w/glue,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46707,Repair anorectal fist w/plug,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46710,Repr per/vag pouch sngl proc,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46712,Repr per/vag pouch dbl proc,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46715,Rep perf anoper fistu,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46716,Rep perf anoper/vestib fistu,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46740,Construction of absent anus,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46750,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46751,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46753,Reconstruction of anus,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46754,Removal of suture from anus,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46760,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46761,Repair of anal sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46762,Implant artificial sphincter,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46900,Destruction anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46910,Destruction anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46916,Cryosurgery anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46917,Laser surgery anal lesions,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46922,Excision of anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46924,Destruction anal lesion(s),General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46930,Destroy internal hemorrhoids,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46940,Treatment of anal fissure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46942,Treatment of anal fissure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46945,Int hrhc lig 1 hroid w/o img,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46946,Int hrhc lig 2+hroid w/o img,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,46947,Hemorrhoidopexy by stapling,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46948,Int hrhc tranal dartlzj 2+,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,46999,Anus surgery procedure,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,47370,Laparo ablate liver tumor rf,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47371,Laparo ablate liver cryosurg,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47379,Laparoscope procedure liver,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47510,Insert catheter bile duct,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47511,Insert bile duct drain,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47525,Change bile duct catheter,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,47530,Revise/reinsert bile tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,47537,Removal biliary drg cath,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,47560,Laparoscopy w/cholangio,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47561,Laparo w/cholangio/biopsy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47562,Laparoscopic cholecystectomy,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47563,Laparo cholecystectomy/graph,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47564,Laparo cholecystectomy/explr,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47570,Laparo cholecystoenterostomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47579,Laparoscope proc biliary,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,47630,Remove bile duct stone,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,48550,Donor pancreatectomy,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49000,Exploration of abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49002,Reopening of abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49010,Exploration behind abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49203,Exc abd tum 5 cm or less,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49204,Exc abd tum over 5 cm,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49205,Exc abd tum over 10 cm,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49215,Excise sacral spine tumor,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49220,Multiple surgery abdomen,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49250,Excision of umbilicus,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49255,Removal of omentum,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49320,Diag laparo separate proc,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49321,Laparoscopy biopsy,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49322,Laparoscopy aspiration,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49323,Laparo drain lymphocele,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49324,Lap insert tunnel ip cath,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49325,Lap revision perm ip cath,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49326,Lap w/omentopexy add-on,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49329,Laparo proc abdm/per/oment,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49402,Remove foreign body adbomen,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49425,Insert abdomen-venous drain,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49426,Revise abdomen-venous shunt,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49428,Ligation of shunt,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49429,Removal of shunt,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49440,Place gastrostomy tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49441,Place duod/jej tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49442,Place cecostomy tube perc,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49446,Change g-tube to g-j perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49450,Replace g/c tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49451,Replace duod/jej tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49452,Replace g-j tube perc,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49460,Fix g/colon tube w/device,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49491,Rpr hern preemie reduc,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49492,Rpr ing hern premie blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49495,Rpr ing hernia baby reduc,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49496,Rpr ing hernia baby blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49500,Rpr ing hernia init reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49501,Rpr ing hernia init blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49505,Prp i/hern init reduc >5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49507,Prp i/hern init block >5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49520,Rerepair ing hernia reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49521,Rerepair ing hernia blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49525,Repair ing hernia sliding,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49540,Repair lumbar hernia,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49550,Rpr rem hernia init reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49553,Rpr fem hernia init blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49555,Rerepair fem hernia reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49557,Rerepair fem hernia blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49560,Rpr ventral hern init reduc,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49561,Rpr ventral hern init block,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49565,Rerepair ventrl hern reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49566,Rerepair ventrl hern block,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49568,Hernia repair w/mesh,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49570,Rpr epigastric hern reduce,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49572,Rpr epigastric hern blocked,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49580,Rpr umbil hern reduc < 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49582,Rpr umbil hern block < 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49585,Rpr umbil hern reduc > 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49587,Rpr umbil hern block > 5 yr,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49590,Repair spigelian hernia,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49600,Repair umbilical lesion,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49606,Repair umbilical lesion,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49610,Repair umbilical lesion,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49650,Lap ing hernia repair init,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49651,Lap ing hernia repair recur,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49652,Lap vent/abd hernia repair,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49653,Lap vent/abd hern proc comp,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49654,Lap inc hernia repair,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49655,Lap inc hern repair comp,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49656,Lap inc hernia repair recur,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49657,Lap inc hern recur comp,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49659,Laparo proc hernia repair,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49900,Repair of abdominal wall,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49904,Omental flap extra-abdom,General Surgery,Per Unit,"$2,599.18 ",OP,"$2,599.18 ","$2,599.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,49905,Omental flap intra-abdom,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49906,Free omental flap microvasc,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,49999,Abdomen surgery procedure,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50389,Remove renal tube w/fluoro,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50390,Drainage of kidney lesion,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50391,Instll rx agnt into rnal tub,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50396,Measure kidney pressure,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50398,Change kidney tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50430,Njx px nfrosgrm &/urtrgrm,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50431,Njx px nfrosgrm &/urtrgrm,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,50541,Laparo ablate renal cyst,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50542,Laparo ablate renal mass,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50543,Laparo partial nephrectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50544,Laparoscopy pyeloplasty,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50549,Laparoscope proc renal,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50945,Laparoscopy ureterolithotomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50947,Laparo new ureter/bladder,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50948,Laparo new ureter/bladder,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,50949,Laparoscope proc ureter,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,51100,Drain bladder by needle,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51500,Removal of bladder cyst,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,51705,Change of bladder tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51710,Change of bladder tube,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51715,Endoscopic injection/implant,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51720,Treatment of bladder lesion,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51725,Simple cystometrogram,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51726,Complex cystometrogram,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51727,Cystometrogram w/up,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51728,Cystometrogram w/vp,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51729,Cystometrogram w/vp&up,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51741,Electro-uroflowmetry first,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51784,Anal/urinary muscle study,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51785,Anal/urinary muscle study,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51792,Urinary reflex study,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,51990,Laparo urethral suspension,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,51992,Laparo sling operation,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,51999,Laparoscope proc bla,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,52010,Cystoscopy & duct catheter,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52270,Cystoscopy & revise urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52275,Cystoscopy & revise urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52276,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52277,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52282,Cystoscopy implant stent,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52283,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52285,Cystoscopy and treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52400,Cystouretero w/congen repr,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52402,Cystourethro cut ejacul duct,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,52442,Cystourethro w/addl implant,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,52601,Prostatectomy (turp),Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,52630,Remove prostate regrowth,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,52647,Laser surgery of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,52648,Laser surgery of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,52649,Prostate laser enucleation,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53000,Incision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53010,Incision of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53020,Incision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53025,Incision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53040,Drainage of urethra abscess,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53060,Drainage of urethra abscess,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53080,Drainage of urinary leakage,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53085,Drainage of urinary leakage,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53200,Biopsy of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53210,Removal of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53215,Removal of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53220,Treatment of urethra lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53230,Removal of urethra lesion,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53235,Removal of urethra lesion,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53240,Surgery for urethra pouch,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53250,Removal of urethra gland,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53260,Treatment of urethra lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53265,Treatment of urethra lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53270,Removal of urethra gland,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53275,Repair of urethra defect,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53400,Revise urethra stage 1,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53405,Revise urethra stage 2,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53410,Reconstruction of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53415,Reconstruction of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53420,Reconstruct urethra stage 1,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53425,Reconstruct urethra stage 2,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53430,Reconstruction of urethra,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53431,Reconstruct urethra/bladder,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53440,Male sling procedure,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53442,Remove/revise male sling,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53444,Insert tandem cuff,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53446,Remove uro sphincter,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53448,Remov/replc ur sphinctr comp,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53449,Repair uro sphincter,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53450,Revision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53460,Revision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53500,Urethrlys transvag w/ scope,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53502,Repair of urethra injury,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53505,Repair of urethra injury,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53510,Repair of urethra injury,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53515,Repair of urethra injury,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53520,Repair of urethra defect,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,53605,Dilate urethra stricture,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53620,Dilate urethra stricture,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53621,Dilate urethra stricture,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53665,Dilation of urethra,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53855,Insert prost urethral stent,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,53860,Transurethral rf treatment,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54000,Slitting of prepuce,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54001,Slitting of prepuce,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54015,Drain penis lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54050,Destruction penis lesion(s),Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54055,Destruction penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54056,Cryosurgery penis lesion(s),Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54057,Laser surg penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54060,Excision of penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54065,Destruction penis lesion(s),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54100,Biopsy of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54105,Biopsy of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54110,Treatment of penis lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54115,Treatment of penis lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54150,Circumcision w/regionl block,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54160,Circumcision neonate,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54161,Circum 28 days or older,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54162,Lysis penil circumic lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54163,Repair of circumcision,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54164,Frenulotomy of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54230,Prepare penis study,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54231,Dynamic cavernosometry,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54300,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54304,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54340,Secondary urethral surgery,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54360,Penis plastic surgery,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54380,Repair penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54385,Repair penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54400,Insert semi-rigid prosthesis,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54401,Insert self-contd prosthesis,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54405,Insert multi-comp penis pros,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54406,Remove muti-comp penis pros,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54408,Repair multi-comp penis pros,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54410,Remove/replace penis prosth,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54411,Remov/replc penis pros comp,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54415,Remove self-contd penis pros,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54416,Remv/repl penis contain pros,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54417,Remv/replc penis pros compl,Urological Surgery,Per Unit,"$6,916.67 ",OP,"$6,916.67 ","$6,916.67 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54420,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54430,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54435,Revision of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54440,Repair of penis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54450,Preputial stretching,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54500,Biopsy of testis,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54505,Biopsy of testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54512,Excise lesion testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54520,Removal of testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54522,Orchiectomy partial,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54530,Removal of testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54535,Extensive testis surgery,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54550,Exploration for testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54560,Exploration for testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54600,Reduce testis torsion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54620,Suspension of testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54640,Orchiopexy ingun/scrot appr,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54650,Orchiopexy (fowler-stephens),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54660,Revision of testis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54670,Repair testis injury,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54680,Relocation of testis(es),Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54690,Laparoscopy orchiectomy,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54692,Laparoscopy orchiopexy,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54699,Laparoscope proc testis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54700,Drainage of scrotum,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54800,Biopsy of epididymis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54830,Remove epididymis lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54840,Remove epididymis lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54860,Removal of epididymis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54861,Removal of epididymis,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,54865,Explore epididymis,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54900,Fusion of spermatic ducts,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,54901,Fusion of spermatic ducts,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55040,Removal of hydrocele,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55041,Removal of hydroceles,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55060,Repair of hydrocele,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55100,Drainage of scrotum abscess,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55110,Explore scrotum,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55120,Removal of scrotum lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55150,Removal of scrotum,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55175,Revision of scrotum,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55180,Revision of scrotum,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55200,Incision of sperm duct,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55250,Removal of sperm duct(s),Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55400,Repair of sperm duct,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55450,Ligation of sperm duct,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55500,Removal of hydrocele,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55520,Removal of sperm cord lesion,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55530,Revise spermatic cord veins,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55535,Revise spermatic cord veins,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55540,Revise hernia & sperm veins,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55550,Laparo ligate spermatic vein,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55559,Laparo proc spermatic cord,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55600,Incise sperm duct pouch,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55605,Incise sperm duct pouch,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55650,Remove sperm duct pouch,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55680,Remove sperm pouch lesion,Urological Surgery,Per Unit,"$1,364.21 ",OP,"$1,364.21 ","$1,364.21 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55801,Removal of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55810,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55815,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55821,Removal of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55831,Removal of prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55840,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55842,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55845,Extensive prostate surgery,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55860,Surgical exposure prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55866,Laparo radical prostatectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55870,Electroejaculation,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,55873,Cryoablate prostate,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55874,Tprnl plmt biodegrdabl matrl,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55880,Abltj mal prst8 tiss hifu,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,55899,Genital surgery procedure,Urological Surgery,Per Unit,$977.77 ,OP,$977.77 ,$977.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,56405,I & d of vulva/perineum,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,56420,Drainage of gland abscess,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,56820,Exam of vulva w/scope,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57150,Treat vagina infection,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57160,Insert pessary/other device,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57170,Fitting of diaphragm/cap,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57220,Revision of urethra,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57230,Repair of urethral lesion,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57240,Anterior colporrhaphy,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57250,Repair rectum & vagina,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57260,Cmbn ant pst colprhy,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57265,Cmbn ap colprhy w/ntrcl rpr,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57267,Insert mesh/pelvic flr addon,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,57268,Repair of bowel bulge,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57270,Repair of bowel pouch,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57287,Revise/remove sling repair,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57288,Repair bladder defect,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57289,Repair bladder & vagina,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,57410,Pelvic examination,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58300,Insert intrauterine device,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58301,Remove intrauterine device,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58321,Artificial insemination,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58322,Artificial insemination,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58323,Sperm washing,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58970,Retrieval of oocyte,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58974,Transfer of embryo,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,58976,Transfer of embryo,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59020,Fetal contract stress test,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59025,Fetal non-stress test,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59030,Fetal scalp blood sample,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59050,Fetal monitor w/report,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59072,Umbilical cord occlud w/us,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59074,Fetal fluid drainage w/us,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59076,Fetal shunt placement w/us,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59400,Obstetrical care,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,59409,Obstetrical care,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,59410,Obstetrical care,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,59610,Vbac delivery,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,59612,Vbac delivery only,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,59614,Vbac care after delivery,Obstetrics,Per Unit,"$1,075.20 ",OP,"$1,075.20 ","$1,075.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,59812,Treatment of miscarriage,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59820,Care of miscarriage,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59821,Treatment of miscarriage,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59830,Treat uterus infection,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59840,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59841,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59850,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59851,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59852,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59855,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59856,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59857,Abortion,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59866,Abortion (mpr),Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,59897,Fetal invas px w/us,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,60000,Drain thyroid/tongue cyst,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,60100,Biopsy of thyroid,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,60300,Aspir/inj thyroid cyst,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,60650,Laparoscopy adrenalectomy,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,60659,Laparo proc endocrine,General Surgery,Per Unit,"$1,656.92 ",OP,"$1,656.92 ","$1,656.92 ",,,,,,,,,,,,,
Molina Medicaid,CPT,60699,Endocrine surgery procedure,General Surgery,Per Unit,"$1,380.09 ",OP,"$1,380.09 ","$1,380.09 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61000,Remove cranial cavity fluid,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,61001,Remove cranial cavity fluid,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,61020,Remove brain cavity fluid,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,61026,Injection into brain canal,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,61070,Brain canal shunt procedure,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,61215,Insert brain-fluid device,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61623,Endovasc tempory vessel occl,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61624,Transcath occlusion cns,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61626,Transcath occlusion non-cns,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61630,Intracranial angioplasty,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61635,Intracran angioplsty w/stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61640,Dilate ic vasospasm init,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61641,Dilat ic vspsm ea vsl sm ter,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61642,Dilat ic vspsm ea diff ter,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61645,Perq art m-thrombect &/nfs,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61651,Evasc prlng admn rx agnt add,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61720,Incise skull/brain surgery,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61770,Incise skull for treatment,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61790,Treat trigeminal nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,61791,Treat trigeminal tract,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,61796,Srs cranial lesion simple,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61797,Srs cran les simple addl,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61798,Srs cranial lesion complex,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61799,Srs cran les complex addl,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61800,Apply srs headframe add-on,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61850,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61880,Revise/remove neuroelectrode,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61885,Insrt/redo neurostim 1 array,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61886,Implant neurostim arrays,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,61888,Revise/remove neuroreceiver,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,62000,Treat skull fracture,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62194,Replace/irrigate catheter,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62225,Replace/irrigate catheter,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,62230,Replace/revise brain shunt,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,62252,Csf shunt reprogram,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62292,Njx chemonucleolysis lmbr,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62302,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62303,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62304,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62305,Myelography lumbar injection,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62310,Inject spine cerv/thoracic,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62311,Inject spine lumbar/sacral,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62318,Inject spine w/cath crv/thrc,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62319,Inject spine w/cath lmb/scrl,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62350,Implant spinal canal cath,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,62355,Remove spinal canal catheter,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62360,Insert spine infusion device,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,62361,Implant spine infusion pump,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,62362,Implant spine infusion pump,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,62365,Remove spine infusion device,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62367,Analyze spine infus pump,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62368,Analyze sp inf pump w/reprog,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62369,Anal sp inf pmp w/reprg&fill,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,62370,Anl sp inf pmp w/mdreprg&fil,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,63600,Remove spinal cord lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,63610,Stimulation of spinal cord,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,63615,Remove lesion of spinal cord,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,63620,Srs spinal lesion,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63621,Srs spinal lesion addl,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63650,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63661,Remove spine eltrd perq aray,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,63662,Remove spine eltrd plate,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,63663,Revise spine eltrd perq aray,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63664,Revise spine eltrd plate,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63685,Insrt/redo spine n generator,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63688,Revise/remove neuroreceiver,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63707,Repair spinal fluid leakage,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63741,Install spinal shunt,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63744,Revision of spinal shunt,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,63746,Removal of spinal shunt,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64400,Njx aa&/strd trigeminal nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64402,N block inj facial,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64405,Njx aa&/strd gr ocpl nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64408,Njx aa&/strd vagus nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64410,N block inj phrenic,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64412,N block inj spinal accessor,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64413,N block inj cervical plexus,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64415,Njx aa&/strd brach plexus,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64416,Njx aa&/strd brach plex nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64417,Njx aa&/strd axillary nrv,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64418,Njx aa&/strd sprscap nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64420,Njx aa&/strd ntrcost nrv 1,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64421,Njx aa&/strd ntrcost nrv ea,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64425,Njx aa&/strd ii ih nerves,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64430,Njx aa&/strd pudendal nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64435,Njx aa&/strd paracrv nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64445,Njx aa&/strd sciatic nerve,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64446,Njx aa&/strd sciatic nrv nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64447,Njx aa&/strd femoral nerve,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64448,Njx aa&/strd fem nerve nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64449,Njx aa&/strd lmbr plex nfs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64450,Njx aa&/strd other pn/branch,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64454,Njx aa&/strd gnclr nrv brnch,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64455,Njx aa&/strd pltr com dg nrv,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64486,Tap block unil by injection,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64487,Tap block uni by infusion,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64488,Tap block bi injection,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64489,Tap block bi by infusion,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64505,N block spenopalatine gangl,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64508,N block carotid sinus s/p,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64510,N block stellate ganglion,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64517,N block inj hypogas plxs,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64530,N block inj celiac pelus,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64550,Appl surface neurostimulator,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64553,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64555,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64561,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64565,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64566,Neuroeltrd stim post tibial,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64568,Inc for vagus n elect impl,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64569,Revise/repl vagus n eltrd,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64570,Remove vagus n eltrd,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64575,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64580,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64581,Implant neuroelectrodes,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64585,Revise/remove neuroelectrode,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64590,Insrt/redo pn/gastr stimul,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64595,Revise/rmv pn/gastr stimul,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64600,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64605,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64610,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64611,Chemodenerv saliv glands,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64612,Destroy nerve face muscle,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64615,Chemodenerv musc migraine,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64616,Chemodenerv musc neck dyston,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64617,Chemodener muscle larynx emg,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64620,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64624,Dstrj nulyt agt gnclr nrv,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64625,Rf abltj nrv nrvtg si jt,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64630,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64632,N block inj common digit,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64640,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64642,Chemodenerv 1 extremity 1-4,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64643,Chemodenerv 1 extrem 1-4 ea,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64644,Chemodenerv 1 extrem 5/> mus,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64645,Chemodenerv 1 extrem 5/> ea,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64646,Chemodenerv trunk musc 1-5,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64647,Chemodenerv trunk musc 6/>,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64650,Chemodenerv eccrine glands,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64653,Chemodenerv eccrine glands,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64680,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64681,Injection treatment of nerve,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64702,Revise finger/toe nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64704,Revise hand/foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64708,Revise arm/leg nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64712,Revision of sciatic nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64713,Revision of arm nerve(s),Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64714,Revise low back nerve(s),Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64716,Revision of cranial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64718,Revise ulnar nerve at elbow,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64719,Revise ulnar nerve at wrist,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64721,Carpal tunnel surgery,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64722,Relieve pressure on nerve(s),Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64726,Release foot/toe nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64727,Internal nerve revision,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64732,Incision of brow nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64734,Incision of cheek nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64736,Incision of chin nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64738,Incision of jaw nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64740,Incision of tongue nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64742,Incision of facial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64744,Incise nerve back of head,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64746,Incise diaphragm nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64763,Incise hip/thigh nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64766,Incise hip/thigh nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64771,Sever cranial nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64772,Incision of spinal nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64774,Remove skin nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64776,Remove digit nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64778,Digit nerve surgery add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64782,Remove limb nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64783,Limb nerve surgery add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64784,Remove nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64786,Remove sciatic nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64787,Implant nerve end,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64788,Remove skin nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64790,Removal of nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64792,Removal of nerve lesion,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64795,Biopsy of nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64802,Sympathectomy cervical,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64804,Remove sympathetic nerves,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64818,Remove sympathetic nerves,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64820,Sympathectomy digital artery,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64821,Remove sympathetic nerves,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64822,Remove sympathetic nerves,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64823,Sympathectomy supfc palmar,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64831,Repair of digit nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64832,Repair nerve add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64834,Repair of hand or foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64835,Repair of hand or foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64836,Repair of hand or foot nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64837,Repair nerve add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64840,Repair of leg nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64856,Repair/transpose nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64857,Repair arm/leg nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64858,Repair sciatic nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64859,Nerve surgery,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64861,Repair of arm nerves,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64862,Repair of low back nerves,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64864,Repair of facial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64865,Repair of facial nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64866,Fusion of facial/other nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64868,Fusion of facial/other nerve,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64872,Subsequent repair of nerve,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64874,Repair & revise nerve add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64876,Repair nerve/shorten bone,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64885,Nerve graft head/neck 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64886,Nerve graft head/neck >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64890,Nerve graft hand/foot 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64891,Nerve graft hand/foot >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64892,Nerve graft arm/leg <4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64893,Nerve graft arm/leg >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64895,Nerve graft hand/foot 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64896,Nerve graft hand/foot >4 cm,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64897,Nerve graft arm/leg 4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64898,Nerve graft arm/leg >4 cm,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64901,Nerve graft add-on,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,64902,Nerve graft add-on,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64905,Nerve pedicle transfer,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64907,Nerve pedicle transfer,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64910,Nerve repair w/allograft,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64911,Neurorraphy w/vein autograft,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64912,Nrv rpr w/nrv algrft 1st,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64913,Nrv rpr w/nrv algrft ea addl,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,64999,Nervous system surgery,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65091,Revise eye,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65093,Revise eye with implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65101,Removal of eye,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65103,Remove eye/insert implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65105,Remove eye/attach implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65110,Removal of eye,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65112,Remove eye/revise socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65114,Remove eye/revise socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65125,Revise ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65130,Insert ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65135,Insert ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65140,Attach ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65150,Revise ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65155,Reinsert ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65175,Removal of ocular implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65205,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65210,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65220,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65222,Remove foreign body from eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65235,Remove foreign body from eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65260,Remove foreign body from eye,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65265,Remove foreign body from eye,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65270,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65272,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65275,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65280,Repair of eye wound,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65285,Repair of eye wound,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65286,Repair of eye wound,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65290,Repair of eye socket wound,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65400,Removal of eye lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65410,Biopsy of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65420,Removal of eye lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65426,Removal of eye lesion,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65430,Corneal smear,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65435,Curette/treat cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65436,Curette/treat cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65450,Treatment of corneal lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65600,Revision of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65710,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65730,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65750,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65755,Corneal transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65756,Corneal trnspl endothelial,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65757,Prep corneal endo allograft,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65760,Revision of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65765,Revision of cornea,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65767,Corneal tissue transplant,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65770,Revise cornea with implant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65771,Radial keratotomy,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65772,Correction of astigmatism,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65775,Correction of astigmatism,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65778,Cover eye w/membrane,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65779,Cover eye w/membrane suture,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65780,Ocular reconst transplant,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65781,Ocular reconst transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65782,Ocular reconst transplant,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65785,Impltj ntrstrml crnl rng seg,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65800,Drainage of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65810,Drainage of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65815,Drainage of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65820,Relieve inner eye pressure,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65850,Incision of eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65855,Trabeculoplasty laser surg,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65860,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,65865,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65870,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65875,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65880,Incise inner eye adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65900,Remove eye lesion,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65920,Remove implant of eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,65930,Remove blood clot from eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66020,Injection treatment of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66030,Injection treatment of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66130,Remove eye lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66150,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66155,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66160,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66170,Glaucoma surgery,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66172,Incision of eye,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66174,Translum dil eye canal,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66175,Trnslum dil eye canal w/stnt,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66179,Aqueous shunt eye w/o graft,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66180,Aqueous shunt eye w/graft,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66183,Insert ant drainage device,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66184,Revision of aqueous shunt,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66185,Revise aqueous shunt eye,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66220,Repair eye lesion,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66225,Repair/graft eye lesion,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66250,Follow-up surgery of eye,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66500,Incision of iris,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66505,Incision of iris,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66600,Remove iris and lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66605,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66625,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66630,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66635,Removal of iris,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66680,Repair iris & ciliary body,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66682,Repair iris & ciliary body,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66700,Destruction ciliary body,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66710,Ciliary transsleral therapy,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66711,Ecp ciliary body destruction,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66720,Destruction ciliary body,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66740,Destruction ciliary body,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66761,Revision of iris,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66762,Revision of iris,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66770,Removal of inner eye lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66820,Incision secondary cataract,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66821,After cataract laser surgery,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66825,Reposition intraocular lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66830,Removal of lens lesion,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66840,Removal of lens material,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66850,Removal of lens material,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66852,Removal of lens material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,66920,Extraction of lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66930,Extraction of lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66940,Extraction of lens,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66982,Xcapsl ctrc rmvl cplx wo ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66983,Cataract surg w/iol 1 stage,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66984,Xcapsl ctrc rmvl w/o ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66985,Insert lens prosthesis,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66986,Exchange lens prosthesis,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66987,Xcapsl ctrc rmvl cplx w/ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66988,Xcapsl ctrc rmvl w/ecp,Ophthalmology Surgery,Per Unit,$925.52 ,OP,$925.52 ,$925.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,66999,Eye surgery procedure,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67005,Partial removal of eye fluid,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67010,Partial removal of eye fluid,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67015,Release of eye fluid,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67025,Replace eye fluid,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67027,Implant eye drug system,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67028,Injection eye drug,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67030,Incise inner eye strands,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67031,Laser surgery eye strands,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67036,Removal of inner eye fluid,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67039,Laser treatment of retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67040,Laser treatment of retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67041,Vit for macular pucker,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67042,Vit for macular hole,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67043,Vit for membrane dissect,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67101,Repair detached retina crtx,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67105,Repair detached retina pc,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67107,Repair detached retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67108,Repair detached retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67110,Repair detached retina,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67112,Rerepair detached retina,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67113,Repair retinal detach cplx,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67115,Release encircling material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67120,Remove eye implant material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67121,Remove eye implant material,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67141,Treatment of retina,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67145,Treatment of retina,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67208,Treatment of retinal lesion,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67210,Treatment of retinal lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67218,Treatment of retinal lesion,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67220,Treatment of choroid lesion,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67221,Ocular photodynamic ther,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67225,Eye photodynamic ther add-on,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67227,Dstrj extensive retinopathy,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67228,Treatment x10sv retinopathy,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67229,Tr retinal les preterm inf,Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67250,Reinforce eye wall,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67255,Reinforce/graft eye wall,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67299,Eye surgery procedure,Ophthalmology Surgery,Per Unit,"$1,212.94 ",OP,"$1,212.94 ","$1,212.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67311,Revise eye muscle,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67312,Revise two eye muscles,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67314,Revise eye muscle,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67316,Revise two eye muscles,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67318,Revise eye muscle(s),Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67320,Revise eye muscle(s) add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67331,Eye surgery follow-up add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67332,Rerevise eye muscles add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67334,Revise eye muscle w/suture,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67335,Eye suture during surgery,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67340,Revise eye muscle add-on,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67343,Release eye tissue,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67345,Destroy nerve of eye muscle,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67346,Biopsy eye muscle,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67399,Unlisted px extraocular musc,Ophthalmology Surgery,Per Unit,"$1,086.25 ",OP,"$1,086.25 ","$1,086.25 ",,,,,,,,,,,,,
Molina Medicaid,CPT,67400,Explore/biopsy eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67405,Explore/drain eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67412,Explore/treat eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67413,Explore/treat eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67414,Explr/decompress eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67415,Aspiration orbital contents,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67445,Explr/decompress eye socket,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67500,Inject/treat eye socket,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67505,Inject/treat eye socket,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67515,Inject/treat eye socket,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67550,Insert eye socket implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67560,Revise eye socket implant,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67570,Decompress optic nerve,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67599,Orbit surgery procedure,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67700,Drainage of eyelid abscess,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67710,Incision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67715,Incision of eyelid fold,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67800,Remove eyelid lesion,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67801,Remove eyelid lesions,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67805,Remove eyelid lesions,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67808,Remove eyelid lesion(s),Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67810,Biopsy eyelid & lid margin,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67820,Revise eyelashes,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67825,Revise eyelashes,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67830,Revise eyelashes,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67835,Revise eyelashes,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67840,Remove eyelid lesion,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67850,Treat eyelid lesion,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67875,Closure of eyelid by suture,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67880,Revision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67882,Revision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67900,Repair brow defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67901,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67902,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67903,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67904,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67906,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67908,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67909,Revise eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67911,Revise eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67912,Correction eyelid w/implant,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67914,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67915,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67916,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67917,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67921,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67922,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67923,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67924,Repair eyelid defect,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67930,Repair eyelid wound,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67935,Repair eyelid wound,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67938,Remove eyelid foreign body,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67950,Revision of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67961,Revision of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67966,Revision of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67971,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67973,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67974,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67975,Reconstruction of eyelid,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,67999,Revision of eyelid,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68020,Incise/drain eyelid lining,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68040,Treatment of eyelid lesions,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68100,Biopsy of eyelid lining,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68110,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68115,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68130,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68135,Remove eyelid lining lesion,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68200,Treat eyelid by injection,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68320,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68325,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68326,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68328,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68330,Revise eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68335,Revise/graft eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68340,Separate eyelid adhesions,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68360,Revise eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68362,Revise eyelid lining,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,68371,Harvest eye tissue alograft,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68399,Eyelid lining surgery,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68400,Incise/drain tear gland,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68420,Incise/drain tear sac,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68440,Incise tear duct opening,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68500,Removal of tear gland,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68505,Partial removal tear gland,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68510,Biopsy of tear gland,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68520,Removal of tear sac,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68525,Biopsy of tear sac,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68530,Clearance of tear duct,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68540,Remove tear gland lesion,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68550,Remove tear gland lesion,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68700,Repair tear ducts,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68705,Revise tear duct opening,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68720,Create tear sac drain,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68745,Create tear duct drain,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68750,Create tear duct drain,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68760,Close tear duct opening,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68761,Close tear duct opening,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68770,Close tear system fistula,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68801,Dilate tear duct opening,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68810,Probe nasolacrimal duct,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68811,Probe nasolacrimal duct,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68815,Probe nasolacrimal duct,Ophthalmology Surgery,Per Unit,$925.56 ,OP,$925.56 ,$925.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68816,Probe nl duct w/balloon,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68840,Explore/irrigate tear ducts,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,68899,Tear duct system surgery,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69005,Drain external ear lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69100,Biopsy of external ear,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69105,Biopsy of external ear canal,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69110,Remove external ear partial,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69120,Removal of external ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69140,Remove ear canal lesion(s),Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69145,Remove ear canal lesion(s),Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69150,Extensive ear canal surgery,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69155,Extensive ear/neck surgery,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69205,Clear outer ear canal,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69222,Clean out mastoid cavity,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69300,Revise external ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69310,Rebuild outer ear canal,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69320,Rebuild outer ear canal,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69399,Outer ear surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69421,Incision of eardrum,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69424,Remove ventilating tube,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69433,Create eardrum opening,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69436,Create eardrum opening,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69440,Exploration of middle ear,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69450,Eardrum revision,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69501,Mastoidectomy,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69502,Mastoidectomy,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69505,Remove mastoid structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69511,Extensive mastoid surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69530,Extensive mastoid surgery,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69540,Remove ear lesion,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69550,Remove ear lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69552,Remove ear lesion,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69601,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69602,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69603,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69604,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69605,Mastoid surgery revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69610,Repair of eardrum,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69620,Repair of eardrum,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69631,Repair eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69632,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69633,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69635,Repair eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69636,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69637,Rebuild eardrum structures,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69641,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69642,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69643,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69644,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69645,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69646,Revise middle ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69650,Release middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69660,Revise middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69661,Revise middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69662,Revise middle ear bone,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69666,Repair middle ear structures,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69667,Repair middle ear structures,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69670,Remove mastoid air cells,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69676,Remove middle ear nerve,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69700,Close mastoid fistula,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69705,Nps surg dilat eust tube uni,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69706,Nps surg dilat eust tube bi,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69710,Implant/replace hearing aid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69711,Remove/repair hearing aid,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69714,Implant temple bone w/stimul,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69715,Temple bne implnt w/stimulat,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69717,Temple bone implant revision,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69718,Revise temple bone implant,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69720,Release facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69725,Release facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69740,Repair facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69745,Repair facial nerve,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69799,Middle ear surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69801,Incise inner ear,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69805,Explore inner ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69806,Explore inner ear,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69820,Establish inner ear window,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69840,Revise inner ear window,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69905,Remove inner ear,Otolaryngology Surgery,Per Unit,"$1,520.70 ",OP,"$1,520.70 ","$1,520.70 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69910,Remove inner ear & mastoid,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69915,Incise inner ear nerve,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69930,Implant cochlear device,Otolaryngology Surgery,Per Unit,"$15,529.51 ",OP,"$15,529.51 ","$15,529.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69949,Inner ear surgery procedure,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,69955,Release facial nerve,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,69960,Release inner ear canal,Otolaryngology Surgery,Per Unit,"$2,241.51 ",OP,"$2,241.51 ","$2,241.51 ",,,,,,,,,,,,,
Molina Medicaid,CPT,70010,Contrast x-ray of brain,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70015,Contrast x-ray of brain,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70030,X-ray eye for foreign body,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70100,X-ray exam of jaw <4views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70110,X-ray exam of jaw 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70120,X-ray exam of mastoids,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70130,X-ray exam of mastoids,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70134,X-ray exam of middle ear,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70140,X-ray exam of facial bones,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70150,X-ray exam of facial bones,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70160,X-ray exam of nasal bones,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70190,X-ray exam of eye sockets,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70200,X-ray exam of eye sockets,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70210,X-ray exam of sinuses,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70220,X-ray exam of sinuses,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70240,X-ray exam pituitary saddle,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70250,X-ray exam of skull,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70260,X-ray exam of skull,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70300,X-ray exam of teeth,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70310,X-ray exam of teeth,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70320,Full mouth x-ray of teeth,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70328,X-ray exam of jaw joint,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70330,X-ray exam of jaw joints,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70336,Magnetic image jaw joint,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70350,X-ray head for orthodontia,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70355,Panoramic x-ray of jaws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70360,X-ray exam of neck,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70370,Throat x-ray & fluoroscopy,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70373,Contrast x-ray of larynx,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70380,X-ray exam of salivary gland,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70450,Ct head/brain w/o dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70460,Ct head/brain w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70470,Ct head/brain w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70480,Ct orbit/ear/fossa w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70481,Ct orbit/ear/fossa w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70482,Ct orbit/ear/fossa w/o&w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70486,Ct maxillofacial w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70487,Ct maxillofacial w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70488,Ct maxillofacial w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70490,Ct soft tissue neck w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70491,Ct soft tissue neck w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70492,Ct sft tsue nck w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70496,Ct angiography head,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70498,Ct angiography neck,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70540,Mri orbit/face/neck w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70542,Mri orbit/face/neck w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70543,Mri orbt/fac/nck w/o &w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70544,Mr angiography head w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70545,Mr angiography head w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70546,Mr angiograph head w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70547,Mr angiography neck w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70548,Mr angiography neck w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70549,Mr angiograph neck w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70551,Mri brain stem w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70552,Mri brain stem w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70553,Mri brain stem w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70554,Fmri brain by tech,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70555,Fmri brain by phys/psych,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70557,Mri brain w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70558,Mri brain w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,70559,Mri brain w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71010,Chest x-ray 1 view frontal,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71015,Chest x-ray stereo frontal,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71020,Chest x-ray 2vw frontal&latl,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71021,Chest x-ray frnt lat lordotc,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71022,Chest x-ray frnt lat oblique,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71023,Chest x-ray and fluoroscopy,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71030,Chest x-ray 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71034,Chest x-ray&fluoro 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71035,Chest x-ray special views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71045,X-ray exam chest 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71046,X-ray exam chest 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71047,X-ray exam chest 3 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71048,X-ray exam chest 4+ views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71100,X-ray exam ribs uni 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71101,X-ray exam unilat ribs/chest,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71110,X-ray exam ribs bil 3 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71111,X-ray exam ribs/chest4/> vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71120,X-ray exam breastbone 2/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71130,X-ray strenoclavic jt 3/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71250,Ct thorax dx c-,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71260,Ct thorax dx c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71270,Ct thorax dx c-/c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71271,Ct thorax lung cancer scr c-,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71275,Ct angiography chest,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71550,Mri chest w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71551,Mri chest w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71552,Mri chest w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,71555,Mri angio chest w or w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72010,X-ray exam spine ap&lat,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72020,X-ray exam of spine 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72040,X-ray exam neck spine 2-3 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72050,X-ray exam neck spine 4/5vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72052,X-ray exam neck spine 6/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72069,X-ray exam trunk spine stand,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72070,X-ray exam thorac spine 2vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72072,X-ray exam thorac spine 3vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72074,X-ray exam thorac spine4/>vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72080,X-ray exam thoracolmb 2/> vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72081,X-ray exam entire spi 1 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72082,X-ray exam entire spi 2/3 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72083,X-ray exam entire spi 4/5 vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72084,X-ray exam entire spi 6/> vw,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72090,X-ray exam scloiosis erect,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72100,X-ray exam l-s spine 2/3 vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72110,X-ray exam l-2 spine 4/>vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72114,X-ray exam l-s spine bending,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72120,X-ray bend only l-s spine,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72125,Ct neck spine w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72126,Ct neck spine w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72127,Ct neck spine w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72128,Ct chest spine w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72129,Ct chest spine w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72130,Ct chest spine w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72131,Ct lumbar spine w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72132,Ct lumbar spine w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72133,Ct lumbar spine w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72141,Mri neck spine w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72142,Mri neck spine w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72146,Mri chest spine w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72147,Mri chest spine w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72148,Mri lumbar spine w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72149,Mri lumbar spine w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72156,Mri neck spine w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72157,Mri chest spine w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72158,Mri lumbar spine w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72159,Mr angio spine w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72170,X-ray exam of pelvis,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72190,X-ray exam of pelvis,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72191,Ct angiograph pelv w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72192,Ct pelvis w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72193,Ct pelvis w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72194,Ct pelvis w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72195,Mri pelvis w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72196,Mri pelvis w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72197,Mri pelvis w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72198,Mr angio pelvis w/o & w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72200,X-ray exam si joints,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72202,X-ray exam si joints 3/> vws,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72220,X-ray exam sacrum tailbone,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72240,Myelography neck spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72255,Myelography thoracic spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72265,Myelography l-s spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72270,Myelogphy 2/> spine regions,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72275,Epidurography,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72285,Discography cerv/thor spine,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,72295,X-ray of lower spine disk,Diagnostic Radiology,Per Unit,$345.35 ,OP,$345.35 ,$345.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73000,X-ray exam of collar bone,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73010,X-ray exam of shoulder blade,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73020,X-ray exam of shoulder,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73030,X-ray exam of shoulder,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73050,X-ray exam of shoulders,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73060,X-ray exam of humerus,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73070,X-ray exam of elbow,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73080,X-ray exam of elbow,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73090,X-ray exam of forearm,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73092,X-ray exam of arm infant,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73100,X-ray exam of wrist,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73110,X-ray exam of wrist,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73120,X-ray exam of hand,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73130,X-ray exam of hand,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73140,X-ray exam of finger(s),Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73200,Ct upper extremity w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73201,Ct upper extremity w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73202,Ct uppr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73206,Ct angio upr extrm w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73218,Mri upper extremity w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73219,Mri upper extremity w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73220,Mri uppr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73221,Mri joint upr extrem w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73222,Mri joint upr extrem w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73223,Mri joint upr extr w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73225,Mr angio upr extr w/o&w/dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73500,X-ray exam of hip,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73501,X-ray exam hip uni 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73502,X-ray exam hip uni 2-3 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73503,X-ray exam hip uni 4/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73510,X-ray exam of hip,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73520,X-ray exam of hips,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73521,X-ray exam hips bi 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73522,X-ray exam hips bi 3-4 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73523,X-ray exam hips bi 5/> views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73530,X-ray exam of hip,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73540,X-ray exam of pelvis & hips,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73550,X-ray exam of thigh,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73551,X-ray exam of femur 1,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73552,X-ray exam of femur 2/>,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73560,X-ray exam of knee 1 or 2,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73562,X-ray exam of knee 3,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73564,X-ray exam knee 4 or more,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73565,X-ray exam of knees,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73590,X-ray exam of lower leg,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73592,X-ray exam of leg infant,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73600,X-ray exam of ankle,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73610,X-ray exam of ankle,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73620,X-ray exam of foot,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73630,X-ray exam of foot,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73650,X-ray exam of heel,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73660,X-ray exam of toe(s),Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73700,Ct lower extremity w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73701,Ct lower extremity w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73702,Ct lwr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73706,Ct angio lwr extr w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73718,Mri lower extremity w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73719,Mri lower extremity w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73720,Mri lwr extremity w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73721,Mri jnt of lwr extre w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73722,Mri joint of lwr extr w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73723,Mri joint lwr extr w/o&w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,73725,Mr ang lwr ext w or w/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74000,X-ray exam of abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74010,X-ray exam of abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74018,X-ray exam abdomen 1 view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74019,X-ray exam abdomen 2 views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74020,X-ray exam of abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74021,X-ray exam abdomen 3+ views,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74022,X-ray exam complete abdomen,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74150,Ct abdomen w/o dye,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74160,Ct abdomen w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74170,Ct abdomen w/o & w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74174,Ct angio abd&pelv w/o&w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74175,Ct angio abdom w/o & w/dye,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74176,Ct abd & pelvis w/o contrast,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74177,Ct abd & pelv w/contrast,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74178,Ct abd & pelv 1/> regns,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74181,Mri abdomen w/o dye,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74182,Mri abdomen w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74183,Mri abdomen w/o & w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74185,Mri angio abdom w orw/o dye,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74210,X-ray xm phrnx&/crv esoph c+,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74220,X-ray xm esophagus 1cntrst,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74235,Remove esophagus obstruction,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74261,Ct colonography dx,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74262,Ct colonography dx w/dye,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74263,Ct colonography screening,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74300,X-ray bile ducts/pancreas,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74301,X-rays at surgery add-on,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74305,X-ray bile ducts/pancreas,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74320,Contrast x-ray of bile ducts,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74327,X-ray bile stone removal,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74328,X-ray bile duct endoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74329,X-ray for pancreas endoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74330,X-ray bile/panc endoscopy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74340,X-ray guide for gi tube,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74355,X-ray guide intestinal tube,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74360,X-ray guide gi dilation,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74363,X-ray bile duct dilation,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74475,X-ray control cath insert,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74480,X-ray control cath insert,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74485,Dilation urtr/urt rs&i,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74710,X-ray measurement of pelvis,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74712,Mri fetal sngl/1st gestation,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74713,Mri fetal ea addl gestation,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,74742,X-ray fallopian tube,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75557,Cardiac mri for morph,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75559,Cardiac mri w/stress img,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75561,Cardiac mri for morph w/dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75563,Card mri w/stress img & dye,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75565,Card mri veloc flow mapping,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75571,Ct hrt w/o dye w/ca test,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75572,Ct hrt w/3d image,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75573,Ct hrt w/3d image congen,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75574,Ct angio hrt w/3d image,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75605,Contrast exam thoracic aorta,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,75635,Ct angio abdominal arteries,Interventional Radiology,Per Unit,$178.94 ,OP,$178.94 ,$178.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75705,Artery x-rays spine,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,75726,Artery x-rays abdomen,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,75736,Artery x-rays pelvis,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,75774,Artery x-ray each vessel,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,75791,Av dialysis shunt imaging,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75842,Vein x-ray adrenal glands,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,75893,Venous sampling by catheter,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,75894,X-rays transcath therapy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75896,X-rays transcath therapy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75901,Remove cva device obstruct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75902,Remove cva lumen obstruct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75945,Intravascular us,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75946,Intravascular us add-on,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75952,Endovasc repair abdom aorta,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75953,Abdom aneurysm endovas rpr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75954,Iliac aneurysm endovas rpr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75956,Xray endovasc thor ao repr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75957,Xray endovasc thor ao repr,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75958,Xray place prox ext thor ao,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75959,Xray place dist ext thor ao,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75962,Repair arterial blockage,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75964,Repair artery blockage each,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75966,Repair arterial blockage,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75968,Repair artery blockage each,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75970,Vascular biopsy,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75980,Contrast xray exam bile duct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75982,Contrast xray exam bile duct,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75984,Xray control catheter change,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,75989,Abscess drainage under x-ray,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76010,X-ray nose to rectum,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76100,X-ray exam of body section,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76101,Complex body section x-ray,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76102,Complex body section x-rays,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76120,Cine/video x-rays,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76125,Cine/video x-rays add-on,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76145,Med physic dos eval rad exps,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76380,Cat scan follow-up study,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76390,Mr spectroscopy,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76391,Mr elastography,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76496,Fluoroscopic procedure,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76497,Ct procedure,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76498,Mri procedure,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76499,Radiographic procedure,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76506,Echo exam of head,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76510,Oph us dx b-scan&quan a-scan,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76511,Oph us dx quan a-scan only,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76512,Oph us dx b-scan,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76513,Oph us dx ant sgm us uni/bi,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76514,Echo exam of eye thickness,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76516,Echo exam of eye,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76519,Echo exam of eye,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76529,Echo exam of eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76536,Us exam of head and neck,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76604,Us exam chest,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76641,Ultrasound breast complete,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76642,Ultrasound breast limited,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76700,Us exam abdom complete,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76705,Echo exam of abdomen,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76706,Us abdl aorta screen aaa,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76770,Us exam abdo back wall comp,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76775,Us exam abdo back wall lim,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76776,Us exam k transpl w/doppler,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76800,Us exam spinal canal,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76801,Ob us < 14 wks single fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76802,Ob us < 14 wks addl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76805,Ob us >= 14 wks sngl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76810,Ob us >= 14 wks addl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76811,Ob us detailed sngl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76812,Ob us detailed addl fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76813,Ob us nuchal meas 1 gest,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76814,Ob us nuchal meas add-on,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76815,Ob us limited fetus(s),Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76816,Ob us follow-up per fetus,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76817,Transvaginal us obstetric,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76818,Fetal biophys profile w/nst,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76819,Fetal biophys profil w/o nst,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76820,Umbilical artery echo,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76821,Middle cerebral artery echo,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76825,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76826,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76827,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76828,Echo exam of fetal heart,Diagnostic Radiology,Per Unit,$56.13 ,OP,$56.13 ,$56.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76830,Transvaginal us non-ob,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76831,Echo exam uterus,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76856,Us exam pelvic complete,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76857,Us exam pelvic limited,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76870,Us exam scrotum,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76872,Us transrectal,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76873,Echograp trans r pros study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76881,Us compl joint r-t w/img,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76882,Us lmtd jt/nonvasc xtr strux,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76885,Us exam infant hips dynamic,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76886,Us exam infant hips static,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76930,Echo guide cardiocentesis,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76932,Echo guide for heart biopsy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76936,Echo guide for artery repair,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76937,Us guide vascular access,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76940,Us guide tissue ablation,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76941,Echo guide for transfusion,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76942,Echo guide for biopsy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76945,Echo guide villus sampling,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76946,Echo guide for amniocentesis,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76948,Echo guide ova aspiration,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76965,Echo guidance radiotherapy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76970,Ultrasound exam follow-up,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76975,Gi endoscopic ultrasound,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76977,Us bone density measure,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76978,Us trgt dyn mbubb 1st les,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76979,Us trgt dyn mbubb ea addl,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76981,Use parenchyma,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76982,Use 1st target lesion,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76983,Use ea addl target lesion,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76998,Us guide intraop,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,76999,Echo examination procedure,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77001,Fluoroguide for vein device,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77002,Needle localization by xray,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77003,Fluoroguide for spine inject,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77011,Ct scan for localization,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77012,Ct scan for needle biopsy,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77013,Ct guide for tissue ablation,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77014,Ct scan for therapy guide,Interventional Radiology,Per Unit,$61.07 ,OP,$61.07 ,$61.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77021,Mri guidance ndl plmt rs&i,Interventional Radiology,Per Unit,$108.13 ,OP,$108.13 ,$108.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77022,Mri gdn parnchyma tiss abltj,Interventional Radiology,Per Unit,$108.13 ,OP,$108.13 ,$108.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77046,Mri breast c- unilateral,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77047,Mri breast c- bilateral,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77048,Mri breast c-+ w/cad uni,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77049,Mri breast c-+ w/cad bi,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77055,Mammogram one breast,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77056,Mammogram both breasts,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77057,Mammogram screening,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77058,Mri one breast,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77059,Mri both breasts,Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77061,Breast tomosynthesis uni,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77062,Breast tomosynthesis bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77063,Breast tomosynthesis bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77065,Dx mammo incl cad uni,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77066,Dx mammo incl cad bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77067,Scr mammo bi incl cad,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77072,X-rays for bone age,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77073,X-rays bone length studies,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77074,X-rays bone survey limited,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77076,X-rays bone survey infant,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77077,Joint survey single view,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77078,Ct bone density axial,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77080,Dxa bone density axial,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77081,Dxa bone density/peripheral,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77084,Magnetic image bone marrow,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77085,Dxa bone density study,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77086,Fracture assessment via dxa,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77261,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77262,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77263,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77280,Set radiation therapy field,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77285,Set radiation therapy field,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77290,Set radiation therapy field,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77293,Respirator motion mgmt simul,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77295,3-d radiotherapy plan,Therapeutic Radiology,Per Unit,$68.45 ,OP,$68.45 ,$68.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77299,Radiation therapy planning,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77300,Radiation therapy dose plan,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77301,Radiotherapy dose plan imrt,Therapeutic Radiology,Per Unit,$68.45 ,OP,$68.45 ,$68.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77306,Telethx isodose plan simple,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77307,Telethx isodose plan cplx,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77316,Brachytx isodose plan simple,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77317,Brachytx isodose intermed,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77318,Brachytx isodose complex,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77321,Special teletx port plan,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77331,Special radiation dosimetry,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77332,Radiation treatment aid(s),Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77333,Radiation treatment aid(s),Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77334,Radiation treatment aid(s),Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77336,Radiation physics consult,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77338,Design mlc device for imrt,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77370,Radiation physics consult,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77371,Srs multisource,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77372,Srs linear based,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77373,Sbrt delivery,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77385,Ntsty modul rad tx dlvr smpl,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77386,Ntsty modul rad tx dlvr cplx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77387,Guidance for radj tx dlvr,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77399,External radiation dosimetry,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77401,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77402,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77407,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77412,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77417,Radiology port images(s),Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77422,Neutron beam tx simple,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77423,Neutron beam tx complex,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77424,Io rad tx delivery by x-ray,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77425,Io rad tx deliver by elctrns,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77427,Radiation tx management x5,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77431,Radiation therapy management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77432,Stereotactic radiation trmt,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77435,Sbrt management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77469,Io radiation tx management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77470,Special radiation treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77499,Radiation therapy management,Therapeutic Radiology,Per Unit,$70.25 ,OP,$70.25 ,$70.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77520,Proton trmt simple w/o comp,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77522,Proton trmt simple w/comp,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77523,Proton trmt intermediate,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77525,Proton treatment complex,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77600,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77605,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77610,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77615,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77620,Hyperthermia treatment,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77750,Infuse radioactive materials,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77761,Apply intrcav radiat simple,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77762,Apply intrcav radiat interm,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77763,Apply intrcav radiat compl,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77767,Hdr rdncl skn surf brachytx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77768,Hdr rdncl skn surf brachytx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77770,Hdr rdncl ntrstl/icav brchtx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77771,Hdr rdncl ntrstl/icav brchtx,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77772,Hdr rdncl ntrstl/icav brchtx,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77776,Apply interstit radiat simpl,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77777,Apply interstit radiat inter,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77778,Apply interstit radiat compl,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77785,Hdr brachytx 1 channel,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77786,Hdr brachytx 2-12 channel,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77787,Hdr brachytx over 12 chan,Therapeutic Radiology,Per Unit,"$1,627.76 ",OP,"$1,627.76 ","$1,627.76 ",,,,,,,,,,,,,
Molina Medicaid,CPT,77789,Apply surf ldr radionuclide,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77790,Radiation handling,Therapeutic Radiology,Per Unit,$194.79 ,OP,$194.79 ,$194.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,77799,Radium/radioisotope therapy,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78012,Thyroid uptake measurement,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78013,Thyroid imaging w/blood flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78014,Thyroid imaging w/blood flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78015,Thyroid met imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78016,Thyroid met imaging/studies,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78018,Thyroid met imaging body,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78020,Thyroid met uptake,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78070,Parathyroid planar imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78071,Parathyrd planar w/wo subtrj,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78072,Parathyrd planar w/spect&ct,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78075,Adrenal cortex & medulla img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78099,Endocrine nuclear procedure,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78102,Bone marrow imaging ltd,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78103,Bone marrow imaging mult,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78104,Bone marrow imaging body,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78110,Plasma volume single,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78111,Plasma volume multiple,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78120,Red cell mass single,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78121,Red cell mass multiple,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78122,Blood volume,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78130,Red cell survival study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78135,Red cell survival kinetics,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78140,Red cell sequestration,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78185,Spleen imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78190,Platelet survival kinetics,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78191,Platelet survival,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78195,Lymph system imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78199,Blood/lymph nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78201,Liver imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78202,Liver imaging with flow,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78205,Liver imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78206,Liver image (3d) with flow,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78215,Liver and spleen imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78216,Liver & spleen image/flow,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78226,Hepatobiliary system imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78227,Hepatobil syst image w/drug,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78230,Salivary gland imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78231,Serial salivary imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78232,Salivary gland function exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78258,Esophageal motility study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78261,Gastric mucosa imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78262,Gastroesophageal reflux exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78264,Gastric emptying imag study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78265,Gastric emptying imag study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78266,Gastric emptying imag study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78267,Breath tst attain/anal c-14,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78270,Vit b-12 absorption exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78271,Vit b-12 absrp exam int fac,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78272,Vit b-12 absorp combined,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78278,Acute gi blood loss imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78282,Gi protein loss exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78290,Meckels divert exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78291,Leveen/shunt patency exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78299,Gi nuclear procedure,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78300,Bone imaging limited area,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78305,Bone imaging multiple areas,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78306,Bone imaging whole body,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78315,Bone imaging 3 phase,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78320,Bone imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78350,Bone mineral single photon,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78351,Bone mineral dual photon,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78399,Musculoskeletal nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78414,Non-imaging heart function,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78428,Cardiac shunt imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78429,Myocrd img pet 1 std w/ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78430,Myocrd img pet rst/strs w/ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78431,Myocrd img pet rst&strs ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78432,Myocrd img pet 2rtracer,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78433,Myocrd img pet 2rtracer ct,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78434,Aqmbf pet rest & rx stress,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78445,Vascular flow imaging,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78451,Ht muscle image spect sing,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78452,Ht muscle image spect mult,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78453,Ht muscle image planar sing,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78454,Ht musc image planar mult,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78456,Acute venous thrombus image,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78457,Venous thrombosis imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78458,Ven thrombosis images bilat,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78459,Myocrd img pet single study,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78466,Heart infarct image,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78468,Heart infarct image (ef),Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78469,Heart infarct image (3d),Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78472,Gated heart planar single,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78473,Gated heart multiple,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78481,Heart first pass single,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78483,Heart first pass multiple,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78491,Myocrd img pet 1std rst/strs,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78492,Myocrd img pet mlt rst&strs,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78494,Heart image spect,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78496,Heart first pass add-on,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78499,Cardiovascular nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78579,Lung ventilation imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78580,Lung perfusion imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78582,Lung ventilat&perfus imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78597,Lung perfusion differential,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78598,Lung perf&ventilat diferentl,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78599,Respiratory nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78600,Brain image < 4 views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78601,Brain image w/flow < 4 views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78605,Brain image 4+ views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78606,Brain image w/flow 4 + views,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78607,Brain imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78608,Brain imaging (pet),Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78609,Brain imaging (pet),Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78610,Brain flow imaging only,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78630,Cerebrospinal fluid scan,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78635,Csf ventriculography,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78645,Csf shunt evaluation,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78647,Cerebrospinal fluid scan,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78650,Csf leakage imaging,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78660,Nuclear exam of tear flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78699,Nervous system nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78700,Kidney imaging morphol,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78701,Kidney imaging with flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78707,K flow/funct image w/o drug,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78708,K flow/funct image w/drug,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78709,K flow/funct image multiple,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78710,Kidney imaging (3d),Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78725,Kidney function study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78730,Urinary bladder retention,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78740,Ureteral reflux study,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78761,Testicular imaging w/flow,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78799,Genitourinary nuclear exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78800,Rp loclzj tum 1 area 1 d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78801,Rp loclzj tum 2+area 1+d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78802,Rp loclzj tum whbdy 1 d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78803,Rp loclzj tum spect 1 area,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78804,Rp loclzj tum whbdy 2+d img,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78805,Abscess imaging ltd area,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78806,Abscess imaging whole body,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78807,Nuclear localization/abscess,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78811,Pet image ltd area,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78812,Pet image skull-thigh,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78813,Pet image full body,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78814,Pet image w/ct lmtd,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78815,Pet image w/ct skull-thigh,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78816,Pet image w/ct full body,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78830,Rp loclzj tum spect w/ct 1,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78831,Rp loclzj tum spect 2 areas,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78832,Rp loclzj tum spect w/ct 2,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78835,Rp quan meas single area,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,78999,Nuclear diagnostic exam,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79005,Nuclear rx oral admin,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79101,Nuclear rx iv admin,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79200,Nuclear rx intracav admin,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79300,Nuclr rx interstit colloid,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79403,Hematopoietic nuclear tx,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79440,Nuclear rx intra-articular,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79445,Nuclear rx intra-arterial,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,79999,Nuclear medicine therapy,Therapeutic Radiology,Per Unit,$174.28 ,OP,$174.28 ,$174.28 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80047,Metabolic panel ionized ca,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80048,Metabolic panel total ca,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80050,General health panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80051,Electrolyte panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80053,Comprehen metabolic panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80055,Obstetric panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80061,Lipid panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80069,Renal function panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80074,Acute hepatitis panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80076,Hepatic function panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80081,Obstetric panel,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80143,Drug assay acetaminophen,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80145,Drug assay adalimumab,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80150,Assay of amikacin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80151,Drug assay amiodarone,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80155,Drug assay caffeine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80156,Assay carbamazepine total,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80157,Assay carbamazepine free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80158,Drug assay cyclosporine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80159,Drug assay clozapine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80161,"Asy carbamazepin 10,11-epxid",Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80162,Assay of digoxin total,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80163,Assay of digoxin free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80164,Assay dipropylacetic acd tot,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80165,Dipropylacetic acid free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80167,Drug assay felbamate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80168,Assay of ethosuximide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80169,Drug assay everolimus,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80170,Assay of gentamicin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80171,Drug screen quant gabapentin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80173,Assay of haloperidol,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80175,Drug screen quan lamotrigine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80176,Assay of lidocaine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80177,Drug scrn quan levetiracetam,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80178,Assay of lithium,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80179,Drug assay salicylate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80180,Drug scrn quan mycophenolate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80181,Drug assay flecainide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80183,Drug scrn quant oxcarbazepin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80184,Assay of phenobarbital,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80185,Assay of phenytoin total,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80186,Assay of phenytoin free,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80187,Drug assay posaconazole,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80188,Assay of primidone,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80189,Drug assay itraconzaole,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80190,Assay of procainamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80192,Assay of procainamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80193,Drug assay leflunomide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80194,Assay of quinidine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80195,Assay of sirolimus,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80197,Assay of tacrolimus,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80198,Assay of theophylline,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80199,Drug screen quant tiagabine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80200,Assay of tobramycin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80201,Assay of topiramate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80202,Assay of vancomycin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80203,Drug screen quant zonisamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80204,Drug assay methotrexate,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80210,Drug assay rufinamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80230,Drug assay infliximab,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80235,Drug assay lacosamide,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80280,Drug assay vedolizumab,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80285,Drug assay voriconazole,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80299,Quantitative assay drug,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80300,Drug screen non tlc devices,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80301,Drug screen class list a,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80302,Drug screen prsmptv 1 class,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80303,Drug screen one/mult class,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80304,Drug screen one/mult class,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80305,Drug test prsmv dir opt obs,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80306,Drug test prsmv instrmnt,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80307,Drug test prsmv chem anlyzr,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80320,Drug screen quantalcohols,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80321,Alcohols biomarkers 1or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80322,Alcohols biomarkers 3/more,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80323,Alkaloids nos,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80324,Drug screen amphetamines 1/2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80325,Amphetamines 3or 4,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80326,Amphetamines 5 or more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80327,Anabolic steroid 1 or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80328,Anabolic steroid 3 or more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80329,Analgesics non-opioid 1 or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80330,Analgesics non-opioid 3-5,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80331,Analgesics non-opioid 6/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80332,Antidepressants class 1 or 2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80333,Antidepressants class 3-5,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80334,Antidepressants class 6/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80335,Antidepressant tricyclic 1/2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80336,Antidepressant tricyclic 3-5,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80337,Tricyclic & cyclicals 6/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80338,Antidepressant not specified,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80339,Antiepileptics nos 1-3,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80340,Antiepileptics nos 4-6,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80341,Antiepileptics nos 7/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80342,Antipsychotics nos 1-3,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80343,Antipsychotics nos 4-6,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80344,Antipsychotics nos 7/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80345,Drug screening barbiturates,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80346,Benzodiazepines1-12,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80347,Benzodiazepines 13 or more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80348,Drug screening buprenorphine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80349,Cannabinoids natural,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80350,Cannabinoids synthetic 1-3,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80351,Cannabinoids synthetic 4-6,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80352,Cannabinoid synthetic 7/more,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80353,Drug screening cocaine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80354,Drug screening fentanyl,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80355,Gabapentin non-blood,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80356,Heroin metabolite,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80357,Ketamine and norketamine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80358,Drug screening methadone,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80359,Methylenedioxyamphetamines,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80360,Methylphenidate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80361,Opiates 1 or more,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80362,Opioids & opiate analogs 1/2,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80363,Opioids & opiate analogs 3/4,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80364,Opioid &opiate analog 5/more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80365,Drug screening oxycodone,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80366,Drug screening pregabalin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80367,Drug screening propoxyphene,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80368,Sedative hypnotics,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80369,Skeletal muscle relaxant 1/2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80370,Skel musc relaxant 3 or more,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80371,Stimulants synthetic,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80372,Drug screening tapentadol,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80373,Drug screening tramadol,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80374,Stereoisomer analysis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80375,Drug/substance nos 1-3,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80376,Drug/substance nos 4-6,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80377,Drug/substance nos 7/more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80400,Acth stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80402,Acth stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80406,Acth stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80408,Aldosterone suppression eval,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80410,Calcitonin stimul panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80412,Crh stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80414,Testosterone response panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80415,Tot estradiol response panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80416,Renin stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80417,Renin stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80418,Pituitary evaluation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80420,Dexamethasone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80422,Glucagon tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80424,Glucagon tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80426,Gonadotropin hormone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80428,Growth hormone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80430,Growth hormone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80432,Insulin suppression panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80434,Insulin tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80435,Insulin tolerance panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80436,Metyrapone panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80438,Trh stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80439,Trh stimulation panel,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80500,Lab pathology consultation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,80502,Lab pathology consultation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81000,Urinalysis nonauto w/scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81001,Urinalysis auto w/scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81002,Urinalysis nonauto w/o scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81003,Urinalysis auto w/o scope,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81005,Urinalysis,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81007,Urine screen for bacteria,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81015,Microscopic exam of urine,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81020,Urinalysis glass test,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81025,Urine pregnancy test,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81050,Urinalysis volume measure,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81099,Urinalysis test procedure,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81105,Hpa-1 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81106,Hpa-2 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81107,Hpa-3 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81108,Hpa-4 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81109,Hpa-5 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81110,Hpa-6 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81111,Hpa-9 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81112,Hpa-15 genotyping,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81120,Idh1 common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81121,Idh2 common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81161,Dmd dup/delet analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81162,Brca1&2 gen full seq dup/del,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81163,Brca1&2 gene full seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81164,Brca1&2 gen ful dup/del alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81165,Brca1 gene full seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81166,Brca1 gene full dup/del alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81167,Brca2 gene full dup/del alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81168,Ccnd1/igh translocation alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81170,Abl1 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81171,Aff2 gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81172,Aff2 gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81173,Ar gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81174,Ar gene known famil variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81175,Asxl1 full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81176,Asxl1 gene target seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81177,Atn1 gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81178,Atxn1 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81179,Atxn2 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81180,Atxn3 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81181,Atxn7 gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81182,Atxn8os gen detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81183,Atxn10 gene detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81184,Cacna1a gen detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81185,Cacna1a gene full gene seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81186,Cacna1a gen known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81187,Cnbp gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81188,Cstb gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81189,Cstb gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81190,Cstb gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81191,Ntrk1 translocation analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81192,Ntrk2 translocation analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81193,Ntrk3 translocation analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81194,Ntrk translocation analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81200,Aspa gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81201,Apc gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81202,Apc gene known fam variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81203,Apc gene dup/delet variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81204,Ar gene charac alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81205,Bckdhb gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81206,Bcr/abl1 gene major bp,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81207,Bcr/abl1 gene minor bp,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81208,Bcr/abl1 gene other bp,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81209,Blm gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81210,Braf gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81211,Brca1&2 seq & com dup/del,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81212,Brca1&2 185&5385&6174 vrnt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81213,Brca1&2 uncom dup/del var,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81214,Brca1 full seq & com dup/del,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81215,Brca1 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81216,Brca2 gene full seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81217,Brca2 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81218,Cebpa gene full sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81219,Calr gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81220,Cftr gene com variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81221,Cftr gene known fam variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81222,Cftr gene dup/delet variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81223,Cftr gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81224,Cftr gene intron poly t,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81225,Cyp2c19 gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81226,Cyp2d6 gene com variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81227,Cyp2c9 gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81228,Cytogen micrarray copy nmbr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81229,Cytogen m array copy no&snp,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81230,Cyp3a4 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81231,Cyp3a5 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81232,Dpyd gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81233,Btk gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81234,Dmpk gene detc abnor allele,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81235,Egfr gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81236,Ezh2 gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81237,Ezh2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81238,F9 full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81239,Dmpk gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81240,F2 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81241,F5 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81242,Fancc gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81243,Fmr1 gene detection,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81244,Fmr1 gene charac alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81245,Flt3 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81246,Flt3 gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81247,G6pd gene alys cmn variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81248,G6pd known familial variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81249,G6pd full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81250,G6pc gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81251,Gba gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81252,Gjb2 gene full sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81253,Gjb2 gene known fam variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81254,Gjb6 gene com variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81255,Hexa gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81256,Hfe gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81257,Hba1/hba2 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81258,Hba1/hba2 gene fam vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81259,Hba1/hba2 full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81260,Ikbkap gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81261,Igh gene rearrange amp meth,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81262,Igh gene rearrang dir probe,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81263,Igh vari regional mutation,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81264,Igk rearrangeabn clonal pop,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81265,Str markers specimen anal,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81266,Str markers spec anal addl,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81267,Chimerism anal no cell selec,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81268,Chimerism anal w/cell select,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81269,Hba1/hba2 gene dup/del vrnts,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81270,Jak2 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81271,Htt gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81272,Kit gene targeted seq analys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81273,Kit gene analys d816 variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81274,Htt gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81275,Kras gene variants exon 2,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81276,Kras gene addl variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81277,Cytogenomic neo microra alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81278,Igh/bcl2 translocation alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81279,Jak2 gene trgt sequence alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81280,Long qt synd gene full seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81281,Long qt synd known fam var,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81282,Long qt syn gene dup/dlt var,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81283,Ifnl3 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81284,Fxn gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81285,Fxn gene charac alleles,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81286,Fxn gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81287,Mgmt gene prmtr mthyltn alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81288,Mlh1 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81289,Fxn gene known famil variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81290,Mcoln1 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81291,Mthfr gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81292,Mlh1 gene full seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81293,Mlh1 gene known variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81294,Mlh1 gene dup/delete variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81295,Msh2 gene full seq,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81296,Msh2 gene known variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81297,Msh2 gene dup/delete variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81298,Msh6 gene full seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81299,Msh6 gene known variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81300,Msh6 gene dup/delete variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81301,Microsatellite instability,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81302,Mecp2 gene full seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81303,Mecp2 gene known variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81304,Mecp2 gene dup/delet variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81305,Myd88 gene p.leu265pro vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81306,Nudt15 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81307,Palb2 gene full gene seq,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81308,Palb2 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81309,Pik3ca gene trgt seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81310,Npm1 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81311,Nras gene variants exon 2&3,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81312,Pabpn1 gene detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81313,Pca3/klk3 antigen,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81314,Pdgfra gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81315,Pml/raralpha com breakpoints,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81316,Pml/raralpha 1 breakpoint,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81317,Pms2 gene full seq analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81318,Pms2 known familial variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81319,Pms2 gene dup/delet variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81320,Plcg2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81321,Pten gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81322,Pten gene known fam variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81323,Pten gene dup/delet variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81324,Pmp22 gene dup/delet,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81325,Pmp22 gene full sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81326,Pmp22 gene known fam variant,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81327,Sept9 gen prmtr mthyltn alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81328,Slco1b1 gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81329,Smn1 gene dos/deletion alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81330,Smpd1 gene common variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81331,Snrpn/ube3a gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81332,Serpina1 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81333,Tgfbi gene common variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81334,Runx1 gene targeted seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81335,Tpmt gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81336,Smn1 gene full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81337,Smn1 gen nown famil seq vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81338,Mpl gene common variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81339,Mpl gene seq alys exon 10,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81340,Trb@ gene rearrange amplify,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81341,Trb@ gene rearrange dirprobe,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81342,Trg gene rearrangement anal,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81343,Ppp2r2b gen detc abnor allel,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81344,Tbp gene detc abnor alleles,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81345,Tert gene targeted seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81346,Tyms gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81347,Sf3b1 gene common variants,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81348,Srsf2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81350,Ugt1a1 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81351,Tp53 gene full gene sequence,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81352,Tp53 gene trgt sequence alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81353,Tp53 gene known famil vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81355,Vkorc1 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81357,U2af1 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81360,Zrsr2 gene common variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81361,Hbb gene com variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81362,Hbb gene known fam variant,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81363,Hbb gene dup/del variants,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81364,Hbb full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81370,Hla i & ii typing lr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81371,Hla i & ii type verify lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81372,Hla i typing complete lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81373,Hla i typing 1 locus lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81374,Hla i typing 1 antigen lr,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81375,Hla ii typing ag equiv lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81376,Hla ii typing 1 locus lr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81377,Hla ii type 1 ag equiv lr,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81378,Hla i & ii typing hr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81379,Hla i typing complete hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81380,Hla i typing 1 locus hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81381,Hla i typing 1 allele hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81382,Hla ii typing 1 loc hr,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81383,Hla ii typing 1 allele hr,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81400,Mopath procedure level 1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81401,Mopath procedure level 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81402,Mopath procedure level 3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81403,Mopath procedure level 4,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81404,Mopath procedure level 5,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81405,Mopath procedure level 6,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81406,Mopath procedure level 7,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81407,Mopath procedure level 8,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81408,Mopath procedure level 9,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81410,Aortic dysfunction/dilation,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81411,Aortic dysfunction/dilation,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81412,Ashkenazi jewish assoc dis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81413,Car ion chnnlpath inc 10 gns,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81414,Car ion chnnlpath inc 2 gns,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81415,Exome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81416,Exome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81417,Exome re-evaluation,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81419,Epilepsy gen seq alys panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81420,Fetal chrmoml aneuploidy,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81422,Fetal chrmoml microdeltj,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81425,Genome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81426,Genome sequence analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81427,Genome re-evaluation,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81430,Hearing loss sequence analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81431,Hearing loss dup/del analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81432,Hrdtry brst ca-rlatd dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81433,Hrdtry brst ca-rlatd dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81434,Hereditary retinal disorders,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81435,Hereditary colon ca dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81436,Hereditary colon ca dsordrs,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81437,Heredtry nurondcrn tum dsrdr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81438,Heredtry nurondcrn tum dsrdr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81439,Hrdtry cardmypy gene panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81440,Mitochondrial gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81442,Noonan spectrum disorders,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81443,Genetic tstg severe inh cond,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81445,Targeted genomic seq analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81448,Hrdtry perph neurphy panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81450,Targeted genomic seq analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81455,Targeted genomic seq analys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81460,Whole mitochondrial genome,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81465,Whole mitochondrial genome,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81470,X-linked intellectual dblt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81471,X-linked intellectual dblt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81479,Unlisted molecular pathology,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81490,Autoimmune rheumatoid arthr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81493,Cor artery disease mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81500,Onco (ovar) two proteins,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81503,Onco (ovar) five proteins,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81504,Oncology tissue of origin,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81506,Endo assay seven anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81507,Fetal aneuploidy trisom risk,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81508,Ftl cgen abnor two proteins,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81509,Ftl cgen abnor 3 proteins,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81510,Ftl cgen abnor three anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81511,Ftl cgen abnor four anal,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81512,Ftl cgen abnor five anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81513,Nfct ds bv rna vag flu alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81514,Nfct ds bv&vaginitis dna alg,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81518,Onc brst mrna 11 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81519,Oncology breast mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81520,Onc breast mrna 58 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81521,Onc breast mrna 70 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81522,Onc breast mrna 12 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81525,Oncology colon mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81528,Oncology colorectal scr,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81529,Onc cutan mlnma mrna 31 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81535,Oncology gynecologic,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81536,Oncology gynecologic,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81538,Oncology lung,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81539,Oncology prostate prob score,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81540,Oncology tum unknown origin,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81541,Onc prostate mrna 46 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81542,Onc prostate mrna 22 cnt gen,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81545,Oncology thyroid,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81546,"Onc thyr mrna 10,196 gen alg",Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81551,Onc prostate 3 genes,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81552,Onc uveal mlnma mrna 15 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81554,Pulm ds ipf mrna 190 gen alg,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81595,Cardiology hrt trnspl mrna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81596,Nfct ds chrnc hcv 6 assays,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,81599,Unlisted maaa,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82009,Test for acetone/ketones,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82010,Acetone assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82013,Acetylcholinesterase assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82016,Acylcarnitines qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82017,Acylcarnitines quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82024,Assay of acth,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82030,Assay of adp & amp,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82040,Assay of serum albumin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82042,Other source albumin quan ea,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82043,Ur albumin quantitative,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82044,Ur albumin semiquantitative,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82045,Albumin ischemia modified,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82075,Assay of breath ethanol,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82077,Assay spec xcp ur&breath ia,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82085,Assay of aldolase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82088,Assay of aldosterone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82103,Alpha-1-antitrypsin total,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82104,Alpha-1-antitrypsin pheno,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82105,Alpha-fetoprotein serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82106,Alpha-fetoprotein amniotic,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82107,Alpha-fetoprotein l3,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82108,Assay of aluminum,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82120,Amines vaginal fluid qual,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82127,Amino acid single qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82128,Amino acids mult qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82131,Amino acids single quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82135,Assay aminolevulinic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82136,Amino acids quant 2-5,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82139,Amino acids quan 6 or more,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82140,Assay of ammonia,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82143,Amniotic fluid scan,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82150,Assay of amylase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82154,Androstanediol glucuronide,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82157,Assay of androstenedione,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82160,Assay of androsterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82163,Assay of angiotensin ii,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82164,Angiotensin i enzyme test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82172,Assay of apolipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82175,Assay of arsenic,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82180,Assay of ascorbic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82190,Atomic absorption,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82232,Assay of beta-2 protein,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82239,Bile acids total,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82240,Bile acids cholylglycine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82247,Bilirubin total,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82248,Bilirubin direct,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82252,Fecal bilirubin test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82261,Assay of biotinidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82270,Occult blood feces,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82271,Occult blood other sources,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82272,Occult bld feces 1-3 tests,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82274,Assay test for blood fecal,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82286,Assay of bradykinin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82300,Assay of cadmium,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82306,Vitamin d 25 hydroxy,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82308,Assay of calcitonin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82310,Assay of calcium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82330,Assay of calcium,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82331,Calcium infusion test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82340,Assay of calcium in urine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82355,Calculus analysis qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82360,Calculus assay quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82365,Calculus spectroscopy,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82370,X-ray assay calculus,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82373,Assay c-d transfer measure,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82374,Assay blood carbon dioxide,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82375,Assay carboxyhb quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82376,Assay carboxyhb qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82378,Carcinoembryonic antigen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82379,Assay of carnitine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82380,Assay of carotene,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82382,Assay urine catecholamines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82383,Assay blood catecholamines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82384,Assay three catecholamines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82387,Assay of cathepsin-d,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82390,Assay of ceruloplasmin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82397,Chemiluminescent assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82415,Assay of chloramphenicol,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82435,Assay of blood chloride,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82436,Assay of urine chloride,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82438,Assay other fluid chlorides,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82441,Test for chlorohydrocarbons,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82465,Assay bld/serum cholesterol,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82480,Assay serum cholinesterase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82482,Assay rbc cholinesterase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82485,Assay chondroitin sulfate,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82486,Gas/liquid chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82487,Paper chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82488,Paper chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82489,Thin layer chromatography,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82491,Chromotography quant sing,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82492,Chromotography quant mult,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82495,Assay of chromium,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82507,Assay of citrate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82523,Collagen crosslinks,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82525,Assay of copper,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82528,Assay of corticosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82530,Cortisol free,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82533,Total cortisol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82540,Assay of creatine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82541,Column chromotography qual,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82542,Col chromotography qual/quan,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82543,Column chromotograph/isotope,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82544,Column chromotograph/isotope,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82550,Assay of ck (cpk),Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82552,Assay of cpk in blood,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82553,Creatine mb fraction,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82554,Creatine isoforms,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82565,Assay of creatinine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82570,Assay of urine creatinine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82575,Creatinine clearance test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82585,Assay of cryofibrinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82595,Assay of cryoglobulin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82600,Assay of cyanide,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82607,Vitamin b-12,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82608,B-12 binding capacity,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82610,Cystatin c,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82615,Test for urine cystines,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82626,Dehydroepiandrosterone,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82627,Dehydroepiandrosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82633,Desoxycorticosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82634,Deoxycortisol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82638,Assay of dibucaine number,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82642,Dihydrotestosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82652,Vit d 1 25-dihydroxy,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82656,Pancreatic elastase fecal,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82657,Enzyme cell activity,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82658,Enzyme cell activity ra,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82664,Electrophoretic test,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82668,Assay of erythropoietin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82670,Assay of total estradiol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82671,Assay of estrogens,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82672,Assay of estrogen,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82677,Assay of estriol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82679,Assay of estrone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82681,Assay dir meas fr estradiol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82693,Assay of ethylene glycol,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82696,Assay of etiocholanolone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82705,Fats/lipids feces qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82710,Fats/lipids feces quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82715,Assay of fecal fat,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82725,Assay of blood fatty acids,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82726,Long chain fatty acids,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82728,Assay of ferritin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82731,Assay of fetal fibronectin,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82735,Assay of fluoride,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82746,Assay of folic acid serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82747,Assay of folic acid rbc,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82757,Assay of semen fructose,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82759,Assay of rbc galactokinase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82760,Assay of galactose,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82775,Assay galactose transferase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82776,Galactose transferase test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82777,Galectin-3,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82784,Assay iga/igd/igg/igm each,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82785,Assay of ige,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82787,Igg 1 2 3 or 4 each,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82800,Blood ph,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82803,Blood gases any combination,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82805,Blood gases w/o2 saturation,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82810,Blood gases o2 sat only,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82820,Hemoglobin-oxygen affinity,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82930,Gastric analy w/ph ea spec,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82938,Gastrin test,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82941,Assay of gastrin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82943,Assay of glucagon,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82945,Glucose other fluid,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82946,Glucagon tolerance test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82947,Assay glucose blood quant,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82948,Reagent strip/blood glucose,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82950,Glucose test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82951,Glucose tolerance test (gtt),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82952,Gtt-added samples,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82955,Assay of g6pd enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82960,Test for g6pd enzyme,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82962,Glucose blood test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82963,Assay of glucosidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82965,Assay of gdh enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82977,Assay of ggt,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82978,Assay of glutathione,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82979,Assay rbc glutathione,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,82985,Assay of glycated protein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83001,Assay of gonadotropin (fsh),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83002,Assay of gonadotropin (lh),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83003,Assay growth hormone (hgh),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83006,Growth stimulation gene 2,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83009,H pylori (c-13) blood,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83010,Assay of haptoglobin quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83012,Assay of haptoglobins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83013,H pylori (c-13) breath,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83014,H pylori drug admin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83015,Heavy metal qual any anal,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83018,Heavy metal quant each nes,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83020,Hemoglobin electrophoresis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83021,Hemoglobin chromotography,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83026,Hemoglobin copper sulfate,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83030,Fetal hemoglobin chemical,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83033,Fetal hemoglobin assay qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83036,Glycosylated hemoglobin test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83037,Glycosylated hb home device,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83045,Blood methemoglobin test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83050,Blood methemoglobin assay,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83051,Assay of plasma hemoglobin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83060,Blood sulfhemoglobin assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83065,Assay of hemoglobin heat,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83068,Hemoglobin stability screen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83069,Assay of urine hemoglobin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83070,Assay of hemosiderin qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83080,Assay of b hexosaminidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83088,Assay of histamine,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83090,Assay of homocystine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83150,Assay of homovanillic acid,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83491,Assay of corticosteroids 17,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83497,Assay of 5-hiaa,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83498,Assay of progesterone 17-d,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83499,Assay of progesterone 20-,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83500,Assay free hydroxyproline,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83505,Assay total hydroxyproline,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83516,Immunoassay nonantibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83518,Immunoassay dipstick,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83519,Ria nonantibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83520,Immunoassay quant nos nonab,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83525,Assay of insulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83527,Assay of insulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83528,Assay of intrinsic factor,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83540,Assay of iron,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83550,Iron binding test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83570,Assay of idh enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83582,Assay of ketogenic steroids,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83586,Assay 17- ketosteroids,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83593,Fractionation ketosteroids,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83605,Assay of lactic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83615,Lactate (ld) (ldh) enzyme,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83625,Assay of ldh enzymes,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83630,Lactoferrin fecal (qual),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83631,Lactoferrin fecal (quant),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83632,Placental lactogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83633,Test urine for lactose,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83655,Assay of lead,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83661,L/s ratio fetal lung,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83662,Foam stability fetal lung,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83663,Fluoro polarize fetal lung,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83664,Lamellar bdy fetal lung,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83670,Assay of lap enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83690,Assay of lipase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83695,Assay of lipoprotein(a),Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83698,Assay lipoprotein pla2,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83700,Lipopro bld electrophoretic,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83701,Lipoprotein bld hr fraction,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83704,Lipoprotein bld quan part,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83718,Assay of lipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83719,Assay of blood lipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83721,Assay of blood lipoprotein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83722,Lipoprtn dir meas sd ldl chl,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83727,Assay of lrh hormone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83735,Assay of magnesium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83775,Assay malate dehydrogenase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83785,Assay of manganese,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83788,Mass spectrometry qual,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83789,Mass spectrometry qual/quan,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83825,Assay of mercury,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83835,Assay of metanephrines,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83857,Assay of methemalbumin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83861,Microfluid analy tears,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83864,Mucopolysaccharides,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83872,Assay synovial fluid mucin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83873,Assay of csf protein,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83874,Assay of myoglobin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83876,Assay myeloperoxidase,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83880,Assay of natriuretic peptide,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83883,Assay nephelometry not spec,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83885,Assay of nickel,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83915,Assay of nucleotidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83916,Oligoclonal bands,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83918,Organic acids total quant,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83919,Organic acids qual each,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83921,Organic acid single quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83930,Assay of blood osmolality,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83935,Assay of urine osmolality,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83937,Assay of osteocalcin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83945,Assay of oxalate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83950,Oncoprotein her-2/neu,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83951,Oncoprotein dcp,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83970,Assay of parathormone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83986,Assay ph body fluid nos,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83987,Exhaled breath condensate,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83992,Assay for phencyclidine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,83993,Assay for calprotectin fecal,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84030,Assay of blood pku,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84035,Assay of phenylketones,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84060,Assay acid phosphatase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84061,Phosphatase forensic exam,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84066,Assay prostate phosphatase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84075,Assay alkaline phosphatase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84078,Assay alkaline phosphatase,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84080,Assay alkaline phosphatases,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84081,Assay phosphatidylglycerol,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84085,Assay of rbc pg6d enzyme,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84087,Assay phosphohexose enzymes,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84100,Assay of phosphorus,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84105,Assay of urine phosphorus,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84106,Test for porphobilinogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84110,Assay of porphobilinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84112,Eval amniotic fluid protein,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84119,Test urine for porphyrins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84120,Assay of urine porphyrins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84126,Assay of feces porphyrins,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84132,Assay of serum potassium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84133,Assay of urine potassium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84134,Assay of prealbumin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84135,Assay of pregnanediol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84138,Assay of pregnanetriol,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84140,Assay of pregnenolone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84143,Assay of 17-hydroxypregneno,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84144,Assay of progesterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84145,Procalcitonin (pct),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84146,Assay of prolactin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84150,Assay of prostaglandin,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84152,Assay of psa complexed,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84153,Assay of psa total,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84154,Assay of psa free,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84155,Assay of protein serum,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84156,Assay of protein urine,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84157,Assay of protein other,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84160,Assay of protein any source,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84163,Pappa serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84165,Protein e-phoresis serum,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84166,Protein e-phoresis/urine/csf,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84181,Western blot test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84182,Protein western blot test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84202,Assay rbc protoporphyrin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84203,Test rbc protoporphyrin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84206,Assay of proinsulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84207,Assay of vitamin b-6,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84210,Assay of pyruvate,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84220,Assay of pyruvate kinase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84228,Assay of quinine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84233,Assay of estrogen,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84234,Assay of progesterone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84235,Assay of endocrine hormone,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84238,Assay nonendocrine receptor,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84244,Assay of renin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84252,Assay of vitamin b-2,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84255,Assay of selenium,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84260,Assay of serotonin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84270,Assay of sex hormone globul,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84275,Assay of sialic acid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84285,Assay of silica,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84295,Assay of serum sodium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84300,Assay of urine sodium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84302,Assay of sweat sodium,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84305,Assay of somatomedin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84307,Assay of somatostatin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84311,Spectrophotometry,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84315,Body fluid specific gravity,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84375,Chromatogram assay sugars,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84376,Sugars single qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84377,Sugars multiple qual,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84378,Sugars single quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84379,Sugars multiple quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84392,Assay of urine sulfate,Laboratory,Per Unit,$2.29 ,OP,$2.29 ,$2.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84402,Assay of free testosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84403,Assay of total testosterone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84410,Testosterone bioavailable,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84425,Assay of vitamin b-1,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84430,Assay of thiocyanate,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84431,Thromboxane urine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84432,Assay of thyroglobulin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84436,Assay of total thyroxine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84437,Assay of neonatal thyroxine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84439,Assay of free thyroxine,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84442,Assay of thyroid activity,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84443,Assay thyroid stim hormone,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84445,Assay of tsi globulin,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84446,Assay of vitamin e,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84449,Assay of transcortin,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84450,Transferase (ast) (sgot),Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84460,Alanine amino (alt) (sgpt),Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84466,Assay of transferrin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84478,Assay of triglycerides,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84479,Assay of thyroid (t3 or t4),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84480,Assay triiodothyronine (t3),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84481,Free assay (ft-3),Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84482,T3 reverse,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84484,Assay of troponin quant,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84485,Assay duodenal fluid trypsin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84488,Test feces for trypsin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84490,Assay of feces for trypsin,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84510,Assay of tyrosine,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84512,Assay of troponin qual,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84520,Assay of urea nitrogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84525,Urea nitrogen semi-quant,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84540,Assay of urine/urea-n,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84545,Urea-n clearance test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84550,Assay of blood/uric acid,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84560,Assay of urine/uric acid,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84577,Assay of feces/urobilinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84578,Test urine urobilinogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84580,Assay of urine urobilinogen,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84583,Assay of urine urobilinogen,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84585,Assay of urine vma,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84586,Assay of vip,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84588,Assay of vasopressin,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84590,Assay of vitamin a,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84591,Assay of nos vitamin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84597,Assay of vitamin k,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84600,Assay of volatiles,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84620,Xylose tolerance test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84630,Assay of zinc,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84681,Assay of c-peptide,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84702,Chorionic gonadotropin test,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84703,Chorionic gonadotropin assay,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84704,Hcg free betachain test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84830,Ovulation tests,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,84999,Clinical chemistry test,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85002,Bleeding time test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85004,Automated diff wbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85007,Bl smear w/diff wbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85008,Bl smear w/o diff wbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85009,Manual diff wbc count b-coat,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85013,Spun microhematocrit,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85014,Hematocrit,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85018,Hemoglobin,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85025,Complete cbc w/auto diff wbc,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85027,Complete cbc automated,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85032,Manual cell count each,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85041,Automated rbc count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85044,Manual reticulocyte count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85045,Automated reticulocyte count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85046,Reticyte/hgb concentrate,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85048,Automated leukocyte count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85049,Automated platelet count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85055,Reticulated platelet assay,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85060,Blood smear interpretation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85097,Bone marrow interpretation,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85130,Chromogenic substrate assay,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85170,Blood clot retraction,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85175,Blood clot lysis time,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85210,Clot factor ii prothrom spec,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85220,Blooc clot factor v test,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85230,Clot factor vii proconvertin,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85240,Clot factor viii ahg 1 stage,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85244,Clot factor viii reltd antgn,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85245,Clot factor viii vw ristoctn,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85246,Clot factor viii vw antigen,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85247,Clot factor viii multimetric,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85250,Clot factor ix ptc/chrstmas,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85260,Clot factor x stuart-power,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85270,Clot factor xi pta,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85280,Clot factor xii hageman,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85290,Clot factor xiii fibrin stab,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85291,Clot factor xiii fibrin scrn,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85292,Clot factor fletcher fact,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85293,Clot factor wght kininogen,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85300,Antithrombin iii activity,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85301,Antithrombin iii antigen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85302,Clot inhibit prot c antigen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85303,Clot inhibit prot c activity,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85305,Clot inhibit prot s total,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85306,Clot inhibit prot s free,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85307,Assay activated protein c,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85335,Factor inhibitor test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85337,Thrombomodulin,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85345,Coagulation time lee & white,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85347,Coagulation time activated,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85348,Coagulation time otr method,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85360,Euglobulin lysis,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85362,Fibrin degradation products,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85366,Fibrinogen test,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85370,Fibrinogen test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85378,Fibrin degrade semiquant,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85379,Fibrin degradation quant,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85380,Fibrin degradj d-dimer,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85384,Fibrinogen activity,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85385,Fibrinogen antigen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85390,Fibrinolysins screen i&r,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85396,Clotting assay whole blood,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85397,Clotting funct activity,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85400,Fibrinolytic plasmin,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85410,Fibrinolytic antiplasmin,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85415,Fibrinolytic plasminogen,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85420,Fibrinolytic plasminogen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85421,Fibrinolytic plasminogen,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85441,Heinz bodies direct,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85445,Heinz bodies induced,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85460,Hemoglobin fetal,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85461,Hemoglobin fetal,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85475,Hemolysin acid,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85520,Heparin assay,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85525,Heparin neutralization,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85530,Heparin-protamine tolerance,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85536,Iron stain peripheral blood,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85540,Wbc alkaline phosphatase,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85547,Rbc mechanical fragility,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85549,Muramidase,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85555,Rbc osmotic fragility,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85557,Rbc osmotic fragility,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85576,Blood platelet aggregation,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85597,Phospholipid pltlt neutraliz,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85598,Hexagnal phosph pltlt neutrl,Laboratory,Per Unit,$6.92 ,OP,$6.92 ,$6.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85610,Prothrombin time,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85611,Prothrombin test,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85612,Viper venom prothrombin time,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85613,Russell viper venom diluted,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85635,Reptilase test,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85651,Rbc sed rate nonautomated,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85652,Rbc sed rate automated,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85660,Rbc sickle cell test,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85670,Thrombin time plasma,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85675,Thrombin time titer,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85705,Thromboplastin inhibition,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85730,Thromboplastin time partial,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85732,Thromboplastin time partial,Laboratory,Per Unit,$2.33 ,OP,$2.33 ,$2.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85810,Blood viscosity examination,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,85999,Hematology procedure,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86000,Agglutinins febrile antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86001,Allergen specific igg,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86003,Allg spec ige crude xtrc ea,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86005,Allg spec ige multiallg scr,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86008,Allg spec ige recomb ea,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86021,Wbc antibody identification,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86022,Platelet antibodies,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86023,Immunoglobulin assay,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86038,Antinuclear antibodies,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86039,Antinuclear antibodies (ana),Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86060,Antistreptolysin o titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86063,Antistreptolysin o screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86140,C-reactive protein,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86141,C-reactive protein hs,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86146,Beta-2 glycoprotein antibody,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86147,Cardiolipin antibody ea ig,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86148,Anti-phospholipid antibody,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86152,Cell enumeration & id,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86153,Cell enumeration phys interp,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86155,Chemotaxis assay,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86156,Cold agglutinin screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86157,Cold agglutinin titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86160,Complement antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86161,Complement/function activity,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86162,Complement total (ch50),Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86171,Complement fixation each,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86185,Counterimmunoelectrophoresis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86200,Ccp antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86215,Deoxyribonuclease antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86225,Dna antibody native,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86226,Dna antibody single strand,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86235,Nuclear antigen antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86243,Fc receptor,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86255,Fluorescent antibody screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86256,Fluorescent antibody titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86277,Growth hormone antibody,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86280,Hemagglutination inhibition,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86294,Immunoassay tumor qual,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86300,Immunoassay tumor ca 15-3,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86301,Immunoassay tumor ca 19-9,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86304,Immunoassay tumor ca 125,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86305,Human epididymis protein 4,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86308,Heterophile antibody screen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86309,Heterophile antibody titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86310,Heterophile antibody absrbj,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86316,Immunoassay tumor other,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86317,Immunoassay infectious agent,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86318,Ia infectious agent antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86320,Serum immunoelectrophoresis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86325,Other immunoelectrophoresis,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86327,Immunoelectrophoresis assay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86328,Ia nfct ab sarscov2 covid19,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86329,Immunodiffusion nes,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86331,Immunodiffusion ouchterlony,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86332,Immune complex assay,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86334,Immunofix e-phoresis serum,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86335,Immunfix e-phorsis/urine/csf,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86336,Inhibin a,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86337,Insulin antibodies,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86340,Intrinsic factor antibody,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86341,Islet cell antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86343,Leukocyte histamine release,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86344,Leukocyte phagocytosis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86352,Cell function assay w/stim,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86353,Lymphocyte transformation,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86355,B cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86356,Mononuclear cell antigen,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86357,Nk cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86359,T cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86360,T cell absolute count/ratio,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86361,T cell absolute count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86367,Stem cells total count,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86376,Microsomal antibody each,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86378,Migration inhibitory factor,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86382,Neutralization test viral,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86384,Nitroblue tetrazolium dye,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86386,Nuclear matrix protein 22,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86403,Particle agglut antbdy scrn,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86406,Particle agglut antbdy titr,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86408,Neutrlzg antb sarscov2 scr,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86409,Neutrlzg antb sarscov2 titer,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86413,Sars-cov-2 antb quantitative,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86430,Rheumatoid factor test qual,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86431,Rheumatoid factor quant,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86480,Tb test cell immun measure,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86481,Tb ag response t-cell susp,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86485,Skin test candida,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86486,Skin test nos antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86490,Coccidioidomycosis skin test,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86510,Histoplasmosis skin test,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86580,Tb intradermal test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86590,Streptokinase antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86592,Syphilis test non-trep qual,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86593,Syphilis test non-trep quant,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86602,Antinomyces antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86603,Adenovirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86606,Aspergillus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86609,Bacterium antibody,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86611,Bartonella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86612,Blastomyces antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86615,Bordetella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86617,Lyme disease antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86618,Lyme disease antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86619,Borrelia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86622,Brucella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86625,Campylobacter antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86628,Candida antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86631,Chlamydia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86632,Chlamydia igm antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86635,Coccidioides antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86638,Q fever antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86641,Cryptococcus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86644,Cmv antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86645,Cmv antibody igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86648,Diphtheria antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86651,Encephalitis californ antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86652,Encephaltis east eqne anbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86653,Encephaltis st louis antbody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86654,Encephaltis west eqne antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86658,Enterovirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86663,Epstein-barr antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86664,Epstein-barr nuclear antigen,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86665,Epstein-barr capsid vca,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86666,Ehrlichia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86668,Francisella tularensis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86671,Fungus nes antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86674,Giardia lamblia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86677,Helicobacter pylori antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86682,Helminth antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86684,Hemophilus influenza antibdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86687,Htlv-i antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86688,Htlv-ii antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86689,Htlv/hiv confirmj antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86692,Hepatitis delta agent antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86694,Herpes simplex nes antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86695,Herpes simplex type 1 test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86696,Herpes simplex type 2 test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86698,Histoplasma antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86701,Hiv-1antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86702,Hiv-2 antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86703,Hiv-1/hiv-2 1 result antbdy,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86704,Hep b core antibody total,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86705,Hep b core antibody igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86706,Hep b surface antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86707,Hepatitis be antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86708,Hepatitis a antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86709,Hepatitis a igm antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86710,Influenza virus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86711,John cunningham antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86713,Legionella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86717,Leishmania antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86720,Leptospira antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86723,Listeria monocytogenes,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86727,Lymph choriomeningitis ab,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86729,Lympho venereum antibody,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86732,Mucormycosis antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86735,Mumps antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86738,Mycoplasma antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86741,Neisseria meningitidis,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86744,Nocardia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86747,Parvovirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86750,Malaria antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86753,Protozoa antibody nos,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86756,Respiratory virus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86757,Rickettsia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86759,Rotavirus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86762,Rubella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86765,Rubeola antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86768,Salmonella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86769,Sars-cov-2 covid-19 antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86771,Shigella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86774,Tetanus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86777,Toxoplasma antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86778,Toxoplasma antibody igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86780,Treponema pallidum,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86784,Trichinella antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86787,Varicella-zoster antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86788,West nile virus ab igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86789,West nile virus antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86790,Virus antibody nos,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86793,Yersinia antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86794,Zika virus igm antibody,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86800,Thyroglobulin antibody,Laboratory,Per Unit,$8.65 ,OP,$8.65 ,$8.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86803,Hepatitis c ab test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86804,Hep c ab test confirm,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86805,Lymphocytotoxicity assay,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86806,Lymphocytotoxicity assay,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86807,Cytotoxic antibody screening,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86808,Cytotoxic antibody screening,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86812,Hla typing a b or c,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86813,Hla typing a b or c,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86816,Hla typing dr/dq,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86817,Hla typing dr/dq,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86821,Lymphocyte culture mixed,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86822,Lymphocyte culture primed,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86825,Hla x-math non-cytotoxic,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86826,Hla x-match noncytotoxc addl,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86828,Hla class i&ii antibody qual,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86829,Hla class i/ii antibody qual,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86830,Hla class i phenotype qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86831,Hla class ii phenotype qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86832,Hla class i high defin qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86833,Hla class ii high defin qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86834,Hla class i semiquant panel,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86835,Hla class ii semiquant panel,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86849,Immunology procedure,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86850,Rbc antibody screen,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86860,Rbc antibody elution,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86870,Rbc antibody identification,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86880,Coombs test direct,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86885,Coombs test indirect qual,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86886,Coombs test indirect titer,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86900,Blood typing serologic abo,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86901,Blood typing serologic rh(d),Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86902,Blood type antigen donor ea,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86904,Blood typing patient serum,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86905,Blood typing rbc antigens,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86906,Bld typing serologic rh phnt,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86910,Blood typing paternity test,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86911,Blood typing antigen system,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86920,Compatibility test spin,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86921,Compatibility test incubate,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86922,Compatibility test antiglob,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86923,Compatibility test electric,Pathology,Per Unit,$23.23 ,OP,$23.23 ,$23.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86940,Hemolysins/agglutinins auto,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86941,Hemolysins/agglutinins,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,86999,Transfusion procedure,Pathology,Per Unit,$3.57 ,OP,$3.57 ,$3.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87003,Small animal inoculation,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87015,Specimen infect agnt concntj,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87040,Blood culture for bacteria,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87045,Feces culture aerobic bact,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87046,Stool cultr aerobic bact ea,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87070,Culture othr specimn aerobic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87071,Culture aerobic quant other,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87073,Culture bacteria anaerobic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87075,Cultr bacteria except blood,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87076,Culture anaerobe ident each,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87077,Culture aerobic identify,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87081,Culture screen only,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87084,Culture of specimen by kit,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87086,Urine culture/colony count,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87088,Urine bacteria culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87101,Skin fungi culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87102,Fungus isolation culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87103,Blood fungus culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87106,Fungi identification yeast,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87107,Fungi identification mold,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87109,Mycoplasma,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87110,Chlamydia culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87116,Mycobacteria culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87118,Mycobacteric identification,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87140,Culture type immunofluoresc,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87143,Culture typing glc/hplc,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87147,Culture type immunologic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87149,Dna/rna direct probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87150,Dna/rna amplified probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87152,Culture type pulse field gel,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87158,Culture typing added method,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87164,Dark field examination,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87166,Dark field examination,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87168,Macroscopic exam arthropod,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87169,Macroscopic exam parasite,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87172,Pinworm exam,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87176,Tissue homogenization cultr,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87177,Ova and parasites smears,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87181,Microbe susceptible diffuse,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87184,Microbe susceptible disk,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87185,Microbe susceptible enzyme,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87186,Microbe susceptible mic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87187,Microbe susceptible mlc,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87188,Microbe suscept macrobroth,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87190,Microbe suscept mycobacteri,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87197,Bactericidal level serum,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87205,Smear gram stain,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87206,Smear fluorescent/acid stai,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87207,Smear special stain,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87209,Smear complex stain,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87210,Smear wet mount saline/ink,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87220,Tissue exam for fungi,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87230,Assay toxin or antitoxin,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87250,Virus inoculate eggs/animal,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87252,Virus inoculation tissue,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87253,Virus inoculate tissue addl,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87254,Virus inoculation shell via,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87255,Genet virus isolate hsv,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87260,Adenovirus ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87265,Pertussis ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87267,Enterovirus antibody dfa,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87269,Giardia ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87270,Chlamydia trachomatis ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87271,Cytomegalovirus dfa,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87272,Cryptosporidium ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87273,Herpes simplex 2 ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87274,Herpes simplex 1 ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87275,Influenza b ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87276,Influenza a ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87277,Legionella micdadei ag if,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87278,Legion pneumophilia ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87279,Parainfluenza ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87280,Respiratory syncytial ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87281,Pneumocystis carinii ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87283,Rubeola ag if,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87285,Treponema pallidum ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87290,Varicella zoster ag if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87299,Antibody detection nos if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87300,Ag detection polyval if,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87301,Adenovirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87305,Aspergillus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87320,Chylmd trach ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87324,Clostridium ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87327,Cryptococcus neoform ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87328,Cryptosporidium ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87329,Giardia ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87332,Cytomegalovirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87335,E coli 0157 ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87336,Entamoeb hist dispr ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87337,Entamoeb hist group ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87338,Hpylori stool ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87339,H pylori ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87340,Hepatitis b surface ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87341,Hepatitis b surface ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87350,Hepatitis be ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87380,Hepatitis delta agent ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87385,Histoplasma capsul ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87389,Hiv-1 ag w/hiv-1&2 ab ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87390,Hiv-1 ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87391,Hiv-2 ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87400,Influenza a/b each ag ia,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87420,Resp syncytial virus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87425,Rotavirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87426,Sarscov coronavirus ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87427,Shiga-like toxin ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87428,Sarscov & inf vir a&b ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87430,Strep a ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87449,Nos each organism ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87450,Ag detect nos ia single,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87451,Polyvalent mult org ea ag ia,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87470,Bartonella dna dir probe,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87471,Bartonella dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87472,Bartonella dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87475,Lyme dis dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87476,Lyme dis dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87477,Lyme dis dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87480,Candida dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87481,Candida dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87482,Candida dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87485,Chylmd pneum dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87486,Chylmd pneum dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87487,Chylmd pneum dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87490,Chylmd trach dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87491,Chylmd trach dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87492,Chylmd trach dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87493,C diff amplified probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87495,Cytomeg dna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87496,Cytomeg dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87497,Cytomeg dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87498,Enterovirus probe&revrs trns,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87500,Vanomycin dna amp probe,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87501,Influenza dna amp prob 1+,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87502,Influenza dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87503,Influenza dna amp prob addl,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87510,Gardner vag dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87511,Gardner vag dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87512,Gardner vag dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87515,Hepatitis b dna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87516,Hepatitis b dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87517,Hepatitis b dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87520,Hepatitis c rna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87521,Hepatitis c probe&rvrs trnsc,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87522,Hepatitis c revrs trnscrpj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87525,Hepatitis g dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87526,Hepatitis g dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87527,Hepatitis g dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87528,Hsv dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87529,Hsv dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87530,Hsv dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87531,Hhv-6 dna dir probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87532,Hhv-6 dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87533,Hhv-6 dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87534,Hiv-1 dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87535,Hiv-1 probe&reverse trnscrpj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87536,Hiv-1 quant&revrse trnscrpj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87537,Hiv-2 dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87538,Hiv-2 probe&revrse trnscripj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87539,Hiv-2 quant&revrse trnscripj,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87540,Legion pneumo dna dir prob,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87541,Legion pneumo dna amp prob,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87542,Legion pneumo dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87550,Mycobacteria dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87551,Mycobacteria dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87552,Mycobacteria dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87555,M.tuberculo dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87556,M.tuberculo dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87557,M.tuberculo dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87560,M.avium-intra dna dir prob,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87561,M.avium-intra dna amp prob,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87562,M.avium-intra dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87563,M. genitalium amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87580,M.pneumon dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87581,M.pneumon dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87590,N.gonorrhoeae dna dir prob,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87591,N.gonorrhoeae dna amp prob,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87592,N.gonorrhoeae dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87623,Hpv low-risk types,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87624,Hpv high-risk types,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87625,Hpv types 16 & 18 only,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87634,Rsv dna/rna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87635,Sars-cov-2 covid-19 amp prb,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87636,Sarscov2 & inf a&b amp prb,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87637,Sarscov2&inf a&b&rsv amp prb,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87640,Staph a dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87641,Mr-staph dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87650,Strep a dna dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87651,Strep a dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87652,Strep a dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87653,Strep b dna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87660,Trichomonas vagin dir probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87661,Trichomonas vaginalis amplif,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87662,Zika virus dna/rna amp probe,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87797,Detect agent nos dna dir,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87798,Detect agent nos dna amp,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87799,Detect agent nos dna quant,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87800,Detect agnt mult dna direc,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87801,Detect agnt mult dna ampli,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87802,Strep b assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87803,Clostridium toxin a w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87804,Influenza assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87806,Hiv w/hiv1&2 antb w/optic,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87807,Rsv assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87808,Trichomonas assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87809,Adenovirus assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87810,Chylmd trach assay w/optic,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87811,Sars-cov-2 covid19 w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87850,N. gonorrhoeae assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87880,Strep a assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87899,Agent nos assay w/optic,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87904,Phenotype dna hiv w/clt add,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87905,Sialidase enzyme assay,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,87999,Microbiology procedure,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88104,Cytopath fl nongyn smears,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88106,Cytopath fl nongyn filter,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88108,Cytopath concentrate tech,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88112,Cytopath cell enhance tech,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88120,Cytp urne 3-5 probes ea spec,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88125,Forensic cytopathology,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88130,Sex chromatin identification,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88140,Sex chromatin identification,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88141,Cytopath c/v interpret,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88142,Cytopath c/v thin layer,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88143,Cytopath c/v thin layer redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88147,Cytopath c/v automated,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88148,Cytopath c/v auto rescreen,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88150,Cytopath c/v manual,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88152,Cytopath c/v auto redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88153,Cytopath c/v redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88154,Cytopath c/v select,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88155,Cytopath c/v index add-on,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88160,Cytopath smear other source,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88161,Cytopath smear other source,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88162,Cytopath smear other source,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88164,Cytopath tbs c/v manual,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88165,Cytopath tbs c/v redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88166,Cytopath tbs c/v auto redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88167,Cytopath tbs c/v select,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88172,Cytp dx eval fna 1st ea site,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88173,Cytopath eval fna report,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88174,Cytopath c/v auto in fluid,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88175,Cytopath c/v auto fluid redo,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88177,Cytp fna eval ea addl,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88182,Cell marker study,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88184,Flowcytometry/ tc 1 marker,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88187,Flowcytometry/read 2-8,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88188,Flowcytometry/read 9-15,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88189,Flowcytometry/read 16 & >,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88199,Cytopathology procedure,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88240,Cell cryopreserve/storage,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88241,Frozen cell preparation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88245,Chromosome analysis 20-25,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88248,Chromosome analysis 50-100,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88249,Chromosome analysis 100,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88261,Chromosome analysis 5,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88262,Chromosome analysis 15-20,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88263,Chromosome analysis 45,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88264,Chromosome analysis 20-25,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88267,Chromosome analys placenta,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88269,Chromosome analys amniotic,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88271,Cytogenetics dna probe,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88272,Cytogenetics 3-5,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88273,Cytogenetics 10-30,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88274,Cytogenetics 25-99,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88275,Cytogenetics 100-300,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88280,Chromosome karyotype study,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88283,Chromosome banding study,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88285,Chromosome count additional,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88289,Chromosome study additional,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88291,Cyto/molecular report,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88299,Cytogenetic study,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88300,Surgical path gross,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88302,Tissue exam by pathologist,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88304,Tissue exam by pathologist,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88305,Tissue exam by pathologist,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88311,Decalcify tissue,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88312,Special stains group 1,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88313,Special stains group 2,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88314,Histochemical stains add-on,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88321,Microslide consultation,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88323,Microslide consultation,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88325,Comprehensive review of data,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88329,Path consult introp,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88331,Path consult intraop 1 bloc,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88332,Path consult intraop addl,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88333,Intraop cyto path consult 1,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88334,Intraop cyto path consult 2,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88342,Immunohisto antb 1st stain,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88346,Immunofluor antb 1st stain,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88347,Immunofluorescent study,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88355,Analysis skeletal muscle,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88356,Analysis nerve,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88358,Analysis tumor,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88363,Xm archive tissue molec anal,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88364,Insitu hybridization (fish),Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88369,M/phmtrc alysishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88371,Protein western blot tissue,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88372,Protein analysis w/probe,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88373,M/phmtrc alys ishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88374,M/phmtrc alys ishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88375,Optical endomicroscpy interp,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88377,M/phmtrc alys ishquant/semiq,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88380,Microdissection laser,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88381,Microdissection manual,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88387,Tiss exam molecular study,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88388,Tiss ex molecul study add-on,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88399,Surgical pathology procedure,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88720,Bilirubin total transcut,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88738,Hgb quant transcutaneous,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88740,Transcutaneous carboxyhb,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88741,Transcutaneous methb,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,88749,In vivo lab service,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89050,Body fluid cell count,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89051,Body fluid cell count,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89055,Leukocyte assessment fecal,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89060,Exam synovial fluid crystals,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89125,Specimen fat stain,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89160,Exam feces for meat fibers,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89190,Nasal smear for eosinophils,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89220,Sputum specimen collection,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89230,Collect sweat for test,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89240,Pathology lab procedure,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89250,Cultr oocyte/embryo <4 days,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89253,Embryo hatching,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89254,Oocyte identification,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89255,Prepare embryo for transfer,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89257,Sperm identification,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89260,Sperm isolation simple,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89261,Sperm isolation complex,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89264,Identify sperm tissue,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89281,Assist oocyte fertilization,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89290,Biopsy oocyte polar body,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89291,Biopsy oocyte polar body,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89300,Semen analysis w/huhner,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89310,Semen analysis w/count,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89320,Semen anal vol/count/mot,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89321,Semen anal sperm detection,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89322,Semen anal strict criteria,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89325,Sperm antibody test,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89329,Sperm evaluation test,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89330,Evaluation cervical mucus,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89331,Retrograde ejaculation anal,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89335,Cryopreserve testicular tiss,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89353,Thawing cryopresrved sperm,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,89398,Unlisted reprod med lab proc,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90287,Botulinum antitoxin,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90288,Botulism ig iv,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,90291,Cmv ig iv,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,90371,Hep b ig im,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90375,Rabies ig im/sc,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90376,Rabies ig heat treated,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90377,Rabies ig ht&sol human im/sc,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90378,Rsv mab im 50mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90384,Rh ig full-dose im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90386,Rh ig iv,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,90389,Tetanus ig im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90393,Vaccina ig im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90396,Varicella-zoster ig im,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90460,Im admin 1st/only component,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90461,Im admin each addl component,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90471,Immunization admin,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90472,Immunization admin each add,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90473,Immune admin oral/nasal,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90474,Immune admin oral/nasal addl,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90476,Adenovirus vaccine type 4,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90477,Adenovirus vaccine type 7,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90581,Anthrax vaccine sc or im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90585,Bcg vaccine percut,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90586,Bcg vaccine intravesical,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90587,Dengue vacc quad 3 dose subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90619,Menacwy-tt vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90620,Menb-4c vacc 2 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90621,Menb-fhbp vacc 2/3 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90625,Cholera vaccine live oral,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90630,Flu vacc iiv4 no preserv id,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90632,Hepa vaccine adult im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90633,Hepa vacc ped/adol 2 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90634,Hepa vacc ped/adol 3 dose,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90636,Hep a/hep b vacc adult im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90644,Hib-mency vacc 6wk-18m0 im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90645,Hib vaccine hboc im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90646,Hib vaccine prp-d im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90647,Hib prp-omp vacc 3 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90648,Hib prp-t vaccine 4 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90649,4vhpv vaccine 3 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90650,2vhpv vaccine 3 dose im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90651,9vhpv vaccine 2/3 dose im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90653,Iiv adjuvant vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90654,Flu vacc iiv3 no preserv id,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90655,Iiv3 vacc no prsv 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90656,Iiv3 vacc no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90657,Iiv3 vaccine splt 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90658,Iiv3 vaccine splt 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90660,Laiv3 vaccine intranasal,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90661,Cciiv3 vac no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90662,Iiv no prsv increased ag im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90664,Laiv vacc pandemic intranasl,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90666,Flu vac pandem prsrv free im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90667,Iiv vacc pandemic adjuvt im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90668,Iiv vaccine pandemic im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90669,Pneumococcal vacc 7 val im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90670,Pcv13 vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90672,Laiv4 vaccine intranasal,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90673,Riv3 vaccine no preserv im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90674,Cciiv4 vac no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90675,Rabies vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90676,Rabies vaccine id,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90680,Rv5 vacc 3 dose live oral,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90681,Rv1 vacc 2 dose live oral,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90682,Riv4 vacc recombinant dna im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90685,Iiv4 vacc no prsv 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90686,Iiv4 vacc no prsv 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90687,Iiv4 vaccine splt 0.25 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90688,Iiv4 vaccine splt 0.5 ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90689,Vacc iiv4 no prsrv 0.25ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90690,Typhoid vaccine oral,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90691,Typhoid vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90692,Typhoid vaccine h-p sc/id,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90693,Typhoid vaccine akd sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90694,Vacc aiiv4 no prsrv 0.5ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90696,Dtap-ipv vaccine 4-6 yrs im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90697,Dtap-ipv-hib-hepb vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90698,Dtap-ipv/hib vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90700,Dtap vaccine < 7 yrs im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90702,Dt vaccine under 7 yrs im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90703,Tetanus vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90704,Mumps vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90705,Measles vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90706,Rubella vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90707,Mmr vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90708,Measles-rubella vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90710,Mmrv vaccine sc,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90712,Oral poliovirus vaccine,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90713,Poliovirus ipv sc/im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90714,Td vacc no presv 7 yrs+ im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90715,Tdap vaccine 7 yrs/> im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90716,Var vaccine live subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90717,Yellow fever vaccine subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90719,Diphtheria vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90720,Dtp/hib vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90721,Dtap/hib vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90723,Dtap-hep b-ipv vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90725,Cholera vaccine injectable,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90727,Plague vaccine im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90732,Ppsv23 vacc 2 yrs+ subq/im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90733,Mpsv4 vaccine subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90734,Menacwyd/menacwycrm vacc im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90735,Encephalitis vaccine sc,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90736,Hzv vaccine live subq,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90738,Inactivated je vacc im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90739,Hepb vacc 2 dose adult im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90740,Hepb vacc 3 dose immunsup im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90743,Hepb vacc 2 dose adolesc im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90744,Hepb vacc 3 dose ped/adol im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90746,Hepb vaccine 3 dose adult im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90747,Hepb vacc 4 dose immunsup im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90748,Hib-hepb vaccine im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90749,Vaccine toxoid,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90750,Hzv vacc recombinant im,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90756,Cciiv4 vacc abx free im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90785,Psytx complex interactive,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90791,Psych diagnostic evaluation,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90792,Psych diag eval w/med srvcs,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90832,Psytx w pt 30 minutes,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90833,Psytx w pt w e/m 30 min,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90834,Psytx w pt 45 minutes,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90836,Psytx w pt w e/m 45 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90837,Psytx w pt 60 minutes,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90838,Psytx w pt w e/m 60 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90839,Psytx crisis initial 60 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90840,Psytx crisis ea addl 30 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90845,Psychoanalysis,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90846,Family psytx w/o pt 50 min,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90847,Family psytx w/pt 50 min,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90849,Multiple family group psytx,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90853,Group psychotherapy,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90863,Pharmacologic mgmt w/psytx,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90865,Narcosynthesis,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90867,Tcranial magn stim tx plan,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90868,Tcranial magn stim tx deli,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90869,Tcran magn stim redetemine,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90870,Electroconvulsive therapy,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90875,Psychophysiological therapy,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90876,Psychophysiological therapy,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90880,Hypnotherapy,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90882,Environmental manipulation,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90885,Psy evaluation of records,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90887,Consultation with family,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90889,Preparation of report,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90899,Psychiatric service/therapy,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90901,Biofeedback train any meth,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90911,Biofeedback peri/uro/rectal,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90912,Bfb training 1st 15 min,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90913,Bfb training ea addl 15 min,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90935,Hemodialysis one evaluation,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90937,Hemodialysis repeated eval,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90940,Hemodialysis access study,Ancillary Services,Per Unit,$159.07 ,OP,$159.07 ,$159.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90945,Dialysis one evaluation,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90947,Dialysis repeated eval,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90989,Dialysis training complete,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90993,Dialysis training incompl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90997,Hemoperfusion,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,90999,Dialysis procedure,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91010,Esophagus motility study,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91013,Esophgl motil w/stim/perfus,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91020,Gastric motility studies,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91022,Duodenal motility study,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91030,Acid perfusion of esophagus,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91034,Gastroesophageal reflux test,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91035,G-esoph reflx tst w/electrod,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91037,Esoph imped function test,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91038,Esoph imped funct test > 1hr,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91040,Esoph balloon distension tst,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91110,Gi tract capsule endoscopy,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,91111,Esophageal capsule endoscopy,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91112,Gi wireless capsule measure,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91117,Colon motility 6 hr study,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91120,Rectal sensation test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91122,Anal pressure record,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91132,Electrogastrography,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91133,Electrogastrography w/test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91200,Liver elastography,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91299,Gastroenterology procedure,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91300,Sarscov2 vac 30mcg/0.3ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91301,Sarscov2 vac 100mcg/0.5ml im,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91302,Coronavirus vaccine 3,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91303,Coronavirus vaccine 4,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91304,Coronavirus vaccine 5,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91305,Coronavirus vaccine 6,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91306,Coronavirus vaccine 7,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91307,Coronavirus vaccine 8,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91308,Coronavirus vaccine 9,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91309,Coronavirus vaccine 10,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,91310,Coronavirus vaccine 11,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92015,Determine refractive state,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92018,New eye exam & treatment,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92019,Eye exam & treatment,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92020,Special eye evaluation,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92025,Corneal topography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92060,Special eye evaluation,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92065,Orthoptic/pleoptic training,Ancillary Services,Per Unit,$123.52 ,OP,$123.52 ,$123.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92071,Contact lens fitting for tx,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92072,Fit contac lens for managmnt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92081,Visual field examination(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92082,Visual field examination(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92083,Visual field examination(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92100,Serial tonometry exam(s),Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92132,Cmptr ophth dx img ant segmt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92133,Cmptr ophth img optic nerve,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92134,Cptr ophth dx img post segmt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92136,Ophthalmic biometry,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92140,Glaucoma provocative tests,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92145,Corneal hysteresis deter,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92201,Opscpy extnd rta draw uni/bi,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92202,Opscpy extnd on/mac draw,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92225,Special eye exam initial,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92226,Special eye exam subsequent,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92227,Img rta detcj/mntr ds staff,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92228,Img rta detc/mntr ds phy/qhp,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92229,Img rta detc/mntr ds poc aly,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92230,Eye exam with photos,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92235,Fluorescein angrph uni/bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92240,Icg angiography uni/bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92242,Fluorescein icg angiography,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92250,Eye exam with photos,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92260,Ophthalmoscopy/dynamometry,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92265,Eye muscle evaluation,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92270,Electro-oculography,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92273,Full field erg w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92274,Multifocal erg w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92275,Electroretinography,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92283,Color vision examination,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92284,Dark adaptation eye exam,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92285,Eye photography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92286,Internal eye photography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92287,Internal eye photography,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92310,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92311,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92312,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92313,Contact lens fitting,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92314,Prescription of contact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92315,Rx cntact lens aphakia 1 eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92316,Rx cntact lens aphakia 2 eye,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92317,Rx corneoscleral cntact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92325,Modification of contact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92326,Replacement of contact lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92340,Fit spectacles monofocal,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92341,Fit spectacles bifocal,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92342,Fit spectacles multifocal,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92352,Fit aphakia spectcl monofocl,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92353,Fit aphakia spectcl multifoc,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92354,Fit spectacles single system,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92355,Fit spectacles compound lens,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92358,Aphakia prosth service temp,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92370,Repair & adjust spectacles,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92371,Repair & adjust spectacles,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92499,Eye service or procedure,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92507,Speech/hearing therapy,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92516,Facial nerve function test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92517,Vemp test i&r cervical,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92518,Vemp test i&r ocular,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92519,Vemp tst i&r cervical&ocular,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92520,Laryngeal function studies,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92521,Evaluation of speech fluency,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92522,Evaluate speech production,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92523,Speech sound lang comprehen,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92524,Behavral qualit analys voice,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92534,Optokinetic nystagmus test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92537,Caloric vstblr test w/rec,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92538,Caloric vstblr test w/rec,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92540,Basic vestibular evaluation,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92543,Caloric vestibular test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92546,Sinusoidal rotational test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92547,Supplemental electrical test,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92548,Cdp-sot 6 cond w/i&r,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92549,Cdp-sot 6 cond w/i&r mct&adt,Otolaryngology,Per Unit,$124.37 ,OP,$124.37 ,$124.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92550,Tympanometry & reflex thresh,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92553,Audiometry air & bone,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92557,Comprehensive hearing test,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92558,Evoked auditory test qual,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92570,Acoustic immitance testing,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92572,Staggered spondaic word test,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92577,Stenger test speech,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92579,Visual audiometry (vra),Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92582,Conditioning play audiometry,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92584,Electrocochleography,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92585,Auditor evoke potent compre,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92586,Auditor evoke potent limit,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92587,Evoked auditory test limited,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92588,Evoked auditory tst complete,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92597,Oral speech device eval,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92601,Cochlear implt f/up exam <7,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92602,Reprogram cochlear implt <7,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92603,Cochlear implt f/up exam 7/>,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92604,Reprogram cochlear implt 7/>,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92605,Ex for nonspeech device rx,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92606,Non-speech device service,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92607,Ex for speech device rx 1hr,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92608,Ex for speech device rx addl,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92610,Evaluate swallowing function,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92618,Ex for nonspeech dev rx add,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92620,Auditory function 60 min,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92621,Auditory function + 15 min,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92625,Tinnitus assessment,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92626,Eval aud funcj 1st hour,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92627,Eval aud funcj ea addl 15,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92630,Aud rehab pre-ling hear loss,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92633,Aud rehab postling hear loss,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92651,Aep hearing status deter i&r,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92652,Aep thrshld est mlt freq i&r,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92653,Aep neurodiagnostic i&r,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92920,Prq cardiac angioplast 1 art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92921,Prq cardiac angio addl art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92924,Prq card angio/athrect 1 art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92925,Prq card angio/athrect addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92928,Prq card stent w/angio 1 vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92929,Prq card stent w/angio addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92933,Prq card stent/ath/angio,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92934,Prq card stent/ath/angio,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92937,Prq revasc byp graft 1 vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92938,Prq revasc byp graft addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92941,Prq card revasc mi 1 vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92943,Prq card revasc chronic 1vsl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92944,Prq card revasc chronic addl,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92950,Heart/lung resuscitation cpr,General Medicine,Per Unit,$385.17 ,OP,$385.17 ,$385.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92953,Temporary external pacing,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92960,Cardioversion electric ext,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92961,Cardioversion electric int,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92971,Cardioassist external,Cardiology,Per Unit,$347.43 ,OP,$347.43 ,$347.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92973,Prq coronary mech thrombect,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92975,Dissolve clot heart vessel,Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92977,Dissolve clot heart vessel,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92978,Endoluminl ivus oct c 1st,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92979,Endoluminl ivus oct c ea,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,92986,Revision of aortic valve,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92987,Revision of mitral valve,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92990,Revision of pulmonary valve,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92997,Pul art balloon repr percut,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,92998,Pul art balloon repr percut,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93000,Electrocardiogram complete,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93005,Electrocardiogram tracing,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93010,Electrocardiogram report,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93015,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93016,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93017,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93018,Cardiovascular stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93024,Cardiac drug stress test,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93025,Microvolt t-wave assess,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93040,Rhythm ecg with report,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93041,Rhythm ecg tracing,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93042,Rhythm ecg report,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93050,Art pressure waveform analys,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93224,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93225,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93226,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93227,Ecg monit/reprt up to 48 hrs,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93228,Remote 30 day ecg rev/report,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93229,Remote 30 day ecg tech supp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93241,Ext ecg>48hr<7d rec scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93242,Ext ecg>48hr<7d recording,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93243,Ext ecg>48hr<7d scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93244,Ext ecg>48hr<7d rev&interpj,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93245,Ext ecg>7d<15d rec scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93246,Ext ecg>7d<15d recording,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93247,Ext ecg>7d<15d scan a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93248,Ext ecg>7d<15d rev&interpj,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93260,Prgrmg dev eval impltbl sys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93261,Interrogate subq defib,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93264,Rem mntr wrls p-art prs snr,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93268,Ecg record/review,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93270,Remote 30 day ecg rev/report,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93271,Ecg/monitoring and analysis,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93272,Ecg/review interpret only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93278,Ecg/signal-averaged,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93279,Prgrmg dev eval pm/ldls pm,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93280,Pm device progr eval dual,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93281,Pm device progr eval multi,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93282,Prgrmg eval implantable dfb,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93283,Prgrmg eval implantable dfb,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93284,Prgrmg eval implantable dfb,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93285,Prgrmg dev eval scrms ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93286,Peri-px eval pm/ldls pm ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93287,Peri-px device eval & prgr,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93288,Interrog evl pm/ldls pm ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93289,Interrog device eval heart,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93290,Interrog dev eval icpms ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93291,Interrog dev eval scrms ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93292,Wcd device interrogate,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93293,Pm phone r-strip device eval,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93294,Rem interrog evl pm/ldls pm,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93295,Dev interrog remote 1/2/mlt,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93296,Rem interrog evl pm/ids,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93297,Rem interrog dev eval icpms,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93298,Rem interrog dev eval scrms,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93299,Interrog eval icpms/scrms,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93303,Echo transthoracic,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93304,Echo transthoracic,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93306,Tte w/doppler complete,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93307,Tte w/o doppler complete,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93308,Tte f-up or lmtd,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93312,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93313,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93314,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93315,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93316,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93317,Echo transesophageal,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93318,Echo transesophageal intraop,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93320,Doppler echo exam heart,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93321,Doppler echo exam heart,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93325,Doppler color flow add-on,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93350,Stress tte only,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93351,Stress tte complete,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93352,Admin ecg contrast agent,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93355,Echo transesophageal (tee),Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93356,Myocrd strain img spckl trck,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93451,Right heart cath,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93452,Left hrt cath w/ventrclgrphy,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93453,R&l hrt cath w/ventriclgrphy,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93454,Coronary artery angio s&i,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93455,Coronary art/grft angio s&i,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93456,R hrt coronary artery angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93457,R hrt art/grft angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93458,L hrt artery/ventricle angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93459,L hrt art/grft angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93460,R&l hrt art/ventricle angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93461,R&l hrt art/ventricle angio,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93462,L hrt cath trnsptl puncture,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93464,Exercise w/hemodynamic meas,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93505,Biopsy of heart lining,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93530,Rt heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93531,R & l heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93532,R & l heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93533,R & l heart cath congenital,Interventional Cardiology,Per Unit,"$1,389.31 ",OP,"$1,389.31 ","$1,389.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93600,Bundle of his recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93602,Intra-atrial recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93603,Right ventricular recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93609,Map tachycardia add-on,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93610,Intra-atrial pacing,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93612,Intraventricular pacing,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93613,Electrophys map 3d add-on,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93615,Esophageal recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93616,Esophageal recording,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93618,Heart rhythm pacing,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93619,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93620,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93621,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93622,Electrophysiology evaluation,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93623,Stimulation pacing heart,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93624,Electrophysiologic study,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93631,Heart pacing mapping,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93640,Evaluation heart device,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93641,Electrophysiology evaluation,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93642,Electrophysiology evaluation,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93644,Electrophysiology evaluation,Cardiology,Per Unit,"$2,978.06 ",OP,"$2,978.06 ","$2,978.06 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93650,Ablate heart dysrhythm focus,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93653,Ep & ablate supravent arrhyt,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93654,Ep & ablate ventric tachy,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93655,Ablate arrhythmia add on,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93656,Tx atrial fib pulm vein isol,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93657,Tx l/r atrial fib addl,Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93660,Tilt table evaluation,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93662,Intracardiac ecg (ice),Cardiology,Per Unit,"$6,831.73 ",OP,"$6,831.73 ","$6,831.73 ",,,,,,,,,,,,,
Molina Medicaid,CPT,93668,Peripheral vascular rehab,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93701,Bioimpedance cv analysis,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93702,Bis xtracell fluid analysis,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93724,Analyze pacemaker system,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93745,Set-up cardiovert-defibrill,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93750,Interrogation vad in person,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93770,Measure venous pressure,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93784,Ambl bp mntr w/software,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93786,Ambl bp mntr w/sw rec only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93788,Ambl bp mntr w/sw a/r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93790,Ambl bp mntr w/sw i&r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93792,Pt/caregiver traing home inr,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93793,Anticoag mgmt pt warfarin,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93797,Cardiac rehab,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93798,Cardiac rehab/monitor,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93799,Cardiovascular procedure,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93880,Extracranial bilat study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93882,Extracranial uni/ltd study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93886,Intracranial complete study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93888,Intracranial limited study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93890,Tcd vasoreactivity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93892,Tcd emboli detect w/o inj,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93893,Tcd emboli detect w/inj,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93895,Carotid intima atheroma eval,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93922,Upr/l xtremity art 2 levels,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93923,Upr/lxtr art stdy 3+ lvls,Cardiology,Per Unit,$174.07 ,OP,$174.07 ,$174.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93924,Lwr xtr vasc stdy bilat,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93925,Lower extremity study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93926,Lower extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93930,Upper extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93931,Upper extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93965,Extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93970,Extremity study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93971,Extremity study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93975,Vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93976,Vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93978,Vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93979,Vascular study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93980,Penile vascular study,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93981,Penile vascular study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93982,Aneurysm pressure sens study,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93985,Dup-scan hemo compl bi std,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93986,Dup-scan hemo compl uni std,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93990,Doppler flow testing,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,93998,Noninvas vasc dx study proc,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94002,Vent mgmt inpat init day,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94003,Vent mgmt inpat subq day,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94004,Vent mgmt nf per day,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94005,Home vent mgmt supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94010,Breathing capacity test,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94011,Spirometry up to 2 yrs old,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94012,Spirmtry w/brnchdil inf-2 yr,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94013,Meas lung vol thru 2 yrs,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94014,Patient recorded spirometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94015,Patient recorded spirometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94016,Review patient spirometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94060,Evaluation of wheezing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94070,Evaluation of wheezing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94150,Vital capacity test,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94200,Lung function test (mbc/mvv),Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94250,Expired gas collection,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94375,Respiratory flow volume loop,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94400,Co2 breathing response curve,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94450,Hypoxia response curve,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94452,Hast w/report,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94453,Hast w/oxygen titrate,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94610,Surfactant admin thru tube,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94617,Exercise tst brncspsm w/ecg,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94618,Pulmonary stress testing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94619,Exercise tst brncspsm wo ecg,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94620,Pulmonary stress test/simple,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94621,Cardiopulm exercise testing,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94640,Airway inhalation treatment,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94642,Aerosol inhalation treatment,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94644,Cbt 1st hour,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94645,Cbt each addl hour,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94660,Pos airway pressure cpap,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94662,Neg press ventilation cnp,Pulmonary,Per Unit,$417.61 ,OP,$417.61 ,$417.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94664,Evaluate pt use of inhaler,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94667,Chest wall manipulation,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94668,Chest wall manipulation,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94669,Mechanical chest wall oscill,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94680,Exhaled air analysis o2,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94681,Exhaled air analysis o2/co2,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94690,Exhaled air analysis,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94726,Pulm funct tst plethysmograp,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94727,Pulm function test by gas,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94728,Airwy resist by oscillometry,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94729,Co/membane diffuse capacity,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94750,Pulmonary compliance study,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94762,Measure blood oxygen level,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94770,Exhaled carbon dioxide test,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94772,Breath recording infant,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94774,Ped home apnea rec compl,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94775,Ped home apnea rec hk-up,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94776,Ped home apnea rec downld,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94777,Ped home apnea rec report,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94780,Cars/bd tst inft-12mo 60 min,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94781,Cars/bd tst inft-12mo +30min,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,94799,Pulmonary service/procedure,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95004,Percut allergy skin tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95012,Exhaled nitric oxide meas,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95017,Perq & icut allg test venoms,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95018,Perq&ic allg test drugs/biol,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95024,Icut allergy test drug/bug,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95027,Icut allergy titrate-airborn,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95028,Icut allergy test-delayed,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95044,Allergy patch tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95052,Photo patch test,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95056,Photosensitivity tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95060,Eye allergy tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95065,Nose allergy test,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95070,Bronchial allergy tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95071,Bronchial allergy tests,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95076,Ingest challenge ini 120 min,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95079,Ingest challenge addl 60 min,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95115,Immunotherapy one injection,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95117,Immunotherapy injections,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95120,Immunotherapy one injection,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95125,Immunotherapy 2/> injections,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95130,Immntx 1 sting insect,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95131,Immntx 2 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95132,Immntx 3 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95133,Immntx 4 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95134,Immntx 5 sting insects,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95144,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95145,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95146,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95147,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95148,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95149,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95165,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95170,Antigen therapy services,Ancillary Services,Per Unit,$14.01 ,OP,$14.01 ,$14.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95180,Rapid desensitization,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95199,Allergy immunology services,Ancillary Services,Per Unit,$22.49 ,OP,$22.49 ,$22.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95249,Cont gluc mntr pt prov eqp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95250,Cont gluc mntr phys/qhp eqp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95251,Cont gluc mntr analysis i&r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95700,Eeg cont rec w/vid eeg tech,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95705,Eeg w/o vid 2-12 hr unmntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95706,Eeg wo vid 2-12hr intmt mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95707,Eeg w/o vid 2-12hr cont mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95708,Eeg wo vid ea 12-26hr unmntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95709,Eeg w/o vid ea 12-26hr intmt,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95710,Eeg w/o vid ea 12-26hr cont,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95711,Veeg 2-12 hr unmonitored,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95712,Veeg 2-12 hr intmt mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95713,Veeg 2-12 hr cont mntr,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95714,Veeg ea 12-26 hr unmntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95715,Veeg ea 12-26hr intmt mntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95716,Veeg ea 12-26hr cont mntr,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95717,Eeg phys/qhp 2-12 hr w/o vid,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95718,Eeg phys/qhp 2-12 hr w/veeg,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95719,Eeg phys/qhp ea incr w/o vid,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95720,Eeg phy/qhp ea incr w/veeg,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95721,Eeg phy/qhp>36<60 hr w/o vid,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95722,Eeg phy/qhp>36<60 hr w/veeg,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95723,Eeg phy/qhp>60<84 hr w/o vid,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95724,Eeg phy/qhp>60<84 hr w/veeg,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95725,Eeg phy/qhp>84 hr w/o vid,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95726,Eeg phy/qhp>84 hr w/veeg,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95782,Polysom <6 yrs 4/> paramtrs,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95783,Polysom <6 yrs cpap/bilvl,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95803,Actigraphy testing,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95805,Multiple sleep latency test,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95807,Sleep study attended,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95808,Polysom any age 1-3> param,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95810,Polysom 6/> yrs 4/> param,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95811,Polysom 6/>yrs cpap 4/> parm,Pulmonary,Per Unit,$437.56 ,OP,$437.56 ,$437.56 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95812,Eeg 41-60 minutes,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95813,Eeg extnd mntr 61-119 min,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95816,Eeg awake and drowsy,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95819,Eeg awake and asleep,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95822,Eeg coma or sleep only,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95824,Eeg cerebral death only,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95827,Eeg all night recording,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95829,Surgery electrocorticogram,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95836,Ecog impltd brn npgt <30 d,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95857,Cholinesterase challenge,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95860,Muscle test one limb,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95861,Muscle test 2 limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95863,Muscle test 3 limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95864,Muscle test 4 limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95865,Muscle test larynx,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95866,Muscle test hemidiaphragm,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95867,Muscle test cran nerv unilat,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95868,Muscle test cran nerve bilat,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95869,Muscle test thor paraspinal,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95870,Muscle test nonparaspinal,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95872,Muscle test one fiber,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95873,Guide nerv destr elec stim,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95874,Guide nerv destr needle emg,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95875,Limb exercise test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95885,Musc tst done w/nerv tst lim,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95886,Musc test done w/n test comp,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95887,Musc tst done w/n tst nonext,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95905,Motor &/ sens nrve cndj test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95907,Nvr cndj tst 1-2 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95908,Nrv cndj tst 3-4 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95909,Nrv cndj tst 5-6 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95910,Nrv cndj test 7-8 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95911,Nrv cndj test 9-10 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95912,Nrv cndj test 11-12 studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95913,Nrv cndj test 13/> studies,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95921,Autonomic nrv parasym inervj,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95922,Autonomic nrv adrenrg inervj,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95923,Autonomic nrv syst funj test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95924,Ans parasymp & symp w/tilt,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95925,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95926,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95927,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95928,C motor evoked uppr limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95929,C motor evoked lwr limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95930,Visual ep test cns w/i&r,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95933,Blink reflex test,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95937,Neuromuscular junction test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95938,Somatosensory testing,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95939,C motor evoked upr&lwr limbs,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95943,Parasymp&symp hrt rate test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95950,Ambulatory eeg monitoring,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95951,Eeg monitoring/videorecord,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95953,Eeg monitoring/computer,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95954,Eeg monitoring/giving drugs,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95955,Eeg during surgery,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95956,Eeg monitor technol attended,Neurology,Per Unit,$261.51 ,OP,$261.51 ,$261.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95957,Eeg digital analysis,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95958,Eeg monitoring/function test,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95965,Meg spontaneous,Diagnostic Radiology,Per Unit,$221.34 ,OP,$221.34 ,$221.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95966,Meg evoked single,Diagnostic Radiology,Per Unit,$221.34 ,OP,$221.34 ,$221.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95967,Meg evoked each addl,Diagnostic Radiology,Per Unit,$221.34 ,OP,$221.34 ,$221.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95970,Alys npgt w/o prgrmg,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95971,Alys smpl sp/pn npgt w/prgrm,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95972,Alys cplx sp/pn npgt w/prgrm,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95973,Analyze neurostim complex,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95974,Cranial neurostim complex,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95975,Cranial neurostim complex,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95976,Alys smpl cn npgt prgrmg,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95977,Alys cplx cn npgt prgrmg,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95978,Analyze neurostim brain/1h,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95979,Analyz neurostim brain addon,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95980,Io anal gast n-stim init,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95981,Io anal gast n-stim subsq,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95982,Io ga n-stim subsq w/reprog,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95983,Alys brn npgt prgrmg 15 min,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95984,Alys brn npgt prgrmg addl 15,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,95999,Neurological procedure,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96000,Motion analysis video/3d,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96001,Motion test w/ft press meas,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96002,Dynamic surface emg,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96003,Dynamic fine wire emg,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96020,Functional brain mapping,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96101,Psycho testing by psych/phys,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96102,Psycho testing by technician,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96103,Psycho testing admin by comp,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96105,Assessment of aphasia,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96110,Developmental screen w/score,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96111,Developmental test extend,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96112,Devel tst phys/qhp 1st hr,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96113,Devel tst phys/qhp ea addl,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96116,Nubhvl xm phys/qhp 1st hr,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96118,Neuropsych tst by psych/phys,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96119,Neuropsych testing by tec,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96120,Neuropsych tst admin w/comp,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96121,Nubhvl xm phy/qhp ea addl hr,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96125,Cognitive test by hc pro,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96127,Brief emotional/behav assmt,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96130,Psycl tst eval phys/qhp 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96131,Psycl tst eval phys/qhp ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96132,Nrpsyc tst eval phys/qhp 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96133,Nrpsyc tst eval phys/qhp ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96136,Psycl/nrpsyc tst phy/qhp 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96137,Psycl/nrpsyc tst phy/qhp ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96138,Psycl/nrpsyc tech 1st,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96139,Psycl/nrpsyc tst tech ea,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96146,Psycl/nrpsyc tst auto result,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96150,Assess hlth/behave init,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96151,Assess hlth/behave subseq,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96153,Intervene hlth/behave group,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96154,Interv hlth/behav fam w/pt,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96155,Interv hlth/behav fam no pt,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96156,Hlth bhv assmt/reassessment,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96160,Pt-focused hlth risk assmt,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96161,Caregiver health risk assmt,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96360,Hydration iv infusion init,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96361,Hydrate iv infusion add-on,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96365,Ther/proph/diag iv inf init,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96366,Ther/proph/diag iv inf addon,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96367,Tx/proph/dg addl seq iv inf,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96368,Ther/diag concurrent inf,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96369,Sc ther infusion up to 1 hr,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96370,Sc ther infusion addl hr,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96371,Sc ther infusion reset pump,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96413,Chemo iv infusion 1 hr,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96415,Chemo iv infusion addl hr,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96416,Chemo prolong infuse w/pump,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96417,Chemo iv infus each addl seq,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96422,Chemo ia infusion up to 1 hr,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96423,Chemo ia infuse each addl hr,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96425,Chemotherapy infusion method,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96446,Chemotx admn prtl cavity,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96450,Chemotherapy into cns,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96549,Chemotherapy unspecified,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96567,Pdt dstr prmlg les skn,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96570,Photodynmc tx 30 min add-on,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96571,Photodynamic tx addl 15 min,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96573,Pdt dstr prmlg les phys/qhp,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96574,Dbrdmt prmlg les w/pdt,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96900,Ultraviolet light therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96902,Trichogram,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96913,Photochemotherapy uv-a or b,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96920,Laser tx skin < 250 sq cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96921,Laser tx skin 250-500 sq cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96922,Laser tx skin >500 sq cm,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96931,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96932,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96933,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96934,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96935,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96936,Rcm celulr subcelulr img skn,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,96999,Dermatological procedure,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97001,Pt evaluation,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97002,Pt re-evaluation,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97003,Ot evaluation,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97004,Ot re-evaluation,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97010,Hot or cold packs therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97012,Mechanical traction therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97014,Electric stimulation therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97016,Vasopneumatic device therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97018,Paraffin bath therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97022,Whirlpool therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97024,Diathermy eg microwave,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97026,Infrared therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97028,Ultraviolet therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97032,Electrical stimulation,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97033,Electric current therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97034,Contrast bath therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97035,Ultrasound therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97039,Physical therapy treatment,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97116,Gait training therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97124,Massage therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97139,Physical medicine procedure,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97161,Pt eval low complex 20 min,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97162,Pt eval mod complex 30 min,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97163,Pt eval high complex 45 min,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97164,Pt re-eval est plan care,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97165,Ot eval low complex 30 min,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97166,Ot eval mod complex 45 min,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97167,Ot eval high complex 60 min,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97168,Ot re-eval est plan care,Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97535,Self care mngment training,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97545,Work hardening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97546,Work hardening add-on,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97755,Assistive technology assess,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97762,C/o for orthotic/prosth use,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97799,Physical medicine procedure,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97802,Medical nutrition indiv in,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97803,Med nutrition indiv subseq,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97804,Medical nutrition group,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97810,Acupunct w/o stimul 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97811,Acupunct w/o stimul addl 15m,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97813,Acupunct w/stimul 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,97814,Acupunct w/stimul addl 15m,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98925,Osteopath manj 1-2 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98926,Osteopath manj 3-4 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98927,Osteopath manj 5-6 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98928,Osteopath manj 7-8 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98929,Osteopath manj 9-10 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98940,Chiropract manj 1-2 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98941,Chiropract manj 3-4 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98942,Chiropractic manj 5 regions,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98943,Chiropract manj xtrspinl 1/>,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98960,Self-mgmt educ & train 1 pt,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98961,Self-mgmt educ/train 2-4 pt,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,98962,Self-mgmt educ/train 5-8 pt,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99050,Medical services after hrs,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99051,Med serv eve/wkend/holiday,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99053,Med serv 10pm-8am 24 hr fac,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99058,Office emergency care,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99060,Out of office emerg med serv,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99078,Group health education,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99091,Collj & interpj data ea 30 d,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99100,Special anesthesia service,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99116,Anesthesia with hypothermia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99135,Special anesthesia procedure,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99140,Emergency anesthesia,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99143,Mod sedat phys/qhp <5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99144,Mod sedat phys/qhp 5yrs/>,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99145,Mod sedat phys/qhp ea 15 min,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99148,Mod sed diff phys/qhp<5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99149,Mod sed diff phys/qhp 5/>yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99150,Mod sed diff phys/qhp add on,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99151,Mod sed same phys/qhp <5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99152,Mod sed same phys/qhp 5/>yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99153,Mod sed same phys/qhp ea,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99155,Mod sed oth phys/qhp <5 yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99156,Mod sed oth phys/qhp 5/>yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99157,Mod sed other phys/qhp ea,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99172,Ocular function screen,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99173,Visual acuity screen,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99174,Ocular instrumnt screen bil,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99175,Induction of vomiting,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99177,Ocular instrumnt screen bil,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99188,App topical fluoride varnish,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99238,Hospital discharge day,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99239,Hospital discharge day,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99363,Anticoagulant mgmt initial,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99364,Anticoagulant mgmt subseq,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99366,Team conf w/pat by hc prof,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99367,Team conf w/o pat by phys,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99368,Team conf w/o pat by hc pro,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99374,Home health care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99375,Home health care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99377,Hospice care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99378,Hospice care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99379,Nursing fac care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99380,Nursing fac care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99406,Behav chng smoking 3-10 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99407,Behav chng smoking > 10 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99408,Audit/dast 15-30 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99409,Audit/dast over 30 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99439,Chrnc care mgmt svc ea addl,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99453,Rem mntr physiol param setup,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99454,Rem mntr physiol param dev,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99457,Rem physiol mntr 1st 20 min,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99458,Rem physiol mntr ea addl 20,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99465,Nb resuscitation,General Medicine,Per Unit,$385.17 ,OP,$385.17 ,$385.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99473,Self-meas bp pt educaj/train,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99474,Self-meas bp 2 readg bid 30d,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99483,Assmt & care pln pt cog imp,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99484,Care mgmt svc bhvl hlth cond,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99487,Cplx chrnc care 1st 60 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99489,Cplx chrnc care ea addl 30,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99490,Chrnc care mgmt svc 1st 20,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99491,Chrnc care mgmt svc 30 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99492,1st psyc collab care mgmt,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99493,Sbsq psyc collab care mgmt,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99494,1st/sbsq psyc collab care,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99495,Trans care mgmt 14 day disch,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99496,Trans care mgmt 7 day disch,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99497,Advncd care plan 30 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99498,Advncd care plan addl 30 min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99503,Home visit resp therapy,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,99504,Home visit mech ventilator,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0001A,Adm sarscov2 30mcg/0.3ml 1st,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0001M,Nfct ds chrnc hcv 6 assays,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0001U,Rbc dna hea 35 ag 11 bld grp,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0002A,Adm sarscov2 30mcg/0.3ml 2nd,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0002M,Liver dis 10 assays w/ash,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0002U,Onc clrct 3 ur metab alg plp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0003A,Fee covid-19 vac 1 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0003M,Liver dis 10 assays w/nash,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0003U,Onc ovar 5 prtn ser alg scor,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0004A,Fee covid-19 vac 1 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0004M,Scoliosis dna alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0004U,Nfct ds dna 27 resist genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0005U,Onco prst8 3 gene ur alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0006M,Onc hep gene risk classifier,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0006U,Detc ia meds 120+ analytes,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0007M,Onc gastro 51 gene nomogram,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0008M,Onc breast risk score,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0008U,Hpylori detcj abx rstnc dna,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0009M,Fetal aneuploidy trisom risk,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0009U,Onc brst ca erbb2 amp/nonamp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0010M,Onc prostate prob score,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0010U,Nfct ds strn typ whl gen seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0011A,Adm sarscov2 100mcg/0.5ml1st,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0011M,Onc prst8 ca mrna 12 gen alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0011U,Rx mntr lc-ms/ms oral fluid,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0012A,Adm sarscov2 100mcg/0.5ml2nd,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0012M,Onc mrna 5 gen rsk urthl ca,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0012U,Germln do gene reargmt detcj,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0013A,Fee covid-19 vac 2 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0013M,Onc mrna 5 gen recr urthl ca,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0013U,Onc sld org neo gene reargmt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0014A,Fee covid-19 vac 2 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0014M,Liver ds alys 3 bmrk srm alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0014U,Hem hmtlmf neo gene reargmt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0015M,Adrnl cortcl tum bchm asy 25,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0015U,Rx metab advrs rx rxn dna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0016M,Onc bladder mrna 209 gen alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0016U,Onc hmtlmf neo rna bcr/abl1,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0017M,Onc dlbcl mrna 20 genes alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0017U,Onc hmtlmf neo jak2 mut dna,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0018U,Onc thyr 10 microrna seq alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0019T,Extracorp shock wv tx ms nos,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0019U,Onc rna tiss predict alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0020U,Rx test prsmv ur w/def conf,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0021A,Fee covid-19 vac 3 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0021U,Onc prst8 detcj 8 autoantb,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0022A,Fee covid-19 vac 3 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0022U,Trgt gen seq dna&rna 23 gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0023A,Fee covid-19 vac 3 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0023U,Onc aml dna detcj/nondetcj,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0024A,Fee covid-19 vac 3 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0024U,Glyca nuc mr spectrsc quan,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0025U,Tenofovir liq chrom ur quan,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0026U,Onc thyr dna&mrna 112 genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0027U,Jak2 gene trgt seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0028U,Cyp2d6 gene cpy nmr cmn vrnt,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0029U,Rx metab advrs trgt seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0030U,Rx metab warf trgt seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0031A,Fee covid-19 vac 4 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0031U,Cyp1a2 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0032A,Fee covid-19 vac 4 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0032U,Comt gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0033A,Fee covid-19 vac 4 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0033U,Htr2a htr2c genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0034A,Fee covid-19 vac 4 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0034U,Tpmt nudt15 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0035U,Neuro csf prion prtn qual,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0036U,Xome tum & nml spec seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0037U,Trgt gen seq dna 324 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0038U,Vitamin d srm microsamp quan,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0039U,Dna antb 2strand hi avidity,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0040U,Bcr/abl1 gene major bp quan,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0041A,Fee covid-19 vac 5 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0041U,B brgdrferi antb 5 prtn igm,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0042A,Fee covid-19 vac 5 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0042T,Ct perfusion w/contrast cbf,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0042U,B brgdrferi antb 12 prtn igg,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0043A,Fee covid-19 vac 5 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0043U,Tbrf b grp antb 4 prtn igm,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0044A,Fee covid-19 vac 5 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0044U,Tbrf b grp antb 4 prtn igg,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0045U,Onc brst dux carc is 12 gene,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0046U,Flt3 gene itd variants quan,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0047U,Onc prst8 mrna 17 gene alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0048U,Onc sld org neo dna 468 gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0049U,Npm1 gene analysis quan,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0050U,Trgt gen seq dna 194 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0051A,Fee covid-19 vac 6 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0051U,Rx mntr lc-ms/ms ur 31 pnl,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0052A,Fee covid-19 vac 6 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0052U,Lpoprtn bld w/5 maj classes,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0053A,Fee covid-19 vac 6 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0053U,Onc prst8 ca fish alys 4 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0054A,Fee covid-19 vac 6 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0054U,Rx mntr 14+ drugs & sbsts,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0055U,Card hrt trnspl 96 dna seq,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0056U,Hem aml dna gene reargmt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0057U,Onc sld org neo mrna 51 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0058T,Cryopreservation ovary tiss,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0058U,Onc merkel cll carc srm quan,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0059U,Onc merkel cll carc srm +/-,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0060U,Twn zyg gen seq alys chrms2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0061A,Fee covid-19 vac 7 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0061U,Tc meas 5 bmrk sfdi m-s alys,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0062A,Fee covid-19 vac 7 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0062U,Ai sle igg&igm alys 80 bmrk,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0063A,Fee covid-19 vac 7 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0063U,Neuro autism 32 amines alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0064A,Fee covid-19 vac 7 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0064U,Antb tp total&rpr ia qual,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0065U,Syfls tst nontreponemal antb,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0066U,Pamg-1 ia cervico-vag fluid,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0067U,Onc brst imhchem prfl 4 bmrk,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0069U,Onc clrct microrna mir-31-3p,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0070U,Cyp2d6 gen com&slct rar vrnt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0071A,Fee covid-19 vac 8 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0071U,Cyp2d6 full gene sequence,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0072A,Fee covid-19 vac 8 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0072U,Cyp2d6 gen cyp2d6-2d7 hybrid,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0073A,Fee covid-19 vac 8 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0073U,Cyp2d6 gen cyp2d7-2d6 hybrid,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0074A,Fee covid-19 vac 8 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0074U,Cyp2d6 nonduplicated gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0075T,Perq stent/chest vert art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0075U,Cyp2d6 5' gene dup/mlt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0076T,S&i stent/chest vert art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0076U,Cyp2d6 3' gene dup/mlt,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0077U,Ig paraprotein qual bld/ur,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0078U,Pain mgt opi use gnotyp pnl,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0079U,Cmprtv dna alys mlt snps,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0080U,Onc lng 5 clin rsk factr alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0081A,Fee covid-19 vac 9 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0081U,Onc uveal mlnma mrna 15 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0082A,Fee covid-19 vac 9 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0083A,Fee covid-19 vac 9 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0083U,Onc rspse chemo cntrst tomog,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0084A,Fee covid-19 vac 9 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0084U,Rbc dna gnotyp 10 bld groups,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0085T,Breath test heart reject,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0085U,Cdtb&vinculin igg antb ia,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0086U,Nfct ds bact&fng org id 6+,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0087U,Crd hrt trnspl mrna 1283 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0088U,Trnsplj kdn algrft rej 1494,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0089U,Onc mlnma prame & linc00518,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0090U,Onc cutan mlnma mrna 23 gene,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0091A,Fee covid-19 vac 10 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0091U,Onc clrct scr whl bld alg,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0092A,Fee covid-19 vac 10 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0092U,Onc lng 3 prtn bmrk plsm alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0093A,Fee covid-19 vac 10 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0093U,Rx mntr 65 com drugs urine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0094A,Fee covid-19 vac 10 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0094U,Genome rapid sequence alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0095U,Inflm ee elisa alys alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0096U,Hpv hi risk types male urine,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0099T,Implant corneal ring,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0100T,Prosth retina receive&gen,Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0101A,Fee covid-19 vac 11 dose 1,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0101T,Extracorp shockwv tx hi enrg,Orthopedic Surgery,Per Unit,$323.78 ,OP,$323.78 ,$323.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0101U,Hered colon ca do 15 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0102A,Fee covid-19 vac 11 dose 2,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0102U,Hered brst ca rltd do 17 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0103A,Fee covid-19 vac 11 booster,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0103T,Holotranscobalamin,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0103U,Hered ova ca pnl 24 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0104A,Fee covid-19 vac 11 res,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0104U,Hered pan ca pnl 32 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0105U,Neph ckd mult eclia tum nec,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0106T,Touch quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0107T,Vibrate quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0107U,C diff tox ag detcj ia stool,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0108T,Cool quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0108U,Gi barrett esoph 9 prtn bmrk,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0109T,Heat quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0109U,Id aspergillus dna 4 species,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0110T,Nos quant sensory test,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0110U,Rx mntr 1+oral onc rx&sbsts,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0111T,Rbc membranes fatty acids,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0111U,Onc colon ca kras&nras alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0112U,Iadi 16s&18s rrna genes,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0113U,Onc prst8 pca3&tmprss2-erg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0114U,Gi barretts esoph vim&ccna1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0115U,Respir iadna 18 viral&2 bact,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0116U,Rx mntr nzm ia 35+oral flu,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0117U,Pain mgmt 11 endogenous anal,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0118U,Trnsplj don-drv cll-fr dna,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0119U,Crd ceramides liq chrom plsm,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0120U,Onc b cll lymphm mrna 58 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0121U,Sc dis vcam-1 whole blood,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0122U,Sc dis p-selectin whl blood,Laboratory,Per Unit,$6.07 ,OP,$6.07 ,$6.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0123T,Scleral fistulization,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0123U,Mchnl fragility rbc prflg,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0124U,Ftl cgen abnor 3 analytes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0125U,Ftl cgen abnor prnt comp 5,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0126T,Chd risk imt study,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0126U,Ftl cgen abnor prnt comp 5 y,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0127U,Ob pe 3 analytes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0128U,Ob pe 3 analytes y chrmsm,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0129U,Hered brst ca rltd do panel,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0130U,Hered colon ca do mrna pnl,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0131U,Hered brst ca rltd do pnl 13,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0132U,Hered ova ca rltd do pnl 17,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0133U,Hered prst8 ca rltd do 11,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0134U,Hered pan ca mrna pnl 18 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0135U,Hered gyn ca mrna pnl 12 gen,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0136U,Atm mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0137U,Palb2 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0138U,Brca1 brca2 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0139U,Neuro austm meas 6 c metablt,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0140U,Nfct ds fungi dna 15 trgt,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0141U,Nfct ds bact&fng gram pos,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0142U,Nfct ds bact&fng gram neg,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0145U,Drug assay 65+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0146U,Drug assay 80+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0147U,Drug assay 85+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0148U,Drug assay 100+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0149U,Drug assay 60+ rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0151U,Nfct bct/vir resp nfctj 33,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0152U,Nfct ds dna untrgt ngnrj seq,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0153U,Onc breast mrna 101 genes,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0154U,Onc urthl ca rna fgfr3 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0155U,Onc brst ca dna pik3ca gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0156U,Copy number sequence alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0157U,Apc mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0158U,Mlh1 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0159U,Msh2 mrna seq alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0160U,Msh6 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0161U,Pms2 mrna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0162U,Hered colon ca trgt mrna pnl,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0163U,Onc clrct scr 3 prtn alg,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0164U,Gi ibs ia anti-cdtb&vinculin,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0165U,Peanut allg asmt epi,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0166U,Liver ds 10 biochem asy srm,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0167U,Chornc gonadotropin hcg ia,Laboratory,Per Unit,$15.04 ,OP,$15.04 ,$15.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0168U,Ftl aneuploidy dna seq alys,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0169U,Nudt15&tpmt gene com vrnt,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0170U,Neuro asd rna next gen seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0171U,Trgt gen seq alys pnl dna 23,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0172T,Lumbar spine process addl,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0172U,Onc sld tum alys brca1 brca2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0173U,Psyc gen alys panel 14 genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0174U,Onc solid tumor 30 prtn trgt,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0175U,Psyc gen alys panel 15 genes,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0176U,Cdtb&vinculin igg antb ia,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0177U,Onc brst ca dna pik3ca 11,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0178T,64 lead ecg w/i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0178U,Peanut allg asmt epi clin rx,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0179T,64 lead ecg w/tracing,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0179U,Onc nonsm cll lng ca alys 23,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0180U,Abo gnotyp abo 7 exons,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0181U,Co gnotyp aqp1 exon 1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0182T,Hdr elect brachytherapy,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0182U,Crom gnotyp cd55 exons 1-10,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0183U,Di gnotyp slc4a1 exon 19,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0184T,Exc rectal tumor endoscopic,General Surgery,Per Unit,"$1,129.81 ",OP,"$1,129.81 ","$1,129.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0184U,Do gnotyp art4 exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0185U,Fut1 gnotyp fut1 exon 4,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0186U,Fut2 gnotyp fut2 exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0187U,Fy gnotyp ackr1 exons 1-2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0188U,Ge gnotyp gypc exons 1-4,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0189U,Gypa gnotyp ntrns 1 5 exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0190U,Gypb gnotyp ntrns 1 5 seux 3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0191T,Insert ant segment drain int,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0191U,In gnotyp cd44 exons 2 3 6,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0192U,Jk gnotyp slc14a1 exon 9,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0193U,Jr gnotyp abcg2 exons 2-26,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0194U,Kel gnotyp kel exon 8,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0195U,Klf1 targeted sequencing,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0196U,Lu gnotyp bcam exon 3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0197U,Lw gnotyp icam4 exon 1,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0198T,Ocular blood flow measure,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0198U,Rhd&rhce gntyp rhd1-10&rhce5,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0199U,Sc gnotyp ermap exons 4 12,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0200U,Xk gnotyp xk exons 1-3,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0201U,Yt gnotyp ache exon 2,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0203U,Ai ibd mrna xprsn prfl 17,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0204U,Onc thyr mrna xprsn alys 593,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0205T,Inirs each vessel add-on,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0205U,Oph amd alys 3 gene variants,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0206T,Cptr dbs alys car elec dta,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0206U,Neuro alzheimer cell aggregj,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0207T,Clear eyelid gland w/heat,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0207U,Neuro alzheimer quan imaging,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0208U,Onc mtc mrna xprsn alys 108,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0209U,Cytog const alys interrog,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0210U,Syphilis tst antb ia quan,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0211U,Onc pan-tum dna&rna gnrj seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0212T,Compre audiometry evaluation,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0212U,Rare ds gen dna alys proband,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0213U,Rare ds gen dna alys ea comp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0214U,Rare ds xom dna alys proband,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0215T,Njx paravert w/us cer/thor,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0215U,Rare ds xom dna alys ea comp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0216U,Neuro inh ataxia dna 12 com,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0217U,Neuro inh ataxia dna 51 gene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0218U,Neuro musc dys dmd seq alys,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0219U,Nfct agt hiv gnrj seq alys,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0220U,Onc brst ca ai assmt 12 feat,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0221U,Abo gnotyp next gnrj seq abo,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0222U,Rhd&rhce gntyp next gnrj seq,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0223T,Acoustic ecg w/i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0224T,Acoustic ecg 1+ analysis,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0224U,Antibody sars-cov-2 titer(s),Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0225T,Acoustic ecg analy & reprog,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0226U,Svnt sarscov2 elisa plsm srm,Laboratory,Per Unit,$9.92 ,OP,$9.92 ,$9.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0227U,Rx asy prsmv30+rx/metablt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0228T,Njx tfrml eprl w/us cer/thor,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0228U,Onc prst8 ma molec prfl alg,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0229T,Njx tfrml eprl w/us cer/thor,Neurology,Per Unit,$454.82 ,OP,$454.82 ,$454.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0229U,Bcat1 promoter mthyltn alys,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0230U,Ar full sequence analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0231U,Cacna1a full gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0232T,Njx platelet plasma,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0232U,Cstb full gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0233T,Skin glycation spectroscopy,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0233U,Fxn gene analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0234U,Mecp2 full gene analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0235T,Trluml perip athrc visceral,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0235U,Pten full gene analysis,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0236T,Trluml perip athrc abd aorta,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0236U,Smn1&smn2 full gene analysis,Laboratory,Per Unit,$74.24 ,OP,$74.24 ,$74.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0237T,Trluml perip athrc brchiocph,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0237U,Car ion chnlpthy gen seq pnl,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0238T,Trluml perip athrc iliac art,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0238U,Onc lnch syn gen dna seq aly,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0239U,Trgt gen seq alys pnl 311+,Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0240T,Esoph motility 3d topography,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0241T,Esoph motility w/stim/perf,Gastroenterology,Per Unit,$343.37 ,OP,$343.37 ,$343.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0243T,Intm msr bronchodil wheeze,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0244T,Cont msr bronchodil wheeze,Pulmonary,Per Unit,$130.30 ,OP,$130.30 ,$130.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0249T,Ligation hemorrhoid w/us,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0253T,Insert aqueous drain device,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0255T,Evasc rpr iliac art bifr s&i,Vascular Surgery,Per Unit,"$1,375.47 ",OP,"$1,375.47 ","$1,375.47 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0263T,Im b1 mrw cel ther cmpl,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0264T,Im b1 mrw cel ther xcl hrvst,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0265T,Im b1 mrw cel ther hrvst onl,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0266T,Implt/rpl crtd sns dev total,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0267T,Implt/rpl crtd sns dev lead,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0268T,Implt/rpl crtd sns dev gen,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0269T,Rev/remvl crtd sns dev total,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0270T,Rev/remvl crtd sns dev lead,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0271T,Rev/remvl crtd sns dev gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0272T,Interrogate crtd sns dev,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0273T,Interrogate crtd sns w/pgrmg,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0278T,Tempr,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0282T,Periph field stimul trial,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0283T,Periph field stimul perm,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0284T,Periph field stimul revise,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0285T,Periph field stimul analys,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0286T,Near ifr spectrsc of wounds,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0288T,Anoscopy w/rf delivery,General Surgery,Per Unit,$798.86 ,OP,$798.86 ,$798.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0289T,Laser inc for pkp/lkp donor,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0290T,Laser inc for pkp/lkp recip,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0294T,Ins lt atrl mont pres lead,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0295T,Ext ecg complete,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0296T,Ext ecg recording,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0297T,Ext ecg scan w/report,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0298T,Ext ecg review and interp,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0301T,Mw therapy for breast tumor,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0302T,Icar ischm mntrng sys compl,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0303T,Icar ischm mntrng sys eltrd,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0304T,Icar ischm mntrng sys device,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0305T,Icar ischm mntrng prgrm eval,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0306T,Icar ischm mntr interr eval,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0307T,Rmvl icar ischm mntrng dvce,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0308T,Insj ocular telescope prosth,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0310T,Motor function mapping ntms,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0311T,Cal & alys cntrl artl press,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0312T,Laps impltj nstim vagus,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0313T,Laps rmvl nstim array vagus,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0314T,Laps rmvl vgl arry&pls gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0315T,Rmvl vagus nerve pls gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0316T,Replc vagus nerve pls gen,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0317T,Elec alys vagus nrv pls gen,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0329T,Mntr io press 24hrs/> uni/bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0330T,Tear film img uni/bi w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0331T,Heart symp image plnr,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0332T,Heart symp image plnr spect,Diagnostic Nuclear Medicine,Per Unit,$525.42 ,OP,$525.42 ,$525.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0333T,Visual ep scr acuity auto,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0335T,Insj sinus tarsi implant,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0337T,Endothel fxnassmnt non-invas,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0341T,Quant pupillometry w/ rprt,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0342T,Thxp apheresis w/hdl delip,Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0346T,Ultrasound elastography,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0348T,Rsa spine exam,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0349T,Rsa upper extr exam,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0350T,Rsa lower extr exam,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0352T,Oct brst/node i&r per spec,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0354T,Oct breast surg cavity i&r,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0355T,Gi tract capsule endoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0356T,Insrt drug device for iop,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0357T,Cryopreservation oocyte(s),Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0358T,Bia whole body,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0362T,Bhv id suprt assmt ea 15 min,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0373T,Adapt bhv tx ea 15 min,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0376T,Insert ant segment drain int,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0377T,Anoscpy inj agent for incont,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0378T,Visual field assmnt rev/rprt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0379T,Vis field assmnt tech suppt,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0380T,Comp animat ret imag series,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0381T,Ext h rate epi sz 14 days,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0382T,Ext h rate sz 14 day ri only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0383T,Ext h rate sz up to 30 days,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0384T,Ex h rate sz 30 day ri only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0385T,Ex h rate for sz ovr 30 day,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0386T,Ex h rate sz 30+ day ri only,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0387T,Leadless c pm ins/rpl ventr,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0388T,Leadless c pm remove ventr,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0389T,Prog eval inper leadls pm,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0390T,Periproc eval inper ledls pm,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0391T,Intergt eval inper leadls pm,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0392T,Lap es sph augment dev place,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0393T,Es sph augmnt device removal,General Surgery,Per Unit,"$2,104.05 ",OP,"$2,104.05 ","$2,104.05 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0394T,Hdr elctrnc skn surf brchytx,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0395T,Hdr elctr ntrst/ntrcv brchtx,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0398T,Mrgfus strtctc les abltj,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0399T,Myocardial strain imaging,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0400T,Mltispectrl digital les alys,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0401T,Mltispectrl digital les alys,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0402T,Colgn cross-link crn med sep,Ophthalmology Surgery,Per Unit,$345.84 ,OP,$345.84 ,$345.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0403T,Diabetes prev standard curr,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0406T,Sin ndsc plmt drg elut mplnt,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0407T,Sin ndsc plmt drg elut mplnt,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0408T,Insj/rplc cardiac modulj sys,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0409T,Insj/rplc car modulj pls gn,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0412T,Rmvl cardiac modulj pls gen,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0414T,Rmvl & rpl car modulj pls gn,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0417T,Prgrmg eval cardiac modulj,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0418T,Interro eval cardiac modulj,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0419T,Dstrj neurofibroma xtnsv,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0420T,Dstrj neurofibroma xtnsv,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0421T,Waterjet prostate abltj cmpl,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0422T,Tactile breast img uni/bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0423T,Assay secretory type ii pla2,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0424T,Insj/rplc nstim apnea compl,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0425T,Insj/rplc nstim apnea sen ld,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0426T,Insj/rplc nstim apnea stm ld,Neurological Surgery,Per Unit,"$2,795.98 ",OP,"$2,795.98 ","$2,795.98 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0427T,Insj/rplc nstim apnea pls gn,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0428T,Rmvl nstim apnea pls gen,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0429T,Rmvl nstim apnea sen ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0430T,Rmvl nstim apnea stimj ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0431T,Rmvl/rplc nstim apnea pls gn,Neurological Surgery,Per Unit,"$7,098.75 ",OP,"$7,098.75 ","$7,098.75 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0432T,Repos nstim apnea stimj ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0433T,Repos nstim apnea sensing ld,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0434T,Interro eval npgs apnea,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0435T,Prgrmg eval npgs apnea 1 ses,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0436T,Prgrmg eval npgs apnea study,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0437T,Impltj synth rnfcmt abdl wal,General Surgery,Per Unit,"$1,330.49 ",OP,"$1,330.49 ","$1,330.49 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0438T,Tprnl plmt biodegrdabl matrl,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0439T,Myocrd contrast prfuj echo,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0440T,Abltj perc uxtr/perph nrv,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0441T,Abltj perc lxtr/perph nrv,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0442T,Abltj perc plex/trncl nrv,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0443T,R-t spctrl alys prst8 tiss,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0446T,Insj impltbl glucose sensor,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0447T,Rmvl impltbl glucose sensor,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0448T,Remvl insj impltbl gluc sens,General Surgery,Per Unit,$367.48 ,OP,$367.48 ,$367.48 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0449T,Insj aqueous drain dev 1st,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0450T,Insj aqueous drain dev each,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0453T,Insj/rplcmt mech-elec ntrfce,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0457T,Remvl mech-elec skin ntrfce,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0462T,Prgrmg eval aortic ventr sys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0463T,Interrog aortic ventr sys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0464T,Visual ep test for glaucoma,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0466T,Insj ch wal respir eltrd/ra,Neurological Surgery,Per Unit,"$12,849.88 ",OP,"$12,849.88 ","$12,849.88 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0467T,Revj/rplmnt ch respir eltrd,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0468T,Rmvl ch wal respir eltrd/ra,Neurological Surgery,Per Unit,$610.14 ,OP,$610.14 ,$610.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0469T,Rta polarize scan oc scr bi,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0470T,Oct skn img acquisj i&r 1st,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0471T,Oct skn img acquisj i&r addl,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0472T,Prgrmg io rta eltrd ra,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0473T,Reprgrmg io rta eltrd ra,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0474T,Insj aqueous drg dev io rsvr,Ophthalmology Surgery,Per Unit,"$1,563.30 ",OP,"$1,563.30 ","$1,563.30 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0475T,Rec ftl car sgl 3 ch i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0476T,Rec ftl car sgl elec tr data,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0477T,Rec ftl car sgl xrtj alys,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0478T,Rec ftl car 3 ch rev i&r,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0481T,Njx autol wbc concentrate,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0482T,Absl quan myocrd bld flo pet,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0485T,Oct mid ear i&r unilateral,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0486T,Oct mid ear i&r bilateral,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0487T,Trvg biomchn mapg w/reprt,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0488T,Diabetes prev online/elec,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0489T,Regn cell tx scldr hands,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0490T,Regn cell tx scldr h mlt inj,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0497T,Xtrnl pt act ecg in-off conn,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0498T,Xtrnl pt act ecg r&i pr 30 d,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0499T,Cysto f/urtl strix/stenosis,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0500T,Hpv 5+ hi risk hpv types,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0501T,Cor ffr derived cor cta data,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0502T,Cor ffr data prep & transmis,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0503T,Cor ffr alys gnrj ffr mdl,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0504T,Cor ffr data review i&r,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0505T,Ev fempop artl revsc,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0506T,Mac pgmt opt dns meas hfp,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0507T,Near ifr 2img mibmn glnd i&r,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0508T,Pls echo us b1 dns meas tib,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0509T,Pattern erg w/i&r,Ophthalmology,Per Unit,$200.58 ,OP,$200.58 ,$200.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0510T,Rmvl sinus tarsi implant,Orthopedic Surgery,Per Unit,"$1,076.12 ",OP,"$1,076.12 ","$1,076.12 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0511T,Rmvl&rinsj sinus tarsi implt,Orthopedic Surgery,Per Unit,"$2,502.66 ",OP,"$2,502.66 ","$2,502.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0514T,Intraop vis axis id pt fixj,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0515T,Insj wcs lv compl sys,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0517T,Insj wcs lv pg compnt,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0518T,Rmvl pg compnt wcs,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0519T,Rmvl & rplcmt pg compnt wcs,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0520T,Rmvl&rplcmt pg wcs new eltrd,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0521T,Interrog dev eval wcs ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0522T,Prgrmg dev eval wcs ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0525T,Insj/rplcmt compl iims,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0527T,Insj/rplcmt iims implt mntr,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0528T,Prgrmg dev eval iims ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0529T,Interrog dev eval iims ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0530T,Removal complete iims,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0532T,Removal iims implt mntr only,Interventional Cardiology,Per Unit,"$3,320.20 ",OP,"$3,320.20 ","$3,320.20 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0533T,Cont rec mvmt do 6-10 days,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0534T,Cont rec mvmt do setup&train,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0535T,Cont rec mvmt do reprt cnfig,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0536T,Cont rec mvmt do dl w/i&r,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0541T,Myocardial imaging mcg,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0542T,Myocardial imaging mcg i&r,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0546T,Rf spectrsc ntraop mrgn asmt,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0547T,B1 matrl qual tst mcrind tib,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0548T,Tprnl balo cntnc dev bi,Urological Surgery,Per Unit,"$2,714.29 ",OP,"$2,714.29 ","$2,714.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0549T,Tprnl balo cntnc dev uni,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0550T,Tprnl balo cntnc dev rmvl ea,Urological Surgery,Per Unit,$834.13 ,OP,$834.13 ,$834.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0551T,Tprnl balo cntnc dev adjmt,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0552T,Low-level laser therapy,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0553T,Perq tcat iliac anast implt,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0554T,B1 str & fx rsk analysis,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0556T,B1 str & fx rsk assessment,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0558T,Ct scan f/biomchn ct alys,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0563T,Evac meibomian glnd heat bi,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0564T,Onc chemo rx cytotox csc 14,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0566T,Autol cell implt adps njx,Orthopedics,Per Unit,$184.59 ,OP,$184.59 ,$184.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0568T,Intro mix saline&air f/ssg,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0571T,Insj/rplcmt icds ss eltrd,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0575T,Prgrmg dev eval icds ss ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0576T,Interrog dev eval icds ss ip,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0577T,Ephys eval icds ss,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0578T,Rem interrog dev icds phys,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0579T,Rem interrog dev icds tech,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0581T,Abltj mal brst tum perq crtx,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0582T,Trurl abltj mal prst8 tiss,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0583T,Tmpst auto tube dlvr sys,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0587T,Perq impltj/rplcmt isdns ptn,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0588T,Revision/removal isdns ptn,Neurology,Per Unit,$250.78 ,OP,$250.78 ,$250.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0589T,Elec alys smpl prgrmg iins,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0590T,Elec alys cplx prgrmg iins,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0591T,Hlth&wb coaching indiv 1st,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0592T,Hlth&wb coaching indiv f-up,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0593T,Hlth&wb coaching group,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0596T,Temp fml iu vlv-pmp 1st insj,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0597T,Temp fml iu valve-pmp rplcmt,Urology,Per Unit,$236.52 ,OP,$236.52 ,$236.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0602T,Transdermal gfr measurements,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0603T,Transdermal gfr monitoring,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0604T,Rem oct rta dev setup&educaj,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0605T,Rem oct rta techl sprt min 8,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0607T,Rem mntr pulm flu mntr setup,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0608T,Rem mntr pulm flu mntr alys,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0609T,Mrs disc pain acquisj data,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0610T,Mrs disc pain transmis data,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0611T,Mrs disc pain alg alys data,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0614T,Rmvl&rplcmt ss impl dfb pg,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0615T,Eye mvmt alys w/o calbrj i&r,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0616T,Insertion of iris prosthesis,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0617T,Insj iris prosth w/rmvl&insj,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0618T,Insj iris prosth sec io lens,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0619T,Cysto w/prst8 commissurotomy,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0620T,Evasc ven artlz tibl/prnl vn,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0621T,Trabeculostomy interno laser,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0622T,Trabeculostomy int lsr w/scp,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0623T,Auto quantification c plaque,Cardiology,Per Unit,$144.45 ,OP,$144.45 ,$144.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0632T,Perq tcat us abltj nrv p-art,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,0633T,Ct breast w/3d uni c-,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0634T,Ct breast w/3d uni c+,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0635T,Ct breast w/3d uni c-/c+,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0636T,Ct breast w/3d bi c-,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0637T,Ct breast w/3d bi c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0638T,Ct breast w/3d bi c-/c+,Diagnostic Radiology,Per Unit,$179.12 ,OP,$179.12 ,$179.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,0639T,Wrls skn snr anisotropy meas,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C1762,"Conn tiss, human(inc fascia)",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C1763,"Conn tiss, non-human",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C1849,"Skin substitute, synthetic",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C1878,Matrl for vocal cord,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C2615,"Sealant, pulmonary, liquid",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8900,"Mra w/cont, abd",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8901,"Mra w/o cont, abd",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8902,"Mra w/o fol w/cont, abd",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8903,"Mri w/cont, breast, uni",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8904,"Mri w/o cont, breast, uni",Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8905,"Mri w/o fol w/cont, brst, un",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8906,"Mri w/cont, breast, bi",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8907,"Mri w/o cont, breast, bi",Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8908,"Mri w/o fol w/cont, breast,",Diagnostic Radiology,Per Unit,$271.57 ,OP,$271.57 ,$271.57 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8909,"Mra w/cont, chest",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8910,"Mra w/o cont, chest",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8911,"Mra w/o fol w/cont, chest",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8912,"Mra w/cont, lwr ext",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8913,"Mra w/o cont, lwr ext",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8914,"Mra w/o fol w/cont, lwr ext",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8918,"Mra w/cont, pelvis",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8919,"Mra w/o cont, pelvis",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8920,"Mra w/o fol w/cont, pelvis",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8921,"Tte w or w/o fol w/cont, com",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8922,"Tte w or w/o fol w/cont, f/u",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8923,"2d tte w or w/o fol w/con,co",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8924,"2d tte w or w/o fol w/con,fu",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8925,"2d tee w or w/o fol w/con,in",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8926,"Tee w or w/o fol w/cont,cong",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8927,"Tee w or w/o fol w/cont, mon",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8928,"Tte w or w/o fol w/con,stres",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8929,"Tte w or wo fol wcon,doppler",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8930,"Tte w or w/o contr, cont ecg",Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8931,"Mra, w/dye, spinal canal",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8932,"Mra, w/o dye, spinal canal",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8933,"Mra, w/o&w/dye, spinal canal",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8934,"Mra, w/dye, upper extremity",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8935,"Mra, w/o dye, upper extr",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8936,"Mra, w/o&w/dye, upper extr",Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C8957,"Prolonged iv inf, req pump",General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9014,"Injection, cerliponase alfa",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9015,"C-1 esterase, haegarda",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9016,"Inj, triptorelin ext rel",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9024,"Inj, daunorubicin-cytarabine",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9025,"Injection, ramucirumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9026,"Injection, vedolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9027,"Injection, pembrolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9028,Inj. inotuzumab ozogamicin,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9029,"Injection, guselkumab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9030,Inj copanlisib,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9031,"Lutetium Lu 177 dotatate, tx",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9032,Voretigene neparvovec-rzyl,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9033,"Inj, akynzeo",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9034,"Injection, dexamethasone 9%",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9035,"Injection, Aristada Initio",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9036,"Injection, patisiran",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9037,"Injection, risperidone",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9038,Inj mogamulizumab-kpkc,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9040,"Injection, fremanezumab-vfrm",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9041,"Inj, coagulation factor xa",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9042,"Inj., belrapzo 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9043,"Injection, levoleucovorin",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9044,"Injection, cemiplimab-rwlc",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9045,Moxetumomab pasudotox-tdfk,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9047,"Injection, caplacizumab-yhdp",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9048,Dexamethasone ophth insert,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9049,"Injection, tagraxofusp-erzs",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9050,"Injection, emapalumab-lzsg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9051,"Injection, omadacycline",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9052,"Injection, ravulizumab-cwv",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9053,"Inj, crizanlizumab-tmca",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9054,"Injection, lefamulin",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9055,"Inj, brexanolone",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9056,"Injection, givosiran",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9057,Inj cetirizine hydrochloride,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9058,"Injection,pegfilgrastim-bmez",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9059,"Injection, meloxicam",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9061,"Injection, teprotumumab-trbw",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9062,Daratumumab hyaluronidase,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9063,"Injection, eptinezumab-jjmr",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9064,Mitomycin pyelocalyceal inst,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9065,Romidepsin non-lyophilized,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9066,Sacituzumab govitecan-hziy,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9069,Belantamab mafodontin-blmf,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9070,"Injection, tafasitamab-cxix",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9071,"Injection, viltolarsen",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9072,"Inj, imm glob asceniv",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9121,"Injection, argatroban",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9122,Mometasone furoate (sinuva),Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9132,"Kcentra, per i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9137,Adynovate Factor VIII recom,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9138,Nuwiq Factor VIII recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9139,"Idelvion, 1 i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9140,Afstyla factor viii recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9141,Factor viii pegylated-aucl,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9248,"Inj, clevidipine butyrate",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9250,Artiss fibrin sealant,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9257,Bevacizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9293,"Injection, glucarpidase",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9349,"Puraply, puraply antimic",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9352,"Neuragen nerve guide, per cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9353,"Neurawrap nerve protector,cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9354,"Veritas collagen matrix, cm2",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9355,"Neuromatrix nerve cuff, cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9356,"Tenoglide tendon prot, cm2",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9358,"Surgimend, fetal",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9359,"Implnt,bon void filler-putty",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9360,"Surgimend, neonatal",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9361,Neuromend nerve wrap,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9362,"Implnt,bon void filler-strip",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9363,Integra meshed bil wound mat,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9364,"Porcine implant, permacol",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9408,"Iodine i-131 iobenguane, tx",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9442,"Injection, belinostat",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9443,"Injection, dalbavancin",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9444,"Injection, oritavancin",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9445,"C-1 esterase, Ruconest",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9446,"Inj, tedizolid phosphate",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9447,"Inj, phenylephrine ketorolac",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9448,Oral netupitant palonosetron,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9449,"Inj, blinatumomab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9450,Fluocinolone acetonide implt,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9451,"Injection, peramivir",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9452,"Inj, ceftolozane/tazobactam",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9453,"Injection, nivolumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9454,"Inj, pasireotide long acting",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9455,"Injection, siltuximab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9456,"Inj, isavuconazonium sulfate",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9460,"Injection, cangrelor",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9465,"Injection, Durolane",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9466,"Injection, benralizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9467,Inj rituximab hyaluronidase,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9468,"Inj, factor ix, Rebinyn",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9469,Inj triamcinolone acetonide,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9470,Aripiprazole lauroxil im,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9471,"Hymovis, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9472,Inj talimogene laherparepvec,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9473,"Injection, mepolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9474,"Inj, irinotecan liposome",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9475,"Injection, necitumumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9476,"Injection, daratumumab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9477,"Injection, elotuzumab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9478,"Injection, sebelipase alfa",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9480,"Injection, trabectedin",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9481,"Injection, reslizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9482,Sotalol hydrochloride iv,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9483,"Injection, atezolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9484,"Injection, eteplirsen",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9485,"Injection, olaratumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9487,"Ustekinumab IV inj, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9488,Conivaptan hcl,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9489,"Injection, nusinersen",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9490,"Injection, bezlotoxumab",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9491,"Injection, avelumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9492,"Injection, durvalumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9493,"Injection, edaravone",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9494,"Injection, ocrelizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9497,"Loxapine, inhalation powder",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9600,Perc drug-el cor stent sing,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9601,Perc drug-el cor stent bran,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9602,Perc d-e cor stent ather s,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9603,Perc d-e cor stent ather br,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9604,Perc d-e cor revasc t cabg s,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9605,Perc d-e cor revasc t cabg b,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9606,Perc d-e cor revasc w ami s,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9607,Perc d-e cor revasc chro sin,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9608,Perc d-e cor revasc chro add,Interventional Cardiology,Per Unit,"$4,903.27 ",OP,"$4,903.27 ","$4,903.27 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9724,Eps stomach plic,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9726,Rxt breast appl place/remov,General Surgery,Per Unit,$702.95 ,OP,$702.95 ,$702.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9728,"Place device/marker, non pro",Therapeutic Radiology,Per Unit,$68.45 ,OP,$68.45 ,$68.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9734,"U/s trtmt, not leiomyomata",General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9737,Lap esoph augmentation,General Surgery,Per Unit,"$3,851.80 ",OP,"$3,851.80 ","$3,851.80 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9739,Cystoscopy prostatic imp 1-3,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9740,Cysto impl 4 or more,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9741,Impl pressure sensor w/angio,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9742,Laryngoscopy with injection,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9743,Bulking/spacer material impl,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9744,Abd us w/contrast,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9745,Nasal endo eustachian tube,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9747,"Ablation, hifu, prostate",Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9749,Repair nasal stenosis w/imp,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9750,Ins/rem-replace compl iims,Interventional Cardiology,Per Unit,"$4,587.29 ",OP,"$4,587.29 ","$4,587.29 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9762,Cardiac mri seg dys strain,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9763,Cardiac mri seg dys stress,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9765,Revasc intra lithotrip-stent,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9767,Revasc lithotrip-stent-ather,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9768,Endo us-guide hep porto grad,Gastroenterology,Per Unit,$616.04 ,OP,$616.04 ,$616.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,C9769,Cysto w/temp pros implant,Urological Surgery,Per Unit,"$1,672.81 ",OP,"$1,672.81 ","$1,672.81 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9770,"Vitrec/mech pars, subret inj",Ophthalmology Surgery,Per Unit,"$1,690.18 ",OP,"$1,690.18 ","$1,690.18 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9771,Nsl/sins cryo post nasal tis,Otolaryngology Surgery,Per Unit,"$1,674.71 ",OP,"$1,674.71 ","$1,674.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9772,Revasc lithotrip tibi/perone,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9773,Revasc lithotr-stent tib/per,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9774,Revasc lithotr-ather tib/per,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9775,Revasc lith-sten-ath tib/per,Interventional Radiology,Per Unit,"$2,821.82 ",OP,"$2,821.82 ","$2,821.82 ",,,,,,,,,,,,,
Molina Medicaid,CPT,C9803,Hopd covid-19 spec collect,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0120,Periodic oral evaluation,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0140,Limit oral eval problm focus,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0145,"Oral evaluation, pt < 3yrs",Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0150,Comprehensve oral evaluation,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0160,Extensv oral eval prob focus,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0170,"Re-eval,est pt,problem focus",Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0171,Re-eval post-op visit,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0180,Comp periodontal evaluation,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0190,Screening of a patient,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0191,Assessment of a patient,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0210,Intraor complete film series,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0220,Intraoral periapical first,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0230,Intraoral periapical ea add,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0240,Intraoral occlusal film,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0250,Extraoral 2d project image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0251,Extraoral posterior image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0260,Extraoral ea additional film,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0270,Dental bitewing single image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0272,Dental bitewings two images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0273,Bitewings - three images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0274,Bitewings four images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0277,Vert bitewings 7 to 8 images,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0290,Skull/facial bone image,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0310,Dental saliography,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0320,Dental tmj arthrogram incl i,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0321,Other tmj images by report,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0322,Dental tomographic survey,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0330,Panoramic image,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0340,2d cephalometric image,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0350,Oral/facial photo images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0351,3d photographic image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0364,Cone beam ct capt & interp,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0365,Cone beam ct interprete man,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0366,Cone beam ct interprete max,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0367,Cone beam ct interp both jaw,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0368,Cone beam ct interprete tmj,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0369,Max mri capture & interprete,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0370,Max ultrasound capt & interp,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0371,Sialoendoscopy capt & interp,Dental,Per Unit,$87.62 ,OP,$87.62 ,$87.62 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0380,Cone beam ct capture limited,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0381,Cone beam ct capt mandible,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0382,Cone beam ct capt maxilla,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0383,Cone beam ct both jaws,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0384,Cone beam ct capture tmj,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0385,Max mri image capture,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0386,Max ultrasound image capture,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0391,Imterprete diagnostic image,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0393,Trtmnt simulation 3d image,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0394,Digital sub 2 or more images,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0395,Fusion 2 or more 3d images,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0411,Hba1c in office testing,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0412,Blood glucose level test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0414,Lab process microbial spec,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0415,Collection of microorganisms,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0416,Viral culture,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0418,Analysis of saliva sample,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0419,Assess of salivary flow,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0421,Gen tst suscept oral disease,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0422,Collect & prep genetic samp,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0423,Genetic test spec analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0425,Caries susceptibility test,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0431,Diag tst detect mucos abnorm,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0460,Pulp vitality test,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0470,Diagnostic casts,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0472,"Gross exam, prep & report",Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0473,"Micro exam, prep & report",Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0474,Micro w exam of surg margins,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0475,Decalcification procedure,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0476,Spec stains for microorganis,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0477,Spec stains not for microorg,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0478,Immunohistochemical stains,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0479,Tissue in-situ hybridization,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0480,Cytopath smear prep & report,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0481,Electron microscopy,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0482,Direct immunofluorescence,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0483,Indirect immunofluorescence,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0484,Consult slides prep elsewher,Pathology,Per Unit,$20.19 ,OP,$20.19 ,$20.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0485,Consult inc prep of slides,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0486,Access of transep cytol samp,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0502,Other oral pathology procedu,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0600,Non-ionizing diag proc,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0601,Caries risk assess low risk,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0602,Caries risk assess mod risk,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0603,Caries risk assess high risk,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0604,Antigen test pub hlth pathog,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0605,Antibody test pub hlth path,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0701,Pano radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0702,2d cephal radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0703,2d oral/facial photo image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0704,3d photo image capture only,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0705,Extra oral post radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0706,Intraoral occlus radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0707,Intraoral periap radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0708,Intraoral bite radio image,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0709,Intraoral cmplt radio images,Dental,Per Unit,$31.95 ,OP,$31.95 ,$31.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D0999,Unspecified diagnostic proce,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1110,Dental prophylaxis adult,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1120,Dental prophylaxis child,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1206,Topical fluoride varnish,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1208,Topical app fluorid ex vrnsh,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1310,Nutri counsel-control caries,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1320,Tobacco counseling,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1321,Couns for high risk sub use,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1330,Oral hygiene instruction,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1351,Dental sealant per tooth,Dental,Per Unit,$24.50 ,OP,$24.50 ,$24.50 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1352,"Prev resin rest, perm tooth",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1353,Sealant repair per tooth,Dental,Per Unit,$24.50 ,OP,$24.50 ,$24.50 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1354,Int caries med app per tooth,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1355,Caries med app per tooth,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1510,Space maintainer fxd unilat,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1515,Fixed bilat space maintainer,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1516,"Fixed bilat space maint, max",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1517,"Fixed bilat space maint, man",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1520,Remove unilat space maintain,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1525,Remove bilat space maintain,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1526,"Remove bilat space main, max",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1527,"Remove bilat space main, man",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1550,Recement space maintainer,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1551,Recement space maint - max,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1552,Recement space maint - man,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1553,Recement unilat space maint,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1555,Remove fix space maintainer,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1556,Rem fixed unilat space maint,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1557,Remove fixed bilat maint max,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1558,Remove fixed bilat man,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1575,"Dist space maint, fixed unil",Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D1999,Unspecified preventive proc,Preventive Care,Per Unit,$98.77 ,OP,$98.77 ,$98.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2140,Amalgam one surface permanen,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2150,Amalgam two surfaces permane,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2160,Amalgam three surfaces perma,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2161,Amalgam 4 or > surfaces perm,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2330,Resin one surface-anterior,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2331,Resin two surfaces-anterior,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2332,Resin three surfaces-anterio,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2335,Resin 4/> surf or w incis an,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2390,Ant resin-based cmpst crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2391,Post 1 srfc resinbased cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2392,Post 2 srfc resinbased cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2393,Post 3 srfc resinbased cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2394,Post >=4srfc resinbase cmpst,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2410,Dental gold foil one surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2420,Dental gold foil two surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2430,Dental gold foil three surfa,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2510,Dental inlay metalic 1 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2520,Dental inlay metallic 2 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2530,Dental inlay metl 3/more sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2542,Dental onlay metallic 2 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2543,Dental onlay metallic 3 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2544,Dental onlay metl 4/more sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2610,Inlay porcelain/ceramic 1 su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2620,Inlay porcelain/ceramic 2 su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2630,Dental onlay porc 3/more sur,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2642,Dental onlay porcelin 2 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2643,Dental onlay porcelin 3 surf,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2644,Dental onlay porc 4/more sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2650,Inlay composite/resin one su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2651,Inlay composite/resin two su,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2652,Dental inlay resin 3/mre sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2662,Dental onlay resin 2 surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2663,Dental onlay resin 3 surface,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2664,Dental onlay resin 4/mre sur,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2710,Crown resin-based indirect,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2712,Crown 3/4 resin-based compos,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2720,Crown resin w/ high noble me,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2721,Crown resin w/ base metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2722,Crown resin w/ noble metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2740,Crown porcelain/ceramic,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2750,Crown porcelain w/ h noble m,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2751,Crown porcelain fused base m,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2752,Crown porcelain w/ noble met,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2753,Crown porc fused to titanium,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2780,Crown 3/4 cast hi noble met,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2781,Crown 3/4 cast base metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2782,Crown 3/4 cast noble metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2783,Crown 3/4 porcelain/ceramic,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2790,Crown full cast high noble m,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2791,Crown full cast base metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2792,Crown full cast noble metal,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2794,Crown-titanium,Dental,Per Unit,"$1,115.94 ",OP,"$1,115.94 ","$1,115.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2799,Provisional crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2910,Recement inlay onlay or part,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2915,Recement cast or prefab post,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2920,Re-cement or re-bond crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2921,Reattach tooth fragment,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2928,Prefab porc/cer crown perm,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2929,Prefab porc/ceram crown pri,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2930,Prefab stnlss steel crwn pri,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2931,Prefab stnlss steel crown pe,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2932,Prefabricated resin crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2933,Prefab stainless steel crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2934,Prefab steel crown primary,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2941,Int therapeutic restoration,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2950,Core build-up incl any pins,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2951,Tooth pin retention,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2952,Post and core cast + crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2953,Each addtnl cast post,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2954,Prefab post/core + crown,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2955,Post removal,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2957,Each addtnl prefab post,Dental,Per Unit,"$1,014.48 ",OP,"$1,014.48 ","$1,014.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,D2960,Labial veneer resin direct,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2961,Labial veneer resin indirect,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2962,Labial veneer porc indirect,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2970,Temp crown (fractured tooth),Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2971,Add proc construct new crown,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2975,Coping,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2980,Crown repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2981,Inlay repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2982,Onlay repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2983,Veneer repair,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2990,Resin infiltration of lesion,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D2999,Dental unspec restorative pr,Dental,Per Unit,$936.64 ,OP,$936.64 ,$936.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3110,Pulp cap direct,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3120,Pulp cap indirect,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3220,Therapeutic pulpotomy,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3221,Gross pulpal debridement,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3222,Part pulp for apexogenesis,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3230,Pulpal therapy anterior prim,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3240,Pulpal therapy posterior pri,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3310,"End thxpy, anterior tooth",Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3320,"End thxpy, premolar tooth",Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3330,"End thxpy, molar tooth",Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3331,Non-surg tx root canal obs,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3332,Incomplete endodontic tx,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3333,Internal root repair,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3346,Retreat root canal anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3347,Retreat root canal premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3348,Retreat root canal molar,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3351,Apexification/recalc initial,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3352,Apexification/recalc interim,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3353,Apexification/recalc final,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3355,Pulpal regeneration initial,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3356,Pulpal regeneration interim,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3357,Pulpal regeneration complete,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3410,Apicoectomy - anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3421,Root surgery premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3425,Root surgery molar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3426,Root surgery ea add root,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3427,Periradicular surgery,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3428,Bone graft peri per tooth,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3429,Bone graft peri each addl,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3430,Retrograde filling,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3431,Biological materials,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3432,Guided tissue regeneration,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3450,Root amputation,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3460,Endodontic endosseous implan,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3470,Intentional replantation,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3471,Surg rep root res anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3472,Surg rep root res premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3473,Surg rep root res molar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3501,Surg exp root surf anterior,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3502,Surg exp root surf premolar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3503,Surg exp root surf molar,Dental,Per Unit,$134.32 ,OP,$134.32 ,$134.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3910,Isolation- tooth w rubb dam,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3920,Tooth splitting,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3950,Canal prep/fitting of dowel,Dental,Per Unit,$135.31 ,OP,$135.31 ,$135.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D3999,Endodontic procedure,Dental,Per Unit,$74.70 ,OP,$74.70 ,$74.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4210,Gingivectomy/plasty 4 or mor,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4211,Gingivectomy/plasty 1 to 3,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4212,Gingivectomy/plasty rest,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4230,Ana crown exp 4 or> per quad,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4231,Ana crown exp 1-3 per quad,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4240,Gingival flap proc w/ planin,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4241,Gngvl flap w rootplan 1-3 th,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4245,Apically positioned flap,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4249,Crown lengthen hard tissue,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4260,Osseous surgery 4 or more,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4261,Osseous surg 1 to 3 teeth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4263,Bone replce graft first site,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4264,Bone replce graft each add,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4265,Bio mtrls to aid soft/os reg,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4266,Guided tiss regen resorble,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4267,Guided tiss regen nonresorb,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4268,Surgical revision procedure,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4270,Pedicle soft tissue graft pr,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4273,Auto tissue graft 1st tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4274,Mesial/distal wedge proc,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4275,Non-auto graft 1st tooth,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4276,Con tissue w dble ped graft,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4277,Soft tissue graft firsttooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4278,Soft tissue graft addl tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4283,Auto tissue graft addl tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4285,Non-auto graft addl tooth,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4320,Provision splnt intracoronal,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4321,Provisional splint extracoro,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4341,Periodontal scaling & root,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4342,Periodontal scaling 1-3teeth,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4346,Scaling gingiv inflammation,Dental,Per Unit,$596.23 ,OP,$596.23 ,$596.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4355,Full mouth debridement,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4381,Localized delivery antimicro,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4910,Periodontal maint procedures,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4920,Unscheduled dressing change,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4921,Gingival irrigation per quad,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D4999,Unspecified periodontal proc,Dental,Per Unit,$561.92 ,OP,$561.92 ,$561.92 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5110,Dentures complete maxillary,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5120,Dentures complete mandible,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5130,Dentures immediat maxillary,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5140,Dentures immediat mandible,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5211,Dentures maxill part resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5212,Dentures mand part resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5213,Dentures maxill part metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5214,Dentures mandibl part metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5221,Immed max part denture resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5222,Immed man part denture resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5223,Immed max part dent metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5224,Immed mand part dent metal,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5225,Maxillary part denture flex,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5226,Mandibular part denture flex,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5281,Removable partial denture,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5282,"Remove unil part denture,max",Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5283,"Remove unil part denture,man",Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5284,Rem unilat dent flex base,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5286,Rem unilat dent 1 pc resin,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5410,Dentures adjust cmplt maxil,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5411,Dentures adjust cmplt mand,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5421,Dentures adjust part maxill,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5422,Dentures adjust part mandbl,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5510,Dentur repr broken compl bas,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5511,Rep broke comp dent base man,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5512,Rep broke comp dent base max,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5520,Replace denture teeth complt,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5610,Dentures repair resin base,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5611,Rep resin part dent base man,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5612,Rep resin part dent base max,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5620,Rep part denture cast frame,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5621,Rep cast part frame man,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5622,Rep cast part frame max,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5630,Rep partial denture clasp,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5640,Replace part denture teeth,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5650,Add tooth to partial denture,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5660,Add clasp to partial denture,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5670,Replc tth&acrlc on mtl frmwk,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5671,Replc tth&acrlc mandibular,Dental,Per Unit,$136.23 ,OP,$136.23 ,$136.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5710,Dentures rebase cmplt maxil,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5711,Dentures rebase cmplt mand,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5720,Dentures rebase part maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5721,Dentures rebase part mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5730,Denture reln cmplt max dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5731,Denture reln cmplt mand dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5740,Denture reln part max dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5741,Denture reln part mand dir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5750,Denture reln cmplt max indir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5751,Denture reln cmplt mand ind,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5760,Denture reln part max indir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5761,Denture reln part mand indir,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5810,Denture interm cmplt maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5811,Denture interm cmplt mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5820,Denture interm part maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5821,Denture interm part mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5850,Denture tiss conditn maxill,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5851,Denture tiss condtin mandbl,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5862,Precision attachment,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5863,Overdenture complete max,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5864,Overdenture partial max,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5865,Overdenture complete mandib,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5866,Overdenture partial mandib,Dental,Per Unit,$162.24 ,OP,$162.24 ,$162.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5867,Replacement of precision att,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5875,Prosthesis modification,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5876,Add metal sub to acrylc dent,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5899,Removable prosthodontic proc,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5911,Facial moulage sectional,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5912,Facial moulage complete,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5913,Nasal prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5914,Auricular prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5915,Orbital prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5916,Ocular prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5919,Facial prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5922,Nasal septal prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5923,Ocular prosthesis interim,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5924,Cranial prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5925,Facial augmentation implant,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5926,Replacement nasal prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5927,Auricular replacement,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5928,Orbital replacement,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5929,Facial replacement,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5931,Surgical obturator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5932,Postsurgical obturator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5933,Refitting of obturator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5934,Mandibular flange prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5935,Mandibular denture prosth,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5936,Temp obturator prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5937,Trismus appliance,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5951,Feeding aid,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5952,Pediatric speech aid,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5953,Adult speech aid,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5954,Superimposed prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5955,Palatal lift prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5958,Intraoral con def inter plt,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5959,Intraoral con def mod palat,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5960,Modify speech aid prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5982,Surgical stent,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5983,Radiation applicator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5984,Radiation shield,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5985,Radiation cone locator,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5986,Fluoride applicator,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5987,Commissure splint,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5988,Surgical splint,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5991,Vesiculobullous disease carr,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5992,Adjust max prost appliance,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5993,Main/clean max prosthesis,Dental,Per Unit,$30.61 ,OP,$30.61 ,$30.61 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5994,Peridontal medicament,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5995,"Peri medicament w/seal, max",Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5996,"Peri medicament w/seal, mand",Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D5999,Maxillofacial prosthesis,Dental,Per Unit,$159.88 ,OP,$159.88 ,$159.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6010,Odontics endosteal implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6011,Second stage implant surgery,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6012,Endosteal implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6013,Surgical place mini implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6040,Odontics eposteal implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6050,Odontics transosteal implnt,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6051,Interim abutment,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6055,Implant connecting bar,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6056,Prefabricated abutment,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6057,Custom abutment,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6058,Abutment supported crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6059,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6060,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6061,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6062,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6063,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6064,Abutment supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6065,Implant supported crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6066,Implant supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6067,Implant supported mtl crown,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6068,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6069,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6070,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6071,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6072,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6073,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6074,Abutment supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6075,Implant supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6076,Implant supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6077,Implant supported retainer,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6080,Implant maintenance,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6081,"Scale & debride, single imp",Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6082,Imp crown porc to base alloy,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6083,Imp crown porc to noble allo,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6084,Imp crown porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6085,Provisional implant crown,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6086,Imp crown base alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6087,Implant crown noble alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6088,Imp crown titanium alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6090,Repair implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6091,Repl semi/precision attach,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6092,Recement supp crown,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6093,Recement supp part denture,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6094,Abut support crown titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6095,Odontics repr abutment,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6096,Remove broken imp ret screw,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6097,Abut crown porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6098,Imp retain porc to base allo,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6099,Imp retainer for fpd,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6100,Removal of implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6101,Debridement of a periimplant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6102,Debridement & contouring,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6103,Bone graft repair perimplant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6104,Bone graft time of implant,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6110,Implnt/abut remov dent max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6111,Implnt/abut remov dent mand,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6112,Imp/abut rem dent part max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6113,Imp/abut rem dent part mand,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6114,Implnt/abut fixed dent max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6115,Implnt/abut fixed dent mand,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6116,Imp/abut fixed dent part max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6117,Imp/abut fixed dent part man,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6118,Imp/abut int fixed dent man,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6119,Int/abut int fixed dent max,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6120,Imp retain porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6121,Retain metal fpd base alloys,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6122,Retain metal fpd noble alloy,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6123,Retain metal fpd titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6190,Radio/surgical implant index,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6191,Semi precision abutment,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6192,Semi precision attachment,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6194,Abut support retainer titani,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6195,Abut retain porc to titanium,Dental,Per Unit,$757.63 ,OP,$757.63 ,$757.63 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6199,Implant procedure,Dental,Per Unit,$688.76 ,OP,$688.76 ,$688.76 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6205,Pontic-indirect resin based,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6210,Prosthodont high noble metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6211,Bridge base metal cast,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6212,Bridge noble metal cast,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6214,Pontic titanium,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6240,Bridge porcelain high noble,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6241,Bridge porcelain base metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6242,Bridge porcelain nobel metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6243,Pontic porcelain to titanium,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6245,Bridge porcelain/ceramic,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6250,Bridge resin w/high noble,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6251,Bridge resin base metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6252,Bridge resin w/noble metal,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6253,Provisional pontic,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6545,Dental retainr cast metl,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6548,Porcelain/ceramic retainer,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6549,Resin retainer,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6600,Porcelain/ceramic inlay 2srf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6601,Porc/ceram inlay >= 3 surfac,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6602,Cst hgh nble mtl inlay 2 srf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6603,Cst hgh nble mtl inlay >=3sr,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6604,Cst bse mtl inlay 2 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6605,Cst bse mtl inlay >= 3 surfa,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6606,Cast noble metal inlay 2 sur,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6607,Cst noble mtl inlay >=3 surf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6608,Onlay porc/crmc 2 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6609,Onlay porc/crmc >=3 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6610,Onlay cst hgh nbl mtl 2 srfc,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6611,Onlay cst hgh nbl mtl >=3srf,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6612,Onlay cst base mtl 2 surface,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6613,Onlay cst base mtl >=3 surfa,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6614,Onlay cst nbl mtl 2 surfaces,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6615,Onlay cst nbl mtl >=3 surfac,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6624,Inlay titanium,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6634,Onlay titanium,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6710,Crown-indirect resin based,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6720,Retain crown resin w hi nble,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6721,Crown resin w/base metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6722,Crown resin w/noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6740,Crown porcelain/ceramic,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6750,Crown porcelain high noble,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6751,Crown porcelain base metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6752,Crown porcelain noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6753,Retain crown porc to titaniu,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6780,Crown 3/4 high noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6781,Crown 3/4 cast based metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6782,Crown 3/4 cast noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6783,Crown 3/4 porcelain/ceramic,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6784,Retainer crown 3/4 titanium,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6790,Crown full high noble metal,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6791,Crown full base metal cast,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6792,Crown full noble metal cast,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6793,Provisional retainer crown,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6794,Crown titanium,Dental,Per Unit,$251.59 ,OP,$251.59 ,$251.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6920,Dental connector bar,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6930,Recement/bond part denture,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6940,Stress breaker,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6950,Precision attachment,Dental,Per Unit,$54.36 ,OP,$54.36 ,$54.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6980,Fixed partial repair,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6985,Pediatric partial denture fx,Dental,Per Unit,$203.37 ,OP,$203.37 ,$203.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D6999,Fixed prosthodontic proc,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7111,Extraction coronal remnants,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7140,Extraction erupted tooth/exr,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7210,Rem imp tooth w mucoper flp,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7220,Impact tooth remov soft tiss,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7230,Impact tooth remov part bony,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7240,Impact tooth remov comp bony,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7241,Impact tooth rem bony w/comp,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7250,Tooth root removal,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7251,Coronectomy,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7260,Oral antral fistula closure,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7261,Primary closure sinus perf,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7270,Tooth reimplantation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7272,Tooth transplantation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7280,Exposure of unerupted tooth,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7282,Mobilize erupted/malpos toot,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7283,Place device impacted tooth,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7285,Biopsy of oral tissue hard,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7286,Biopsy of oral tissue soft,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7287,Exfoliative cytolog collect,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7288,Brush biopsy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7290,Repositioning of teeth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7291,Transseptal fiberotomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7292,Screw retained plate,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7293,Temp anchorage dev w flap,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7294,Temp anchorage dev w/o flap,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7295,"Bone harvest,auto graft proc",Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7296,"Corticotomy, 1-3 teeth",Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7297,"Corticotomy, 4 or more teeth",Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7310,Alveoplasty w/ extraction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7311,Alveoloplasty w/extract 1-3,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7320,Alveoplasty w/o extraction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7321,Alveoloplasty not w/extracts,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7340,Vestibuloplasty ridge extens,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7350,Vestibuloplasty exten graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7410,Rad exc lesion up to 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7411,Excision benign lesion>1.25c,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7412,Excision benign lesion compl,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7413,Excision malig lesion<=1.25c,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7414,Excision malig lesion>1.25cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7415,Excision malig les complicat,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7440,Malig tumor exc to 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7441,Malig tumor > 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7450,Rem odontogen cyst to 1.25cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7451,Rem odontogen cyst > 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7460,Rem nonodonto cyst to 1.25cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7461,Rem nonodonto cyst > 1.25 cm,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7465,Lesion destruction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7471,Rem exostosis any site,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7472,Removal of torus palatinus,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7473,Remove torus mandibularis,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7485,Surg reduct osseoustuberosit,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7490,Maxilla or mandible resectio,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7510,I&d absc intraoral soft tiss,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7511,Incision/drain abscess intra,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7520,I&d abscess extraoral,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7521,Incision/drain abscess extra,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7530,Removal fb skin/areolar tiss,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7540,Removal of fb reaction,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7550,Removal of sloughed off bone,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7560,Maxillary sinusotomy,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7610,Maxilla open reduct simple,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7620,Clsd reduct simpl maxilla fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7630,Open red simpl mandible fx,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7640,Clsd red simpl mandible fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7650,Open red simp malar/zygom fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7660,Clsd red simp malar/zygom fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7670,Closd rductn splint alveolus,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7671,Alveolus open reduction,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7680,Reduct simple facial bone fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7710,Maxilla open reduct compound,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7720,Clsd reduct compd maxilla fx,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7730,Open reduct compd mandble fx,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7740,Clsd reduct compd mandble fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7750,Open red comp malar/zygma fx,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7760,Clsd red comp malar/zygma fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7770,Open reduc compd alveolus fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7771,Alveolus clsd reduc stblz te,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7780,Reduct compnd facial bone fx,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7810,Tmj open reduct-dislocation,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7820,Closed tmp manipulation,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7830,Tmj manipulation under anest,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7840,Removal of tmj condyle,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7850,Tmj meniscectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7852,Tmj repair of joint disc,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7854,Tmj excisn of joint membrane,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7856,Tmj cutting of a muscle,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7858,Tmj reconstruction,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7860,Tmj cutting into joint,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7865,Tmj reshaping components,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7870,Tmj aspiration joint fluid,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7871,Lysis + lavage w catheters,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7872,Tmj diagnostic arthroscopy,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7873,Tmj arthroscopy lysis adhesn,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7874,Tmj arthroscopy disc reposit,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7875,Tmj arthroscopy synovectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7876,Tmj arthroscopy discectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7877,Tmj arthroscopy debridement,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7880,Occlusal orthotic appliance,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7881,Occ orthotic device adjust,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7899,Tmj unspecified therapy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7910,Dent sutur recent wnd to 5cm,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7911,Dental suture wound to 5 cm,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7912,Suture complicate wnd > 5 cm,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7920,Dental skin graft,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7921,Collect & appl blood product,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7922,Place intra-socket bio dress,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7940,Reshaping bone orthognathic,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7941,Bone cutting ramus closed,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7943,Cutting ramus open w/graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7944,Bone cutting segmented,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7945,Bone cutting body mandible,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7946,Reconstruction maxilla total,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7947,Reconstruct maxilla segment,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7948,Reconstruct midface no graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7949,Reconstruct midface w/graft,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7950,Mandible graft,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7951,Sinus aug w bone or bone sub,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7952,Sinus augmentation vertical,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7953,Bone replacement graft,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7955,Repair maxillofacial defects,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7960,Frenulectomy/frenectomy,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7961,Buccal/labial frenectomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7962,Lingual frenectomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7963,Frenuloplasty,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7970,Excision hyperplastic tissue,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7971,Excision pericoronal gingiva,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7972,Surg redct fibrous tuberosit,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7979,Non-surgical sialolithotomy,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7980,Surgical sialolithotomy,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7981,Excision of salivary gland,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7982,Sialodochoplasty,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7983,Closure of salivary fistula,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7990,Emergency tracheotomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7991,Dental coronoidectomy,Oral and Maxillofacial Surgery,Per Unit,$451.22 ,OP,$451.22 ,$451.22 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7993,Surg place craniofacial impl,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7994,Surg place zygomatic impl,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7995,Synthetic graft facial bones,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7996,Implant mandible for augment,Oral and Maxillofacial Surgery,Per Unit,$410.20 ,OP,$410.20 ,$410.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7997,Appliance removal,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7998,Intraoral place of fix dev,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D7999,Oral surgery procedure,Oral and Maxillofacial Surgery,Per Unit,$394.52 ,OP,$394.52 ,$394.52 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8010,Limited dental tx primary,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8020,Limited dental tx transition,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8030,Limited dental tx adolescent,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8040,Limited dental tx adult,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8050,Intercep dental tx primary,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8060,Intercep dental tx transitn,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8070,Compre dental tx transition,Dental,Per Unit,$195.04 ,OP,$195.04 ,$195.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8080,Compre dental tx adolescent,Dental,Per Unit,$195.04 ,OP,$195.04 ,$195.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8090,Compre dental tx adult,Dental,Per Unit,$195.04 ,OP,$195.04 ,$195.04 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8210,Orthodontic rem appliance tx,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8220,Fixed appliance therapy habt,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8660,Preorthodontic tx visit,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8670,Periodic orthodontc tx visit,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8680,Orthodontic retention,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8681,Removable retainer adjust,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8690,Orthodontic treatment,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8691,Repair ortho appliance,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8692,Replacement retainer,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8693,Rebond/recement retainers,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8694,Repair fixed retainers,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8695,Remove fixed ortho appliance,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8696,Rep of ortho appliance max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8697,Rep of ortho appliance man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8698,Recement fixed retainer max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8699,Recement fixed retainer man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8701,Repair fixed retainer max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8702,Repair of fixed retainer man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8703,Replace broken retainer max,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8704,Replace broken retainer man,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D8999,Orthodontic procedure,Dental,Per Unit,$177.32 ,OP,$177.32 ,$177.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9110,Tx dental pain minor proc,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9120,Fix partial denture section,Dental,Per Unit,$110.21 ,OP,$110.21 ,$110.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9130,Temporomandibular joint dysf,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9210,Dent anesthesia w/o surgery,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9211,Regional block anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9212,Trigeminal block anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9215,Local anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9219,Eval mod/deep sed/gen anest,Dental,Per Unit,$130.37 ,OP,$130.37 ,$130.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9220,General anesthesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9221,General anesthesia ea ad 15m,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9222,"Deep anest, 1st 15 min",Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9223,General anesth ea addl 15 mi,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9230,Analgesia,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9239,"Iv mod sedation, 1st 15 min",Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9241,Intravenous sedation,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9242,Iv sedation ea ad 15 m,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9243,Iv sedation ea addl 15m,Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9248,Sedation (non-iv),Dental,Per Unit,$24.43 ,OP,$24.43 ,$24.43 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9310,Dental consultation,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9311,Consult w/med hlth care prof,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9410,Dental house call,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9420,Hospital/asc call,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9430,Office visit during hours,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9440,Office visit after hours,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9450,Case presentation tx plan,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9610,Dent therapeutic drug inject,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9612,Thera par drugs 2 or > admin,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9613,Infiltration thera drug,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9630,Drugs/meds disp for home use,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9910,Dent appl desensitizing med,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9911,Appl desensitizing resin,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9920,Behavior management,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9930,Treatment of complications,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9931,Clean/inspect rem appliance,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9932,Clean & inspect rem dent max,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9933,Clean & inspect rem dent man,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9934,Clean rem part denture max,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9935,Clean rem part denture mand,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9940,Dental occlusal guard,Dental,Per Unit,$156.21 ,OP,$156.21 ,$156.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9941,Fabrication athletic guard,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9942,Repair/reline occlusal guard,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9943,Occlusal guard adjustment,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9944,"Occ guard, hard, full arch",Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9945,"Occ guard, soft, full arch",Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9946,"Occ guard, hard, part arch",Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9950,Occlusion analysis,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9951,Limited occlusal adjustment,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9952,Complete occlusal adjustment,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9970,Enamel microabrasion,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9971,Odontoplasty per tooth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9972,Extrnl bleaching per arch,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9973,Extrnl bleaching per tooth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9974,Intrnl bleaching per tooth,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9975,External bleaching home app,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9991,"Case mgmt, appt barriers",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9992,"Case mgmt, care coordination",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9993,"Case mgmt, interviewing",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9994,"Case mgmt, pt education",Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9995,Teledentistry real-time,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9996,Teledentistry dent review,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9997,Dent case mgmt special needs,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,D9999,Adjunctive procedure,Dental,Per Unit,$136.51 ,OP,$136.51 ,$136.51 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0008,Admin influenza virus vac,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0009,Admin pneumococcal vaccine,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0010,Admin hepatitis b vaccine,Ancillary Services,Per Unit,$23.26 ,OP,$23.26 ,$23.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0027,Semen analysis,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0068,Adm iv infusion drug in home,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0069,Adm sq infusion drug in home,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0070,Adm of chemo drug in home,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0071,Comm svcs by rhc/fqhc 5 min,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0076,Care manag h vst new pt 20 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0077,Care manag h vst new pt 30 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0078,Care manag h vst new pt 45 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0079,Care manag h vst new pt 60 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0080,Care manag h vst new pt 75 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0081,Care man h v ext pt 20 mi,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0082,Care man h v ext pt 30 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0083,Care man h v ext pt 45 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0084,Care man h v ext pt 60 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0085,Care man h v ext pt 75 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0086,Care man home care plan 30 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0087,Care man home care plan 60 m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0088,Adm iv drug 1st home visit,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0089,Adm subq drug 1st home visit,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0090,Adm iv chemo 1st home visit,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0103,Psa screening,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0104,Ca screen;flexi sigmoidscope,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0105,Colorectal scrn; hi risk ind,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0108,Diab manage trn per indiv,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0109,Diab manage trn ind/group,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0117,Glaucoma scrn hgh risk direc,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0118,Glaucoma scrn hgh risk direc,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0121,Colon ca scrn not hi rsk ind,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0122,Colon ca scrn; barium enema,Diagnostic Radiology,Per Unit,$31.74 ,OP,$31.74 ,$31.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0123,Screen cerv/vag thin layer,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0124,Screen c/v thin layer by md,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0127,Trim nail(s),General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0128,Corf skilled nursing service,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0130,Single energy x-ray study,Diagnostic Radiology,Per Unit,$50.13 ,OP,$50.13 ,$50.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0141,"Scr c/v cyto,autosys and md",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0143,"Scr c/v cyto,thinlayer,rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0144,"Scr c/v cyto,thinlayer,rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0145,"Scr c/v cyto,thinlayer,rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0147,"Scr c/v cyto, automated sys",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0148,"Scr c/v cyto, autosys, rescr",Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0151,"Hhcp-serv of pt,ea 15 min",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0152,"Hhcp-serv of ot,ea 15 min",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0153,"Hhcp-svs of s/l path,ea 15mn",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0155,"Hhcp-svs of csw,ea 15 min",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0157,Hhc pt assistant ea 15,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0158,Hhc ot assistant ea 15,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0159,Hhc pt maint ea 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0160,Hhc occup therapy ea 15,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0161,Hhc slp ea 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0162,"Hhc rn e&m plan svs, 15 min",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0166,"Extrnl counterpulse, per tx",Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0175,"Opps service,sched team conf",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0176,Opps/php;activity therapy,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0177,Opps/php; train & educ serv,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0179,Md recertification hha pt,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0180,Md certification hha patient,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0181,Home health care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0182,Hospice care supervision,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0186,"Dstry eye lesn,fdr vssl tech",Ophthalmology Surgery,Per Unit,$312.24 ,OP,$312.24 ,$312.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0202,Scr mammo bi incl cad,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0204,Dx mammo incl cad bi,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0206,Dx mammo incl cad uni,Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0219,Pet img wholbod melano nonco,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0235,Pet not otherwise specified,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0237,Therapeutic procd strg endur,Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0238,"Oth resp proc, indiv",Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0239,"Oth resp proc, group",Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0248,Demonstrate use home inr mon,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0252,Pet imaging initial dx,Diagnostic Radiology,Per Unit,$697.72 ,OP,$697.72 ,$697.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0255,Current percep threshold tst,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0257,Unsched dialysis esrd pt hos,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0270,Mnt subs tx for change dx,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0271,Group mnt 2 or more 30 mins,Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0278,"Iliac art angio,cardiac cath",Interventional Radiology,Per Unit,"$1,525.89 ",OP,"$1,525.89 ","$1,525.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0279,"Tomosynthesis, mammo",Diagnostic Radiology,Per Unit,$39.40 ,OP,$39.40 ,$39.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0283,Elec stim other than wound,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0289,"Arthro, loose body + chondro",Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0293,"Non-cov surg proc,clin trial",Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0297,Ldct for lung ca screen,Diagnostic Radiology,Per Unit,$162.95 ,OP,$162.95 ,$162.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0306,Cbc/diffwbc w/o platelet,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0307,Cbc without platelet,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0328,Fecal blood scrn immunoassay,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0339,"Robot lin-radsurg com, first",Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0340,Robt lin-radsurg fractx 2-5,Therapeutic Radiology,Per Unit,"$2,592.65 ",OP,"$2,592.65 ","$2,592.65 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0365,Vessel mapping hemo access,Diagnostic Radiology,Per Unit,$114.16 ,OP,$114.16 ,$114.16 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0378,Hospital observation per hr,Ancillary Services,Per Unit,$651.20 ,OP,$651.20 ,$651.20 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0389,Ultrasound exam aaa screen,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0396,Alcohol/subs interv 15-30mn,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0397,Alcohol/subs interv >30 min,Behavioral Health,Per Unit,$84.55 ,OP,$84.55 ,$84.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0403,Ekg for initial prevent exam,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0404,Ekg tracing for initial prev,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0405,Ekg interpret & report preve,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0409,Corf related serv 15 mins ea,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0410,Grp psych partial hosp 45-50,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0411,Inter active grp psych parti,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0412,Open tx iliac spine uni/bil,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0413,Pelvic ring fracture uni/bil,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0414,Pelvic ring fx treat int fix,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0415,Open tx post pelvic fxcture,Orthopedic Surgery,Per Unit,"$2,555.93 ",OP,"$2,555.93 ","$2,555.93 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0420,Ed svc ckd ind per session,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0421,Ed svc ckd grp per session,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0422,Intens cardiac rehab w/exerc,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0423,Intens cardiac rehab no exer,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0424,Pulmonary rehab w exer,Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0431,Drug screen multiple class,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0432,Eia hiv-1/hiv-2 screen,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0433,Elisa hiv-1/hiv-2 screen,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0434,Drug screen multi drug class,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0435,Oral hiv-1/hiv-2 screen,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0436,Tobacco-use counsel 3-10 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0437,Tobacco-use counsel>10min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0442,Annual alcohol screen 15 min,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0443,Brief alcohol misuse counsel,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0444,Depression screen annual,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0445,High inten beh couns std 30m,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0446,Intens behave ther cardio dx,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0447,Behavior counsel obesity 15m,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0448,Place perm pacing cardiovert,Interventional Cardiology,Per Unit,"$13,158.48 ",OP,"$13,158.48 ","$13,158.48 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G0451,Devlopment test interpt&rep,Behavioral Health,Per Unit,$458.21 ,OP,$458.21 ,$458.21 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0452,Molecular pathology interpr,Pathology,Per Unit,$18.36 ,OP,$18.36 ,$18.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0459,Telehealth inpt pharm mgmt,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0464,"Colorec CA scr, sto bas DNA",Laboratory,Per Unit,$210.68 ,OP,$210.68 ,$210.68 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0472,Hep c screen high risk/other,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0473,Group behave couns 2-10,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0475,Hiv combination assay,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0476,Hpv combo assay ca screen,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0477,Drug test presump optical,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0478,Drug test presump opt inst,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0479,Drug test presump not opt,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0480,Drug test def 1-7 classes,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0491,Dialysis acu kidney no esrd,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0492,Md/oth eval acut kid no esrd,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0495,Rn care train/edu in hh,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0496,Lpn care train/edu in hh,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0498,Chemo extend iv infus w/pump,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0499,Hepb screen high risk indiv,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0500,Mod sedat endo service >5yrs,Anesthesia,Per Unit,$13.45 ,OP,$13.45 ,$13.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0502,"Init psych care manag, 70min",Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0503,"Subseq psych care man,60mi",Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0504,Init/sub psych care add 30 m,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0506,Comp asses care plan ccm svc,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0507,Care manage serv minimum 20,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0511,Ccm/bhi by rhc/fqhc 20min mo,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0512,Cocm by rhc/fqhc 60 min mo,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0515,Cognitive skills development,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0516,"Insert drug del implant, >=4",General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0517,Remove drug implant,General Surgery,Per Unit,$171.35 ,OP,$171.35 ,$171.35 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0518,Remove w insert drug implant,General Surgery,Per Unit,$597.65 ,OP,$597.65 ,$597.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G0659,Drug test def simple all cl,Laboratory,Per Unit,$17.30 ,OP,$17.30 ,$17.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2000,Blinded conv. tx mdd clin tr,Behavioral Health,Per Unit,$276.44 ,OP,$276.44 ,$276.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2010,Remot image submit by pt,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2011,Alcohol/sub misuse assess,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2012,Brief check in by md/qhp,Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2014,Post-d/c care plan overs 30m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2015,Post-d/c care plan overs 60m,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2058,Ccm add 20min,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2064,Md mang high risk dx 30,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2065,Clin mang h risk dx 30,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2066,Inter devc remote 30d,Ancillary Services,Per Unit,$24.11 ,OP,$24.11 ,$24.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2082,Visit esketamine 56m or less,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2083,"Visit esketamine, > 56m",Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2168,Svs by pt in home health,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2169,Svs by ot in home health,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2213,Initiat med assist tx in er,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2214,Init/sub psych care m 1st 30,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2250,"Remot img sub by pt, non e/m",Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2251,"Brief chkin, 5-10, non-e/m",Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G2252,"Brief chkin by md/qhp, 11-20",Ancillary Services,Per Unit,$26.19 ,OP,$26.19 ,$26.19 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G3001,"Admin + supply, tositumomab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6001,Echo guidance radiotherapy,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6002,Stereoscopic x-ray guidance,Interventional Radiology,Per Unit,$180.85 ,OP,$180.85 ,$180.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6003,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6004,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6005,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6006,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6007,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6008,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6009,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6010,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6011,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6012,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6013,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6014,Radiation treatment delivery,Therapeutic Radiology,Per Unit,$469.79 ,OP,$469.79 ,$469.79 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6015,Radiation tx delivery imrt,Therapeutic Radiology,Per Unit,$279.80 ,OP,$279.80 ,$279.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6016,Delivery comp imrt,Therapeutic Radiology,Per Unit,$434.17 ,OP,$434.17 ,$434.17 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6018,Ileoscopy w/stent,Gastroenterology,Per Unit,"$1,302.71 ",OP,"$1,302.71 ","$1,302.71 ",,,,,,,,,,,,,
Molina Medicaid,CPT,G6019,Colonoscopy lesion removal,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6020,Colonoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6021,Unlisted px small intestine,General Surgery,Per Unit,$960.01 ,OP,$960.01 ,$960.01 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6022,Sigmoidoscopy w/ablate tumr,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6023,Sigmoidoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6024,Lesion removal colonoscopy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6025,Colonoscopy w/stent,Gastroenterology,Per Unit,$476.14 ,OP,$476.14 ,$476.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6027,Anoscopy hra w/spec collect,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6028,Anoscopy hra w/biopsy,Gastroenterology,Per Unit,$427.85 ,OP,$427.85 ,$427.85 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6030,Assay of amitriptyline,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6031,Assay of benzodiazepines,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6032,Assay of desipramine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6034,Assay of doxepin,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6035,Assay of gold,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6036,Assay of Imipramine,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6037,Assay of nortiptyline,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6038,Assay of salicylate,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6039,Assay of acetaminophen,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6040,Assay of ethanol,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6041,Assay of urine alkaloids,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6042,Assay of amphetamines,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6043,Assay of barbiturates,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6044,Assay of cocaine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6045,Assay of dihydrocodeinone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6046,Assay of dihydromorphinone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6047,Assay of dihydrotestosterone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6048,Assay of dimethadione,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6049,Assay of Epiandrosterone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6050,Assay of Ethchlorvynol,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6051,Assay of flurazepam,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6052,Assay of meprobamate,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6053,Assay of methadone,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6054,Assay of methsuximide,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6055,Assay of nicotine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6056,Assay of opiates,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6057,Assay of phenothiazine,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G6058,Drug confirmation,Laboratory,Per Unit,$7.84 ,OP,$7.84 ,$7.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9012,Other specified case mgmt,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9016,Demo-smoking cessation coun,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9020,Rimantadine hcl 100mg oral,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9034,"Zanamivir, inh pwdr, brand",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9035,"Oseltamivir phosp, brand",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9143,Warfarin respon genetic test,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9147,Outpt iv insulin tx any mea,General Medicine,Per Unit,$278.91 ,OP,$278.91 ,$278.91 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9157,Transesoph doppl cardiac mon,Cardiology,Per Unit,$276.65 ,OP,$276.65 ,$276.65 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9187,Bpci home visit,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9477,Care coord at hospice,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9686,Nursing facility conference,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9873,1 em core session,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9874,4 em core sessions,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9875,9 em core sessions,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9876,2 em core ms mo 7-9 no wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9877,2 em core ms mo 10-12 no wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9878,2 em core ms mo 7-9 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9879,2 em core ms mo 10-12 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9880,Em 5 percent wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9881,Em 9 percent wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9882,2 em ongoing ms mo 13-15 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9883,2 em ongoing ms mo 16-18 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9884,2 em ongoing ms mo 19-21 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9885,2 em ongoing ms mo 22-24 wl,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9890,Em bridge payment,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,G9987,Bpci advanced in home visit,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0001,Alcohol and/or drug assess,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0002,Alcohol and/or drug screenin,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0003,Alcohol and/or drug screenin,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0004,Alcohol and/or drug services,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0005,Alcohol and/or drug services,Behavioral Health,Per Unit,$119.88 ,OP,$119.88 ,$119.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0006,Alcohol and/or drug services,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0007,Alcohol and/or drug services,Behavioral Health,Per Unit,$135.70 ,OP,$135.70 ,$135.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0014,Alcohol and/or drug services,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0015,Alcohol and/or drug services,Behavioral Health,Per Unit,$339.88 ,OP,$339.88 ,$339.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0020,Alcohol and/or drug services,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0022,Alcohol and/or drug interven,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0031,Mh health assess by non-md,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0032,Mh svc plan dev by non-md,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0033,Oral med adm direct observe,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0034,Med trng & support per 15min,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0035,Mh partial hosp tx under 24h,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0037,Comm psy sup tx pgm per diem,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0046,"Mental health service, nos",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0047,Alcohol/drug abuse svc nos,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0049,Alcohol/drug screening,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H0050,Alcohol/drug service 15 min,Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H1002,Carecoordination prenatal,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H1003,Prenatal at risk education,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H1011,Family assessment,Behavioral Health,Per Unit,$156.88 ,OP,$156.88 ,$156.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2000,Comp multidisipln evaluation,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2001,Rehabilitation program 1/2 d,Behavioral Health,Per Unit,$166.94 ,OP,$166.94 ,$166.94 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2010,Comprehensive med svc 15 min,Behavioral Health,Per Unit,$80.13 ,OP,$80.13 ,$80.13 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2011,"Crisis interven svc, 15 min",Behavioral Health,Per Unit,$135.70 ,OP,$135.70 ,$135.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2012,"Behav hlth day treat, per hr",Behavioral Health,Per Unit,$276.34 ,OP,$276.34 ,$276.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2014,"Skills train and dev, 15 min",Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2017,"Psysoc rehab svc, per 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2018,"Psysoc rehab svc, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2019,"Ther behav svc, per 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2020,"Ther behav svc, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2027,"Psychoed svc, per 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2028,"Sex offend tx svc, 15 min",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2029,"Sex offend tx svc, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2032,"Activity therapy, per 15 min",Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2033,Multisys ther/juvenile 15min,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2035,"A/d tx program, per hour",Behavioral Health,Per Unit,$84.40 ,OP,$84.40 ,$84.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,H2036,"A/d tx program, per diem",Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0121,"Inj., omadacycline, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0122,"Inj., eravacycline, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0129,Abatacept injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0130,Abciximab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0135,Adalimumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0178,Aflibercept injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0179,"Inj, brolucizumab-dbll, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0180,Agalsidase beta injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0185,"Inj., aprepitant, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0202,"Injection, alemtuzumab",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0205,Alglucerase injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0207,Amifostine,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0210,Methyldopate hcl injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0215,Alefacept,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0220,Alglucosidase alfa injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0221,Lumizyme injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0222,"Inj., patisiran, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0223,Inj givosiran 0.5 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0256,Alpha 1 proteinase inhibitor,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0257,Glassia injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0287,Amphotericin b lipid complex,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0288,Ampho b cholesteryl sulfate,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0289,Amphotericin b liposome inj,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0291,"Inj., plazomicin, 5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0348,Anidulafungin injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0350,Injection anistreplase 30 u,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0364,Apomorphine hydrochloride,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0365,"Aprotonin, 10,000 kiu",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0401,Inj aripiprazole ext rel 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0475,Baclofen 10 mg injection,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0480,Basiliximab,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0485,Belatacept injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0490,Belimumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0517,"Inj., benralizumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0558,Peng benzathine/procaine inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0561,Penicillin g benzathine inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0565,"Inj, bezlotoxumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0567,"Inj., cerliponase alfa 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0570,Buprenorphine implant 74.2mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0583,Bivalirudin,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0584,"Injection, burosumab-twza 1m",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0585,"Injection,onabotulinumtoxina",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0586,Abobotulinumtoxina,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0587,"Inj, rimabotulinumtoxinb",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0588,Incobotulinumtoxin a,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0591,"Inj deoxycholic acid, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0593,"Inj., lanadelumab-flyo, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0594,Busulfan injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0596,"Injection, ruconest",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0597,"C-1 esterase, berinert",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0598,"C-1 esterase, cinryze",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0599,"Inj., haegarda 10 units",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0600,Edetate calcium disodium inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0604,"Cinacalcet, esrd on dialysis",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0606,"Inj, etelcalcetide, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0630,Calcitonin salmon injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0637,Caspofungin acetate,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0638,Canakinumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0641,Inj levoleucovorin nos 0.5mg,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0642,"Injection, khapzory, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0691,Inj lefamulin 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0693,"Inj., cefiderocol, 5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0695,Inj ceftolozane tazobactam,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0712,Ceftaroline fosamil inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0714,Ceftazidime and avibactam,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0716,Centruroides immune f(ab),Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0717,Certolizumab pegol inj 1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0740,Cidofovir injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0742,Inj imip 4 cilas 4 releb 2mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0775,"Collagenase, clost hist inj",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0791,Inj crizanlizumab-tmca 5mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0795,Corticorelin ovine triflutal,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0800,Corticotropin injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0833,Cosyntropin injection nos,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0840,Crotalidae poly immune fab,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0841,Inj crotalidae im f(ab')2 eq,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0850,Cytomegalovirus imm iv /vial,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0875,"Injection, dalbavancin",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0878,Daptomycin injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0881,"Darbepoetin alfa, non-esrd",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0882,"Darbepoetin alfa, esrd use",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0883,Argatroban nonesrd use 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0884,Argatroban esrd dialysis 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0885,"Epoetin alfa, non-esrd",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0886,Epoetin alfa 1000 units esrd,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0890,Peginesatide injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0894,Decitabine injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J0896,Inj luspatercept-aamt 0.25mg,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J0897,Denosumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1095,"Injection, dexamethasone 9%",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1096,Dexametha opth insert 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1097,Phenylep ketorolac opth soln,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1162,Digoxin immune fab (ovine),Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1190,Dexrazoxane hcl injection,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1201,Inj. cetirizine hcl 0.5mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1205,Chlorothiazide sodium inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1212,Dimethyl sulfoxide 50% 50 ml,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1267,Doripenem injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1290,Ecallantide injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1300,Eculizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1301,"Injection, edaravone, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1303,"Inj., ravulizumab-cwvz 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1322,"Elosulfase alfa, injection",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1327,Eptifibatide injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1410,Inj estrogen conjugate 25 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1428,"Inj, eteplirsen, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1429,Inj golodirsen 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1430,Ethanolamine oleate 100 mg,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1436,Etidronate disodium inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1437,Inj. fe derisomaltose 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1438,Etanercept injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1439,Inj ferric carboxymaltos 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1442,Inj filgrastim excl biosimil,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1446,"Inj, tbo-filgrastim, 5 mcg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1447,Inj tbo filgrastim 1 microg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1451,"Fomepizole, 15 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1452,Intraocular fomivirsen na,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1453,Fosaprepitant injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1454,"Inj fosnetupitant, palonoset",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1455,Foscarnet sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1457,Gallium nitrate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1458,Galsulfase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1459,Inj ivig privigen 500 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1460,Gamma globulin 1 cc inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1555,"Inj cuvitru, 100 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1556,"Inj, imm glob bivigam, 500mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1557,Gammaplex injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1558,"Inj. xembify, 100 mg",Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1559,Hizentra injection,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1560,Gamma globulin > 10 cc inj,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1561,Gamunex-c/gammaked,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1562,"Vivaglobin, inj",Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1566,"Immune globulin, powder",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1568,Octagam injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1569,Gammagard liquid injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1570,Ganciclovir sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1571,Hepagam b im injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1572,Flebogamma injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1573,"Hepagam b intravenous, inj",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1575,Hyqvia 100mg immuneglobulin,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1595,Injection glatiramer acetate,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1599,"Ivig non-lyophilized, nos",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1602,Golimumab for iv use 1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1610,Glucagon hydrochloride/1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1628,"Inj., guselkumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1632,"Inj., brexanolone, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1640,"Hemin, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1670,Tetanus immune globulin inj,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1675,Histrelin acetate,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1738,Inj. meloxicam 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1740,Ibandronate sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1742,Ibutilide fumarate injection,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1743,Idursulfase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1744,Icatibant injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1745,Infliximab not biosimil 10mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1746,"Inj., ibalizumab-uiyk, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1750,Inj iron dextran,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1756,Iron sucrose injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1786,Imuglucerase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1823,"Inj. inebilizumab-cdon, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1826,Interferon beta-1a inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1830,Interferon beta-1b / .25 mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1833,"Injection, isavuconazonium",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1930,Lanreotide injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1931,Laronidase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J1942,Aripiprazole lauroxil 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1943,"Inj., aristada initio, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1944,Aripirazole lauroxil 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1945,Lepirudin,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J1950,Leuprolide acetate /3.75 mg,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2062,Loxapine for inhalation 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2170,Mecasermin injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2182,"Injection, mepolizumab, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2186,"Inj., meropenem, vaborbactam",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2248,Micafungin sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2278,Ziconotide injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2315,"Naltrexone, depot form",Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2323,Natalizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2325,Nesiritide injection,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2326,"Inj, nusinersen, 0.1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2350,"Injection, ocrelizumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2353,"Octreotide injection, depot",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2355,Oprelvekin injection,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2357,Omalizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2407,"Injection, oritavancin",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2425,Palifermin injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2426,Paliperidone palmitate inj,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2469,Palonosetron hcl,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2502,"Inj, pasireotide long acting",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2503,Pegaptanib sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2504,"Pegademase bovine, 25 iu",Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2505,"Injection, pegfilgrastim 6mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2507,Pegloticase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2513,Pentastarch 10% solution,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2515,Pentobarbital sodium inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2545,Pentamidine non-comp unit,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2547,"Injection, peramivir",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2562,Plerixafor injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2597,Inj desmopressin acetate,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2724,Protein c concentrate,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2730,Pralidoxime chloride inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2770,Quinupristin/dalfopristin,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2778,Ranibizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2783,Rasburicase,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2786,"Injection, reslizumab, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2790,Rho d immune globulin inj,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2791,Rhophylac injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2792,"Rho(d) immune globulin h, sd",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2793,Rilonacept injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2794,"Inj risperdal consta, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2796,Romiplostim injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2797,"Inj., rolapitant, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2798,"Inj., perseris, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2805,Sincalide injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2820,Sargramostim injection,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2840,Inj sebelipase alfa 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2850,Inj secretin synthetic human,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J2860,"Injection, siltuximab",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2993,Reteplase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J2997,Alteplase recombinant,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3031,"Inj., fremanezumab-vfrm 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3032,Inj. eptinezumab-jjmr 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3060,"Inj, taliglucerase alfa 10 u",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3090,Inj tedizolid phosphate,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3095,Telavancin injection,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3101,Tenecteplase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3110,Teriparatide injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3111,Inj. romosozumab-aqqg 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3145,Testosterone undecanoate 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3240,Thyrotropin injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3241,Inj. teprotumumab-trbw 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3243,Tigecycline injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3245,"Inj., tildrakizumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3246,Tirofiban hcl,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3262,Tocilizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3285,Treprostinil injection,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3300,Triamcinolone a inj prs-free,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3304,Inj triamcinolone ace xr 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3315,Triptorelin pamoate,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3316,"Inj., triptorelin xr 3.75 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3355,"Urofollitropin, 75 iu",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3357,"Ustekinumab sub cu inj, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3358,"Ustekinumab, iv inject, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3365,"Urokinase 250,000 iu inj",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3380,"Injection, vedolizumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3385,Velaglucerase alfa,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3396,Verteporfin injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3397,"Inj., vestronidase alfa-vjbk",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3398,Inj luxturna 1 billion vec g,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3399,Inj onase abepar-xioi treat,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J3470,Hyaluronidase injection,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3471,"Ovine, up to 999 usp units",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3472,"Ovine, 1000 usp units",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J3473,Hyaluronidase recombinant,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7169,"Inj andexxa, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7170,"Inj., emicizumab-kxwh 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7175,"Inj, factor x, (human), 1iu",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7177,"Inj., fibryga, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7178,Inj human fibrinogen con nos,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7179,Vonvendi inj 1 iu vwf:rco,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7180,Factor xiii anti-hem factor,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7181,Factor xiii recomb a-subunit,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7182,Factor viii recomb novoeight,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7183,Wilate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7185,Xyntha inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7186,Antihemophilic viii/vwf comp,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7187,"Humate-p, inj",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7188,Factor viii recomb obizur,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7189,Factor viia recomb novoseven,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7190,Factor viii,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7191,Factor viii (porcine),Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7192,Factor viii recombinant nos,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7193,Factor ix non-recombinant,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7194,Factor ix complex,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7195,Factor ix recombinant nos,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7196,Antithrombin recombinant,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7197,Antithrombin iii injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7198,Anti-inhibitor,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7199,Hemophilia clot factor noc,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7200,Factor ix recombinan rixubis,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7201,Factor ix alprolix recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7202,Factor ix idelvion inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7203,Factor ix recomb gly rebinyn,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7204,Inj recombin esperoct per iu,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7205,Factor viii fc fusion recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7207,Factor viii pegylated recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7208,Inj. jivi 1 iu,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7209,Factor viii nuwiq recomb 1iu,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7210,"Inj, afstyla, 1 i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7211,"Inj, kovaltry, 1 i.u.",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7212,Factor viia recomb sevenfact,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7296,"Kyleena, 19.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7297,"Liletta, 52 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7298,"Mirena, 52 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7300,Intraut copper contraceptive,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7301,"Skyla, 13.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7302,Levonorgestrel iu 52 mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7303,Contraceptive vaginal ring,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7304,Contraceptive hormone patch,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7306,Levonorgestrel implant sys,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7307,Etonogestrel implant system,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7308,Aminolevulinic acid hcl top,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7309,"Methyl aminolevulinate, top",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7310,Ganciclovir long act implant,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7311,"Inj., retisert, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7312,Dexamethasone intra implant,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7313,"Inj., iluvien, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7314,"Inj., yutiq, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7315,Ophthalmic mitomycin,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7316,"Inj, ocriplasmin, 0.125 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7318,"Inj, durolane 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7320,"Genvisc 850, inj, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7321,Hyalgan or supartz inj dose,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7322,Hymovis injection 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7323,Euflexxa inj per dose,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7324,Orthovisc inj per dose,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7325,Synvisc or synvisc-one,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7326,Gel-one,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7327,Monovisc inj per dose,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7328,Gelsyn-3 injection 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7329,"Inj, trivisc 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7330,Cultured chondrocytes implnt,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7331,"Synojoynt, inj., 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7332,"Inj., triluron, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7333,Visco-3 inj dose,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7336,Capsaicin 8% patch,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7340,Carbidopa levodopa ent 100ml,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7345,"Aminolevulinic acid, 10% gel",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7351,Inj bimatoprost itc imp1mcg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7352,"Afamelanotide implant, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7401,Mometasone furoate sinus imp,Chemotherapy and Pharmacotherapy,Per Unit,$384.11 ,OP,$384.11 ,$384.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7501,Azathioprine parenteral,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7504,Lymphocyte immune globulin,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J7505,Monoclonal antibodies,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7511,Antithymocyte globuln rabbit,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7513,"Daclizumab, parenteral",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7525,Tacrolimus injection,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7639,Dornase alfa non-comp unit,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7685,Tobramycin comp unit,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J7686,"Treprostinil, non-comp unit",Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J8501,Oral aprepitant,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J8560,Etoposide oral 50 mg,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J8562,Oral fludarabine phosphate,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J8565,Gefitinib oral,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J8655,"Oral netupitant, palonosetro",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J8670,"Rolapitant, oral, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J8705,Topotecan oral,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9010,Alemtuzumab injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9015,Aldesleukin injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9017,Arsenic trioxide injection,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9019,Erwinaze injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9020,"Asparaginase, nos",Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9022,"Inj, atezolizumab,10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9023,"Injection, avelumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9025,Azacitidine injection,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9027,Clofarabine injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9030,Bcg live intravesical 1mg,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9031,Bcg live intravesical vac,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9032,"Injection, belinostat, 10mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9033,"Inj., treanda 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9034,"Inj., bendeka 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9035,Bevacizumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9036,Inj. belrapzo/bendamustine,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9039,"Injection, blinatumomab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9040,Bleomycin sulfate injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9041,"Inj., velcade 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9042,Brentuximab vedotin inj,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9043,Cabazitaxel injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9044,"Inj, bortezomib, nos, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9047,"Injection, carfilzomib, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9050,Carmustine injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9055,Cetuximab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9057,"Inj., copanlisib, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9065,Inj cladribine per 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9070,Cyclophosphamide 100 mg inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9098,Cytarabine liposome inj,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9118,Inj. calaspargase pegol-mknl,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9119,"Inj., cemiplimab-rwlc, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9120,Dactinomycin injection,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9144,"Daratumumab, hyaluronidase",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9145,"Injection, daratumumab 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9150,Daunorubicin injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9151,Daunorubicin citrate inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9153,"Inj daunorubicin, cytarabine",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9155,Degarelix injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9160,Denileukin diftitox inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9171,Docetaxel injection,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9173,"Inj., durvalumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9176,"Injection, elotuzumab, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9177,Inj enfort vedo-ejfv 0.25mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9179,Eribulin mesylate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9185,Fludarabine phosphate inj,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9198,"Inj. infugem, 100 mg",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9199,"Injection, infugem, 200 mg",Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9200,Floxuridine injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9202,Goserelin acetate implant,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9203,Gemtuzumab ozogamicin 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9204,"Inj mogamulizumab-kpkc, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9205,Inj irinotecan liposome 1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9207,Ixabepilone injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9208,Ifosfamide injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9210,"Inj., emapalumab-lzsg, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9211,Idarubicin hcl injection,Chemotherapy and Pharmacotherapy,Per Unit,$77.84 ,OP,$77.84 ,$77.84 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9213,Interferon alfa-2a inj,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9214,Interferon alfa-2b inj,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9216,Interferon gamma 1-b inj,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9217,Leuprolide acetate suspnsion,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9219,Leuprolide acetate implant,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9223,"Inj. lurbinectedin, 0.1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9225,Vantas implant,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9226,Supprelin la implant,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9227,Inj. isatuximab-irfc 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9228,Ipilimumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9229,Inj inotuzumab ozogam 0.1 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9230,Mechlorethamine hcl inj,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9245,Inj melpha hydroch nos 50 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9246,"Inj., evomela, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9261,Nelarabine injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9262,"Inj, omacetaxine mep, 0.01mg",Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9264,Paclitaxel protein bound,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9266,Pegaspargase injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9268,Pentostatin injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9269,Inj. tagraxofusp-erzs 10 mcg,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9270,Plicamycin (mithramycin) inj,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9271,Inj pembrolizumab,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9280,Mitomycin injection,Chemotherapy and Pharmacotherapy,Per Unit,$244.88 ,OP,$244.88 ,$244.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9281,Mitomycin instillation,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9285,"Inj, olaratumab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9293,Mitoxantrone hydrochl / 5 mg,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9295,"Injection, necitumumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9299,"Injection, nivolumab",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9300,Gemtuzumab ozogamicin inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9301,Obinutuzumab inj,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9302,Ofatumumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9303,Panitumumab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9304,"Inj. pemetrexed, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9305,Inj. pemetrexed nos 10mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9306,"Injection, pertuzumab, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9307,Pralatrexate injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9308,"Injection, ramucirumab",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9309,"Inj, polatuzumab vedotin 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$4,027.28 ",OP,"$4,027.28 ","$4,027.28 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9310,Rituximab injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9311,"Inj rituximab, hyaluronidase",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9312,"Inj., rituximab, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9313,"Inj., lumoxiti, 0.01 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9315,Romidepsin injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9316,"Pertuzu, trastuzu, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9317,Sacituzumab govitecan-hziy,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9320,Streptozocin injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9325,Inj talimogene laherparepvec,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9328,Temozolomide injection,Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9330,Temsirolimus injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9340,Thiotepa injection,Chemotherapy and Pharmacotherapy,Per Unit,$189.67 ,OP,$189.67 ,$189.67 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9352,Injection trabectedin 0.1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9354,"Inj, ado-trastuzumab emt 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9355,Inj trastuzumab excl biosimi,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9356,"Inj. herceptin hylecta, 10mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9357,Valrubicin injection,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9358,Inj fam-trastu deru-nxki 1mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9371,"Inj, vincristine sul lip 1mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,J9395,"Injection, fulvestrant",Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9400,"Inj, ziv-aflibercept, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,J9600,Porfimer sodium injection,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,L8604,Dextranomer/hyaluronic acid,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,L8605,Inj bulking agent anal canal,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,L8607,Inj vocal cord bulking agent,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,M0239,Bamlanivimab-xxxx infusion,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,M0243,Casirivi and imdevi infusion,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P2028,Cephalin floculation test,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P2029,Congo red blood test,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P2031,Hair analysis,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P2033,Blood thymol turbidity,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P2038,Blood mucoprotein,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P3000,Screen pap by tech w md supv,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P3001,Screening pap smear by phys,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P7001,Culture bacterial urine,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9010,Whole blood for transfusion,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9011,Blood split unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9012,Cryoprecipitate each unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9016,Rbc leukocytes reduced,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9017,Plasma 1 donor frz w/in 8 hr,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9019,"Platelets, each unit",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9020,Plaelet rich plasma unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9021,Red blood cells unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9022,Washed red blood cells unit,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9023,"Frozen plasma, pooled, sd",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9031,Platelets leukocytes reduced,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9032,"Platelets, irradiated",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9033,Platelets leukoreduced irrad,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9034,"Platelets, pheresis",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9035,Platelet pheres leukoreduced,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9036,Platelet pheresis irradiated,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9037,Plate pheres leukoredu irrad,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9038,Rbc irradiated,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9039,Rbc deglycerolized,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9040,Rbc leukoreduced irradiated,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9041,"Albumin (human),5%, 50ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9043,"Plasma protein fract,5%,50ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9044,Cryoprecipitatereducedplasma,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9045,"Albumin (human), 5%, 250 ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9046,"Albumin (human), 25%, 20 ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9047,"Albumin (human), 25%, 50ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9048,"Plasmaprotein fract,5%,250ml",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9050,"Granulocytes, pheresis unit",Hematology,Per Unit,"$1,474.66 ",OP,"$1,474.66 ","$1,474.66 ",,,,,,,,,,,,,
Molina Medicaid,CPT,P9051,"Blood, l/r, cmv-neg",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9052,"Platelets, hla-m, l/r, unit",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9053,"Plt, pher, l/r cmv-neg, irr",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9054,"Blood, l/r, froz/degly/wash",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9055,"Plt, aph/pher, l/r, cmv-neg",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9056,"Blood, l/r, irradiated",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9057,"Rbc, frz/deg/wsh, l/r, irrad",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9058,"Rbc, l/r, cmv-neg, irrad",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9059,"Plasma, frz between 8-24hour",Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9060,Fr frz plasma donor retested,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9070,Pathogen reduced plasma pool,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9071,Pathogen reduced plasma sing,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9072,Plate path red/rapid bac tes,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9073,Platelets pheresis path redu,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9099,Blood component/product noc,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,P9100,Pathogen test for platelets,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0035,Cardiokymography,Cardiology,Per Unit,$14.69 ,OP,$14.69 ,$14.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0081,Infusion ther other than che,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0084,Chemotherapy by infusion,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0085,Chemo by both infusion and o,General Medicine,Per Unit,$178.41 ,OP,$178.41 ,$178.41 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0091,Obtaining screen pap smear,Pathology,Per Unit,$13.31 ,OP,$13.31 ,$13.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0111,Wet mounts/ w preparations,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0112,Potassium hydroxide preps,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0113,Pinworm examinations,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0114,Fern test,Laboratory,Per Unit,$2.86 ,OP,$2.86 ,$2.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0115,Post-coital mucous exam,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0138,"Ferumoxytol, non-esrd",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0139,"Ferumoxytol, esrd use",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0239,Bamlanivimab-xxxx,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0243,Casirivimab and imdevimab,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q0515,Sermorelin acetate injection,Chemotherapy and Pharmacotherapy,Per Unit,$518.96 ,OP,$518.96 ,$518.96 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2017,"Teniposide, 50 mg",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2028,"Inj, sculptra, 0.5mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2034,Agriflu vaccine,Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2035,"Afluria vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2036,"Flulaval vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2037,"Fluvirin vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2038,"Fluzone vacc, 3 yrs & >, im",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2039,"Influenza virus vaccine, nos",Preventive Care,Per Unit,$12.53 ,OP,$12.53 ,$12.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q2040,Tisagenlecleucel car-pos t,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q2043,Sipuleucel-t auto cd54+,Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q2049,Imported lipodox inj,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q2050,Doxorubicin inj 10mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q3014,Telehealth facility fee,Ancillary Services,Per Unit,$8.33 ,OP,$8.33 ,$8.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q3027,Inj beta interferon im 1 mcg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q3028,Inj beta interferon sq 1 mcg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4074,Iloprost non-comp unit dose,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4081,"Epoetin alfa, 100 units esrd",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4100,"Skin substitute, nos",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4101,Apligraf,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4102,Oasis wound matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4103,Oasis burn matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4104,Integra bmwd,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4105,Integra drt or omnigraft,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4106,Dermagraft,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4107,Graftjacket,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4108,Integra matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4110,Primatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4111,Gammagraft,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4112,Cymetra injectable,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4113,Graftjacket xpress,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4114,Integra flowable wound matri,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4115,Alloskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4116,Alloderm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4117,Hyalomatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4118,Matristem micromatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4119,Matristem wound matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4120,Matristem burn matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4121,Theraskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4122,"Dermacell, awm, porous sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4123,Alloskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4124,Oasis tri-layer wound matrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4125,Arthroflex,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4126,Memoderm/derma/tranz/integup,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4127,Talymed,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4128,Flexhd/allopatchhd/matrixhd,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4129,Unite biomatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4130,Strattice tm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4131,Epifix or epicord,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4132,"Grafix core, grafixpl core",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4133,Grafix stravix prime pl sqcm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4134,Hmatrix,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4135,Mediskin,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4136,Ezderm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4137,Amnioexcel biodexcel 1sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4138,"Biodfence dryflex, 1cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4139,"Amnio or biodmatrix, inj 1cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4140,Biodfence 1cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4141,"Alloskin ac, 1 cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4142,Xcm biologic tiss matrix 1cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4143,"Repriza, 1cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4145,"Epifix, inj, 1mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4146,"Tensix, 1cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4147,Architect ecm px fx 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4148,Neox neox rt or clarix cord,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4149,"Excellagen, 0.1 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4150,Allowrap ds or dry 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4151,"Amnioband, guardian 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4152,Dermapure 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4153,"Dermavest, plurivest sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4154,Biovance 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4155,Neoxflo or clarixflo 1 mg,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4156,Neox 100 or clarix 100,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4157,Revitalon 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4158,"Kerecis omega3, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4159,Affinity1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4160,Nushield 1 square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4161,Bio-connekt per square cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4162,"Wndex flw, bioskn flw, 0.5cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4163,"Woundex, bioskin, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4164,"Helicoll, per square cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4165,"Keramatrix, kerasorb sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4166,"Cytal, per square centimeter",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4167,"Truskin, per sq centimeter",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4168,"Amnioband, 1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4169,"Artacent wound, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4170,"Cygnus, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4171,"Interfyl, 1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4172,Puraply or puraply am,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4173,Palingen or palingen xplus,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4174,Palingen or promatrx,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4175,Miroderm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4176,"Neopatch or therion, 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4177,"Floweramnioflo, 0.1 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4178,"Floweramniopatch, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4179,"Flowerderm, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4180,"Revita, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4181,"Amnio wound, per square cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4182,"Transcyte, per sq centimeter",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4183,"Surgigraft, 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4184,Cellesta or duo per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4185,Cellesta flowab amnion 0.5cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4186,Epifix 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4187,Epicord 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4188,Amnioarmor 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4189,"Artacent ac, 1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4190,Artacent ac 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4191,Restorigin 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4192,"Restorigin, 1 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4193,Coll-e-derm 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4194,Novachor 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4195,Puraply 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4196,Puraply am 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4197,Puraply xt 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4198,Genesis amnio membrane 1sqcm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4200,Skin te 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4201,Matrion 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4202,"Keroxx (2.5g/cc), 1cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4203,"Derma-gide, 1 sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4204,Xwrap 1 sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4205,Membrane graft or wrap sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4206,Fluid flow or fluid gf 1 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4208,Novafix per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4209,Surgraft per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4210,Axolotl graf dualgraf sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4211,Amnion bio or axobio sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4212,"Allogen, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4213,"Ascent, 0.5 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4214,Cellesta cord per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4215,"Axolotl ambient, cryo 0.1 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4216,Artacent cord per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4217,Woundfix biowound plus xplus,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4218,Surgicord per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4219,Surgigraft dual per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4220,"Bellacell hd, surederm sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4221,Amniowrap2 per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4222,"Progenamatrix, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4226,Myown harv prep proc sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4227,Amniocore per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4228,"Bionextpatch, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4229,Cogenex amnio memb per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4230,Cogenex flow amnion 0.5 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4231,"Corplex p, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4232,"Corplex, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4233,Surfactor /nudyn per 0.5 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4234,"Xcellerate, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4235,Amniorepair or altiply sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4236,Carepatch per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4237,"Cryo-cord, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4238,"Derm-maxx, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4239,Amnio-maxx or lite per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4240,Corecyte topical only 0.5 cc,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4241,"Polycyte, topical only 0.5cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4242,"Amniocyte plus, per 0.5 cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4244,"Procenta, per 200 mg",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4245,"Amniotext, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4246,"Coretext or protext, per cc",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4247,"Amniotext patch, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4248,Dermacyte amn mem allo sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4249,"Amniply, per sq cm",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4250,Amnioamp-mp per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4254,Novafix dl per sq cm,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q4255,"Reguard, topical use per sq",DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5101,"Injection, zarxio",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5102,"Inj., infliximab biosimilar",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5103,"Injection, inflectra",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5104,"Injection, renflexis",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5105,Inj retacrit esrd on dialysi,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5106,Inj retacrit non-esrd use,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5107,Inj mvasi 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5108,"Injection, fulphila",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5109,"Injection, ixifi, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5110,Nivestym,Chemotherapy and Pharmacotherapy,Per Unit,$182.12 ,OP,$182.12 ,$182.12 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5111,"Injection, udenyca 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5112,Inj ontruzant 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5113,Inj herzuma 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5114,Inj ogivri 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5115,Inj truxima 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5116,"Inj., trazimera, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5117,"Inj., kanjinti, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5118,"Inj., zirabev, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q5119,"Inj ruxience, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5120,Inj pegfilgrastim-bmez 0.5mg,Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5121,"Inj. avsola, 10 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$1,236.31 ",OP,"$1,236.31 ","$1,236.31 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q5122,"Inj, nyvepria",Chemotherapy and Pharmacotherapy,Per Unit,"$1,836.04 ",OP,"$1,836.04 ","$1,836.04 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q9975,Factor VIII FC Fusion Recomb,Chemotherapy and Pharmacotherapy,Per Unit,"$2,528.43 ",OP,"$2,528.43 ","$2,528.43 ",,,,,,,,,,,,,
Molina Medicaid,CPT,Q9979,"Injection, Alemtuzumab",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9980,"Genvisc, inj, 1mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9984,Kyleena,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9987,Pathogen test for platelets,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9988,Platelet pheresis path reduc,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9989,"Ustekinumab IV Inj, 1 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9991,Buprenorph xr 100 mg or less,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9992,Buprenorphine xr over 100 mg,Chemotherapy and Pharmacotherapy,Per Unit,$814.32 ,OP,$814.32 ,$814.32 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9993,"Inj., triamcinolone ext rel",Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,Q9995,"inj. emicizumab-kxwh, 0.5 mg",Chemotherapy and Pharmacotherapy,Per Unit,"$10,767.37 ",OP,"$10,767.37 ","$10,767.37 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S0013,"Esketamine, nasal spray",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0040,"Injection, ticarcillin disod",Chemotherapy and Pharmacotherapy,Per Unit,$855.06 ,OP,$855.06 ,$855.06 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0088,Imatinib 100 mg,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0126,Inj follitropin alfa 75 iu,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0132,Inj ganirelix acetat 250 mcg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0140,"Saquinavir, 200 mg",Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0142,Colistimethate inh sol mg,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0145,Peg interferon alfa-2a/180,Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0148,Peg interferon alfa-2b/10,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0155,Epoprostenol dilutant,Chemotherapy and Pharmacotherapy,Per Unit,$99.44 ,OP,$99.44 ,$99.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0166,Inj olanzapine 2.5mg,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0175,Flutamide 125 mg,Chemotherapy and Pharmacotherapy,Per Unit,$100.71 ,OP,$100.71 ,$100.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0178,Lomustine 10 mg,Chemotherapy and Pharmacotherapy,Per Unit,$233.27 ,OP,$233.27 ,$233.27 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0190,"Mifepristone, oral, 200 mg",Chemotherapy and Pharmacotherapy,Per Unit,$45.71 ,OP,$45.71 ,$45.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0195,Pneumo vaccine 5-9 yrs,Preventive Care,Per Unit,$52.77 ,OP,$52.77 ,$52.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0199,Med abortion inc all ex drug,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0201,Partial hospitalization serv,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0220,Medical conference by physic,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0221,"Medical conference, 60 min",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0250,Comp geriatr assmt team,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0257,End of life counseling,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0271,Home hospice case 30 days,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0280,"Medical home, initial plan",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0281,"Medical home, maintenance",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0311,Comp mgmt care coord adv ill,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0315,Disease management program,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0316,Follow-up/reassessment,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0340,Lifestyle mod 1st stage,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0353,Cancer treatmentplan initial,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0354,Cancer treatment plan change,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0390,Rout foot care per visit,General Surgery,Per Unit,$46.77 ,OP,$46.77 ,$46.77 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0395,Impression casting ft,Orthopedics,Per Unit,$185.40 ,OP,$185.40 ,$185.40 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0592,Comp cont lens eval,Ophthalmology,Per Unit,$27.36 ,OP,$27.36 ,$27.36 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0601,Screening proctoscopy,Preventive Care,Per Unit,$387.00 ,OP,$387.00 ,$387.00 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0618,Audiometry for hearing aid,Otolaryngology,Per Unit,$78.72 ,OP,$78.72 ,$78.72 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0800,Laser in situ keratomileusis,Ophthalmology Surgery,Per Unit,$751.45 ,OP,$751.45 ,$751.45 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S0810,Photorefractive keratectomy,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S0812,Phototherap keratect,Ophthalmology Surgery,Per Unit,"$1,197.94 ",OP,"$1,197.94 ","$1,197.94 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2066,Breast gap flap reconst,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2067,"Breast ""stacked"" diep/gap",General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2068,Breast diep or siea flap,General Surgery,Per Unit,"$2,963.62 ",OP,"$2,963.62 ","$2,963.62 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2083,Adjustment gastric band,Gastroenterology,Per Unit,$119.18 ,OP,$119.18 ,$119.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2112,Knee arthroscp harv,Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2202,Echosclerotherapy,Vascular Surgery,Per Unit,$500.46 ,OP,$500.46 ,$500.46 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2225,Myringotomy laser-assist,Otolaryngology Surgery,Per Unit,$729.78 ,OP,$729.78 ,$729.78 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2230,Implant semi-imp hear,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2235,Implant auditory brain imp,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2260,Induced abortion 17-24 weeks,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2265,Induced abortion 25-28 wks,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2266,Induced abortion 29-31 wks,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2267,Induced abortion 32 or more,Obstetrics,Per Unit,$983.66 ,OP,$983.66 ,$983.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2300,"Arthroscopy, shoulder, surgi",Orthopedic Surgery,Per Unit,"$1,170.79 ",OP,"$1,170.79 ","$1,170.79 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2340,Chemodenervation of abductor,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2341,Chemodenerv adduct vocal,Otolaryngology Surgery,Per Unit,"$1,283.26 ",OP,"$1,283.26 ","$1,283.26 ",,,,,,,,,,,,,
Molina Medicaid,CPT,S2342,Nasal endoscop po debrid,Otolaryngology Surgery,Per Unit,$230.30 ,OP,$230.30 ,$230.30 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2400,Fetal surg congen hernia,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2401,Fetal surg urin trac obstr,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2402,Fetal surg cong cyst malf,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2403,Fetal surg pulmon sequest,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2404,Fetal surg myelomeningo,Obstetrics,Per Unit,$482.07 ,OP,$482.07 ,$482.07 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2405,Fetal surg sacrococ teratoma,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2409,Fetal surg noc,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S2411,Fetoscop laser ther ttts,Obstetrics,Per Unit,$139.58 ,OP,$139.58 ,$139.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3620,Newborn metabolic screening,Laboratory,Per Unit,$5.86 ,OP,$5.86 ,$5.86 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3630,Eosinophil blood count,Laboratory,Per Unit,$3.99 ,OP,$3.99 ,$3.99 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3645,Hiv-1 antibody testing of or,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3650,"Saliva test, hormone level;",Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3652,"Saliva test, hormone level;",Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3655,Antisperm antibodies test,Laboratory,Per Unit,$5.75 ,OP,$5.75 ,$5.75 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3708,Gastrointestinal fat absorpt,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3721,Pca3 testing,Laboratory,Per Unit,$6.42 ,OP,$6.42 ,$6.42 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3722,Dose optimization auc - 5fu,Laboratory,Per Unit,$7.38 ,OP,$7.38 ,$7.38 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3800,Genetic testing als,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3840,Dna analysis ret-oncogene,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3841,Gene test retinoblastoma,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3842,Gene test hippel-lindau,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3844,Dna analysis deafness,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3845,Gene test alpha-thalassemia,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3846,Gene test beta-thalassemia,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3849,Gene test niemann-pick,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3850,Gene test sickle cell,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3852,Dna analysis apoe alzheimer,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3853,Gene test myo musclr dyst,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3854,Gene profile panel breast,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3861,Genetic test brugada,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3865,Comp genet test hyp cardiomy,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3866,Spec gene test hyp cardiomy,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3870,Cgh test developmental delay,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3890,Fecal dna analysis,Laboratory,Per Unit,$22.80 ,OP,$22.80 ,$22.80 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3900,Surface emg,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3902,Ballistocardiogram,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S3904,Masters two step,Cardiology,Per Unit,$80.87 ,OP,$80.87 ,$80.87 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4011,Ivf package,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4013,Compl gift case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4014,Compl zift case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4015,Complete ivf nos case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4016,Frozen ivf case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4017,Ivf canc a stim case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4018,F emb trns canc case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4020,Ivf canc a aspir case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4021,Ivf canc p aspir case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4022,Asst oocyte fert case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4023,Incompl donor egg case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4025,Donor serv ivf case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4026,Procure donor sperm,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4027,Store prev froz embryos,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4028,Microsurg epi sperm asp,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4030,Sperm procure init visit,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4031,Sperm procure subs visit,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4035,Stimulated iui case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4037,Cryo embryo transf case rate,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4040,Monit store cryo embryo 30 d,Obstetrics,Per Unit,$175.09 ,OP,$175.09 ,$175.09 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4042,Ovulation mgmt per cycle,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4981,Insert levonorgestrel ius,Gynecology,Per Unit,$102.34 ,OP,$102.34 ,$102.34 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S4989,Contracept iud,Chemotherapy and Pharmacotherapy,Per Unit,$191.26 ,OP,$191.26 ,$191.26 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S5180,Hh respiratory thrpy in eval,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S5181,Hh respiratory thrpy nos/day,Pulmonary,Per Unit,$138.31 ,OP,$138.31 ,$138.31 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8032,Low dose CT lung screening,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8035,Magnetic source imaging,Diagnostic Radiology,Per Unit,$133.33 ,OP,$133.33 ,$133.33 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8037,Mrcp,Interventional Radiology,Per Unit,$224.69 ,OP,$224.69 ,$224.69 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8055,Us guidance fetal reduct,Interventional Radiology,Per Unit,$63.29 ,OP,$63.29 ,$63.29 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8080,Scintimammography,Diagnostic Nuclear Medicine,Per Unit,$239.98 ,OP,$239.98 ,$239.98 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8092,Electron beam computed tomog,Diagnostic Radiology,Per Unit,$79.18 ,OP,$79.18 ,$79.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8110,Peak expiratory flow rate (p,Pulmonary,Per Unit,$42.64 ,OP,$42.64 ,$42.64 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8930,Auricular electrostimulation,Neurology,Per Unit,$187.24 ,OP,$187.24 ,$187.24 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8940,Hippotherapy per session,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8948,Low-level laser trmt 15 min,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8950,"Complex lymphedema therapy,",Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S8990,Pt or manip for maint,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9015,Automated eeg monitoring,Neurology,Per Unit,$147.66 ,OP,$147.66 ,$147.66 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9024,Paranasal sinus ultrasound,Diagnostic Radiology,Per Unit,$86.73 ,OP,$86.73 ,$86.73 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9061,Medical supplies and equipme,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9090,Vertebral axial decompressio,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9098,Home phototherapy visit,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9128,"Speech therapy, in the home,",Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9129,"Occupational therapy, in the",Rehabilitation,Per Unit,$306.55 ,OP,$306.55 ,$306.55 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9131,Pt in the home per diem,Rehabilitation,Per Unit,$192.71 ,OP,$192.71 ,$192.71 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9140,"Diabetic management program,",Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9141,"Diabetic management program,",Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9145,Insulin pump initiation,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9152,"Speech therapy, re-eval",Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9211,Home mgmt gest hypertension,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9213,Hm preeclamp per diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9214,Hm gest dm per diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9335,Ht hemodialysis diem,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9339,Hit periton dialysis diem,Nephrology,Per Unit,$540.95 ,OP,$540.95 ,$540.95 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9370,Ht inj antiemetic diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9372,Ht inj anticoag diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9445,Pt education noc individ,Preventive Care,Per Unit,$20.58 ,OP,$20.58 ,$20.58 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9446,Pt education noc group,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9452,Nutrition class,Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9453,Smoking cessation class,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9455,"Diabetic management program,",Preventive Care,Per Unit,$26.23 ,OP,$26.23 ,$26.23 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9465,"Diabetic management program,",Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9470,"Nutritional counseling, diet",Ancillary Services,Per Unit,$100.15 ,OP,$100.15 ,$100.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9472,Cardiac rehabilitation progr,Rehabilitation,Per Unit,$274.82 ,OP,$274.82 ,$274.82 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9473,Pulmonary rehabilitation pro,Rehabilitation,Per Unit,$73.11 ,OP,$73.11 ,$73.11 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9475,Ambulatory setting substance,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9476,Vestibular rehab per diem,Rehabilitation,Per Unit,$142.44 ,OP,$142.44 ,$142.44 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9480,Intensive outpatient psychia,Behavioral Health,Per Unit,$339.88 ,OP,$339.88 ,$339.88 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9482,Family stabilization 15 min,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9484,Crisis intervention per hour,Behavioral Health,Per Unit,$135.70 ,OP,$135.70 ,$135.70 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9485,Crisis intervention mental h,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9537,Ht hem horm inj diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9538,Hit blood products diem,Hematology,Per Unit,$378.53 ,OP,$378.53 ,$378.53 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9558,Ht inj growth horm diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9559,Hit inj interferon diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9560,Ht inj hormone diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,S9562,Ht inj palivizumab diem,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T1006,Family/couple counseling,Behavioral Health,Per Unit,$89.14 ,OP,$89.14 ,$89.14 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T1007,Treatment plan development,Behavioral Health,Per Unit,$94.47 ,OP,$94.47 ,$94.47 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T1012,Alcohol/substance abuse skil,Behavioral Health,Per Unit,$48.15 ,OP,$48.15 ,$48.15 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T1016,Case management,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T1017,Targeted case management,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T1023,Program intake assessment,Behavioral Health,Per Unit,$70.18 ,OP,$70.18 ,$70.18 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T1040,Comm bh clinic svc per diem,Behavioral Health,Per Unit,$220.60 ,OP,$220.60 ,$220.60 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T2022,"Case management, per month",Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,T2023,Targeted case mgmt per month,Ancillary Services,Per Unit,$69.37 ,OP,$69.37 ,$69.37 ,,,,,,,,,,,,,
Molina Medicaid,CPT,U0001,2019-ncov diagnostic p,Laboratory,Per Unit,$15.25 ,OP,$15.25 ,$15.25 ,,,,,,,,,,,,,
Molina Medicaid,CPT,U0002,Covid-19 lab test non-cdc,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,U0005,Infec agen detec ampli probe,Laboratory,Per Unit,$4.59 ,OP,$4.59 ,$4.59 ,,,,,,,,,,,,,
Molina Medicaid,CPT,V2785,Corneal tissue processing,Ophthalmology,Per Unit,"$1,390.89 ",OP,"$1,390.89 ","$1,390.89 ",,,,,,,,,,,,,
Molina Medicaid,CPT,V2790,Amniotic membrane,DME and Supplies,Per Unit,$263.49 ,OP,$263.49 ,$263.49 ,,,,,,,,,,,,,
Molina Medicaid,CPT,V5362,Speech screening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,V5363,Language screening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
Molina Medicaid,CPT,V5364,Dysphagia screening,Rehabilitation,Per Unit,$15.74 ,OP,$15.74 ,$15.74 ,,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-001,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,Surgical,Relative Weights,"$158,272.86 ",IP,930,"281,947.26",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-002,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,Surgical,Relative Weights,"$81,947.36 ",IP,930,"155,072.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-003,ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITH MAJOR O.R. PROCEDURES,Surgical,Relative Weights,"$104,584.83 ",IP,930,"284,088.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-004,TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE- MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES,Surgical,Relative Weights,"$65,264.59 ",IP,930,"224,999.56",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-005,LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,Surgical,Relative Weights,"$56,027.10 ",IP,930,"99,513.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-006,LIVER TRANSPLANT WITHOUT MCC,Surgical,Relative Weights,"$25,708.42 ",IP,930,"45,669.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-007,LUNG TRANSPLANT,Surgical,Relative Weights,"$63,389.72 ",IP,930,"112,664.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-008,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,Surgical,Relative Weights,"$29,742.26 ",IP,930,"52,824.47",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-010,PANCREAS TRANSPLANT,Surgical,Relative Weights,"$19,816.13 ",IP,930,"35,214.69",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-011,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC,Surgical,Relative Weights,"$27,487.49 ",IP,930,"48,829.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-012,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC,Surgical,Relative Weights,"$20,981.01 ",IP,930,"74,654.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-013,TRACHEOSTOMY FOR FACE- MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$14,910.27 ",IP,930,"29,317.87",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-014,ALLOGENEIC BONE MARROW TRANSPLANT,Surgical,Relative Weights,"$58,446.64 ",IP,930,"124,388.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-016,AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,Surgical,Relative Weights,"$36,874.97 ",IP,930,"65,472.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-017,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,Surgical,Relative Weights,"$26,580.44 ",IP,930,"47,017.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-018,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,Medical,Relative Weights,"$205,004.44 ",IP,880,"363,360.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-019,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,Surgical,Relative Weights,"$36,565.14 ",IP,930,"64,846.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-020,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,Surgical,Relative Weights,"$56,585.45 ",IP,930,"100,455.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-021,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,Surgical,Relative Weights,"$41,293.64 ",IP,930,"73,312.59",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-022,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,Surgical,Relative Weights,"$26,509.82 ",IP,930,"47,303.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-023,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,Surgical,Relative Weights,"$31,048.37 ",IP,930,"73,951.33",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-024,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,Surgical,Relative Weights,"$21,562.36 ",IP,930,"39,702.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-025,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$24,619.08 ",IP,930,"100,858.36",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-026,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,Surgical,Relative Weights,"$16,761.60 ",IP,930,"47,469.26",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-027,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$13,763.45 ",IP,930,"29,826.86",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-028,SPINAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$31,876.05 ",IP,930,"56,651.88",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-029,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,Surgical,Relative Weights,"$18,046.91 ",IP,930,"39,621.18",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-030,SPINAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$12,901.29 ",IP,930,"29,340.89",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-031,VENTRICULAR SHUNT PROCEDURES WITH MCC,Surgical,Relative Weights,"$23,930.99 ",IP,930,"42,499.62",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-032,VENTRICULAR SHUNT PROCEDURES WITH CC,Surgical,Relative Weights,"$12,133.27 ",IP,930,"24,825.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-033,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,427.44 ",IP,930,"16,749.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-034,CAROTID ARTERY STENT PROCEDURES WITH MCC,Surgical,Relative Weights,"$21,776.39 ",IP,930,"38,688.76",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-035,CAROTID ARTERY STENT PROCEDURES WITH CC,Surgical,Relative Weights,"$12,807.68 ",IP,930,"22,749.33",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-036,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,139.62 ",IP,930,"18,019.58",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-037,EXTRACRANIAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,941.81 ",IP,930,"33,522.99",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-038,EXTRACRANIAL PROCEDURES WITH CC,Surgical,Relative Weights,"$9,080.39 ",IP,930,"22,772.44",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-039,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,235.51 ",IP,930,"14,297.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-040,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC,Surgical,Relative Weights,"$21,156.18 ",IP,930,"74,748.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-041,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR,Surgical,Relative Weights,"$12,862.42 ",IP,930,"22,882.69",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-042,PERIPHERAL- CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,407.30 ",IP,930,"20,244.51",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-052,SPINAL DISORDERS AND INJURIES WITH CC/MCC,Medical,Relative Weights,"$10,146.19 ",IP,880,"17,960.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-053,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,Medical,Relative Weights,"$6,220.73 ",IP,880,"11,058.80",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-054,NERVOUS SYSTEM NEOPLASMS WITH MCC,Medical,Relative Weights,"$7,490.17 ",IP,880,"26,640.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-055,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,Medical,Relative Weights,"$5,718.21 ",IP,880,"16,029.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-056,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,Medical,Relative Weights,"$12,017.22 ",IP,880,"21,291.18",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-057,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,Medical,Relative Weights,"$6,938.38 ",IP,880,"12,305.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-058,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,Medical,Relative Weights,"$9,512.84 ",IP,880,"16,905.04",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-059,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,Medical,Relative Weights,"$6,170.92 ",IP,880,"11,554.38",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-060,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,Medical,Relative Weights,"$5,023.55 ",IP,880,"9,686.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-061,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC,Medical,Relative Weights,"$15,826.63 ",IP,880,"28,113.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-062,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC,Medical,Relative Weights,"$10,884.09 ",IP,880,"19,343.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-063,ISCHEMIC STROKE- PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC,Medical,Relative Weights,"$9,359.02 ",IP,880,"16,644.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,Medical,Relative Weights,"$10,504.19 ",IP,880,"29,588.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,Medical,Relative Weights,"$5,583.55 ",IP,880,"15,543.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,Medical,Relative Weights,"$3,895.35 ",IP,880,"12,253.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-067,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,Medical,Relative Weights,"$7,804.93 ",IP,880,"13,867.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-068,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,Medical,Relative Weights,"$4,865.90 ",IP,880,"12,660.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-069,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,Medical,Relative Weights,"$4,308.64 ",IP,880,"9,563.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-070,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,Medical,Relative Weights,"$9,194.25 ",IP,880,"16,318.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-071,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,Medical,Relative Weights,"$5,538.66 ",IP,880,"9,839.13",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-072,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,224.34 ",IP,880,"9,341.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-073,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,Medical,Relative Weights,"$7,953.28 ",IP,880,"17,444.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-074,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,Medical,Relative Weights,"$5,578.08 ",IP,880,"9,913.11",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-075,VIRAL MENINGITIS WITH CC/MCC,Medical,Relative Weights,"$8,906.31 ",IP,880,"15,827.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-076,VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,391.41 ",IP,880,"9,548.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-077,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,Medical,Relative Weights,"$8,391.20 ",IP,880,"14,911.51",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-078,HYPERTENSIVE ENCEPHALOPATHY WITH CC,Medical,Relative Weights,"$5,199.82 ",IP,880,"9,237.57",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-079,HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,Medical,Relative Weights,"$3,989.50 ",IP,880,"7,074.67",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-080,NONTRAUMATIC STUPOR AND COMA WITH MCC,Medical,Relative Weights,"$11,470.36 ",IP,880,"20,363.53",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-081,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,Medical,Relative Weights,"$4,232.55 ",IP,880,"10,010.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-082,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,Medical,Relative Weights,"$12,392.75 ",IP,880,"21,980.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-083,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,Medical,Relative Weights,"$7,357.15 ",IP,880,"16,494.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-084,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,Medical,Relative Weights,"$4,957.32 ",IP,880,"8,801.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-085,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,Medical,Relative Weights,"$12,654.41 ",IP,880,"45,763.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-086,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,Medical,Relative Weights,"$6,976.70 ",IP,880,"17,459.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-087,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,Medical,Relative Weights,"$4,727.41 ",IP,880,"9,138.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-088,CONCUSSION WITH MCC,Medical,Relative Weights,"$7,965.87 ",IP,880,"14,204.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-089,CONCUSSION WITH CC,Medical,Relative Weights,"$5,821.67 ",IP,880,"13,793.62",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-090,CONCUSSION WITHOUT CC/MCC,Medical,Relative Weights,"$4,678.14 ",IP,880,"10,126.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-091,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,Medical,Relative Weights,"$9,036.59 ",IP,880,"16,050.39",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-092,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,Medical,Relative Weights,"$5,413.31 ",IP,880,"12,405.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-093,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$4,281.82 ",IP,880,"10,377.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-094,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,Medical,Relative Weights,"$19,914.12 ",IP,880,"50,515.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-095,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,Medical,Relative Weights,"$13,725.13 ",IP,880,"33,641.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-096,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$12,769.36 ",IP,880,"22,694.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-097,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,Medical,Relative Weights,"$20,584.69 ",IP,880,"36,527.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-098,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,Medical,Relative Weights,"$11,563.97 ",IP,880,"38,577.09",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-099,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,Medical,Relative Weights,"$7,674.10 ",IP,880,"13,601.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-100,SEIZURES WITH MCC,Medical,Relative Weights,"$10,271.54 ",IP,880,"21,842.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-101,SEIZURES WITHOUT MCC,Medical,Relative Weights,"$4,863.16 ",IP,880,"8,634.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-102,HEADACHES WITH MCC,Medical,Relative Weights,"$6,312.15 ",IP,880,"11,210.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-103,HEADACHES WITHOUT MCC,Medical,Relative Weights,"$4,540.74 ",IP,880,"8,918.22",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-113,ORBITAL PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$12,012.30 ",IP,930,"21,334.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-114,ORBITAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,924.26 ",IP,930,"14,070.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,Surgical,Relative Weights,"$7,973.53 ",IP,930,"14,146.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-116,INTRAOCULAR PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$10,306.03 ",IP,930,"18,272.66",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-117,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,699.60 ",IP,930,"10,112.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-121,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,Medical,Relative Weights,"$6,517.43 ",IP,880,"11,570.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-122,ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,Medical,Relative Weights,"$3,533.51 ",IP,880,"6,709.38",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-123,NEUROLOGICAL EYE DISORDERS,Medical,Relative Weights,"$4,197.52 ",IP,880,"8,500.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-124,OTHER DISORDERS OF THE EYE WITH MCC,Medical,Relative Weights,"$7,674.64 ",IP,880,"13,615.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-125,OTHER DISORDERS OF THE EYE WITHOUT MCC,Medical,Relative Weights,"$4,581.80 ",IP,880,"8,131.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-135,SINUS AND MASTOID PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$11,733.67 ",IP,930,"20,836.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-136,SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,872.69 ",IP,930,"12,221.04",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-137,MOUTH PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$8,264.20 ",IP,930,"14,295.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-138,MOUTH PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$4,688.54 ",IP,930,"11,787.56",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-139,SALIVARY GLAND PROCEDURES,Surgical,Relative Weights,"$6,755.55 ",IP,930,"11,941.67",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,Medical,Relative Weights,"$21,775.30 ",IP,930,"38,747.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-141,MAJOR HEAD AND NECK PROCEDURES WITH CC,Medical,Relative Weights,"$12,076.34 ",IP,930,"21,487.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$8,786.43 ",IP,930,"15,660.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-143,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$16,311.63 ",IP,930,"28,849.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-144,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$9,642.57 ",IP,930,"17,039.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-145,OTHER EAR- NOSE- MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$6,703.55 ",IP,930,"11,812.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-146,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH MCC,Medical,Relative Weights,"$11,173.12 ",IP,880,"19,790.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-147,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITH CC,Medical,Relative Weights,"$7,122.31 ",IP,880,"12,664.91",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-148,EAR- NOSE- MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$4,308.09 ",IP,880,"7,653.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-149,DYSEQUILIBRIUM,Medical,Relative Weights,"$4,034.39 ",IP,880,"7,392.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-150,EPISTAXIS WITH MCC,Medical,Relative Weights,"$7,266.83 ",IP,880,"12,894.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-151,EPISTAXIS WITHOUT MCC,Medical,Relative Weights,"$4,042.05 ",IP,880,"7,173.96",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-152,OTITIS MEDIA AND URI WITH MCC,Medical,Relative Weights,"$5,914.73 ",IP,880,"10,482.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-153,OTITIS MEDIA AND URI WITHOUT MCC,Medical,Relative Weights,"$3,904.11 ",IP,880,"6,916.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-154,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,467.29 ",IP,880,"15,014.70",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-155,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITH CC,Medical,Relative Weights,"$4,978.67 ",IP,880,"8,892.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-156,OTHER EAR- NOSE- MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,604.13 ",IP,880,"7,456.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-157,DENTAL AND ORAL DISEASES WITH MCC,Medical,Relative Weights,"$8,628.23 ",IP,880,"15,305.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-158,DENTAL AND ORAL DISEASES WITH CC,Medical,Relative Weights,"$4,927.76 ",IP,880,"9,313.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-159,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,Medical,Relative Weights,"$3,629.86 ",IP,880,"6,737.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-163,MAJOR CHEST PROCEDURES WITH MCC,Surgical,Relative Weights,"$27,407.57 ",IP,930,"101,978.91",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-164,MAJOR CHEST PROCEDURES WITH CC,Surgical,Relative Weights,"$14,536.94 ",IP,930,"39,411.86",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-165,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,491.60 ",IP,930,"18,578.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-166,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$20,382.70 ",IP,930,"46,767.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-167,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$9,955.69 ",IP,930,"30,246.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-168,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,414.08 ",IP,930,"22,687.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-175,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,Medical,Relative Weights,"$8,462.91 ",IP,880,"18,304.55",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-176,PULMONARY EMBOLISM WITHOUT MCC,Medical,Relative Weights,"$4,859.88 ",IP,880,"15,051.96",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-177,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,Medical,Relative Weights,"$10,122.10 ",IP,880,"28,695.97",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-178,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,Medical,Relative Weights,"$6,611.58 ",IP,880,"23,962.45",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-179,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,Medical,Relative Weights,"$4,777.22 ",IP,880,"12,328.33",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-180,RESPIRATORY NEOPLASMS WITH MCC,Medical,Relative Weights,"$9,524.33 ",IP,880,"24,073.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-181,RESPIRATORY NEOPLASMS WITH CC,Medical,Relative Weights,"$6,131.50 ",IP,880,"16,177.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-182,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,Medical,Relative Weights,"$4,335.46 ",IP,880,"9,666.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-183,MAJOR CHEST TRAUMA WITH MCC,Medical,Relative Weights,"$8,533.53 ",IP,880,"18,222.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-184,MAJOR CHEST TRAUMA WITH CC,Medical,Relative Weights,"$5,697.96 ",IP,880,"15,216.38",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-185,MAJOR CHEST TRAUMA WITHOUT CC/MCC,Medical,Relative Weights,"$4,241.86 ",IP,880,"8,201.76",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-186,PLEURAL EFFUSION WITH MCC,Medical,Relative Weights,"$8,450.87 ",IP,880,"40,210.79",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-187,PLEURAL EFFUSION WITH CC,Medical,Relative Weights,"$5,654.17 ",IP,880,"12,210.89",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-188,PLEURAL EFFUSION WITHOUT CC/MCC,Medical,Relative Weights,"$3,993.33 ",IP,880,"9,884.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-189,PULMONARY EDEMA AND RESPIRATORY FAILURE,Medical,Relative Weights,"$6,711.76 ",IP,880,"16,929.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,Medical,Relative Weights,"$6,158.88 ",IP,880,"14,531.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,Medical,Relative Weights,"$4,840.72 ",IP,880,"13,266.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,Medical,Relative Weights,"$3,807.76 ",IP,880,"9,118.38",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-193,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,Medical,Relative Weights,"$7,181.98 ",IP,880,"19,397.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Medical,Relative Weights,"$4,729.05 ",IP,880,"11,652.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-195,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,Medical,Relative Weights,"$3,644.64 ",IP,880,"7,432.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-196,INTERSTITIAL LUNG DISEASE WITH MCC,Medical,Relative Weights,"$9,517.22 ",IP,880,"17,102.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-197,INTERSTITIAL LUNG DISEASE WITH CC,Medical,Relative Weights,"$5,512.39 ",IP,880,"17,659.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-198,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,Medical,Relative Weights,"$4,069.42 ",IP,880,"9,378.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-199,PNEUMOTHORAX WITH MCC,Medical,Relative Weights,"$9,798.58 ",IP,880,"19,033.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-200,PNEUMOTHORAX WITH CC,Medical,Relative Weights,"$5,892.84 ",IP,880,"15,173.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-201,PNEUMOTHORAX WITHOUT CC/MCC,Medical,Relative Weights,"$3,884.40 ",IP,880,"7,175.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-202,BRONCHITIS AND ASTHMA WITH CC/MCC,Medical,Relative Weights,"$5,293.42 ",IP,880,"9,399.15",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-203,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,Medical,Relative Weights,"$3,870.17 ",IP,880,"6,867.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-204,RESPIRATORY SIGNS AND SYMPTOMS,Medical,Relative Weights,"$4,344.22 ",IP,880,"8,328.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,Medical,Relative Weights,"$9,222.71 ",IP,880,"34,334.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,Medical,Relative Weights,"$4,850.03 ",IP,880,"8,606.80",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,Medical,Relative Weights,"$31,399.81 ",IP,880,"76,148.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,Medical,Relative Weights,"$13,930.41 ",IP,880,"31,656.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-215,OTHER HEART ASSIST SYSTEM IMPLANT,Surgical,Relative Weights,"$57,797.41 ",IP,930,"108,611.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$54,955.82 ",IP,930,"126,394.99",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-217,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,Surgical,Relative Weights,"$35,491.13 ",IP,930,"74,069.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-218,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Relative Weights,"$33,442.73 ",IP,930,"50,063.91",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-219,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$44,107.86 ",IP,930,"95,509.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-220,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,Surgical,Relative Weights,"$29,588.99 ",IP,930,"60,249.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-221,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,Surgical,Relative Weights,"$25,070.69 ",IP,930,"57,682.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-222,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITH MCC,Surgical,Relative Weights,"$43,524.32 ",IP,930,"81,970.99",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-223,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI- HF OR SHOCK WITHOUT MCC,Surgical,Relative Weights,"$31,741.94 ",IP,930,"60,468.58",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-224,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITH MCC,Surgical,Relative Weights,"$41,160.07 ",IP,930,"71,663.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-225,CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI- HF OR SHOCK WITHOUT MCC,Surgical,Relative Weights,"$30,752.23 ",IP,930,"54,771.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$35,937.26 ",IP,930,"64,359.26",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Relative Weights,"$28,531.40 ",IP,930,"51,121.99",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-228,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,Surgical,Relative Weights,"$29,178.43 ",IP,930,"60,499.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$18,837.37 ",IP,930,"57,167.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-231,CORONARY BYPASS WITH PTCA WITH MCC,Surgical,Relative Weights,"$47,711.44 ",IP,930,"82,643.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-232,CORONARY BYPASS WITH PTCA WITHOUT MCC,Surgical,Relative Weights,"$32,591.51 ",IP,930,"57,414.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-233,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,Surgical,Relative Weights,"$43,367.22 ",IP,930,"137,557.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-234,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,Surgical,Relative Weights,"$29,209.63 ",IP,930,"52,820.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-235,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,Surgical,Relative Weights,"$33,414.27 ",IP,930,"94,461.59",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-236,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,Surgical,Relative Weights,"$22,427.26 ",IP,930,"49,122.62",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-239,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,Surgical,Relative Weights,"$26,363.12 ",IP,930,"84,834.80",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-240,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,Surgical,Relative Weights,"$15,266.08 ",IP,930,"54,863.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-241,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,Surgical,Relative Weights,"$8,716.91 ",IP,930,"19,430.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,Surgical,Relative Weights,"$20,405.14 ",IP,930,"41,106.15",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,Surgical,Relative Weights,"$13,786.44 ",IP,930,"32,586.89",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,Surgical,Relative Weights,"$11,294.65 ",IP,930,"20,107.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-245,AICD GENERATOR PROCEDURES,Surgical,Relative Weights,"$29,657.41 ",IP,930,"52,699.88",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Relative Weights,"$17,102.63 ",IP,930,"30,425.56",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-247,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,Surgical,Relative Weights,"$10,801.43 ",IP,930,"19,353.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-248,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,Surgical,Relative Weights,"$17,310.10 ",IP,930,"30,894.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-249,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,Surgical,Relative Weights,"$10,256.76 ",IP,930,"32,084.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-250,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,Surgical,Relative Weights,"$13,804.51 ",IP,930,"24,556.94",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-251,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,Surgical,Relative Weights,"$9,078.20 ",IP,930,"24,457.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-252,OTHER VASCULAR PROCEDURES WITH MCC,Surgical,Relative Weights,"$18,205.11 ",IP,930,"61,448.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-253,OTHER VASCULAR PROCEDURES WITH CC,Surgical,Relative Weights,"$14,525.99 ",IP,930,"37,067.89",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-254,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,940.36 ",IP,930,"21,026.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-255,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,Surgical,Relative Weights,"$13,878.41 ",IP,930,"24,753.56",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-256,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,Surgical,Relative Weights,"$9,000.46 ",IP,930,"19,755.71",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-257,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,378.39 ",IP,930,"11,301.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,Surgical,Relative Weights,"$17,342.40 ",IP,930,"31,161.45",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,Surgical,Relative Weights,"$11,436.43 ",IP,930,"20,638.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,Surgical,Relative Weights,"$19,527.65 ",IP,930,"34,888.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,Surgical,Relative Weights,"$10,914.75 ",IP,930,"19,383.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,Surgical,Relative Weights,"$9,339.86 ",IP,930,"16,626.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-263,VEIN LIGATION AND STRIPPING,Surgical,Relative Weights,"$12,662.62 ",IP,930,"22,439.79",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Surgical,Relative Weights,"$17,810.43 ",IP,930,"31,614.09",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-265,AICD LEAD PROCEDURES,Surgical,Relative Weights,"$18,422.98 ",IP,930,"32,732.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,Surgical,Relative Weights,"$38,580.69 ",IP,930,"69,084.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$30,643.84 ",IP,930,"54,519.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,Surgical,Relative Weights,"$38,117.59 ",IP,930,"67,696.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,Surgical,Relative Weights,"$23,621.16 ",IP,930,"41,998.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,Surgical,Relative Weights,"$28,394.00 ",IP,930,"50,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,Surgical,Relative Weights,"$19,517.25 ",IP,930,"34,697.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$14,715.94 ",IP,930,"26,172.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-273,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,Surgical,Relative Weights,"$20,947.62 ",IP,930,"37,351.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-274,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$17,991.08 ",IP,930,"31,980.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-280,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH MCC,Medical,Relative Weights,"$8,796.28 ",IP,880,"29,690.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-281,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITH CC,Medical,Relative Weights,"$5,094.17 ",IP,880,"23,082.57",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-282,ACUTE MYOCARDIAL INFARCTION- DISCHARGED ALIVE WITHOUT CC/MCC,Medical,Relative Weights,"$3,974.72 ",IP,880,"20,276.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-283,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH MCC,Medical,Relative Weights,"$10,207.50 ",IP,880,"38,792.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-284,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITH CC,Medical,Relative Weights,"$3,959.94 ",IP,880,"25,216.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-285,ACUTE MYOCARDIAL INFARCTION- EXPIRED WITHOUT CC/MCC,Medical,Relative Weights,"$2,708.02 ",IP,880,"4,831.96",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-286,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITH MCC,Medical,Relative Weights,"$11,694.25 ",IP,880,"31,281.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-287,CIRCULATORY DISORDERS EXCEPT AMI- WITH CARDIAC CATHETERIZATION WITHOUT MCC,Medical,Relative Weights,"$6,104.13 ",IP,880,"20,170.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-288,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,Medical,Relative Weights,"$14,700.07 ",IP,880,"47,943.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-289,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,Medical,Relative Weights,"$8,997.18 ",IP,880,"15,989.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-290,ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,621.32 ",IP,880,"9,963.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-291,HEART FAILURE AND SHOCK WITH MCC,Medical,Relative Weights,"$6,942.76 ",IP,880,"24,955.04",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-292,HEART FAILURE AND SHOCK WITH CC,Medical,Relative Weights,"$4,726.86 ",IP,880,"13,086.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-293,HEART FAILURE AND SHOCK WITHOUT CC/MCC,Medical,Relative Weights,"$3,229.15 ",IP,880,"9,312.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-294,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,Medical,Relative Weights,"$7,022.14 ",IP,880,"12,745.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-295,DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,387.03 ",IP,880,"9,551.97",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-296,CARDIAC ARREST- UNEXPLAINED WITH MCC,Medical,Relative Weights,"$8,732.24 ",IP,880,"15,523.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-297,CARDIAC ARREST- UNEXPLAINED WITH CC,Medical,Relative Weights,"$3,870.17 ",IP,880,"6,858.58",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-298,CARDIAC ARREST- UNEXPLAINED WITHOUT CC/MCC,Medical,Relative Weights,"$2,675.73 ",IP,880,"4,752.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-299,PERIPHERAL VASCULAR DISORDERS WITH MCC,Medical,Relative Weights,"$8,389.56 ",IP,880,"17,496.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-300,PERIPHERAL VASCULAR DISORDERS WITH CC,Medical,Relative Weights,"$5,713.83 ",IP,880,"10,144.77",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-301,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,067.78 ",IP,880,"8,251.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-302,ATHEROSCLEROSIS WITH MCC,Medical,Relative Weights,"$5,993.01 ",IP,880,"17,024.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-303,ATHEROSCLEROSIS WITHOUT MCC,Medical,Relative Weights,"$3,709.23 ",IP,880,"13,191.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-304,HYPERTENSION WITH MCC,Medical,Relative Weights,"$6,005.05 ",IP,880,"10,664.57",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-305,HYPERTENSION WITHOUT MCC,Medical,Relative Weights,"$4,050.26 ",IP,880,"8,013.43",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-306,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,Medical,Relative Weights,"$8,251.61 ",IP,880,"14,637.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-307,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,764.63 ",IP,880,"8,453.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-308,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,Medical,Relative Weights,"$6,573.81 ",IP,880,"18,068.11",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-309,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,Medical,Relative Weights,"$4,108.29 ",IP,880,"10,737.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-310,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,061.10 ",IP,880,"7,351.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-311,ANGINA PECTORIS,Medical,Relative Weights,"$3,823.64 ",IP,880,"6,784.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-312,SYNCOPE AND COLLAPSE,Medical,Relative Weights,"$4,591.10 ",IP,880,"8,308.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-313,CHEST PAIN,Medical,Relative Weights,"$3,948.99 ",IP,880,"7,016.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,Medical,Relative Weights,"$11,411.79 ",IP,880,"21,590.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,Medical,Relative Weights,"$5,328.46 ",IP,880,"14,251.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,959.94 ",IP,880,"10,062.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,Surgical,Relative Weights,"$23,636.48 ",IP,930,"42,010.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$13,168.42 ",IP,930,"23,786.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-326,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$29,101.79 ",IP,930,"72,806.55",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-327,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC,Surgical,Relative Weights,"$14,039.35 ",IP,930,"36,840.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-328,STOMACH- ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,124.73 ",IP,930,"21,222.70",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-329,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Relative Weights,"$26,747.40 ",IP,930,"58,786.79",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-330,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Relative Weights,"$13,955.04 ",IP,930,"32,076.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-331,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,363.40 ",IP,930,"22,739.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-332,RECTAL RESECTION WITH MCC,Surgical,Relative Weights,"$22,780.34 ",IP,930,"40,490.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-333,RECTAL RESECTION WITH CC,Surgical,Relative Weights,"$11,721.62 ",IP,930,"23,168.53",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-334,RECTAL RESECTION WITHOUT CC/MCC,Surgical,Relative Weights,"$8,805.59 ",IP,930,"22,161.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-335,PERITONEAL ADHESIOLYSIS WITH MCC,Surgical,Relative Weights,"$21,422.77 ",IP,930,"40,376.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-336,PERITONEAL ADHESIOLYSIS WITH CC,Surgical,Relative Weights,"$12,542.73 ",IP,930,"30,773.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-337,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$8,962.69 ",IP,930,"19,745.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$15,312.61 ",IP,930,"42,970.69",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$9,291.69 ",IP,930,"29,459.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,723.80 ",IP,930,"17,383.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$12,712.98 ",IP,930,"22,545.89",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$7,843.79 ",IP,930,"16,376.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,068.55 ",IP,930,"11,823.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-344,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,428.12 ",IP,930,"27,263.96",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-345,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,Surgical,Relative Weights,"$8,642.46 ",IP,930,"24,196.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-346,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,981.63 ",IP,930,"18,121.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-347,ANAL AND STOMAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$13,491.94 ",IP,930,"23,961.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-348,ANAL AND STOMAL PROCEDURES WITH CC,Surgical,Relative Weights,"$7,379.59 ",IP,930,"14,526.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-349,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,360.76 ",IP,930,"9,532.51",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-350,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,Surgical,Relative Weights,"$13,437.75 ",IP,930,"23,871.66",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-351,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,Surgical,Relative Weights,"$8,171.14 ",IP,930,"14,886.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-352,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,045.56 ",IP,930,"10,736.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-353,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,Surgical,Relative Weights,"$16,558.51 ",IP,930,"42,132.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-354,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,Surgical,Relative Weights,"$9,770.12 ",IP,930,"22,629.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-355,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,Surgical,Relative Weights,"$7,445.83 ",IP,930,"14,128.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$23,581.20 ",IP,930,"41,772.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$12,417.93 ",IP,930,"21,937.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,385.07 ",IP,930,"16,746.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-368,MAJOR ESOPHAGEAL DISORDERS WITH MCC,Medical,Relative Weights,"$10,669.51 ",IP,880,"18,906.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-369,MAJOR ESOPHAGEAL DISORDERS WITH CC,Medical,Relative Weights,"$5,896.67 ",IP,880,"14,533.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-370,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,095.15 ",IP,880,"9,008.96",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-371,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,Medical,Relative Weights,"$9,476.71 ",IP,880,"20,975.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-372,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,Medical,Relative Weights,"$5,634.46 ",IP,880,"14,263.75",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-373,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,Medical,Relative Weights,"$4,075.99 ",IP,880,"7,237.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-374,DIGESTIVE MALIGNANCY WITH MCC,Medical,Relative Weights,"$11,351.58 ",IP,880,"20,879.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-375,DIGESTIVE MALIGNANCY WITH CC,Medical,Relative Weights,"$6,610.49 ",IP,880,"16,469.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-376,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$4,920.64 ",IP,880,"8,713.88",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-377,GASTROINTESTINAL HEMORRHAGE WITH MCC,Medical,Relative Weights,"$9,859.89 ",IP,880,"17,510.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-378,GASTROINTESTINAL HEMORRHAGE WITH CC,Medical,Relative Weights,"$5,438.49 ",IP,880,"11,201.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-379,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,Medical,Relative Weights,"$3,488.08 ",IP,880,"8,353.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-380,COMPLICATED PEPTIC ULCER WITH MCC,Medical,Relative Weights,"$10,327.38 ",IP,880,"18,330.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-381,COMPLICATED PEPTIC ULCER WITH CC,Medical,Relative Weights,"$5,798.68 ",IP,880,"16,393.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-382,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,Medical,Relative Weights,"$4,207.37 ",IP,880,"9,875.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-383,UNCOMPLICATED PEPTIC ULCER WITH MCC,Medical,Relative Weights,"$7,185.26 ",IP,880,"12,760.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-384,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,Medical,Relative Weights,"$4,887.25 ",IP,880,"8,686.62",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-385,INFLAMMATORY BOWEL DISEASE WITH MCC,Medical,Relative Weights,"$8,880.58 ",IP,880,"15,760.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-386,INFLAMMATORY BOWEL DISEASE WITH CC,Medical,Relative Weights,"$5,447.25 ",IP,880,"12,619.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-387,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,Medical,Relative Weights,"$3,912.32 ",IP,880,"11,388.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-388,GASTROINTESTINAL OBSTRUCTION WITH MCC,Medical,Relative Weights,"$8,291.03 ",IP,880,"18,414.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-389,GASTROINTESTINAL OBSTRUCTION WITH CC,Medical,Relative Weights,"$4,506.25 ",IP,880,"9,770.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-390,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,Medical,Relative Weights,"$3,191.93 ",IP,880,"7,374.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-391,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC,Medical,Relative Weights,"$6,838.21 ",IP,880,"13,398.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-392,ESOPHAGITIS- GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,192.04 ",IP,880,"7,984.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,Medical,Relative Weights,"$9,093.52 ",IP,880,"16,096.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,Medical,Relative Weights,"$5,150.55 ",IP,880,"10,892.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,566.36 ",IP,880,"9,654.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-405,PANCREAS- LIVER AND SHUNT PROCEDURES WITH MCC,Surgical,Relative Weights,"$31,408.02 ",IP,930,"112,898.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-406,PANCREAS- LIVER AND SHUNT PROCEDURES WITH CC,Surgical,Relative Weights,"$15,770.25 ",IP,930,"41,825.91",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-407,PANCREAS- LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$11,594.08 ",IP,930,"27,794.09",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-408,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,Surgical,Relative Weights,"$20,543.63 ",IP,930,"39,095.75",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-409,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,Surgical,Relative Weights,"$11,585.32 ",IP,930,"20,580.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-410,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$8,584.98 ",IP,930,"15,240.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-411,CHOLECYSTECTOMY WITH C.D.E. WITH MCC,Surgical,Relative Weights,"$20,546.92 ",IP,930,"36,525.86",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-412,CHOLECYSTECTOMY WITH C.D.E. WITH CC,Surgical,Relative Weights,"$12,467.19 ",IP,930,"22,151.66",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-413,CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$9,475.07 ",IP,930,"24,838.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,Surgical,Relative Weights,"$19,861.57 ",IP,930,"47,586.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,Surgical,Relative Weights,"$11,121.67 ",IP,930,"25,671.18",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-416,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$7,785.77 ",IP,930,"20,836.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,Surgical,Relative Weights,"$13,270.79 ",IP,930,"23,590.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,Surgical,Relative Weights,"$9,245.70 ",IP,930,"19,926.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,Surgical,Relative Weights,"$7,200.04 ",IP,930,"15,420.41",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,Surgical,Relative Weights,"$19,249.56 ",IP,930,"34,206.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,Surgical,Relative Weights,"$10,441.79 ",IP,930,"18,581.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,957.11 ",IP,930,"14,127.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$22,913.91 ",IP,930,"40,678.39",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-424,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$12,503.32 ",IP,930,"22,209.09",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-425,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,444.85 ",IP,930,"15,022.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-432,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,Medical,Relative Weights,"$10,295.63 ",IP,880,"19,308.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-433,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,Medical,Relative Weights,"$5,637.74 ",IP,880,"11,980.70",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-434,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Relative Weights,"$3,397.75 ",IP,880,"9,045.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,Medical,Relative Weights,"$9,598.23 ",IP,880,"18,484.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,Medical,Relative Weights,"$6,139.17 ",IP,880,"13,731.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-437,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,Medical,Relative Weights,"$4,904.22 ",IP,880,"8,707.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,Medical,Relative Weights,"$8,746.47 ",IP,880,"25,887.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,Medical,Relative Weights,"$4,626.68 ",IP,880,"14,357.76",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$3,318.93 ",IP,880,"9,273.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-441,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC,Medical,Relative Weights,"$10,288.51 ",IP,880,"20,401.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-442,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC,Medical,Relative Weights,"$5,090.88 ",IP,880,"14,680.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-443,DISORDERS OF LIVER EXCEPT MALIGNANCY- CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC,Medical,Relative Weights,"$3,630.40 ",IP,880,"8,700.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-444,DISORDERS OF THE BILIARY TRACT WITH MCC,Medical,Relative Weights,"$9,150.45 ",IP,880,"16,244.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-445,DISORDERS OF THE BILIARY TRACT WITH CC,Medical,Relative Weights,"$5,898.31 ",IP,880,"13,433.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-446,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,Medical,Relative Weights,"$4,470.12 ",IP,880,"8,848.68",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-453,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,Surgical,Relative Weights,"$50,295.75 ",IP,930,"89,490.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-454,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,Surgical,Relative Weights,"$33,354.05 ",IP,930,"59,358.91",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-455,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,Surgical,Relative Weights,"$26,173.17 ",IP,930,"46,635.59",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-456,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH MCC,Surgical,Relative Weights,"$47,076.99 ",IP,930,"83,693.91",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-457,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITH CC,Surgical,Relative Weights,"$35,559.01 ",IP,930,"63,290.47",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-458,SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE- MALIGNANCY- INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC,Surgical,Relative Weights,"$27,411.95 ",IP,930,"48,839.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-459,SPINAL FUSION EXCEPT CERVICAL WITH MCC,Surgical,Relative Weights,"$36,859.64 ",IP,930,"65,527.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,Surgical,Relative Weights,"$21,516.92 ",IP,930,"38,280.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-461,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,Surgical,Relative Weights,"$33,291.65 ",IP,930,"59,145.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-462,BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,Surgical,Relative Weights,"$17,196.24 ",IP,930,"30,605.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-463,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Relative Weights,"$29,397.39 ",IP,930,"103,000.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-464,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Relative Weights,"$16,290.28 ",IP,930,"33,683.44",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-465,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$10,094.73 ",IP,930,"17,945.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-466,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,Surgical,Relative Weights,"$29,262.73 ",IP,930,"52,028.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-467,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,Surgical,Relative Weights,"$19,583.48 ",IP,930,"34,810.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,Surgical,Relative Weights,"$15,340.53 ",IP,930,"27,294.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,Surgical,Relative Weights,"$16,892.43 ",IP,930,"31,852.97",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,Surgical,Relative Weights,"$10,402.37 ",IP,930,"18,493.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-471,CERVICAL SPINAL FUSION WITH MCC,Surgical,Relative Weights,"$27,478.19 ",IP,930,"48,833.53",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-472,CERVICAL SPINAL FUSION WITH CC,Surgical,Relative Weights,"$16,716.17 ",IP,930,"29,719.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,Surgical,Relative Weights,"$13,898.66 ",IP,930,"24,726.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-474,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,Surgical,Relative Weights,"$22,312.85 ",IP,930,"39,644.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-475,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,Surgical,Relative Weights,"$12,022.70 ",IP,930,"25,444.94",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-476,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,351.56 ",IP,930,"18,391.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-477,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Surgical,Relative Weights,"$18,386.85 ",IP,930,"32,676.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-478,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Surgical,Relative Weights,"$12,910.04 ",IP,930,"41,472.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-479,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Surgical,Relative Weights,"$9,905.33 ",IP,930,"17,611.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-480,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,Surgical,Relative Weights,"$16,563.44 ",IP,930,"33,955.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-481,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,Surgical,Relative Weights,"$11,474.20 ",IP,930,"27,785.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-482,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,Surgical,Relative Weights,"$9,009.22 ",IP,930,"16,467.71",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-483,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,Surgical,Relative Weights,"$13,059.49 ",IP,930,"23,228.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-485,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,Surgical,Relative Weights,"$18,664.39 ",IP,930,"33,169.58",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-486,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,Surgical,Relative Weights,"$11,765.96 ",IP,930,"37,924.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-487,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Relative Weights,"$8,978.57 ",IP,930,"16,429.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-488,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,Surgical,Relative Weights,"$10,815.12 ",IP,930,"19,220.76",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-489,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,Surgical,Relative Weights,"$7,106.44 ",IP,930,"13,956.09",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-492,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH MCC,Surgical,Relative Weights,"$18,995.02 ",IP,930,"33,759.46",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-493,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITH CC,Surgical,Relative Weights,"$12,731.59 ",IP,930,"22,633.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-494,LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP- FOOT AND FEMUR WITHOUT CC/MCC,Surgical,Relative Weights,"$10,136.33 ",IP,930,"18,026.39",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-495,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,Surgical,Relative Weights,"$19,936.01 ",IP,930,"35,375.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-496,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,Surgical,Relative Weights,"$10,873.69 ",IP,930,"19,327.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-497,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,Surgical,Relative Weights,"$7,945.61 ",IP,930,"14,198.99",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-498,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,Surgical,Relative Weights,"$14,143.35 ",IP,930,"25,155.58",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-499,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,Surgical,Relative Weights,"$6,563.41 ",IP,930,"11,668.15",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-500,SOFT TISSUE PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,459.54 ",IP,930,"30,700.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-501,SOFT TISSUE PROCEDURES WITH CC,Surgical,Relative Weights,"$9,602.06 ",IP,930,"18,582.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-502,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,295.84 ",IP,930,"12,954.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-503,FOOT PROCEDURES WITH MCC,Surgical,Relative Weights,"$14,454.83 ",IP,930,"25,587.77",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-504,FOOT PROCEDURES WITH CC,Surgical,Relative Weights,"$9,716.47 ",IP,930,"17,267.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-505,FOOT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,716.47 ",IP,930,"17,267.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-506,MAJOR THUMB OR JOINT PROCEDURES,Surgical,Relative Weights,"$8,121.33 ",IP,930,"22,732.26",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$11,281.51 ",IP,930,"19,685.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-508,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,716.80 ",IP,930,"13,763.88",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-509,ARTHROSCOPY,Surgical,Relative Weights,"$9,232.02 ",IP,930,"16,292.77",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-510,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,019.20 ",IP,930,"26,580.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-511,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITH CC,Surgical,Relative Weights,"$10,769.68 ",IP,930,"19,161.38",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-512,SHOULDER- ELBOW OR FOREARM PROCEDURES- EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,509.44 ",IP,930,"15,148.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-513,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$8,605.24 ",IP,930,"16,495.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-514,HAND OR WRIST PROCEDURES- EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,469.14 ",IP,930,"9,677.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-515,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,191.86 ",IP,930,"30,535.56",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-516,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$10,744.50 ",IP,930,"20,939.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-517,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,653.84 ",IP,930,"17,164.18",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-518,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,Surgical,Relative Weights,"$19,634.94 ",IP,930,"34,889.58",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-519,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,Surgical,Relative Weights,"$10,729.18 ",IP,930,"19,056.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-520,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,Surgical,Relative Weights,"$7,763.87 ",IP,930,"13,796.97",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,Surgical,Relative Weights,"$16,784.59 ",IP,930,"29,819.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,Surgical,Relative Weights,"$11,984.93 ",IP,930,"21,308.70",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-533,FRACTURES OF FEMUR WITH MCC,Medical,Relative Weights,"$7,752.38 ",IP,880,"13,750.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-534,FRACTURES OF FEMUR WITHOUT MCC,Medical,Relative Weights,"$4,325.61 ",IP,880,"9,003.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-535,FRACTURES OF HIP AND PELVIS WITH MCC,Medical,Relative Weights,"$6,748.43 ",IP,880,"12,009.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-536,FRACTURES OF HIP AND PELVIS WITHOUT MCC,Medical,Relative Weights,"$4,224.34 ",IP,880,"10,296.75",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-537,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITH CC/MCC,Medical,Relative Weights,"$5,120.44 ",IP,880,"9,083.77",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-538,SPRAINS- STRAINS- AND DISLOCATIONS OF HIP- PELVIS AND THIGH WITHOUT CC/MCC,Medical,Relative Weights,"$3,958.85 ",IP,880,"11,438.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-539,OSTEOMYELITIS WITH MCC,Medical,Relative Weights,"$10,661.84 ",IP,880,"18,895.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-540,OSTEOMYELITIS WITH CC,Medical,Relative Weights,"$7,125.05 ",IP,880,"16,619.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-541,OSTEOMYELITIS WITHOUT CC/MCC,Medical,Relative Weights,"$4,615.74 ",IP,880,"11,354.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-542,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,Medical,Relative Weights,"$9,903.69 ",IP,880,"42,249.68",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-543,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,Medical,Relative Weights,"$5,721.50 ",IP,880,"21,655.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-544,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,Medical,Relative Weights,"$4,257.18 ",IP,880,"12,656.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-545,CONNECTIVE TISSUE DISORDERS WITH MCC,Medical,Relative Weights,"$13,702.14 ",IP,880,"28,263.70",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-546,CONNECTIVE TISSUE DISORDERS WITH CC,Medical,Relative Weights,"$6,612.68 ",IP,880,"17,348.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-547,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,563.18 ",IP,880,"10,953.43",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-548,SEPTIC ARTHRITIS WITH MCC,Medical,Relative Weights,"$11,226.22 ",IP,880,"19,756.13",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-549,SEPTIC ARTHRITIS WITH CC,Medical,Relative Weights,"$6,842.04 ",IP,880,"12,137.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-550,SEPTIC ARTHRITIS WITHOUT CC/MCC,Medical,Relative Weights,"$4,811.16 ",IP,880,"8,709.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-551,MEDICAL BACK PROBLEMS WITH MCC,Medical,Relative Weights,"$8,908.50 ",IP,880,"20,193.22",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-552,MEDICAL BACK PROBLEMS WITHOUT MCC,Medical,Relative Weights,"$5,164.24 ",IP,880,"9,169.43",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-553,BONE DISEASES AND ARTHROPATHIES WITH MCC,Medical,Relative Weights,"$6,960.28 ",IP,880,"12,345.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-554,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,Medical,Relative Weights,"$4,338.20 ",IP,880,"7,693.75",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-555,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Relative Weights,"$7,491.26 ",IP,880,"13,265.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-556,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,Medical,Relative Weights,"$4,426.88 ",IP,880,"7,848.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-557,TENDONITIS- MYOSITIS AND BURSITIS WITH MCC,Medical,Relative Weights,"$7,658.77 ",IP,880,"13,568.22",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-558,TENDONITIS- MYOSITIS AND BURSITIS WITHOUT MCC,Medical,Relative Weights,"$4,715.36 ",IP,880,"8,354.69",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-559,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,Medical,Relative Weights,"$10,210.78 ",IP,880,"18,182.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-560,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,Medical,Relative Weights,"$5,890.10 ",IP,880,"11,188.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-561,AFTERCARE- MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,Medical,Relative Weights,"$4,337.65 ",IP,880,"7,700.57",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-562,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITH MCC,Medical,Relative Weights,"$7,728.29 ",IP,880,"18,525.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-563,FRACTURE- SPRAIN- STRAIN AND DISLOCATION EXCEPT FEMUR- HIP- PELVIS AND THIGH WITHOUT MCC,Medical,Relative Weights,"$4,774.48 ",IP,880,"9,252.79",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-564,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,340.29 ",IP,880,"14,735.33",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-565,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,Medical,Relative Weights,"$5,524.98 ",IP,880,"17,516.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-566,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$4,115.95 ",IP,880,"7,315.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-570,SKIN DEBRIDEMENT WITH MCC,Surgical,Relative Weights,"$15,555.66 ",IP,930,"27,608.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-571,SKIN DEBRIDEMENT WITH CC,Surgical,Relative Weights,"$8,952.29 ",IP,930,"15,893.68",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-572,SKIN DEBRIDEMENT WITHOUT CC/MCC,Surgical,Relative Weights,"$6,045.56 ",IP,930,"10,732.71",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-573,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Relative Weights,"$30,321.42 ",IP,930,"53,900.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-574,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Relative Weights,"$17,771.57 ",IP,930,"31,618.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-575,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Relative Weights,"$9,651.88 ",IP,930,"17,146.44",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-576,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,Surgical,Relative Weights,"$27,719.04 ",IP,930,"49,165.46",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-577,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,Surgical,Relative Weights,"$13,956.69 ",IP,930,"40,864.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-578,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,Surgical,Relative Weights,"$8,732.24 ",IP,930,"15,873.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-579,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC,Surgical,Relative Weights,"$17,215.40 ",IP,930,"28,499.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-580,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC,Surgical,Relative Weights,"$9,463.57 ",IP,930,"15,577.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-581,OTHER SKIN- SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,536.70 ",IP,930,"12,187.94",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-582,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$8,994.44 ",IP,930,"15,922.88",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-583,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$8,438.28 ",IP,930,"14,969.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-584,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$10,054.22 ",IP,930,"17,757.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-585,BREAST BIOPSY- LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,522.69 ",IP,930,"16,904.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-592,SKIN ULCERS WITH MCC,Medical,Relative Weights,"$9,274.72 ",IP,880,"16,418.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-593,SKIN ULCERS WITH CC,Medical,Relative Weights,"$6,243.72 ",IP,880,"11,065.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-594,SKIN ULCERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,466.84 ",IP,880,"7,969.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-595,MAJOR SKIN DISORDERS WITH MCC,Medical,Relative Weights,"$11,038.46 ",IP,880,"19,585.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-596,MAJOR SKIN DISORDERS WITHOUT MCC,Medical,Relative Weights,"$5,445.06 ",IP,880,"9,628.87",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-597,MALIGNANT BREAST DISORDERS WITH MCC,Medical,Relative Weights,"$8,999.37 ",IP,880,"15,931.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-598,MALIGNANT BREAST DISORDERS WITH CC,Medical,Relative Weights,"$6,092.09 ",IP,880,"10,816.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-599,MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,675.29 ",IP,880,"6,533.46",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-600,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,Medical,Relative Weights,"$5,457.10 ",IP,880,"9,692.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-601,NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,759.59 ",IP,880,"8,644.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-602,CELLULITIS WITH MCC,Medical,Relative Weights,"$7,937.40 ",IP,880,"17,311.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-603,CELLULITIS WITHOUT MCC,Medical,Relative Weights,"$4,672.67 ",IP,880,"8,223.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-604,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITH MCC,Medical,Relative Weights,"$8,090.13 ",IP,880,"14,516.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-605,TRAUMA TO THE SKIN- SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC,Medical,Relative Weights,"$4,948.01 ",IP,880,"10,528.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-606,MINOR SKIN DISORDERS WITH MCC,Medical,Relative Weights,"$8,277.34 ",IP,880,"14,708.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-607,MINOR SKIN DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,533.62 ",IP,880,"8,036.39",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-614,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$13,081.38 ",IP,930,"23,233.11",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-615,ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,621.66 ",IP,930,"30,961.86",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-616,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Relative Weights,"$21,711.25 ",IP,930,"38,826.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-617,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Relative Weights,"$11,111.27 ",IP,930,"24,974.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-618,AMPUTATION OF LOWER LIMB FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$7,133.81 ",IP,930,"12,683.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-619,O.R. PROCEDURES FOR OBESITY WITH MCC,Surgical,Relative Weights,"$16,759.96 ",IP,930,"46,417.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-620,O.R. PROCEDURES FOR OBESITY WITH CC,Surgical,Relative Weights,"$9,649.14 ",IP,930,"29,276.15",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-621,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,Surgical,Relative Weights,"$8,742.64 ",IP,930,"21,824.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-622,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH MCC,Surgical,Relative Weights,"$19,788.21 ",IP,930,"35,167.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-623,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITH CC,Surgical,Relative Weights,"$10,244.72 ",IP,930,"20,650.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-624,SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE- NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,015.45 ",IP,930,"10,651.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-625,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,547.45 ",IP,930,"27,656.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-626,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC,Surgical,Relative Weights,"$9,048.09 ",IP,930,"16,454.94",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-627,THYROID- PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,474.73 ",IP,930,"12,627.38",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-628,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$20,141.29 ",IP,930,"35,997.31",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-629,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$12,838.33 ",IP,930,"42,844.13",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-630,OTHER ENDOCRINE- NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,714.61 ",IP,930,"62,529.13",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-637,DIABETES WITH MCC,Medical,Relative Weights,"$7,535.60 ",IP,880,"16,384.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-638,DIABETES WITH CC,Medical,Relative Weights,"$4,813.90 ",IP,880,"11,497.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-639,DIABETES WITHOUT CC/MCC,Medical,Relative Weights,"$3,336.99 ",IP,880,"6,523.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-640,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITH MCC,Medical,Relative Weights,"$6,737.48 ",IP,880,"16,032.71",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-641,MISCELLANEOUS DISORDERS OF NUTRITION- METABOLISM- FLUIDS AND ELECTROLYTES WITHOUT MCC,Medical,Relative Weights,"$4,128.54 ",IP,880,"8,705.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-642,INBORN AND OTHER DISORDERS OF METABOLISM,Medical,Relative Weights,"$7,060.45 ",IP,880,"12,532.53",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-643,ENDOCRINE DISORDERS WITH MCC,Medical,Relative Weights,"$9,129.11 ",IP,880,"16,190.56",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-644,ENDOCRINE DISORDERS WITH CC,Medical,Relative Weights,"$5,582.46 ",IP,880,"9,912.13",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-645,ENDOCRINE DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$4,207.37 ",IP,880,"7,473.77",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,Neonate,Relative Weights,"$24,746.62 ",IP,930,"43,930.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,Neonate,Relative Weights,"$20,245.30 ",IP,930,"35,953.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-652,KIDNEY TRANSPLANT,Surgical,Relative Weights,"$17,435.46 ",IP,930,"30,972.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-653,MAJOR BLADDER PROCEDURES WITH MCC,Surgical,Relative Weights,"$29,884.04 ",IP,930,"53,042.51",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-654,MAJOR BLADDER PROCEDURES WITH CC,Surgical,Relative Weights,"$15,890.13 ",IP,930,"34,877.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-655,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$11,387.71 ",IP,930,"20,247.69",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-656,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,Surgical,Relative Weights,"$17,982.32 ",IP,930,"31,944.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-657,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,Surgical,Relative Weights,"$10,590.68 ",IP,930,"24,776.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-658,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,Surgical,Relative Weights,"$8,637.53 ",IP,930,"18,687.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-659,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,Surgical,Relative Weights,"$14,596.06 ",IP,930,"25,939.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-660,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,Surgical,Relative Weights,"$7,899.63 ",IP,930,"22,402.18",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-661,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,Surgical,Relative Weights,"$5,822.77 ",IP,930,"16,610.09",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-662,MINOR BLADDER PROCEDURES WITH MCC,Surgical,Relative Weights,"$16,078.98 ",IP,930,"28,518.67",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-663,MINOR BLADDER PROCEDURES WITH CC,Surgical,Relative Weights,"$8,755.77 ",IP,930,"15,524.76",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-664,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,480.20 ",IP,930,"11,527.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-665,PROSTATECTOMY WITH MCC,Surgical,Relative Weights,"$16,650.48 ",IP,930,"29,559.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-666,PROSTATECTOMY WITH CC,Surgical,Relative Weights,"$9,523.24 ",IP,930,"16,881.68",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-667,PROSTATECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$5,460.38 ",IP,930,"9,684.36",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-668,TRANSURETHRAL PROCEDURES WITH MCC,Surgical,Relative Weights,"$15,361.88 ",IP,930,"34,290.18",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-669,TRANSURETHRAL PROCEDURES WITH CC,Surgical,Relative Weights,"$8,558.71 ",IP,930,"14,911.51",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-670,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,356.38 ",IP,930,"9,916.13",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-671,URETHRAL PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$9,750.96 ",IP,930,"17,294.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-672,URETHRAL PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,297.37 ",IP,930,"11,202.86",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-673,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,Surgical,Relative Weights,"$18,985.71 ",IP,930,"72,221.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-674,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,Surgical,Relative Weights,"$13,045.80 ",IP,930,"24,957.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-675,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,605.35 ",IP,930,"20,920.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-682,RENAL FAILURE WITH MCC,Medical,Relative Weights,"$8,061.66 ",IP,880,"28,276.40",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-683,RENAL FAILURE WITH CC,Medical,Relative Weights,"$4,813.35 ",IP,880,"15,981.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-684,RENAL FAILURE WITHOUT CC/MCC,Medical,Relative Weights,"$3,327.69 ",IP,880,"11,604.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-686,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,Medical,Relative Weights,"$10,265.52 ",IP,880,"18,233.73",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-687,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,Medical,Relative Weights,"$5,748.32 ",IP,880,"15,308.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-688,KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,Medical,Relative Weights,"$3,754.12 ",IP,880,"6,670.71",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Medical,Relative Weights,"$6,099.21 ",IP,880,"13,266.88",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Medical,Relative Weights,"$4,346.41 ",IP,880,"7,711.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-693,URINARY STONES WITH MCC,Medical,Relative Weights,"$7,310.62 ",IP,880,"16,038.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-694,URINARY STONES WITHOUT MCC,Medical,Relative Weights,"$4,221.60 ",IP,880,"7,989.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-695,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,Medical,Relative Weights,"$6,227.85 ",IP,880,"11,060.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-696,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Relative Weights,"$3,787.51 ",IP,880,"10,088.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-697,URETHRAL STRICTURE,Medical,Relative Weights,"$5,470.24 ",IP,880,"9,704.80",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-698,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,816.54 ",IP,880,"16,964.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-699,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,Medical,Relative Weights,"$5,621.87 ",IP,880,"13,322.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-700,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$4,086.39 ",IP,880,"7,322.67",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-707,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$10,522.26 ",IP,930,"19,671.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-708,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,162.93 ",IP,930,"16,904.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-709,PENIS PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$12,677.40 ",IP,930,"22,504.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-710,PENIS PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,767.27 ",IP,930,"16,135.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-711,TESTES PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$11,668.53 ",IP,930,"20,736.34",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-712,TESTES PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,802.51 ",IP,930,"10,293.71",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-713,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,Surgical,Relative Weights,"$8,174.97 ",IP,930,"14,519.23",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-714,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$5,084.32 ",IP,930,"9,038.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-715,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$11,066.38 ",IP,930,"19,651.97",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-716,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$6,983.82 ",IP,930,"12,425.45",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$9,856.61 ",IP,930,"17,506.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-718,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$6,758.29 ",IP,930,"12,033.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-722,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$9,374.89 ",IP,880,"16,635.41",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-723,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITH CC,Medical,Relative Weights,"$5,977.14 ",IP,880,"10,601.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-724,MALIGNANCY- MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$3,547.74 ",IP,880,"12,900.09",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-725,BENIGN PROSTATIC HYPERTROPHY WITH MCC,Medical,Relative Weights,"$7,036.92 ",IP,880,"12,478.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-726,BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,Medical,Relative Weights,"$4,076.54 ",IP,880,"7,235.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$7,778.65 ",IP,880,"13,803.79",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,Medical,Relative Weights,"$4,410.46 ",IP,880,"7,821.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-729,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,Medical,Relative Weights,"$5,515.12 ",IP,880,"9,780.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-730,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,114.20 ",IP,880,"5,506.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-734,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC,Surgical,Relative Weights,"$12,175.97 ",IP,930,"21,636.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-735,PELVIC EVISCERATION- RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$7,738.14 ",IP,930,"13,759.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-736,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,Surgical,Relative Weights,"$23,323.37 ",IP,930,"41,449.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-737,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,Surgical,Relative Weights,"$11,266.18 ",IP,930,"24,678.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-738,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$8,079.18 ",IP,930,"16,233.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-739,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,Surgical,Relative Weights,"$20,932.84 ",IP,930,"37,200.43",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-740,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,Surgical,Relative Weights,"$9,862.08 ",IP,930,"17,521.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-741,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$7,006.26 ",IP,930,"12,454.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-742,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,Surgical,Relative Weights,"$9,405.00 ",IP,930,"16,713.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,Surgical,Relative Weights,"$6,201.03 ",IP,930,"11,021.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-744,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC,Surgical,Relative Weights,"$9,828.14 ",IP,930,"17,462.80",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-745,D&C- CONIZATION- LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC,Surgical,Relative Weights,"$6,404.66 ",IP,930,"11,393.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-746,VAGINA- CERVIX AND VULVA PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$8,821.46 ",IP,930,"15,985.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-747,VAGINA- CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,140.70 ",IP,930,"10,529.41",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Surgical,Relative Weights,"$7,376.86 ",IP,930,"13,124.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$14,855.53 ",IP,930,"26,353.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,012.94 ",IP,930,"14,269.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-754,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$9,996.75 ",IP,880,"17,725.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-755,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Relative Weights,"$6,181.87 ",IP,880,"13,542.79",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-756,MALIGNANCY- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$5,027.39 ",IP,880,"9,899.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-757,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH MCC,Medical,Relative Weights,"$8,346.31 ",IP,880,"14,816.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-758,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITH CC,Medical,Relative Weights,"$5,308.20 ",IP,880,"9,412.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-759,INFECTIONS- FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC,Medical,Relative Weights,"$3,740.98 ",IP,880,"7,933.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-760,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,Medical,Relative Weights,"$5,036.69 ",IP,880,"12,819.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-761,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,234.08 ",IP,880,"9,742.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-768,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,Surgical,Relative Weights,"$6,402.47 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-769,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,Surgical,Relative Weights,"$8,854.85 ",IP,930,"16,800.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-770,ABORTION WITH D&C- ASPIRATION CURETTAGE OR HYSTEROTOMY,Surgical,Relative Weights,"$4,870.83 ",IP,930,"8,928.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-776,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,Medical,Relative Weights,"$4,239.67 ",IP,880,"7,483.50",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-779,ABORTION WITHOUT D&C,Medical,Relative Weights,"$5,797.04 ",IP,880,"10,127.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-783,CESAREAN SECTION WITH STERILIZATION WITH MCC,C-Section,Relative Weights,"$10,263.33 ",IP,"2,975.00","17,026.59",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-784,CESAREAN SECTION WITH STERILIZATION WITH CC,C-Section,Relative Weights,"$5,999.03 ",IP,"2,975.00","9,954.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-785,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,C-Section,Relative Weights,"$5,018.63 ",IP,"2,975.00","8,321.91",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-786,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,C-Section,Relative Weights,"$8,727.86 ",IP,"2,975.00","14,466.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-787,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,C-Section,Relative Weights,"$5,826.60 ",IP,"2,975.00","9,662.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,C-Section,Relative Weights,"$4,857.69 ",IP,"2,975.00","8,065.51",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-789,NEONATES- DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY,Medical,Relative Weights,"$9,415.40 ",IP,"9,415.40","15,624.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-790,EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME- NEONATE,Medical,Relative Weights,"$31,049.47 ",IP,"31,049.47","59,778.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-791,PREMATURITY WITH MAJOR PROBLEMS,Medical,Relative Weights,"$21,205.45 ",IP,"18,126.50","35,189.68",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-792,PREMATURITY WITHOUT MAJOR PROBLEMS,Medical,Relative Weights,"$12,795.09 ",IP,"8,021.48","21,232.55",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-793,FULL TERM NEONATE WITH MAJOR PROBLEMS,Medical,Relative Weights,"$21,782.42 ",IP,"6,433.54","36,147.06",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,Medical,Relative Weights,"$7,709.68 ",IP,"2,637.93","12,794.26",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-795,NORMAL NEWBORN,Medical,Relative Weights,"$1,043.90 ",IP,280,"1,732.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-796,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,Vaginal Delivery,Relative Weights,"$5,861.63 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-797,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,Vaginal Delivery,Relative Weights,"$5,032.86 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-798,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,Vaginal Delivery,Relative Weights,"$4,529.79 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-799,SPLENECTOMY WITH MCC,Surgical,Relative Weights,"$28,177.22 ",IP,930,"50,070.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-800,SPLENECTOMY WITH CC,Surgical,Relative Weights,"$16,169.85 ",IP,930,"28,728.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-801,SPLENECTOMY WITHOUT CC/MCC,Surgical,Relative Weights,"$9,218.33 ",IP,930,"23,774.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-802,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,Surgical,Relative Weights,"$20,318.10 ",IP,930,"36,100.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-803,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,Surgical,Relative Weights,"$10,326.83 ",IP,930,"18,346.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-804,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,Surgical,Relative Weights,"$7,477.03 ",IP,930,"13,279.12",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-805,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,Vaginal Delivery,Relative Weights,"$5,637.74 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-806,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,Vaginal Delivery,Relative Weights,"$4,021.25 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-807,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,Vaginal Delivery,Relative Weights,"$3,515.99 ",IP,"2,125.00","547,309.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-808,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,Medical,Relative Weights,"$11,965.22 ",IP,880,"21,199.68",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-809,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,Medical,Relative Weights,"$6,696.98 ",IP,880,"13,075.41",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-810,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$5,264.41 ",IP,880,"10,300.53",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-811,RED BLOOD CELL DISORDERS WITH MCC,Medical,Relative Weights,"$7,550.38 ",IP,880,"15,949.69",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-812,RED BLOOD CELL DISORDERS WITHOUT MCC,Medical,Relative Weights,"$4,818.82 ",IP,880,"8,563.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-813,COAGULATION DISORDERS,Medical,Relative Weights,"$8,457.98 ",IP,880,"15,036.11",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-814,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,Medical,Relative Weights,"$10,355.30 ",IP,880,"18,405.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-815,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,Medical,Relative Weights,"$5,437.94 ",IP,880,"13,663.66",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-816,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,Medical,Relative Weights,"$3,618.91 ",IP,880,"6,433.20",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$12,627.58 ",IP,930,"22,405.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$7,443.64 ",IP,930,"12,814.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$5,404.00 ",IP,930,"9,713.56",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-820,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$31,156.76 ",IP,930,"122,617.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-821,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$11,797.71 ",IP,930,"27,576.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-822,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,850.80 ",IP,930,"27,517.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-823,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,Surgical,Relative Weights,"$24,643.16 ",IP,930,"43,774.77",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-824,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,Surgical,Relative Weights,"$12,942.89 ",IP,930,"22,998.52",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-825,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,671.91 ",IP,930,"13,634.41",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-826,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$27,613.94 ",IP,930,"49,028.21",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-827,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$13,688.46 ",IP,930,"33,856.22",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-828,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,163.59 ",IP,930,"32,407.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,Surgical,Relative Weights,"$17,563.00 ",IP,930,"31,204.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,112.57 ",IP,930,"14,372.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,Medical,Relative Weights,"$6,140.81 ",IP,880,"10,912.79",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,Medical,Relative Weights,"$4,260.47 ",IP,880,"7,590.57",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$2,939.58 ",IP,880,"5,217.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,Medical,Relative Weights,"$33,130.16 ",IP,880,"151,525.57",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,Medical,Relative Weights,"$11,570.54 ",IP,880,"108,442.41",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,Medical,Relative Weights,"$6,423.82 ",IP,880,"19,754.19",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-837,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,Medical,Relative Weights,"$31,198.36 ",IP,880,"55,476.01",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-838,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,Medical,Relative Weights,"$12,372.49 ",IP,880,"21,987.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-839,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Relative Weights,"$8,141.04 ",IP,880,"14,467.64",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-840,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,Medical,Relative Weights,"$17,629.24 ",IP,880,"38,835.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-841,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,Medical,Relative Weights,"$8,876.75 ",IP,880,"23,414.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-842,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,Medical,Relative Weights,"$6,005.05 ",IP,880,"10,675.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-843,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,Medical,Relative Weights,"$10,442.33 ",IP,880,"18,522.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-844,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,Medical,Relative Weights,"$6,482.39 ",IP,880,"21,166.22",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-845,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$4,646.94 ",IP,880,"15,814.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,Medical,Relative Weights,"$14,631.64 ",IP,880,"25,988.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,Medical,Relative Weights,"$7,313.90 ",IP,880,"12,996.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,Medical,Relative Weights,"$5,650.88 ",IP,880,"10,016.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-849,RADIOTHERAPY,Medical,Relative Weights,"$13,650.14 ",IP,880,"24,213.33",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-853,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$27,194.08 ",IP,930,"91,309.54",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-854,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$11,617.07 ",IP,930,"37,668.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-855,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$8,319.49 ",IP,930,"27,510.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$25,530.51 ",IP,930,"119,992.39",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,Surgical,Relative Weights,"$11,508.68 ",IP,930,"20,964.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,442.54 ",IP,930,"20,693.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-862,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,Medical,Relative Weights,"$10,382.67 ",IP,880,"64,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-863,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,Medical,Relative Weights,"$5,536.47 ",IP,880,"11,618.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-864,FEVER AND INFLAMMATORY CONDITIONS,Medical,Relative Weights,"$4,798.02 ",IP,880,"8,517.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-865,VIRAL ILLNESS WITH MCC,Medical,Relative Weights,"$8,089.58 ",IP,880,"15,920.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-866,VIRAL ILLNESS WITHOUT MCC,Medical,Relative Weights,"$4,592.74 ",IP,880,"8,149.30",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-867,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,Medical,Relative Weights,"$12,246.04 ",IP,880,"31,175.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-868,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,Medical,Relative Weights,"$5,835.36 ",IP,880,"20,802.66",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-869,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,Medical,Relative Weights,"$3,987.86 ",IP,880,"9,060.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,Medical,Relative Weights,"$35,247.53 ",IP,880,"62,539.00",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,Medical,Relative Weights,"$10,248.55 ",IP,880,"31,444.24",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,Medical,Relative Weights,"$5,618.04 ",IP,880,"15,068.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-876,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,Surgical,Relative Weights,"$17,889.26 ",IP,930,"31,745.49",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-880,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,Medical,Relative Weights,"$4,732.33 ",IP,485,"8,406.28",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-881,DEPRESSIVE NEUROSES,Medical,Relative Weights,"$4,390.20 ",IP,485,"7,800.83",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-882,NEUROSES EXCEPT DEPRESSIVE,Medical,Relative Weights,"$4,508.44 ",IP,485,"8,011.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-883,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,Medical,Relative Weights,"$8,658.88 ",IP,485,"15,363.17",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-884,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,Medical,Relative Weights,"$7,922.62 ",IP,485,"14,053.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-885,PSYCHOSES,Medical,Relative Weights,"$6,784.56 ",IP,485,"12,041.93",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-886,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,Medical,Relative Weights,"$6,698.62 ",IP,485,"11,890.08",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-887,OTHER MENTAL DISORDER DIAGNOSES,Medical,Relative Weights,"$5,910.90 ",IP,485,"10,500.07",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-894,ALCOHOL- DRUG ABUSE OR DEPENDENCE- LEFT AMA,Medical,Relative Weights,"$3,005.26 ",IP,"3,005.26","5,329.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-895,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,Medical,Relative Weights,"$8,754.13 ",IP,"8,754.13","21,100.96",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-896,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC,Medical,Relative Weights,"$9,745.49 ",IP,"9,745.49","17,297.32",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-897,ALCOHOL- DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC,Medical,Relative Weights,"$4,527.06 ",IP,"4,527.06","8,035.42",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-901,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,Surgical,Relative Weights,"$23,367.16 ",IP,930,"41,488.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-902,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,Surgical,Relative Weights,"$10,752.71 ",IP,930,"23,640.59",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,Surgical,Relative Weights,"$6,214.71 ",IP,930,"11,230.37",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-904,SKIN GRAFTS FOR INJURIES WITH CC/MCC,Surgical,Relative Weights,"$20,401.86 ",IP,930,"36,224.11",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-905,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,Surgical,Relative Weights,"$9,032.21 ",IP,930,"15,982.25",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-906,HAND PROCEDURES FOR INJURIES,Surgical,Relative Weights,"$9,874.13 ",IP,930,"17,460.85",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-907,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,Surgical,Relative Weights,"$21,612.72 ",IP,930,"52,333.81",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-908,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,Surgical,Relative Weights,"$11,224.03 ",IP,930,"23,274.39",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,Surgical,Relative Weights,"$7,504.95 ",IP,930,"14,200.04",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-913,TRAUMATIC INJURY WITH MCC,Medical,Relative Weights,"$8,969.81 ",IP,880,"15,928.72",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-914,TRAUMATIC INJURY WITHOUT MCC,Medical,Relative Weights,"$4,854.95 ",IP,880,"8,649.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-915,ALLERGIC REACTIONS WITH MCC,Medical,Relative Weights,"$9,303.18 ",IP,880,"16,524.44",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-916,ALLERGIC REACTIONS WITHOUT MCC,Medical,Relative Weights,"$3,604.13 ",IP,880,"6,398.16",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-917,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,Medical,Relative Weights,"$8,093.41 ",IP,880,"18,792.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-918,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,Medical,Relative Weights,"$4,333.27 ",IP,880,"7,700.57",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-919,COMPLICATIONS OF TREATMENT WITH MCC,Medical,Relative Weights,"$10,094.73 ",IP,880,"17,856.05",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-920,COMPLICATIONS OF TREATMENT WITH CC,Medical,Relative Weights,"$5,608.73 ",IP,880,"11,715.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-921,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,Medical,Relative Weights,"$3,820.35 ",IP,880,"8,817.98",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-922,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC,Medical,Relative Weights,"$8,693.92 ",IP,880,"15,453.70",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-923,OTHER INJURY- POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC,Medical,Relative Weights,"$5,144.53 ",IP,880,"9,056.51",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-927,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,Surgical,Relative Weights,"$115,455.24 ",IP,930,"204,714.78",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,Surgical,Relative Weights,"$35,754.43 ",IP,930,"63,456.92",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,Surgical,Relative Weights,"$16,498.30 ",IP,930,"29,288.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-933,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,Medical,Relative Weights,"$12,387.27 ",IP,880,"21,975.48",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,Medical,Relative Weights,"$10,624.62 ",IP,880,"18,857.68",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-935,NON-EXTENSIVE BURNS,Medical,Relative Weights,"$10,580.83 ",IP,880,"18,818.74",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-939,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,Surgical,Relative Weights,"$18,472.79 ",IP,930,"32,961.27",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-940,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,Surgical,Relative Weights,"$12,157.36 ",IP,930,"35,826.95",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-941,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,Surgical,Relative Weights,"$10,527.18 ",IP,930,"18,735.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-945,REHABILITATION WITH CC/MCC,Medical,Relative Weights,"$8,112.02 ",IP,"8,112.02","24,048.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-946,REHABILITATION WITHOUT CC/MCC,Medical,Relative Weights,"$6,164.90 ",IP,"6,164.90","13,242.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-947,SIGNS AND SYMPTOMS WITH MCC,Medical,Relative Weights,"$6,536.04 ",IP,880,"11,584.43",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-948,SIGNS AND SYMPTOMS WITHOUT MCC,Medical,Relative Weights,"$4,308.64 ",IP,880,"7,647.03",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-949,AFTERCARE WITH CC/MCC,Medical,Relative Weights,"$6,075.67 ",IP,880,"16,233.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-950,AFTERCARE WITHOUT CC/MCC,Medical,Relative Weights,"$4,051.91 ",IP,880,"7,192.45",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-951,OTHER FACTORS INFLUENCING HEALTH STATUS,Medical,Relative Weights,"$3,063.29 ",IP,880,"12,539.35",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Relative Weights,"$34,428.06 ",IP,930,"99,563.62",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-956,LIMB REATTACHMENT- HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA,Surgical,Relative Weights,"$21,075.17 ",IP,930,"48,319.58",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Surgical,Relative Weights,"$40,622.52 ",IP,930,"81,020.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,Surgical,Relative Weights,"$23,022.29 ",IP,930,"41,927.10",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-959,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Surgical,Relative Weights,"$14,977.60 ",IP,930,"34,550.88",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,Medical,Relative Weights,"$14,943.66 ",IP,880,"41,610.90",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,Medical,Relative Weights,"$8,166.22 ",IP,880,"28,388.26",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-965,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,Medical,Relative Weights,"$4,995.09 ",IP,880,"16,749.46",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-969,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,Surgical,Relative Weights,"$32,033.71 ",IP,930,"56,334.55",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-970,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,Surgical,Relative Weights,"$16,360.35 ",IP,930,"28,667.60",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-974,HIV WITH MAJOR RELATED CONDITION WITH MCC,Medical,Relative Weights,"$14,727.98 ",IP,880,"95,225.61",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-975,HIV WITH MAJOR RELATED CONDITION WITH CC,Medical,Relative Weights,"$7,018.30 ",IP,880,"34,297.84",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-976,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,Medical,Relative Weights,"$5,198.18 ",IP,880,"20,273.82",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-977,HIV WITH OR WITHOUT OTHER RELATED CONDITION,Medical,Relative Weights,"$7,249.31 ",IP,880,"32,684.59",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-981,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$25,260.09 ",IP,930,"51,698.29",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-982,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$13,885.52 ",IP,930,"34,570.65",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-983,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$9,044.80 ",IP,930,"16,317.63",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-987,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,Surgical,Relative Weights,"$17,932.50 ",IP,930,"55,966.14",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-988,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,Surgical,Relative Weights,"$9,340.95 ",IP,930,"18,900.02",,,,,,,,,,,,,
United Healthcare MCR ADV,DRG,MS-989,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,Surgical,Relative Weights,"$6,150.66 ",IP,930,"12,784.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,176,Anesth pharyngeal surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,211,Anesth cran surg hemotoma,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,214,Anesth skull drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,215,Anesth skull repair/fract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,524,Anesth chest drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,540,Anesth chest surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,542,Anesthesia removal pleura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,546,Anesth lung chest wall surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,560,Anesth heart surg w/o pump,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,561,Anesth heart surg <1 yr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,562,Anesth hrt surg w/pmp age 1+,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,567,Anesth cabg w/pump,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,580,Anesth heart/lung transplnt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,632,Anesth removal of nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,792,Anesth hemorr/excise liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,794,Anesth pancreas removal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,796,Anesth for liver transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,844,Anesth pelvis surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,846,Anesth hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,848,Anesth pelvic organ surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,864,Anesth removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,866,Anesth removal of adrenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,868,Anesth kidney transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,882,Anesth major vein ligation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,908,Anesth removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,932,Anesth amputation of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,934,Anesth penis nodes removal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,936,Anesth penis nodes removal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1272,Anesth femoral artery surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1442,Anesth knee artery surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1444,Anesth knee artery repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1502,Anesth lwr leg embolectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1652,Anesth shoulder vessel surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1654,Anesth shoulder vessel surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1656,Anesth arm-leg vessel surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,1990,Support for organ donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10005,Fna bx w/us gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10007,Fna bx w/fluor gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10009,Fna bx w/ct gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10011,Fna bx w/mr gdn 1st les,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10021,Fna bx w/o img gdn 1st les,APC 5052,RVU Per Unit,$335.15 ,OP,220.23,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10030,Guide cathet fluid drainage,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10035,Perq dev soft tiss 1st imag,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10040,Acne surgery,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10060,Drainage of skin abscess,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,288.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10061,Drainage of skin abscess,APC 5052,RVU Per Unit,$335.15 ,OP,288.27,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10080,Drainage of pilonidal cyst,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10081,Drainage of pilonidal cyst,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"2,234.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10120,Remove foreign body,APC 5052,RVU Per Unit,$335.15 ,OP,288.27,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10121,Remove foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10140,Drainage of hematoma/fluid,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10160,Puncture drainage of lesion,APC 5052,RVU Per Unit,$335.15 ,OP,205.5,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,10180,Complex drainage wound,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11000,Debride infected skin,APC 5053,RVU Per Unit,$507.97 ,OP,218.7,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11004,Debride genitalia & perineum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11005,Debride abdom wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11006,Debride genit/per/abdom wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11008,Remove mesh from abd wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11010,Debride skin at fx site,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11011,Debride skin musc at fx site,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11012,Deb skin bone at fx site,APC 5073,RVU Per Case,"$2,296.73 ",OP,819.6,"2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11042,Deb subq tissue 20 sq cm/<,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11043,Deb musc/fascia 20 sq cm/<,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11044,Deb bone 20 sq cm/<,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,378.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11055,Trim skin lesion,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11056,Trim skin lesions 2 to 4,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11057,Trim skin lesions over 4,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11102,Tangntl bx skin single les,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11104,Punch bx skin single lesion,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11106,Incal bx skn single les,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11200,Removal of skin tags 2.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11305,Shave skin lesion 0.5 cm/<,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11306,Shave skin lesion 0.6-1.0 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11307,Shave skin lesion 1.1-2.0 cm,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11308,Shave skin lesion >2.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11310,Shave skin lesion 0.5 cm/<,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11311,Shave skin lesion 0.6-1.0 cm,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11312,Shave skin lesion 1.1-2.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,218.7,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11313,Shave skin lesion >2.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11400,Exc tr-ext b9+marg 0.5 cm<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11401,Exc tr-ext b9+marg 0.6-1 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11402,Exc tr-ext b9+marg 1.1-2 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11403,Exc tr-ext b9+marg 2.1-3cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11404,Exc tr-ext b9+marg 3.1-4 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11406,Exc tr-ext b9+marg >4.0 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11420,Exc h-f-nk-sp b9+marg 0.5/<,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11421,Exc h-f-nk-sp b9+marg 0.6-1,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11422,Exc h-f-nk-sp b9+marg 1.1-2,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11423,Exc h-f-nk-sp b9+marg 2.1-3,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11424,Exc h-f-nk-sp b9+marg 3.1-4,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11426,Exc h-f-nk-sp b9+marg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11440,Exc face-mm b9+marg 0.5 cm/<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11441,Exc face-mm b9+marg 0.6-1 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11442,Exc face-mm b9+marg 1.1-2 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11443,Exc face-mm b9+marg 2.1-3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11444,Exc face-mm b9+marg 3.1-4 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11446,Exc face-mm b9+marg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11450,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11451,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11462,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11463,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11470,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11471,Removal sweat gland lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11600,Exc tr-ext mal+marg 0.5 cm/<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11601,Exc tr-ext mal+marg 0.6-1 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11602,Exc tr-ext mal+marg 1.1-2 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11603,Exc tr-ext mal+marg 2.1-3 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11604,Exc tr-ext mal+marg 3.1-4 cm,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11606,Exc tr-ext mal+marg >4 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11620,Exc h-f-nk-sp mal+marg 0.5/<,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11621,Exc s/n/h/f/g mal+mrg 0.6-1,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11622,Exc s/n/h/f/g mal+mrg 1.1-2,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11623,Exc s/n/h/f/g mal+mrg 2.1-3,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11624,Exc s/n/h/f/g mal+mrg 3.1-4,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11626,Exc s/n/h/f/g mal+mrg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11640,Exc f/e/e/n/l mal+mrg 0.5cm<,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11641,Exc f/e/e/n/l mal+mrg 0.6-1,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11642,Exc f/e/e/n/l mal+mrg 1.1-2,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11643,Exc f/e/e/n/l mal+mrg 2.1-3,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11644,Exc f/e/e/n/l mal+mrg 3.1-4,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11646,Exc f/e/e/n/l mal+mrg >4 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11719,Trim nail(s) any number,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11720,Debride nail 1-5,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11721,Debride nail 6 or more,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11730,Removal of nail plate,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11740,Drain blood from under nail,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11750,Removal of nail bed,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11755,Biopsy nail unit,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11760,Repair of nail bed,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11762,Reconstruction of nail bed,APC 5054,RVU Per Unit,"$1,662.33 ",OP,297.3,"1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11765,Excision of nail fold toe,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11770,Remove pilonidal cyst simple,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11771,Remove pilonidal cyst exten,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11772,Remove pilonidal cyst compl,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11900,Inject skin lesions 7,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11920,Correct skin color 6.0 cm/<,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11921,Correct skn color 6.1-20.0cm,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11950,Tx contour defects 1 cc/<,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,297.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11951,Tx contour defects 1.1-5.0cc,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11952,Tx contour defects 5.1-10cc,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11954,Tx contour defects >10.0 cc,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11960,Insert tissue expander(s),APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11970,Rplcmt tiss xpndr perm implt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11971,Rmvl tis xpndr wo insj implt,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11976,Remove contraceptive capsule,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11980,Implant hormone pellet(s),APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11981,Insert drug implant device,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11982,Remove drug implant device,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,11983,Remove/insert drug implant,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12001,Rpr s/n/ax/gen/trnk 2.5cm/<,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12002,Rpr s/n/ax/gen/trnk2.6-7.5cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12004,Rpr s/n/ax/gen/trk7.6-12.5cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12005,Rpr s/n/a/gen/trk12.6-20.0cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12006,Rpr s/n/a/gen/trk20.1-30.0cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12007,Rpr s/n/ax/gen/trnk >30.0 cm,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,297.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12011,Rpr f/e/e/n/l/m 2.5 cm/<,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12013,Rpr f/e/e/n/l/m 2.6-5.0 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12014,Rpr f/e/e/n/l/m 5.1-7.5 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12015,Rpr f/e/e/n/l/m 7.6-12.5 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12016,Rpr fe/e/en/l/m 12.6-20.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12017,Rpr fe/e/en/l/m 20.1-30.0 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12018,Rpr f/e/e/n/l/m >30.0 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12020,Closure of split wound,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12021,Closure of split wound,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12031,Intmd rpr s/a/t/ext 2.5 cm/<,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12032,Intmd rpr s/a/t/ext 2.6-7.5,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12034,Intmd rpr s/tr/ext 7.6-12.5,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12035,Intmd rpr s/a/t/ext 12.6-20,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12036,Intmd rpr s/a/t/ext 20.1-30,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12037,Intmd rpr s/tr/ext >30.0 cm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12041,Intmd rpr n-hf/genit 2.5cm/<,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12042,Intmd rpr n-hf/genit2.6-7.5,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12044,Intmd rpr n-hf/genit7.6-12.5,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12045,Intmd rpr n-hf/genit12.6-20,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12046,Intmd rpr n-hf/genit20.1-30,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12047,Intmd rpr n-hf/genit >30.0cm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12051,Intmd rpr face/mm 2.5 cm/<,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12052,Intmd rpr face/mm 2.6-5.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12053,Intmd rpr face/mm 5.1-7.5 cm,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12054,Intmd rpr face/mm 7.6-12.5cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12055,Intmd rpr face/mm 12.6-20 cm,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12056,Intmd rpr face/mm 20.1-30.0,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,12057,Intmd rpr face/mm >30.0 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13100,Cmplx rpr trunk 1.1-2.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13101,Cmplx rpr trunk 2.6-7.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13120,Cmplx rpr s/a/l 1.1-2.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13121,Cmplx rpr s/a/l 2.6-7.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13131,Cmplx rpr f/c/c/m/n/ax/g/h/f,APC 5052,RVU Per Unit,$335.15 ,OP,297.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13132,Cmplx rpr f/c/c/m/n/ax/g/h/f,APC 5053,RVU Per Unit,$507.97 ,OP,297.3,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13151,Cmplx rpr e/n/e/l 1.1-2.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13152,Cmplx rpr e/n/e/l 2.6-7.5 cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,13160,Late closure of wound,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14000,Tis trnfr trunk 10 sq cm/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14001,Tis trnfr trunk 10.1-30sqcm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14020,Tis trnfr s/a/l 10 sq cm/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14021,Tis trnfr s/a/l 10.1-30 sqcm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14040,Tis trnfr f/c/c/m/n/a/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14041,Tis trnfr f/c/c/m/n/a/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14060,Tis trnfr e/n/e/l 10 sq cm/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14061,Tis trnfr e/n/e/l10.1-30sqcm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14301,Tis trnfr any 30.1-60 sq cm,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,14350,Filleted finger/toe flap,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15002,Wound prep trk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15004,Wound prep f/n/hf/g,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15040,Harvest cultured skin graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,297.3,"1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15050,Skin pinch graft,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15100,Skin splt grft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15110,Epidrm autogrft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15115,Epidrm a-grft face/nck/hf/g,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15120,Skn splt a-grft fac/nck/hf/g,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15130,Derm autograft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15135,Derm autograft face/nck/hf/g,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15150,Cult skin grft t/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15155,Cult skin graft f/n/hf/g,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15200,Skin full graft trunk,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15220,Skin full graft sclp/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15240,Skin full grft face/genit/hf,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15260,Skin full graft een & lips,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15271,Skin sub graft trnk/arm/leg,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15273,Skin sub grft t/arm/lg child,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15275,Skin sub graft face/nk/hf/g,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15277,Skn sub grft f/n/hf/g child,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15570,Skin pedicle flap trunk,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15572,Skin pedicle flap arms/legs,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15574,Pedcle fh/ch/ch/m/n/ax/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15576,Pedicle e/n/e/l/ntroral,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15600,Delay flap trunk,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15610,Delay flap arms/legs,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15620,Delay flap f/c/c/n/ax/g/h/f,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15630,Delay flap eye/nos/ear/lip,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15650,Transfer skin pedicle flap,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15730,Mdfc flap w/prsrv vasc pedcl,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15731,Forehead flap w/vasc pedicle,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"2,811.11","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15733,Musc myoq/fscq flp h&n pedcl,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15734,Muscle-skin graft trunk,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15736,Muscle-skin graft arm,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15738,Muscle-skin graft leg,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15740,Island pedicle flap graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15750,Neurovascular pedicle flap,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15756,Free myo/skin flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15757,Free skin flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15758,Free fascial flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15760,Composite skin graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15769,Grfg autol soft tiss dir exc,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15770,Derma-fat-fascia graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15771,Grfg autol fat lipo 50 cc/<,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15773,Grfg autol fat lipo 25 cc/<,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15775,Hair trnspl 1-15 punch grfts,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15776,Hair trnspl >15 punch grafts,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,"1,053.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15780,Dermabrasion total face,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15781,Dermabrasion segmental face,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15782,Dermabrasion other than face,APC 5073,RVU Per Case,"$2,296.73 ",OP,819.6,"2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15783,Dermabrasion suprfl any site,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15786,Abrasion lesion single,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15788,Chemical peel face epiderm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15789,Chemical peel face dermal,APC 5053,RVU Per Unit,$507.97 ,OP,325.32,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15792,Chemical peel nonfacial,APC 5053,RVU Per Case,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15793,Chemical peel nonfacial,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15819,Plastic surgery neck,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15820,Revision of lower eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15821,Revision of lower eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15822,Revision of upper eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15823,Revision of upper eyelid,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15824,Removal of forehead wrinkles,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15825,Removal of neck wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15826,Removal of brow wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15828,Removal of face wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15829,Removal of skin wrinkles,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15830,Exc skin abd,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,019.12","5,362.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15832,Excise excessive skin thigh,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15833,Excise excessive skin leg,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15834,Excise excessive skin hip,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15835,Excise excessive skin buttck,APC 5073,RVU Per Case,"$2,296.73 ",OP,"1,053.46","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15836,Excise excessive skin arm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15837,Excise excess skin arm/hand,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15838,Excise excess skin fat pad,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15839,Excise excess skin & tissue,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15840,Nerve palsy fascial graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15841,Nerve palsy muscle graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15842,Nerve palsy microsurg graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15845,Skin and muscle repair face,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15850,Remove sutures same surgeon,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15851,Remove sutures diff surgeon,APC 5054,RVU Per Unit,"$1,662.33 ",OP,535.8,"1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15852,Dressing change not for burn,APC 5053,RVU Per Case,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15860,Test for blood flow in graft,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15876,Suction lipectomy head&neck,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15877,Suction lipectomy trunk,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15878,Suction lipectomy upr extrem,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15879,Suction lipectomy lwr extrem,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15920,Removal of tail bone ulcer,APC 5073,RVU Per Case,"$2,296.73 ",OP,819.6,"2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15922,Removal of tail bone ulcer,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15931,Remove sacrum pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15933,Remove sacrum pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15934,Remove sacrum pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15935,Remove sacrum pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15936,Remove sacrum pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15937,Remove sacrum pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15940,Remove hip pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15941,Remove hip pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15944,Remove hip pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15945,Remove hip pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15946,Remove hip pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15950,Remove thigh pressure sore,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15951,Remove thigh pressure sore,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15952,Remove thigh pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15953,Remove thigh pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15956,Remove thigh pressure sore,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15958,Remove thigh pressure sore,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,15999,Removal of pressure sore,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,16000,Initial treatment of burn(s),APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,16020,Dress/debrid p-thick burn s,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,16025,Dress/debrid p-thick burn m,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,16030,Dress/debrid p-thick burn l,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,16035,Incision of burn scab initi,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,16036,Escharotomy addl incision,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17000,Destruct premalg lesion,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17004,Destroy premal lesions 15/>,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,514.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17106,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,514.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17107,Destruction of skin lesions,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,514.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17108,Destruction of skin lesions,APC 5054,RVU Per Unit,"$1,662.33 ",OP,514.08,"1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17110,Destruct b9 lesion 1-14,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17111,Destruct lesion 15 or more,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17250,Chem caut of granltj tissue,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17260,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17261,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17262,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17263,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17264,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17266,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17270,Destruction of skin lesions,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,325.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17271,Destruction of skin lesions,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17272,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17273,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17274,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17276,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17280,Destruction of skin lesions,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17281,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17282,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17283,Destruction of skin lesions,APC 5052,RVU Per Unit,$335.15 ,OP,325.32,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17284,Destruction of skin lesions,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17286,Destruction of skin lesions,APC 5053,RVU Per Unit,$507.97 ,OP,325.32,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17311,Mohs 1 stage h/n/hf/g,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,746.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17313,Mohs 1 stage t/a/l,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,746.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17340,Cryotherapy of skin,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17360,Skin peel therapy,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17380,Hair removal by electrolysis,APC 5053,RVU Per Unit,$507.97 ,OP,218.7,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,17999,Skin tissue procedure,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19000,Drainage of breast lesion,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19020,Incision of breast lesion,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19081,Bx breast 1st lesion strtctc,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19083,Bx breast 1st lesion us imag,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19085,Bx breast 1st lesion mr imag,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19100,Bx breast percut w/o image,APC 5072,RVU Per Case,"$1,363.50 ",OP,782.08,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19101,Biopsy of breast open,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19105,Cryosurg ablate fa each,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19110,Nipple exploration,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19112,Excise breast duct fistula,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19120,Removal of breast lesion,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19125,Excision breast lesion,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19281,Perq device breast 1st imag,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19283,Perq dev breast 1st strtctc,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19285,Perq dev breast 1st us imag,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19287,Perq dev breast 1st mr guide,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19296,Place po breast cath for rad,APC 5093,RVU Per Case,"$8,644.27 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19298,Place breast rad tube/caths,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","5,362.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19300,Removal of breast tissue,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19301,Partial mastectomy,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19302,P-mastectomy w/ln removal,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,410.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19303,Mast simple complete,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","5,611.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19305,Mast radical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19306,Mast rad urban type,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19307,Mast mod rad,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19316,Suspension of breast,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","5,611.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19318,Breast reduction,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,410.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19325,Breast augmentation w/implt,APC 5093,RVU Per Case,"$8,644.27 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19328,Rmvl intact breast implant,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,060.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19330,Rmvl ruptured breast implant,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,060.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19340,Insj breast implt sm d mast,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19342,Insj/rplcmt brst implt sep d,APC 5093,RVU Per Case,"$8,644.27 ",OP,"8,644.27","10,260.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19350,Breast reconstruction,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19355,Correct inverted nipple(s),APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19357,Tiss xpndr plmt brst rcnstj,APC 5094,RVU Per Case,"$14,467.16 ",OP,"10,260.73","14,467.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19361,Brst rcnstj latsms drsi flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19364,Brst rcnstj free flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19367,Brst rcnstj 1 pdcl tram flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19368,Brst rcnstj 1pdcl tram anast,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19369,Brst rcnstj 2 pdcl tram flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19370,Revj peri-implt capsule brst,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19371,Peri-implt capslc brst compl,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19380,Revj reconstructed breast,APC 5092,RVU Per Case,"$5,362.86 ",OP,"5,362.86","7,585.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19396,Design custom breast implant,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","5,611.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,19499,Breast surgery procedure,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,861.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20100,Explore wound neck,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,845.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20101,Explore wound chest,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20102,Explore wound abdomen,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20103,Explore wound extremity,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,845.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20150,Excise epiphyseal bar,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20200,Muscle biopsy,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20205,Deep muscle biopsy,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20206,Needle biopsy muscle,APC 5072,RVU Per Case,"$1,363.50 ",OP,782.08,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20220,Bone biopsy trocar/needle,APC 5072,RVU Per Case,"$1,363.50 ",OP,819.6,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20225,Bone biopsy trocar/needle,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20240,Bone biopsy open superficial,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20245,Bone biopsy open deep,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20250,Open bone biopsy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20251,Open bone biopsy,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20500,Injection of sinus tract,APC 5163,RVU Per Case,"$1,310.96 ",OP,491.14,"1,310.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20520,Removal of foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,819.6,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20525,Removal of foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20526,Ther injection carp tunnel,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20527,Inj dupuytren cord w/enzyme,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20550,Inj tendon sheath/ligament,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20551,Inj tendon origin/insertion,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20552,Inj trigger point 1/2 muscl,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20553,Inject trigger points 3/>,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20555,Place ndl musc/tis for rt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20560,Ndl insj w/o njx 1 or 2 musc,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20561,Ndl insj w/o njx 3+ musc,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20600,Drain/inj joint/bursa w/o us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20604,Drain/inj joint/bursa w/us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20605,Drain/inj joint/bursa w/o us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20606,Drain/inj joint/bursa w/us,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20610,Drain/inj joint/bursa w/o us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20611,Drain/inj joint/bursa w/us,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20612,Aspirate/inj ganglion cyst,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20615,Treatment of bone cyst,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20650,Insert and remove bone pin,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20660,Apply rem fixation device,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20661,Application of head brace,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20662,Application of pelvis brace,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20663,Application of thigh brace,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20664,Application of halo,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20665,Removal of fixation device,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20670,Removal of support implant,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20680,Removal of support implant,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20690,Apply bone fixation device,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20692,Apply bone fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20693,Adjust bone fixation device,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20694,Remove bone fixation device,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20696,Comp multiplane ext fixation,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20697,Comp ext fixate strut change,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20802,Replantation arm complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20805,Replant forearm complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20808,Replantation hand complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20816,Replantation digit complete,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20822,Replantation digit complete,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20824,Replantation thumb complete,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20827,Replantation thumb complete,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20838,Replantation foot complete,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20900,Removal of bone for graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20902,Removal of bone for graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20910,Remove cartilage for graft,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,"4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20912,Remove cartilage for graft,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20920,Removal of fascia for graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20922,Removal of fascia for graft,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20924,Removal of tendon for graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20950,Fluid pressure muscle,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20955,Fibula bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20956,Iliac bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20957,Mt bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20962,Other bone graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20969,Bone/skin graft microvasc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20970,Bone/skin graft iliac crest,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20972,Bone/skin graft metatarsal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20973,Bone/skin graft great toe,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20974,Electrical bone stimulation,Lab Services,Per Unit,$50.41 ,OP,50.41,50.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20979,Us bone stimulation,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20982,Ablate bone tumor(s) perq,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20983,Ablate bone tumor(s) perq,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,20999,Musculoskeletal surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21010,Incision of jaw joint,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21011,Exc face les sc <2 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21012,Exc face les sbq 2 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21013,Exc face tum deep < 2 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21014,Exc face tum deep 2 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21015,Resect face/scalp tum < 2 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21016,Resect face/scalp tum 2 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21025,Excision of bone lower jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21026,Excision of facial bone(s),APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21029,Contour of face bone lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21030,Excise max/zygoma b9 tumor,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21031,Remove exostosis mandible,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21032,Remove exostosis maxilla,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21034,Excise max/zygoma mal tumor,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21040,Excise mandible lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21044,Removal of jaw bone lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21045,Extensive jaw surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21046,Remove mandible cyst complex,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21047,Excise lwr jaw cyst w/repair,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21048,Remove maxilla cyst complex,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21049,Excis uppr jaw cyst w/repair,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21050,Removal of jaw joint,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21060,Remove jaw joint cartilage,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21070,Remove coronoid process,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21073,Mnpj of tmj w/anesth,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21076,Prepare face/oral prosthesis,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21077,Prepare face/oral prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21079,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21080,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21081,Prepare face/oral prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21082,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21083,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21084,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21085,Prepare face/oral prosthesis,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,"3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21086,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21087,Prepare face/oral prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21088,Prepare face/oral prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21089,Prepare face/oral prosthesis,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21100,Maxillofacial fixation,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21110,Interdental fixation,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21120,Reconstruction of chin,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21121,Reconstruction of chin,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21122,Reconstruction of chin,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21123,Reconstruction of chin,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21125,Augmentation lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21127,Augmentation lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21137,Reduction of forehead,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21138,Reduction of forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21139,Reduction of forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21141,Lefort i-1 piece w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21142,Lefort i-2 piece w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21143,Lefort i-3/> piece w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21145,Lefort i-1 piece w/ graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21146,Lefort i-2 piece w/ graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21147,Lefort i-3/> piece w/ graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21150,Lefort ii anterior intrusion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21151,Lefort ii w/bone grafts,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21154,Lefort iii w/o lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21155,Lefort iii w/ lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21159,Lefort iii w/fhdw/o lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21160,Lefort iii w/fhd w/ lefort i,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21172,Reconstruct orbit/forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21175,Reconstruct orbit/forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21179,Reconstruct entire forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21180,Reconstruct entire forehead,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21181,Contour cranial bone lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21182,Reconstruct cranial bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21183,Reconstruct cranial bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21184,Reconstruct cranial bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21188,Reconstruction of midface,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21193,Reconst lwr jaw w/o graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21194,Reconst lwr jaw w/graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21195,Reconst lwr jaw w/o fixation,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21196,Reconst lwr jaw w/fixation,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21198,Reconstr lwr jaw segment,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21199,Reconstr lwr jaw w/advance,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21206,Reconstruct upper jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21208,Augmentation of facial bones,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21209,Reduction of facial bones,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21210,Face bone graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21215,Lower jaw bone graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21230,Rib cartilage graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21235,Ear cartilage graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21240,Reconstruction of jaw joint,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21242,Reconstruction of jaw joint,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21243,Reconstruction of jaw joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"7,651.26","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21244,Reconstruction of lower jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21245,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21246,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21247,Reconstruct lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21248,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21249,Reconstruction of jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21255,Reconstruct lower jaw bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21256,Reconstruction of orbit,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21260,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21261,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21263,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21267,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21268,Revise eye sockets,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21270,Augmentation cheek bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21275,Revision orbitofacial bones,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21280,Revision of eyelid,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21282,Revision of eyelid,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21295,Revision of jaw muscle/bone,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21296,Revision of jaw muscle/bone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21299,Cranio/maxillofacial surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21310,Closed tx nose fx w/o manj,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21315,Closed tx nose fx w/o stablj,APC 5163,RVU Per Case,"$1,310.96 ",OP,491.14,"1,310.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21320,Closed tx nose fx w/ stablj,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21325,Open tx nose fx uncomplicatd,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21330,Open tx nose fx w/skele fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21335,Open tx nose & septal fx,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21336,Open tx septal fx w/wo stabj,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21337,Closed tx septal&nose fx,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21338,Open nasoethmoid fx w/o fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21339,Open nasoethmoid fx w/ fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21340,Perq tx nasoethmoid fx,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21343,Open tx dprsd front sinus fx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21344,Open tx compl front sinus fx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21345,Closed tx nose/jaw fx,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21346,Opn tx nasomax fx w/fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21347,Opn tx nasomax fx multple,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21348,Opn tx nasomax fx w/graft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21355,Perq tx malar fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21356,Opn tx dprsd zygomatic arch,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21360,Opn tx dprsd malar fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21365,Opn tx complx malar fx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21366,Opn tx complx malar w/grft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21385,Opn tx orbit fx transantral,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21386,Opn tx orbit fx periorbital,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21387,Opn tx orbit fx combined,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21390,Opn tx orbit periorbtl implt,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21395,Opn tx orbit periorbt w/grft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21400,Closed tx orbit w/o manipulj,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21401,Closed tx orbit w/manipulj,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21406,Opn tx orbit fx w/o implant,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21407,Opn tx orbit fx w/implant,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21408,Opn tx orbit fx w/bone grft,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21421,Treat mouth roof fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21422,Treat mouth roof fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21423,Treat mouth roof fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21431,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21432,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21433,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21435,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21436,Treat craniofacial fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21440,Treat dental ridge fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21445,Treat dental ridge fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21450,Treat lower jaw fracture,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21451,Treat lower jaw fracture,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21452,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21453,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21454,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21461,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21462,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21465,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21470,Treat lower jaw fracture,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21480,Reset dislocated jaw,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21485,Reset dislocated jaw,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21490,Repair dislocated jaw,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21497,Interdental wiring,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21499,Head surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21501,Drain neck/chest lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21502,Drain chest lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21510,Drainage of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21550,Biopsy of neck/chest,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21552,Exc neck les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21554,Exc neck tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21555,Exc neck les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21556,Exc neck tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21557,Resect neck thorax tumor<5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21558,Resect neck tumor 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21600,Partial removal of rib,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21601,Exc chest wall tumor w/ribs,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21602,Exc ch wal tum w/o lymphadec,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21603,Exc ch wal tum w/lymphadec,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21610,Partial removal of rib,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21615,Removal of rib,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21616,Removal of rib and nerves,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21620,Partial removal of sternum,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21627,Sternal debridement,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21630,Extensive sternum surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21632,Extensive sternum surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21685,Hyoid myotomy & suspension,APC 5165,RVU Per Case,"$4,928.81 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21700,Revision of neck muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21705,Revision of neck muscle/rib,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21720,Revision of neck muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21725,Revision of neck muscle,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21740,Reconstruction of sternum,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21742,Repair stern/nuss w/o scope,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21743,Repair sternum/nuss w/scope,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21750,Repair of sternum separation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21811,Optx of rib fx w/fixj scope,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21812,Treatment of rib fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21813,Treatment of rib fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21820,Treat sternum fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21825,Treat sternum fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21899,Neck/chest surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21920,Biopsy soft tissue of back,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21925,Biopsy soft tissue of back,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21930,Exc back les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21931,Exc back les sc 3 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21932,Exc back tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21933,Exc back tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21935,Resect back tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,21936,Resect back tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22010,I&d p-spine c/t/cerv-thor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22015,I&d abscess p-spine l/s/ls,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22100,Remove part of neck vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22101,Remove part thorax vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22102,Remove part lumbar vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22110,Remove part of neck vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22112,Remove part thorax vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22114,Remove part lumbar vertebra,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22206,Incis spine 3 column thorac,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22207,Incis spine 3 column lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22210,Incis 1 vertebral seg cerv,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22212,Incis 1 vertebral seg thorac,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22214,Incis 1 vertebral seg lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22220,Incis w/discectomy cervical,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22222,Incis w/discectomy thoracic,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22224,Incis w/discectomy lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22310,Closed tx vert fx w/o manj,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22315,Closed tx vert fx w/manj,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22318,Treat odontoid fx w/o graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22319,Treat odontoid fx w/graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22325,Treat spine fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22326,Treat neck spine fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22327,Treat thorax spine fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22505,Manipulation of spine,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22510,Perq cervicothoracic inject,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22511,Perq lumbosacral injection,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22513,Perq vertebral augmentation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22514,Perq vertebral augmentation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22532,Lat thorax spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22533,Lat lumbar spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22548,Neck spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22551,Neck spine fuse&remov bel c2,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22554,Neck spine fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22556,Thorax spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22558,Lumbar spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22586,Prescrl fuse w/ instr l5-s1,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22590,Spine & skull spinal fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22595,Neck spinal fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22600,Neck spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22610,Thorax spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22612,Lumbar spine fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,843.00","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22630,Lumbar spine fusion,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22633,Lumbar spine fusion combined,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22800,Post fusion 6 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22802,Post fusion 7-12 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22804,Post fusion 13/> vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22808,Ant fusion 2-3 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22810,Ant fusion 4-7 vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22812,Ant fusion 8/> vert seg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22818,Kyphectomy 1-2 segments,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22819,Kyphectomy 3 or more,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22830,Exploration of spinal fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22849,Reinsert spinal fixation,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22850,Remove spine fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22852,Remove spine fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22855,Remove spine fixation device,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22856,Cerv artific diskectomy,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22857,Lumbar artif diskectomy,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22861,Revise cerv artific disc,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22862,Revise lumbar artif disc,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22864,Remove cerv artif disc,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22865,Remove lumb artif disc,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22867,Insj stablj dev w/dcmprn,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22869,Insj stablj dev w/o dcmprn,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22899,Spine surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22900,Exc abdl tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22901,Exc abdl tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22902,Exc abd les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22903,Exc abd les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22904,Radical resect abd tumor<5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22905,Rad resect abd tumor 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,22999,Abdomen surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23000,Removal of calcium deposits,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23020,Release shoulder joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23030,Drain shoulder lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23031,Drain shoulder bursa,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23035,Drain shoulder bone lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23040,Exploratory shoulder surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23044,Exploratory shoulder surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23065,Biopsy shoulder tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23066,Biopsy shoulder tissues,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23071,Exc shoulder les sc 3 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23073,Exc shoulder tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23075,Exc shoulder les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23076,Exc shoulder tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23077,Resect shoulder tumor < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23078,Resect shoulder tumor 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23100,Biopsy of shoulder joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23101,Shoulder joint surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23105,Remove shoulder joint lining,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23106,Incision of collarbone joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23107,Explore treat shoulder joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23120,Partial removal collar bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23125,Removal of collar bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23130,Remove shoulder bone part,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23140,Removal of bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23145,Removal of bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23146,Removal of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23150,Removal of humerus lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23155,Removal of humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23156,Removal of humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23170,Remove collar bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23172,Remove shoulder blade lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23174,Remove humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23180,Remove collar bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23182,Remove shoulder blade lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23184,Remove humerus lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23190,Partial removal of scapula,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23195,Removal of head of humerus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23200,Resect clavicle tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23210,Resect scapula tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23220,Resect prox humerus tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23330,Remove shoulder foreign body,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23333,Remove shoulder fb deep,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23334,Shoulder prosthesis removal,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23335,Shoulder prosthesis removal,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23395,Muscle transfer shoulder/arm,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23397,Muscle transfers,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23400,Fixation of shoulder blade,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23405,Incision of tendon & muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23406,Incise tendon(s) & muscle(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23410,Repair rotator cuff acute,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23412,Repair rotator cuff chronic,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23415,Release of shoulder ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23420,Repair of shoulder,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23430,Repair biceps tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23440,Remove/transplant tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23450,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23455,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23460,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23462,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23465,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23466,Repair shoulder capsule,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23470,Reconstruct shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23472,Reconstruct shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23473,Revis reconst shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23474,Revis reconst shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23480,Revision of collar bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23485,Revision of collar bone,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23490,Reinforce clavicle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23491,Reinforce shoulder bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23500,Treat clavicle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23505,Treat clavicle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23515,Treat clavicle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23520,Treat clavicle dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23525,Treat clavicle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23530,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23532,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23540,Treat clavicle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23545,Treat clavicle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23550,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23552,Treat clavicle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23570,Treat shoulder blade fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23575,Treat shoulder blade fx,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23585,Treat scapula fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23600,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23605,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23615,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23616,Treat humerus fracture,APC 5116,RVU Per Case,"$15,377.54 ",OP,"11,460.57","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23620,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23625,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23630,Treat humerus fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23650,Treat shoulder dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23655,Treat shoulder dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23660,Treat shoulder dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23665,Treat dislocation/fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23670,Treat dislocation/fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23675,Treat dislocation/fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23680,Treat dislocation/fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23700,Fixation of shoulder,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23800,Fusion of shoulder joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23802,Fusion of shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23900,Amputation of arm & girdle,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23920,Amputation at shoulder joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23921,Amputation follow-up surgery,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,053.46","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23929,Shoulder surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23930,Drainage of arm lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23931,Drainage of arm bursa,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,23935,Drain arm/elbow bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24000,Exploratory elbow surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24006,Release elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24065,Biopsy arm/elbow soft tissue,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24066,Biopsy arm/elbow soft tissue,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24071,Exc arm/elbow les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24073,Ex arm/elbow tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24075,Exc arm/elbow les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24076,Ex arm/elbow tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24077,Resect arm/elbow tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24079,Resect arm/elbow tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24100,Biopsy elbow joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24101,Explore/treat elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24102,Remove elbow joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24105,Removal of elbow bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24110,Remove humerus lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24115,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24116,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24120,Remove elbow lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24125,Remove/graft bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24126,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24130,Removal of head of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24134,Removal of arm bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24136,Remove radius bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24138,Remove elbow bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24140,Partial removal of arm bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24145,Partial removal of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24147,Partial removal of elbow,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24149,Radical resection of elbow,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24150,Resect distal humerus tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24152,Resect radius tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24155,Removal of elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24160,Remove elbow joint implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24164,Remove radius head implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24200,Removal of arm foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,819.6,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24201,Removal of arm foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24300,Manipulate elbow w/anesth,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24301,Muscle/tendon transfer,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24305,Arm tendon lengthening,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24310,Revision of arm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24320,Repair of arm tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24330,Revision of arm muscles,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24331,Revision of arm muscles,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24332,Tenolysis triceps,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24340,Repair of biceps tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24341,Repair arm tendon/muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24342,Repair of ruptured tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24343,Repr elbow lat ligmnt w/tiss,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24344,Reconstruct elbow lat ligmnt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24345,Repr elbw med ligmnt w/tissu,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24346,Reconstruct elbow med ligmnt,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24357,Repair elbow perc,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24358,Repair elbow w/deb open,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24359,Repair elbow deb/attch open,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24360,Reconstruct elbow joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24361,Reconstruct elbow joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24362,Reconstruct elbow joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24363,Replace elbow joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24365,Reconstruct head of radius,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24366,Reconstruct head of radius,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24370,Revise reconst elbow joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24371,Revise reconst elbow joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24400,Revision of humerus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24410,Revision of humerus,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24420,Revision of humerus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24430,Repair of humerus,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24435,Repair humerus with graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24470,Revision of elbow joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24495,Decompression of forearm,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24498,Reinforce humerus,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24500,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24505,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24515,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24516,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24530,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24535,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24538,Treat humerus fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24545,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24546,Treat humerus fracture,APC 5116,RVU Per Case,"$15,377.54 ",OP,"11,460.57","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24560,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24565,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24566,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24575,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24576,Treat humerus fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24577,Treat humerus fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24579,Treat humerus fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24582,Treat humerus fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24586,Treat elbow fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24587,Treat elbow fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24600,Treat elbow dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24605,Treat elbow dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24615,Treat elbow dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24620,Treat elbow fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24635,Treat elbow fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24640,Treat elbow dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24650,Treat radius fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24655,Treat radius fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24665,Treat radius fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24666,Treat radius fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24670,Treat ulnar fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24675,Treat ulnar fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24685,Treat ulnar fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24800,Fusion of elbow joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24802,Fusion/graft of elbow joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24900,Amputation of upper arm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24920,Amputation of upper arm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24925,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24930,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24931,Amputate upper arm & implant,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24935,Revision of amputation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24940,Revision of upper arm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,24999,Upper arm/elbow surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25000,Incision of tendon sheath,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25001,Incise flexor carpi radialis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25020,Decompress forearm 1 space,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25023,Decompress forearm 1 space,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25024,Decompress forearm 2 spaces,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25025,Decompress forearm 2 spaces,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25028,Drainage of forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25031,Drainage of forearm bursa,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25035,Treat forearm bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25040,Explore/treat wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25065,Biopsy forearm soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25066,Biopsy forearm soft tissues,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25071,Exc forearm les sc 3 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25073,Exc forearm tum deep 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25075,Exc forearm les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25076,Exc forearm tum deep < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25077,Resect forearm/wrist tum<3cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25078,Resect forarm/wrist tum 3cm>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25085,Incision of wrist capsule,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25100,Biopsy of wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25101,Explore/treat wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25105,Remove wrist joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25107,Remove wrist joint cartilage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25109,Excise tendon forearm/wrist,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25110,Remove wrist tendon lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25111,Remove wrist tendon lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25112,Reremove wrist tendon lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25115,Remove wrist/forearm lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25116,Remove wrist/forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25118,Excise wrist tendon sheath,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25119,Partial removal of ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25120,Removal of forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25125,Remove/graft forearm lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25126,Remove/graft forearm lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25130,Removal of wrist lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25135,Remove & graft wrist lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25136,Remove & graft wrist lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25145,Remove forearm bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25150,Partial removal of ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25151,Partial removal of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25170,Resect radius/ulnar tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25210,Removal of wrist bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25215,Removal of wrist bones,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25230,Partial removal of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25240,Partial removal of ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25248,Remove forearm foreign body,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25250,Removal of wrist prosthesis,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25251,Removal of wrist prosthesis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25259,Manipulate wrist w/anesthes,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25260,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25263,Repair forearm tendon/muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25265,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25270,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25272,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25274,Repair forearm tendon/muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25275,Repair forearm tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25280,Revise wrist/forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25290,Incise wrist/forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25295,Release wrist/forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25300,Fusion of tendons at wrist,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25301,Fusion of tendons at wrist,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25310,Transplant forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25312,Transplant forearm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25315,Revise palsy hand tendon(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25316,Revise palsy hand tendon(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25320,Repair/revise wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25332,Revise wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25335,Realignment of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25337,Reconstruct ulna/radioulnar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25350,Revision of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25355,Revision of radius,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25360,Revision of ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25365,Revise radius & ulna,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25370,Revise radius or ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25375,Revise radius & ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25390,Shorten radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25391,Lengthen radius or ulna,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25392,Shorten radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25393,Lengthen radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25394,Repair carpal bone shorten,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25400,Repair radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25405,Repair/graft radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25415,Repair radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25420,Repair/graft radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25425,Repair/graft radius or ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25426,Repair/graft radius & ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25430,Vasc graft into carpal bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25431,Repair nonunion carpal bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25440,Repair/graft wrist bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25441,Reconstruct wrist joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","21,470.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25442,Reconstruct wrist joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25443,Reconstruct wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25444,Reconstruct wrist joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25445,Reconstruct wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25446,Wrist replacement,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","21,470.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25447,Repair wrist joints,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25449,Remove wrist joint implant,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25450,Revision of wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25455,Revision of wrist joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25490,Reinforce radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25491,Reinforce ulna,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,230.16","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25492,Reinforce radius and ulna,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25500,Treat fracture of radius,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25505,Treat fracture of radius,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25515,Treat fracture of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25520,Treat fracture of radius,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25525,Treat fracture of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25526,Treat fracture of radius,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25530,Treat fracture of ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25535,Treat fracture of ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25545,Treat fracture of ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25560,Treat fracture radius & ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25565,Treat fracture radius & ulna,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25574,Treat fracture radius & ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25575,Treat fracture radius/ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25600,Treat fracture radius/ulna,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25605,Treat fracture radius/ulna,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25606,Treat fx distal radial,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25607,Treat fx rad extra-articul,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25608,Treat fx rad intra-articul,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25609,Treat fx radial 3+ frag,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25622,Treat wrist bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25624,Treat wrist bone fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25628,Treat wrist bone fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25630,Treat wrist bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25635,Treat wrist bone fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25645,Treat wrist bone fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25650,Treat wrist bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25651,Pin ulnar styloid fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25652,Treat fracture ulnar styloid,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25660,Treat wrist dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25670,Treat wrist dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25671,Pin radioulnar dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25675,Treat wrist dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25676,Treat wrist dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25680,Treat wrist fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25685,Treat wrist fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25690,Treat wrist dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25695,Treat wrist dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25800,Fusion of wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25805,Fusion/graft of wrist joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25810,Fusion/graft of wrist joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25820,Fusion of hand bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"3,235.63","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25825,Fuse hand bones with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25830,Fusion radioulnar jnt/ulna,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25900,Amputation of forearm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25905,Amputation of forearm,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25907,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25909,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25915,Amputation of forearm,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25920,Amputate hand at wrist,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25922,Amputate hand at wrist,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25924,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25927,Amputation of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25929,Amputation follow-up surgery,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","2,811.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25931,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,25999,Forearm or wrist surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26010,Drainage of finger abscess,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,288.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26011,Drainage of finger abscess,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26020,Drain hand tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26025,Drainage of palm bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26030,Drainage of palm bursas,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26034,Treat hand bone lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26035,Decompress fingers/hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26037,Decompress fingers/hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26040,Release palm contracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26045,Release palm contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26055,Incise finger tendon sheath,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26060,Incision of finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26070,Explore/treat hand joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26075,Explore/treat finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26080,Explore/treat finger joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26100,Biopsy hand joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26105,Biopsy finger joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26110,Biopsy finger joint lining,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26111,Exc hand les sc 1.5 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26113,Exc hand tum deep 1.5 cm/>,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26115,Exc hand les sc < 1.5 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26116,Exc hand tum deep < 1.5 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26117,Rad resect hand tumor < 3 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26118,Rad resect hand tumor 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26121,Release palm contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26123,Release palm contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26130,Remove wrist joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26135,Revise finger joint each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26140,Revise finger joint each,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26145,Tendon excision palm/finger,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26160,Remove tendon sheath lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26170,Removal of palm tendon each,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26180,Removal of finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26185,Remove finger bone,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26200,Remove hand bone lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26205,Remove/graft bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26210,Removal of finger lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26215,Remove/graft finger lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26230,Partial removal of hand bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26235,Partial removal finger bone,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26236,Partial removal finger bone,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26250,Extensive hand surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26260,Resect prox finger tumor,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26262,Resect distal finger tumor,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26320,Removal of implant from hand,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26340,Manipulate finger w/anesth,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26341,Manipulat palm cord post inj,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26350,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26352,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26356,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26357,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26358,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26370,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26372,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26373,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26390,Revise hand/finger tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26392,Repair/graft hand tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26410,Repair hand tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26412,Repair/graft hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26415,Excision hand/finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26416,Graft hand or finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26418,Repair finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26420,Repair/graft finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26426,Repair finger/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26428,Repair/graft finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26432,Repair finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26433,Repair finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26434,Repair/graft finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26437,Realignment of tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26440,Release palm/finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26442,Release palm & finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26445,Release hand/finger tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26449,Release forearm/hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26450,Incision of palm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26455,Incision of finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26460,Incise hand/finger tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26471,Fusion of finger tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26474,Fusion of finger tendons,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26476,Tendon lengthening,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26477,Tendon shortening,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26478,Lengthening of hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26479,Shortening of hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26480,Transplant hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26483,Transplant/graft hand tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26485,Transplant palm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26489,Transplant/graft palm tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26490,Revise thumb tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26492,Tendon transfer with graft,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26494,Hand tendon/muscle transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26496,Revise thumb tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26497,Finger tendon transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26498,Finger tendon transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26499,Revision of finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26500,Hand tendon reconstruction,APC 5114,RVU Per Case,"$6,071.26 ",OP,"3,235.63","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26502,Hand tendon reconstruction,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26508,Release thumb contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26510,Thumb tendon transfer,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26516,Fusion of knuckle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26517,Fusion of knuckle joints,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26518,Fusion of knuckle joints,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26520,Release knuckle contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26525,Release finger contracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26530,Revise knuckle joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26531,Revise knuckle with implant,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26535,Revise finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26536,Revise/implant finger joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,501.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26540,Repair hand joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26541,Repair hand joint with graft,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26542,Repair hand joint with graft,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26545,Reconstruct finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26546,Repair nonunion hand,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26548,Reconstruct finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26550,Construct thumb replacement,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26551,Great toe-hand transfer,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26553,Single transfer toe-hand,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26554,Double transfer toe-hand,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26555,Positional change of finger,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26556,Toe joint transfer,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26560,Repair of web finger,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26561,Repair of web finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26562,Repair of web finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26565,Correct metacarpal flaw,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26567,Correct finger deformity,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26568,Lengthen metacarpal/finger,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26580,Repair hand deformity,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26587,Reconstruct extra finger,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26590,Repair finger deformity,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26591,Repair muscles of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26593,Release muscles of hand,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26596,Excision constricting tissue,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26600,Treat metacarpal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26605,Treat metacarpal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26607,Treat metacarpal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26608,Treat metacarpal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26615,Treat metacarpal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26641,Treat thumb dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26645,Treat thumb fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26650,Treat thumb fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26665,Treat thumb fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26670,Treat hand dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26675,Treat hand dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26676,Pin hand dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26685,Treat hand dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26686,Treat hand dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26700,Treat knuckle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26705,Treat knuckle dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26706,Pin knuckle dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26715,Treat knuckle dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26720,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26725,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26727,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26735,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26740,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26742,Treat finger fracture each,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26746,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26750,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26755,Treat finger fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26756,Pin finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26765,Treat finger fracture each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26770,Treat finger dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26775,Treat finger dislocation,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,"2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26776,Pin finger dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26785,Treat finger dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26820,Thumb fusion with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26841,Fusion of thumb,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26842,Thumb fusion with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26843,Fusion of hand joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26844,Fusion/graft of hand joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26850,Fusion of knuckle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26852,Fusion of knuckle with graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,182.91","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26860,Fusion of finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26862,Fusion/graft of finger joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26910,Amputate metacarpal bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26951,Amputation of finger/thumb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26952,Amputation of finger/thumb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26989,Hand/finger surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26990,Drainage of pelvis lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26991,Drainage of pelvis bursa,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,26992,Drainage of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27000,Incision of hip tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27001,Incision of hip tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27003,Incision of hip tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27005,Incision of hip tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27006,Incision of hip tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27025,Incision of hip/thigh fascia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27027,Buttock fasciotomy,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27030,Drainage of hip joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27033,Exploration of hip joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27035,Denervation of hip joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27036,Excision of hip joint/muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27040,Biopsy of soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27041,Biopsy of soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27043,Exc hip pelvis les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27045,Exc hip/pelv tum deep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27047,Exc hip/pelvis les sc < 3 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27048,Exc hip/pelv tum deep < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27049,Resect hip/pelv tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27050,Biopsy of sacroiliac joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27052,Biopsy of hip joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27054,Removal of hip joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27057,Buttock fasciotomy w/dbrdmt,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27059,Resect hip/pelv tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27060,Removal of ischial bursa,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27062,Remove femur lesion/bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27065,Remove hip bone les super,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27066,Remove hip bone les deep,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27067,Remove/graft hip bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27070,Part remove hip bone super,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27071,Part removal hip bone deep,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27075,Resect hip tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27076,Resect hip tum incl acetabul,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27077,Resect hip tum w/innom bone,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27078,Rsect hip tum incl femur,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27080,Removal of tail bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27086,Remove hip foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"1,363.70","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27087,Remove hip foreign body,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27090,Removal of hip prosthesis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27091,Removal of hip prosthesis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27097,Revision of hip tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27098,Transfer tendon to pelvis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27100,Transfer of abdominal muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27105,Transfer of spinal muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27110,Transfer of iliopsoas muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27111,Transfer of iliopsoas muscle,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27120,Reconstruction of hip socket,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27122,Reconstruction of hip socket,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27125,Partial hip replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27130,Total hip arthroplasty,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27132,Total hip arthroplasty,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27134,Revise hip joint replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27137,Revise hip joint replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27138,Revise hip joint replacement,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27140,Transplant femur ridge,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27146,Incision of hip bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27147,Revision of hip bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27151,Incision of hip bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27156,Revision of hip bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27158,Revision of pelvis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27161,Incision of neck of femur,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27165,Incision/fixation of femur,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27170,Repair/graft femur head/neck,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27175,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27176,Treat slipped epiphysis,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27177,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27178,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27179,Revise head/neck of femur,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27181,Treat slipped epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27185,Revision of femur epiphysis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27187,Reinforce hip bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27197,Clsd tx pelvic ring fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27198,Clsd tx pelvic ring fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27200,Treat tail bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27202,Treat tail bone fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27220,Treat hip socket fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27222,Treat hip socket fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27226,Treat hip wall fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27227,Treat hip fracture(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27228,Treat hip fracture(s),APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27230,Treat thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27232,Treat thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27235,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27236,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27238,Treat thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27240,Treat thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27244,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27245,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27246,Treat thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27248,Treat thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27250,Treat hip dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27252,Treat hip dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27253,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27254,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27256,Treat hip dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27257,Treat hip dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27258,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27259,Treat hip dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27265,Treat hip dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27266,Treat hip dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27267,Cltx thigh fx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27268,Cltx thigh fx w/mnpj,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27269,Optx thigh fx,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27275,Manipulation of hip joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27279,Arthrodesis sacroiliac joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27280,Fusion of sacroiliac joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27282,Fusion of pubic bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27284,Fusion of hip joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27286,Fusion of hip joint,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27290,Amputation of leg at hip,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27295,Amputation of leg at hip,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27299,Pelvis/hip joint surgery,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27301,Drain thigh/knee lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27303,Drainage of bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27305,Incise thigh tendon & fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27306,Incision of thigh tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27307,Incision of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27310,Exploration of knee joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27323,Biopsy thigh soft tissues,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27324,Biopsy thigh soft tissues,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27325,Neurectomy hamstring,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27326,Neurectomy popliteal,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27327,Exc thigh/knee les sc < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27328,Exc thigh/knee tum deep <5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27329,Resect thigh/knee tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27330,Biopsy knee joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27331,Explore/treat knee joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27332,Removal of knee cartilage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27333,Removal of knee cartilage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27334,Remove knee joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27335,Remove knee joint lining,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27337,Exc thigh/knee les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27339,Exc thigh/knee tum dep 5cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27340,Removal of kneecap bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27345,Removal of knee cyst,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27347,Remove knee cyst,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27350,Removal of kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27355,Remove femur lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27356,Remove femur lesion/graft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27357,Remove femur lesion/graft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27360,Partial removal leg bone(s),APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27364,Resect thigh/knee tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27365,Resect femur/knee tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27372,Removal of foreign body,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27380,Repair of kneecap tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27381,Repair/graft kneecap tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27385,Repair of thigh muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27386,Repair/graft of thigh muscle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27390,Incision of thigh tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27391,Incision of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27392,Incision of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27393,Lengthening of thigh tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27394,Lengthening of thigh tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27395,Lengthening of thigh tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27396,Transplant of thigh tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27397,Transplants of thigh tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27400,Revise thigh muscles/tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27403,Repair of knee cartilage,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27405,Repair of knee ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27407,Repair of knee ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27409,Repair of knee ligaments,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27412,Autochondrocyte implant knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27415,Osteochondral knee allograft,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27416,Osteochondral knee autograft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27418,Repair degenerated kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27420,Revision of unstable kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27422,Revision of unstable kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27424,Revision/removal of kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27425,Lat retinacular release open,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27427,Reconstruction knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27428,Reconstruction knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27429,Reconstruction knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27430,Revision of thigh muscles,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27435,Incision of knee joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27437,Revise kneecap,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27438,Revise kneecap with implant,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,501.79","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27440,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27441,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27442,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27443,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"6,700.13","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27445,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27446,Revision of knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","41,197.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27447,Total knee arthroplasty,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27448,Incision of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27450,Incision of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27454,Realignment of thigh bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27455,Realignment of knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27457,Realignment of knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27465,Shortening of thigh bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27466,Lengthening of thigh bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27468,Shorten/lengthen thighs,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27470,Repair of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27472,Repair/graft of thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27475,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27477,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27479,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27485,Surgery to stop leg growth,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27486,Revise/replace knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27487,Revise/replace knee joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27488,Removal of knee prosthesis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27495,Reinforce thigh,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27496,Decompression of thigh/knee,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27497,Decompression of thigh/knee,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27498,Decompression of thigh/knee,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27499,Decompression of thigh/knee,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27500,Treatment of thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27501,Treatment of thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27502,Treatment of thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27503,Treatment of thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27506,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27507,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27508,Treatment of thigh fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27509,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27510,Treatment of thigh fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27511,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27513,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27514,Treatment of thigh fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27516,Treat thigh fx growth plate,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27517,Treat thigh fx growth plate,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27519,Treat thigh fx growth plate,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27520,Treat kneecap fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27524,Treat kneecap fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27530,Treat knee fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27532,Treat knee fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27535,Treat knee fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27536,Treat knee fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27538,Treat knee fracture(s),APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27540,Treat knee fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27550,Treat knee dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27552,Treat knee dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27556,Treat knee dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27557,Treat knee dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27558,Treat knee dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27560,Treat kneecap dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27562,Treat kneecap dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27566,Treat kneecap dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27570,Fixation of knee joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27580,Fusion of knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27590,Amputate leg at thigh,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27591,Amputate leg at thigh,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27592,Amputate leg at thigh,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27594,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27596,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27598,Amputate lower leg at knee,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27599,Leg surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27600,Decompression of lower leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27601,Decompression of lower leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27602,Decompression of lower leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27603,Drain lower leg lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27604,Drain lower leg bursa,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27605,Incision of achilles tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27606,Incision of achilles tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27607,Treat lower leg bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27610,Explore/treat ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27612,Exploration of ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27613,Biopsy lower leg soft tissue,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27614,Biopsy lower leg soft tissue,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27615,Resect leg/ankle tum < 5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27616,Resect leg/ankle tum 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27618,Exc leg/ankle tum < 3 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27619,Exc leg/ankle tum deep <5 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27620,Explore/treat ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27625,Remove ankle joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27626,Remove ankle joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27630,Removal of tendon lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27632,Exc leg/ankle les sc 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27634,Exc leg/ankle tum dep 5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27635,Remove lower leg bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27637,Remove/graft leg bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27638,Remove/graft leg bone lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27640,Partial removal of tibia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27641,Partial removal of fibula,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27645,Resect tibia tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27646,Resect fibula tumor,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27647,Resect talus/calcaneus tum,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27650,Repair achilles tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27652,Repair/graft achilles tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27654,Repair of achilles tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27656,Repair leg fascia defect,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27658,Repair of leg tendon each,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27659,Repair of leg tendon each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27664,Repair of leg tendon each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27665,Repair of leg tendon each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27675,Repair lower leg tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27676,Repair lower leg tendons,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27680,Release of lower leg tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27681,Release of lower leg tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27685,Revision of lower leg tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27686,Revise lower leg tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27687,Revision of calf tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27690,Revise lower leg tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27691,Revise lower leg tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27695,Repair of ankle ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27696,Repair of ankle ligaments,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27698,Repair of ankle ligament,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27700,Revision of ankle joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,700.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27702,Reconstruct ankle joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27703,Reconstruction ankle joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27704,Removal of ankle implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27705,Incision of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27707,Incision of fibula,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27709,Incision of tibia & fibula,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,033.44","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27712,Realignment of lower leg,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27715,Revision of lower leg,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27720,Repair of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27722,Repair/graft of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27724,Repair/graft of tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27725,Repair of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27726,Repair fibula nonunion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27727,Repair of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27730,Repair of tibia epiphysis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27732,Repair of fibula epiphysis,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27734,Repair lower leg epiphyses,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27740,Repair of leg epiphyses,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27742,Repair of leg epiphyses,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","8,230.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27745,Reinforce tibia,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27750,Treatment of tibia fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27752,Treatment of tibia fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27756,Treatment of tibia fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27758,Treatment of tibia fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27759,Treatment of tibia fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27760,Cltx medial ankle fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27762,Cltx med ankle fx w/mnpj,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27766,Optx medial ankle fx,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27767,Cltx post ankle fx,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,199.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27768,Cltx post ankle fx w/mnpj,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27769,Optx post ankle fx,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27780,Treatment of fibula fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27781,Treatment of fibula fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27784,Treatment of fibula fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27786,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27788,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27792,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27808,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27810,Treatment of ankle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27814,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27816,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27818,Treatment of ankle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27822,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27823,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","11,460.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27824,Treat lower leg fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27825,Treat lower leg fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27826,Treat lower leg fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27827,Treat lower leg fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27828,Treat lower leg fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,460.57","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27829,Treat lower leg joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27830,Treat lower leg dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27831,Treat lower leg dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27832,Treat lower leg dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27840,Treat ankle dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27842,Treat ankle dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27846,Treat ankle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27848,Treat ankle dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27860,Fixation of ankle joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27870,Fusion of ankle joint open,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27871,Fusion of tibiofibular joint,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","13,335.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27880,Amputation of lower leg,APC 5116,RVU Per Case,"$15,377.54 ",OP,"15,377.54","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27881,Amputation of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27882,Amputation of lower leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27884,Amputation follow-up surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27886,Amputation follow-up surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27888,Amputation of foot at ankle,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27889,Amputation of foot at ankle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,033.44","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27892,Decompression of leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27893,Decompression of leg,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,180.37","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27894,Decompression of leg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,27899,Leg/ankle surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28001,Drainage of bursa of foot,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28002,Treatment of foot infection,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28003,Treatment of foot infection,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,180.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28005,Treat foot bone lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28008,Incision of foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28010,Incision of toe tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28011,Incision of toe tendons,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28020,Exploration of foot joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28022,Exploration of foot joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28024,Exploration of toe joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28035,Decompression of tibia nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28039,Exc foot/toe tum sc 1.5 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28041,Exc foot/toe tum dep 1.5cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28043,Exc foot/toe tum sc < 1.5 cm,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28045,Exc foot/toe tum deep <1.5cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28046,Resect foot/toe tumor < 3 cm,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28047,Resect foot/toe tumor 3 cm/>,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28050,Biopsy of foot joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28052,Biopsy of foot joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28054,Biopsy of toe joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28055,Neurectomy foot,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28060,Partial removal foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28062,Removal of foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28070,Removal of foot joint lining,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28072,Removal of foot joint lining,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28080,Removal of foot lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28086,Excise foot tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28088,Excise foot tendon sheath,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28090,Removal of foot lesion,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28092,Removal of toe lesions,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28100,Removal of ankle/heel lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28102,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28103,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28104,Removal of foot lesion,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28106,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28107,Remove/graft foot lesion,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28108,Removal of toe lesions,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28110,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28111,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28112,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28113,Part removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28114,Removal of metatarsal heads,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28116,Revision of foot,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28118,Removal of heel bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28119,Removal of heel spur,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28120,Part removal of ankle/heel,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28122,Partial removal of foot bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28124,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28126,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28130,Removal of ankle bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28140,Removal of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28150,Removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28153,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28160,Partial removal of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28171,Resect tarsal tumor,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28173,Resect metatarsal tumor,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28175,Resect phalanx of toe tumor,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28190,Removal of foot foreign body,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28192,Removal of foot foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28193,Removal of foot foreign body,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28200,Repair of foot tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28202,Repair/graft of foot tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28208,Repair of foot tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28210,Repair/graft of foot tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28220,Release of foot tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28222,Release of foot tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28225,Release of foot tendon,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28226,Release of foot tendons,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28230,Incision of foot tendon(s),APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28232,Incision of toe tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28234,Incision of foot tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28238,Revision of foot tendon,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28240,Release of big toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28250,Revision of foot fascia,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28260,Release of midfoot joint,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28261,Revision of foot tendon,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28262,Revision of foot and ankle,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28264,Release of midfoot joint,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28270,Release of foot contracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28272,Release of toe joint each,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28280,Fusion of toes,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28285,Repair of hammertoe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28286,Repair of hammertoe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28288,Partial removal of foot bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28289,Corrj halux rigdus w/o implt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28291,Corrj halux rigdus w/implt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28292,Correction hallux valgus,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,655.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28295,Correction hallux valgus,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28296,Correction hallux valgus,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,655.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28297,Correction hallux valgus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28298,Correction hallux valgus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28299,Correction hallux valgus,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,655.45","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28300,Incision of heel bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28302,Incision of ankle bone,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28304,Incision of midfoot bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28305,Incise/graft midfoot bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28306,Incision of metatarsal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28307,Incision of metatarsal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28308,Incision of metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28309,Incision of metatarsals,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28310,Revision of big toe,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28312,Revision of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28313,Repair deformity of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28315,Removal of sesamoid bone,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28320,Repair of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28322,Repair of metatarsals,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28340,Resect enlarged toe tissue,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28341,Resect enlarged toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28344,Repair extra toe(s),APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28345,Repair webbed toe(s),APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28360,Reconstruct cleft foot,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28400,Treatment of heel fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28405,Treatment of heel fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28406,Treatment of heel fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28415,Treat heel fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28420,Treat/graft heel fracture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,518.88","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28430,Treatment of ankle fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28435,Treatment of ankle fracture,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28436,Treatment of ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28445,Treat ankle fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28446,Osteochondral talus autogrft,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28450,Treat midfoot fracture each,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28455,Treat midfoot fracture each,APC 5112,RVU Per Case,"$1,349.30 ",OP,337.64,"1,349.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28456,Treat midfoot fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28465,Treat midfoot fracture each,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28470,Treat metatarsal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28475,Treat metatarsal fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28476,Treat metatarsal fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28485,Treat metatarsal fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28490,Treat big toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28495,Treat big toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28496,Treat big toe fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28505,Treat big toe fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28510,Treatment of toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28515,Treatment of toe fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28525,Treat toe fracture,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28530,Treat sesamoid bone fracture,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28531,Treat sesamoid bone fracture,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28540,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28545,Treat foot dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28546,Treat foot dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28555,Repair foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28570,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28575,Treat foot dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,337.64,"2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28576,Treat foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,112.93","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28585,Repair foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28600,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28605,Treat foot dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28606,Treat foot dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28615,Repair foot dislocation,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28630,Treat toe dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28635,Treat toe dislocation,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28636,Treat toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28645,Repair toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28660,Treat toe dislocation,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28665,Treat toe dislocation,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,"2,923.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28666,Treat toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,112.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28675,Repair of toe dislocation,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","7,518.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28705,Fusion of foot bones,APC 5116,RVU Per Case,"$15,377.54 ",OP,"8,183.43","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28715,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28725,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28730,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28735,Fusion of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28737,Revision of foot bones,APC 5115,RVU Per Case,"$11,934.03 ",OP,"8,183.43","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28740,Fusion of foot bones,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28750,Fusion of big toe joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28755,Fusion of big toe joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"4,091.38","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28760,Fusion of big toe joint,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,183.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28800,Amputation of midfoot,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28805,Amputation thru metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28810,Amputation toe & metatarsal,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28820,Amputation of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28825,Partial amputation of toe,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28890,Hi enrgy eswt plantar fascia,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,033.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,28899,Foot/toes surgery procedure,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,337.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29000,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29010,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29015,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29035,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29040,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29044,Application of body cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29046,Application of body cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29049,Application of figure eight,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29055,Application of shoulder cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29058,Application of shoulder cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29065,Application of long arm cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29075,Application of forearm cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29085,Apply hand/wrist cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29086,Apply finger cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29105,Apply long arm splint,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29125,Apply forearm splint,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29126,Apply forearm splint,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29130,Application of finger splint,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29131,Application of finger splint,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29200,Strapping of chest,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29240,Strapping of shoulder,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29260,Strapping of elbow or wrist,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29280,Strapping of hand or finger,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29305,Application of hip cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29325,Application of hip casts,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29345,Application of long leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29355,Application of long leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29358,Apply long leg cast brace,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29365,Application of long leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29405,Apply short leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29425,Apply short leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29435,Apply short leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29440,Addition of walker to cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29445,Apply rigid leg cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29450,Application of leg cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29505,Application long leg splint,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29515,Application lower leg splint,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29520,Strapping of hip,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29530,Strapping of knee,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29540,Strapping of ankle and/or ft,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29550,Strapping of toes,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29580,Application of paste boot,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29581,Apply multlay comprs lwr leg,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29584,Appl multlay comprs arm/hand,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,136.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29700,Removal/revision of cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29705,Removal/revision of cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29710,Removal/revision of cast,APC 5102,RVU Per Unit,$233.72 ,OP,233.72,456.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29720,Repair of body cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29730,Windowing of cast,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29740,Wedging of cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29750,Wedging of clubfoot cast,APC 5102,RVU Per Unit,$233.72 ,OP,212.47,233.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29799,Casting/strapping procedure,APC 5101,RVU Per Unit,$136.81 ,OP,136.81,212.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29800,Jaw arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29804,Jaw arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29805,Sho arthrs dx +- synovial bx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29806,Sho arthrs srg capsulorpaphy,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29807,Sho arthrs srg rpr slap les,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29819,Sho arthrs srg rmvl loose/fb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29820,Sho arthrs srg prtl synvct,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29821,Sho arthrs srg compl synvct,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29822,Sho arthrs srg lmtd dbrdmt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29823,Sho arthrs srg xtnsv dbrdmt,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29824,Sho arthrs srg dstl claviclc,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29825,Sho arthrs srg lss&rescj ads,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29827,Sho arthrs srg rt8tr cuf rpr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29828,Sho arthrs srg bicp tenodsis,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29830,Elbow arthroscopy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29834,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29835,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29836,Elbow arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29837,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29838,Elbow arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29840,Wrist arthroscopy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29843,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29844,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29845,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29846,Wrist arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29847,Wrist arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29848,Wrist endoscopy/surgery,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29850,Knee arthroscopy/surgery,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29851,Knee arthroscopy/surgery,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29855,Tibial arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29856,Tibial arthroscopy/surgery,APC 5115,RVU Per Case,"$11,934.03 ",OP,"5,733.49","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29860,Hip arthroscopy dx,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29861,Hip arthro w/fb removal,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29862,Hip arthr0 w/debridement,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29863,Hip arthr0 w/synovectomy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29866,Autgrft implnt knee w/scope,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29867,Allgrft implnt knee w/scope,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29868,Meniscal trnspl knee w/scpe,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29870,Knee arthroscopy dx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29871,Knee arthroscopy/drainage,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29873,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29874,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29875,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29876,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29877,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29879,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29880,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29881,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29882,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29883,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29884,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29885,Knee arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29886,Knee arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29887,Knee arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29888,Knee arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29889,Knee arthroscopy/surgery,APC 5115,RVU Per Case,"$11,934.03 ",OP,"9,114.17","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29891,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29892,Ankle arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"5,733.49","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29893,Scope plantar fasciotomy,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","4,091.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29894,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29895,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29897,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29898,Ankle arthroscopy/surgery,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29899,Ankle arthroscopy/surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","9,114.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29900,Mcp joint arthroscopy dx,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29901,Mcp joint arthroscopy surg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29902,Mcp joint arthroscopy surg,APC 5112,RVU Per Case,"$1,349.30 ",OP,"1,349.30","3,235.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29904,Subtalar arthro w/fb rmvl,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29905,Subtalar arthro w/exc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29906,Subtalar arthro w/deb,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29907,Subtalar arthro w/fusion,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29914,Hip arthro w/femoroplasty,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29915,Hip arthro acetabuloplasty,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29916,Hip arthro w/labral repair,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,29999,Arthroscopy of joint,APC 5111,RVU Per Unit,$199.81 ,OP,199.81,"5,733.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30000,Drainage of nose lesion,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30020,Drainage of nose lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30100,Intranasal biopsy,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30110,Removal of nose polyp(s),APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30115,Removal of nose polyp(s),APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30117,Removal of intranasal lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30118,Removal of intranasal lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30120,Revision of nose,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30124,Removal of nose lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30125,Removal of nose lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30130,Excise inferior turbinate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30140,Resect inferior turbinate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30150,Partial removal of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30160,Removal of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30200,Injection treatment of nose,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30210,Nasal sinus therapy,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30220,Insert nasal septal button,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30300,Remove nasal foreign body,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30310,Remove nasal foreign body,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30320,Remove nasal foreign body,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30400,Reconstruction of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30410,Reconstruction of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30420,Reconstruction of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30430,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30435,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30450,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30460,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30462,Revision of nose,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30465,Repair nasal stenosis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30468,Rpr nsl vlv collapse w/implt,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30520,Repair of nasal septum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30540,Repair nasal defect,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30545,Repair nasal defect,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30560,Release of nasal adhesions,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30580,Repair upper jaw fistula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30600,Repair mouth/nose fistula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30620,Intranasal reconstruction,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30630,Repair nasal septum defect,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30801,Ablate inf turbinate superf,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30802,Ablate inf turbinate submuc,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30901,Control of nosebleed,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30903,Control of nosebleed,APC 5734,RVU Per Unit,$108.49 ,OP,108.49,236.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30905,Control of nosebleed,APC 5734,RVU Per Unit,$108.49 ,OP,108.49,236.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30906,Repeat control of nosebleed,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,236.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30915,Ligation nasal sinus artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30920,Ligation upper jaw artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30930,Ther fx nasal inf turbinate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,30999,Nasal surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31000,Irrigation maxillary sinus,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31002,Irrigation sphenoid sinus,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31020,Exploration maxillary sinus,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31030,Exploration maxillary sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31032,Explore sinus remove polyps,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31040,Exploration behind upper jaw,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31050,Exploration sphenoid sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31051,Sphenoid sinus surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31070,Exploration of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31075,Exploration of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31080,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31081,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31084,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31085,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31086,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31087,Removal of frontal sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31090,Exploration of sinuses,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31200,Removal of ethmoid sinus,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31201,Removal of ethmoid sinus,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31205,Removal of ethmoid sinus,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31225,Removal of upper jaw,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31230,Removal of upper jaw,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31231,Nasal endoscopy dx,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,281.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31233,Nsl/sins ndsc dx max sinusc,APC 5152,RVU Per Unit,$364.87 ,OP,281.52,364.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31235,Nsl/sins ndsc dx sphn sinusc,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31237,Nasal/sinus endoscopy surg,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31238,Nasal/sinus endoscopy surg,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31239,Nasal/sinus endoscopy surg,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31240,Nasal/sinus endoscopy surg,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31241,Nsl/sins ndsc w/artery lig,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31253,Nsl/sins ndsc total,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31254,Nsl/sins ndsc w/prtl ethmdct,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31255,Nsl/sins ndsc w/tot ethmdct,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31256,Exploration maxillary sinus,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31257,Nsl/sins ndsc tot w/sphendt,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31259,Nsl/sins ndsc sphn tiss rmvl,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31267,Endoscopy maxillary sinus,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31276,Nsl/sins ndsc frnt tiss rmvl,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31287,Nasal/sinus endoscopy surg,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31288,Nasal/sinus endoscopy surg,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31290,Nasal/sinus endoscopy surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31291,Nasal/sinus endoscopy surg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31292,Nsl/sins ndsc med/inf dcmprn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31293,Nsl/sins ndsc med&inf dcmprn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31294,Nsl/sins ndsc surg on dcmprn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31295,Nsl/sins ndsc surg max sins,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31296,Nsl/sins ndsc surg frnt sins,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31297,Nsl/sins ndsc surg sphn sins,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31298,Nsl/sins ndsc surg frnt&sphn,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31299,Sinus surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31300,Removal of larynx lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31360,Removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31365,Removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31367,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31368,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31370,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31375,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31380,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31382,Partial removal of larynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31390,Removal of larynx & pharynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31395,Reconstruct larynx & pharynx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31400,Revision of larynx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31420,Removal of epiglottis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31500,Insert emergency airway,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,485.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31502,Change of windpipe airway,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,472.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31505,Diagnostic laryngoscopy,APC 5151,RVU Per Unit,$159.31 ,OP,154.19,159.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31510,Laryngoscopy with biopsy,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31511,Remove foreign body larynx,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,281.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31512,Removal of larynx lesion,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31513,Injection into vocal cord,APC 5152,RVU Per Unit,$364.87 ,OP,281.52,364.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31515,Laryngoscopy for aspiration,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,"2,962.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31520,Dx laryngoscopy newborn,APC 5152,RVU Per Unit,$364.87 ,OP,281.52,364.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31525,Dx laryngoscopy excl nb,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","2,962.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31526,Dx laryngoscopy w/oper scope,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31527,Laryngoscopy for treatment,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31528,Laryngoscopy and dilation,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31529,Laryngoscopy and dilation,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31530,Laryngoscopy w/fb removal,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31531,Laryngoscopy w/fb & op scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31535,Laryngoscopy w/biopsy,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31536,Laryngoscopy w/bx & op scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31540,Laryngoscopy w/exc of tumor,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31541,Larynscop w/tumr exc + scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31545,Remove vc lesion w/scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31546,Remove vc lesion scope/graft,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31551,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31552,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31553,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31554,Laryngoplasty laryngeal sten,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31560,Laryngoscop w/arytenoidectom,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31561,Larynscop remve cart + scop,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,396.81","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31570,Laryngoscope w/vc inj,APC 5154,RVU Per Case,"$3,002.24 ",OP,"2,962.98","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31571,Laryngoscop w/vc inj + scope,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31572,Largsc w/laser dstrj les,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31573,Largsc w/ther injection,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31574,Largsc w/njx augmentation,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31575,Diagnostic laryngoscopy,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,281.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31576,Laryngoscopy with biopsy,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31577,Largsc w/rmvl foreign bdy(s),APC 5152,RVU Per Unit,$364.87 ,OP,364.87,770.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31578,Largsc w/removal lesion,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,396.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31579,Laryngoscopy telescopic,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,770.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31580,Laryngoplasty laryngeal web,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31584,Laryngoplasty fx rdctj fixj,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31587,Laryngoplasty cricoid split,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31590,Reinnervate larynx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31591,Laryngoplasty medialization,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31592,Cricotracheal resection,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31599,Larynx surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31600,Incision of windpipe,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31601,Incision of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31603,Incision of windpipe,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31605,Incision of windpipe,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31610,Incision of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31611,Surgery/speech prosthesis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31612,Puncture/clear windpipe,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31613,Repair windpipe opening,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31614,Repair windpipe opening,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31615,Visualization of windpipe,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31622,Dx bronchoscope/wash,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31623,Dx bronchoscope/brush,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31624,Dx bronchoscope/lavage,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31625,Bronchoscopy w/biopsy(s),APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31626,Bronchoscopy w/markers,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31628,Bronchoscopy/lung bx each,APC 5154,RVU Per Case,"$3,002.24 ",OP,"1,907.43","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31629,Bronchoscopy/needle bx each,APC 5154,RVU Per Case,"$3,002.24 ",OP,"1,907.43","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31630,Bronchoscopy dilate/fx repr,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31631,Bronchoscopy dilate w/stent,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31634,Bronch w/balloon occlusion,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31635,Bronchoscopy w/fb removal,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31636,Bronchoscopy bronch stents,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31638,Bronchoscopy revise stent,APC 5155,RVU Per Case,"$5,642.74 ",OP,"4,408.58","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31640,Bronchoscopy w/tumor excise,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31641,Bronchoscopy treat blockage,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","4,408.58",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31643,Diag bronchoscope/catheter,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31645,Brnchsc w/ther aspir 1st,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31646,Brnchsc w/ther aspir sbsq,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,"1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31647,Bronchial valve init insert,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31648,Bronchial valve remov init,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31649,Bronchial valve remov addl,APC 5153,RVU Per Case,"$1,450.13 ",OP,"1,450.13","1,450.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31652,Bronch ebus samplng 1/2 node,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31653,Bronch ebus samplng 3/> node,APC 5154,RVU Per Case,"$3,002.24 ",OP,"3,002.24","3,002.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31660,Bronch thermoplsty 1 lobe,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31661,Bronch thermoplsty 2/> lobes,APC 5155,RVU Per Case,"$5,642.74 ",OP,"5,642.74","5,642.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31717,Bronchial brush biopsy,APC 5152,RVU Per Unit,$364.87 ,OP,364.87,770.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31720,Clearance of airways,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31725,Clearance of airways,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31730,Intro windpipe wire/tube,APC 5153,RVU Per Case,"$1,450.13 ",OP,770.41,"1,450.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31750,Repair of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31755,Repair of windpipe,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31760,Repair of windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31766,Reconstruction of windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31770,Repair/graft of bronchus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31775,Reconstruct bronchus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31780,Reconstruct windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31781,Reconstruct windpipe,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31785,Remove windpipe lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31786,Remove windpipe lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31800,Repair of windpipe injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31805,Repair of windpipe injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31820,Closure of windpipe lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31825,Repair of windpipe defect,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31830,Revise windpipe scar,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,31899,Airways surgical procedure,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,"1,907.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32035,Thoracostomy w/rib resection,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32036,Thoracostomy w/flap drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32096,Open wedge/bx lung infiltr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32097,Open wedge/bx lung nodule,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32098,Open biopsy of lung pleura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32100,Exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32110,Explore/repair chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32120,Re-exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32124,Explore chest free adhesions,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32140,Removal of lung lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32141,Remove/treat lung lesions,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32150,Removal of lung lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32151,Remove lung foreign body,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32160,Open chest heart massage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32200,Drain open lung lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32215,Treat chest lining,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32220,Release of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32225,Partial release of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32310,Removal of chest lining,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32320,Free/remove chest lining,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32400,Needle biopsy chest lining,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32408,Core ndl bx lng/med perq,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32440,Remove lung pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32442,Sleeve pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32445,Removal of lung extrapleural,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32480,Partial removal of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32482,Bilobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32484,Segmentectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32486,Sleeve lobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32488,Completion pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32491,Lung volume reduction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32501,Repair bronchus add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32503,Resect apical lung tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32504,Resect apical lung tum/chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32505,Wedge resect of lung initial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32506,Wedge resect of lung add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32507,Wedge resect of lung diag,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32540,Removal of lung lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32550,Insert pleural cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32551,Insertion of chest tube,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32552,Remove lung catheter,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32553,Ins mark thor for rt perq,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32554,Aspirate pleura w/o imaging,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32555,Aspirate pleura w/ imaging,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32556,Insert cath pleura w/o image,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32557,Insert cath pleura w/ image,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32560,Treat pleurodesis w/agent,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32561,Lyse chest fibrin init day,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32562,Lyse chest fibrin subq day,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32601,Thoracoscopy diagnostic,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32604,Thoracoscopy wbx sac,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32606,Thoracoscopy w/bx med space,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,398.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32607,Thoracoscopy w/bx infiltrate,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32608,Thoracoscopy w/bx nodule,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32609,Thoracoscopy w/bx pleura,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32650,Thoracoscopy w/pleurodesis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32651,Thoracoscopy remove cortex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32652,Thoracoscopy rem totl cortex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32653,Thoracoscopy remov fb/fibrin,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32654,Thoracoscopy contrl bleeding,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32655,Thoracoscopy resect bullae,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32656,Thoracoscopy w/pleurectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32658,Thoracoscopy w/sac fb remove,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32659,Thoracoscopy w/sac drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32661,Thoracoscopy w/pericard exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32662,Thoracoscopy w/mediast exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32663,Thoracoscopy w/lobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32664,Thoracoscopy w/ th nrv exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32665,Thoracoscop w/esoph musc exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32666,Thoracoscopy w/wedge resect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32667,Thoracoscopy w/w resect addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32668,Thoracoscopy w/w resect diag,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32669,Thoracoscopy remove segment,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32670,Thoracoscopy bilobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32671,Thoracoscopy pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32672,Thoracoscopy for lvrs,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32673,Thoracoscopy w/thymus resect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32674,Thoracoscopy lymph node exc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32800,Repair lung hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32810,Close chest after drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32815,Close bronchial fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32820,Reconstruct injured chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32850,Donor pneumonectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32851,Lung transplant single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32852,Lung transplant with bypass,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32853,Lung transplant double,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32854,Lung transplant with bypass,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32855,Prepare donor lung single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32856,Prepare donor lung double,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32900,Removal of rib(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32905,Revise & repair chest wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32906,Revise & repair chest wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32940,Revision of lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32960,Therapeutic pneumothorax,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,725.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32994,Ablate pulm tumor perq crybl,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32997,Total lung lavage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32998,Ablate pulm tumor perq rf,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,32999,Chest surgery procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,725.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33016,Pericardiocentesis w/imaging,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33017,Prcrd drg 6yr+ w/o cgen car,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33018,Prcrd drg 0-5yr or w/anomly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33019,Perq prcrd drg insj cath ct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33020,Incision of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33025,Incision of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33030,Partial removal of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33031,Partial removal of heart sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33050,Resect heart sac lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33120,Removal of heart lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33130,Removal of heart lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33140,Heart revascularize (tmr),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33141,Heart tmr w/other procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33202,Insert epicard eltrd open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33203,Insert epicard eltrd endo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33206,Insert heart pm atrial,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","24,770.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33207,Insert heart pm ventricular,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","24,770.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33208,Insrt heart pm atrial & vent,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","30,573.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33210,Insert electrd/pm cath sngl,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33211,Insert card electrodes dual,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33212,Insert pulse gen sngl lead,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","19,689.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33213,Insert pulse gen dual leads,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","22,588.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33214,Upgrade of pacemaker system,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","30,573.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33215,Reposition pacing-defib lead,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,130.52",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33216,Insert 1 electrode pm-defib,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33217,Insert 2 electrode pm-defib,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","11,789.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33218,Repair lead pace-defib one,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","5,130.52",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33220,Repair lead pace-defib dual,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","5,130.52",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33221,Insert pulse gen mult leads,APC 5224,RVU Per Case,"$18,035.87 ",OP,"18,035.87","18,035.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33222,Relocation pocket pacemaker,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33223,Relocate pocket for defib,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33224,Insert pacing lead & connect,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","61,548.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33226,Reposition l ventric lead,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,130.52",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33227,Remove&replace pm gen singl,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33228,Remv&replc pm gen dual lead,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","10,078.61",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33229,Remv&replc pm gen mult leads,APC 5224,RVU Per Case,"$18,035.87 ",OP,"18,035.87","18,035.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33230,Insrt pulse gen w/dual leads,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33231,Insrt pulse gen w/mult leads,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33233,Removal of pm generator,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33234,Removal of pacemaker system,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33235,Removal pacemaker electrode,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33236,Remove electrode/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33237,Remove electrode/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33238,Remove electrode/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33240,Insrt pulse gen w/singl lead,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33241,Remove pulse generator,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33243,Remove eltrd/thoracotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33244,Remove elctrd transvenously,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33249,Insj/rplcmt defib w/lead(s),APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33250,Ablate heart dysrhythm focus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33251,Ablate heart dysrhythm focus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33254,Ablate atria lmtd,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33255,Ablate atria w/o bypass ext,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33256,Ablate atria w/bypass exten,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33257,Ablate atria lmtd add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33258,Ablate atria x10sv add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33259,Ablate atria w/bypass add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33261,Ablate heart dysrhythm focus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33262,Rmvl& replc pulse gen 1 lead,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33263,Rmvl & rplcmt dfb gen 2 lead,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33264,Rmvl & rplcmt dfb gen mlt ld,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33265,Ablate atria lmtd endo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33266,Ablate atria x10sv endo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33270,Ins/rep subq defibrillator,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33271,Insj subq impltbl dfb elctrd,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33272,Rmvl of subq defibrillator,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33273,Repos prev impltbl subq dfb,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33274,Tcat insj/rpl perm ldls pm,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33275,Tcat rmvl perm ldls pm w/img,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33285,Insj subq car rhythm mntr,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33286,Rmvl subq car rhythm mntr,APC 5071,RVU Per Case,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33289,Tcat impl wrls p-art prs snr,APC 5200,RVU Per Case,"$27,924.53 ",OP,"27,924.53","27,924.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33300,Repair of heart wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33305,Repair of heart wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33310,Exploratory heart surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33315,Exploratory heart surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33320,Repair major blood vessel(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33321,Repair major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33322,Repair major blood vessel(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33330,Insert major vessel graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33335,Insert major vessel graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33340,Perq clsr tcat l atr apndge,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33361,Replace aortic valve perq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33362,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33363,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33364,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33365,Replace aortic valve open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33366,Trcath replace aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33367,Replace aortic valve w/byp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33368,Replace aortic valve w/byp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33369,Replace aortic valve w/byp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33390,Valvuloplasty aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33391,Valvuloplasty aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33404,Prepare heart-aorta conduit,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33405,Replacement aortic valve opn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33406,Replacement aortic valve opn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33410,Replacement aortic valve opn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33411,Replacement of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33412,Replacement of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33413,Replacement of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33414,Repair of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33415,Revision subvalvular tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33416,Revise ventricle muscle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33417,Repair of aortic valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33418,Repair tcat mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33420,Revision of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33422,Revision of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33425,Repair of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33426,Repair of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33427,Repair of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33430,Replacement of mitral valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33440,Rplcmt a-valve tlcj autol pv,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33460,Revision of tricuspid valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33463,Valvuloplasty tricuspid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33464,Valvuloplasty tricuspid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33465,Replace tricuspid valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33468,Revision of tricuspid valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33470,Revision of pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33471,Valvotomy pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33474,Revision of pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33475,Replacement pulmonary valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33476,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33477,Implant tcat pulm vlv perq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33478,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33496,Repair prosth valve clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33500,Repair heart vessel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33501,Repair heart vessel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33502,Coronary artery correction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33503,Coronary artery graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33504,Coronary artery graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33505,Repair artery w/tunnel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33506,Repair artery translocation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33507,Repair art intramural,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33510,Cabg vein single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33511,Cabg vein two,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33512,Cabg vein three,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33513,Cabg vein four,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33514,Cabg vein five,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33516,Cabg vein six or more,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33517,Cabg artery-vein single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33518,Cabg artery-vein two,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33519,Cabg artery-vein three,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33521,Cabg artery-vein four,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33522,Cabg artery-vein five,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33523,Cabg art-vein six or more,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33530,Coronary artery bypass/reop,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33533,Cabg arterial single,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33534,Cabg arterial two,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33535,Cabg arterial three,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33536,Cabg arterial four or more,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33542,Removal of heart lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33545,Repair of heart damage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33548,Restore/remodel ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33572,Open coronary endarterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33600,Closure of valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33602,Closure of valve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33606,Anastomosis/artery-aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33608,Repair anomaly w/conduit,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33610,Repair by enlargement,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33611,Repair double ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33612,Repair double ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33615,Repair modified fontan,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33617,Repair single ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33619,Repair single ventricle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33620,Apply r&l pulm art bands,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33621,Transthor cath for stent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33622,Redo compl cardiac anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33641,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33645,Revision of heart veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33647,Repair heart septum defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33660,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33665,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33670,Repair of heart chambers,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33675,Close mult vsd,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33676,Close mult vsd w/resection,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33677,Cl mult vsd w/rem pul band,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33681,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33684,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33688,Repair heart septum defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33690,Reinforce pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33692,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33694,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33697,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33702,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33710,Repair of heart defects,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33720,Repair of heart defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33722,Repair of heart defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33724,Repair venous anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33726,Repair pul venous stenosis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33730,Repair heart-vein defect(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33732,Repair heart-vein defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33735,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33736,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33737,Revision of heart chamber,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33741,Tas congenital car anomal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33745,Tis cgen car anomal 1st shnt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33746,Tis cgen car anomal ea addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33750,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33755,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33762,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33764,Major vessel shunt & graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33766,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33767,Major vessel shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33768,Cavopulmonary shunting,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33770,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33771,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33774,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33775,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33776,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33777,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33778,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33779,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33780,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33781,Repair great vessels defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33782,Nikaidoh proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33783,Nikaidoh proc w/ostia implt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33786,Repair arterial trunk,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33788,Revision of pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33800,Aortic suspension,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33802,Repair vessel defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33803,Repair vessel defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33813,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33814,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33820,Revise major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33822,Revise major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33824,Revise major vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33840,Remove aorta constriction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33845,Remove aorta constriction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33851,Remove aorta constriction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33852,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33853,Repair septal defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33858,As-aort grf f/aortic dsj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33859,As-aort grf f/ds oth/thn dsj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33863,Ascending aortic graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33864,Ascending aortic graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33871,Transvrs a-arch grf hypthrm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33875,Thoracic aortic graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33877,Thoracoabdominal graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33880,Endovasc taa repr incl subcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33881,Endovasc taa repr w/o subcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33883,Insert endovasc prosth taa,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33884,Endovasc prosth taa add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33886,Endovasc prosth delayed,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33889,Artery transpose/endovas taa,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33891,Car-car bp grft/endovas taa,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33910,Remove lung artery emboli,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33915,Remove lung artery emboli,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33916,Surgery of great vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33917,Repair pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33920,Repair pulmonary atresia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33922,Transect pulmonary artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33924,Remove pulmonary shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33925,Rpr pul art unifocal w/o cpb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33926,Repr pul art unifocal w/cpb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33927,Impltj tot rplcmt hrt sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33928,Rmvl & rplcmt tot hrt sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33929,Rmvl rplcmt hrt sys f/trnspl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33930,Removal of donor heart/lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33933,Prepare donor heart/lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33935,Transplantation heart/lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33940,Removal of donor heart,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33944,Prepare donor heart,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33945,Transplantation of heart,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33946,Ecmo/ecls initiation venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33947,Ecmo/ecls initiation artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33948,Ecmo/ecls daily mgmt-venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33949,Ecmo/ecls daily mgmt artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33951,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33952,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33953,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33954,Ecmo/ecls insj prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33955,Ecmo/ecls insj ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33956,Ecmo/ecls insj ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33957,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33958,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33959,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33962,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33963,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33964,Ecmo/ecls repos perph cnula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33965,Ecmo/ecls rmvl perph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33966,Ecmo/ecls rmvl prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33967,Insert i-aort percut device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33968,Remove aortic assist device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33969,Ecmo/ecls rmvl perph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33970,Aortic circulation assist,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33971,Aortic circulation assist,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33973,Insert balloon device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33974,Remove intra-aortic balloon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33975,Implant ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33976,Implant ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33977,Remove ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33978,Remove ventricular device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33979,Insert intracorporeal device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33980,Remove intracorporeal device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33981,Replace vad pump ext,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33982,Replace vad intra w/o bp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33983,Replace vad intra w/bp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33984,Ecmo/ecls rmvl prph cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33985,Ecmo/ecls rmvl ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33986,Ecmo/ecls rmvl ctr cannula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33987,Artery expos/graft artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33988,Insertion of left heart vent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33989,Removal of left heart vent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33990,Insj perq vad l hrt arterial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33991,Insj perq vad l hrt artl&ven,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33992,Rmvl perq left heart vad,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33993,Reposg perq r/l hrt vad,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33995,Insj perq vad r hrt venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33997,Rmvl perq right heart vad,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,33999,Cardiac surgery procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,725.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34001,Removal of artery clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34051,Removal of artery clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34101,Removal of artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34111,Removal of arm artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34151,Removal of artery clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34201,Removal of artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34203,Removal of leg artery clot,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34401,Removal of vein clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34421,Removal of vein clot,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34451,Removal of vein clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34471,Removal of vein clot,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,"7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34490,Removal of vein clot,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34501,Repair valve femoral vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34502,Reconstruct vena cava,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34510,Transposition of vein valve,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34520,Cross-over vein graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34530,Leg vein fusion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34701,Evasc rpr a-ao ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34702,Evasc rpr a-ao ndgft rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34703,Evasc rpr a-unilac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34704,Evasc rpr a-unilac ndgft rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34705,Evac rpr a-biiliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34706,Evasc rpr a-biiliac rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34707,Evasc rpr ilio-iliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34708,Evasc rpr ilio-iliac rpt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34709,Plmt xtn prosth evasc rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34710,Dlyd plmt xtn prosth 1st vsl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34711,Dlyd plmt xtn prosth ea addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34712,Tcat dlvr enhncd fixj dev,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34717,Evasc rpr a-iliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34718,Evasc rpr n/a a-iliac ndgft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34808,Endovas iliac a device addon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34812,Opn fem art expos,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34813,Femoral endovas graft add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34820,Opn iliac art expos,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34830,Open aortic tube prosth repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34831,Open aortoiliac prosth repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34832,Open aortofemor prosth repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34833,Opn ilac art expos cndt crtj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34834,Opn brach art expos,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34841,Endovasc visc aorta 1 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34842,Endovasc visc aorta 2 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34843,Endovasc visc aorta 3 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34844,Endovasc visc aorta 4 graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34845,Visc & infraren abd 1 prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34846,Visc & infraren abd 2 prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34847,Visc & infraren abd 3 prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,34848,Visc & infraren abd 4+ prost,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35001,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35002,Repair artery rupture neck,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35005,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35011,Repair defect of artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35013,Repair artery rupture arm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35021,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35022,Repair artery rupture chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35045,Repair defect of arm artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35081,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35082,Repair artery rupture aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35091,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35092,Repair artery rupture aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35102,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35103,Repair artery rupture aorta,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35111,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35112,Repair artery rupture spleen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35121,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35122,Repair artery rupture belly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35131,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35132,Repair artery rupture groin,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35141,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35142,Repair artery rupture thigh,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35151,Repair defect of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35152,Repair ruptd popliteal art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35180,Repair blood vessel lesion,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35182,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35184,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35188,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35189,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35190,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35201,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35206,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35207,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35211,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35216,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35221,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35226,Repair blood vessel lesion,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35231,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35236,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35241,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35246,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35251,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35256,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35261,Repair blood vessel lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,486.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35266,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35271,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35276,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35281,Repair blood vessel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35286,Repair blood vessel lesion,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,486.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35301,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35302,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35303,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35304,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35305,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35306,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35311,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35321,Rechanneling of artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,579.90","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35331,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35341,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35351,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35355,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35361,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35363,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35371,Rechanneling of artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35372,Rechanneling of artery,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35390,Reoperation carotid add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35400,Angioscopy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35501,Art byp grft ipsilat carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35506,Art byp grft subclav-carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35508,Art byp grft carotid-vertbrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35509,Art byp grft contral carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35510,Art byp grft carotid-brchial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35511,Art byp grft subclav-subclav,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35512,Art byp grft subclav-brchial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35515,Art byp grft subclav-vertbrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35516,Art byp grft subclav-axilary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35518,Art byp grft axillary-axilry,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35521,Art byp grft axill-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35522,Art byp grft axill-brachial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35523,Art byp grft brchl-ulnr-rdl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35525,Art byp grft brachial-brchl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35526,Art byp grft aor/carot/innom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35531,Art byp grft aorcel/aormesen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35533,Art byp grft axill/fem/fem,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35535,Art byp grft hepatorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35536,Art byp grft splenorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35537,Art byp grft aortoiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35538,Art byp grft aortobi-iliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35539,Art byp grft aortofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35540,Art byp grft aortbifemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35556,Art byp grft fem-popliteal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35558,Art byp grft fem-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35560,Art byp grft aortorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35563,Art byp grft ilioiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35565,Art byp grft iliofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35566,Art byp fem-ant-post tib/prl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35570,Art byp tibial-tib/peroneal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35571,Art byp pop-tibl-prl-other,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35583,Vein byp grft fem-popliteal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35585,Vein byp fem-tibial peroneal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35587,Vein byp pop-tibl peroneal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35600,Harvest art for cabg add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35601,Art byp common ipsi carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35606,Art byp carotid-subclavian,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35612,Art byp subclav-subclavian,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35616,Art byp subclav-axillary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35621,Art byp axillary-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35623,Art byp axillary-pop-tibial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35626,Art byp aorsubcl/carot/innom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35631,Art byp aor-celiac-msn-renal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35632,Art byp ilio-celiac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35633,Art byp ilio-mesenteric,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35634,Art byp iliorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35636,Art byp spenorenal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35637,Art byp aortoiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35638,Art byp aortobi-iliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35642,Art byp carotid-vertebral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35645,Art byp subclav-vertebrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35646,Art byp aortobifemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35647,Art byp aortofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35650,Art byp axillary-axillary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35654,Art byp axill-fem-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35656,Art byp femoral-popliteal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35661,Art byp femoral-femoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35663,Art byp ilioiliac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35665,Art byp iliofemoral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35666,Art byp fem-ant-post tib/prl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35671,Art byp pop-tibl-prl-other,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35681,Composite byp grft pros&vein,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35682,Composite byp grft 2 veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35683,Composite byp grft 3/> segmt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35691,Art trnsposj vertbrl carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35693,Art trnsposj subclavian,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35694,Art trnsposj subclav carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35695,Art trnsposj carotid subclav,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35697,Reimplant artery each,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35700,Reoperation bypass graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35701,Expl n/flwd surg neck art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35702,Expl n/flwd surg uxtr art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35703,Expl n/flwd surg lxtr art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35800,Explore neck vessels,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35820,Explore chest vessels,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35840,Explore abdominal vessels,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35860,Explore limb vessels,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35870,Repair vessel graft defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35875,Removal of clot in graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35876,Removal of clot in graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35879,Revise graft w/vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35881,Revise graft w/vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35883,Revise graft w/nonauto graft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35884,Revise graft w/vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35901,Excision graft neck,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35903,Excision graft extremity,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35905,Excision graft thorax,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,35907,Excision graft abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36002,Pseudoaneurysm injection trt,APC 5181,RVU Per Unit,$524.87 ,OP,492.86,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36221,Place cath thoracic aorta,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36222,Place cath carotid/inom art,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36223,Place cath carotid/inom art,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36224,Place cath carotd art,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36225,Place cath subclavian art,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36226,Place cath vertebral art,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36251,Ins cath ren art 1st unilat,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36252,Ins cath ren art 1st bilat,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36253,Ins cath ren art 2nd+ unilat,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36254,Ins cath ren art 2nd+ bilat,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36260,Insertion of infusion pump,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36261,Revision of infusion pump,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36262,Removal of infusion pump,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36415,Routine venipuncture,Lab Services,Per Unit,$3.00 ,OP,3,3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36420,Vein access cutdown < 1 yr,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36425,Vein access cutdown > 1 yr,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36430,Blood transfusion service,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36440,Bl push transfuse 2 yr/<,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36450,Bl exchange/transfuse nb,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36455,Bl exchange/transfuse non-nb,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36456,Prtl exchange transfuse nb,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36460,Transfusion service fetal,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36465,Njx noncmpnd sclrsnt 1 vein,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36466,Njx noncmpnd sclrsnt mlt vn,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36468,Njx sclrsnt spider veins,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36470,Njx sclrsnt 1 incmptnt vein,APC 5052,RVU Per Unit,$335.15 ,OP,216.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36471,Njx sclrsnt mlt incmptnt vn,APC 5052,RVU Per Unit,$335.15 ,OP,216.3,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36473,Endovenous mchnchem 1st vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36475,Endovenous rf 1st vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36478,Endovenous laser 1st vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36482,Endoven ther chem adhes 1st,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36511,Apheresis wbc,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36512,Apheresis rbc,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36513,Apheresis platelets,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,"2,346.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36514,Apheresis plasma,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36516,Apheresis immunoads slctv,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","6,053.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36522,Photopheresis,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","6,053.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36555,Insert non-tunnel cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"1,759.54","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36556,Insert non-tunnel cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"1,759.54","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36557,Insert tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,540.10","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36558,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36560,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36561,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36563,Insert tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36565,Insert tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36566,Insert tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","16,717.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36568,Insj picc <5 yr w/o imaging,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36569,Insj picc 5 yr+ w/o imaging,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36570,Insert picvad cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36571,Insert picvad cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36572,Insj picc rs&i <5 yr,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36573,Insj picc rs&i 5 yr+,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36575,Repair tunneled cv cath,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,"1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36576,Repair tunneled cv cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36578,Replace tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36580,Replace cvad cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36581,Replace tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36582,Replace tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36583,Replace tunneled cv cath,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36584,Compl rplcmt picc rs&i,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36585,Replace picvad cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36589,Removal tunneled cv cath,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36590,Removal tunneled cv cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36591,Draw blood off venous device,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36592,Collect blood from picc,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36593,Declot vascular device,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36595,Mech remov tunneled cv cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,540.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36596,Mech remov tunneled cv cath,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36597,Reposition venous catheter,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,759.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36598,Inj w/fluor eval cv device,APC 5693,RVU Per Unit,$197.21 ,OP,122.24,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36600,Withdrawal of arterial blood,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36640,Insertion catheter artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,709.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36660,Insertion catheter artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36680,Insert needle bone cavity,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36800,Insertion of cannula,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36810,Insertion of cannula,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36815,Insertion of cannula,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36818,Av fuse uppr arm cephalic,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36819,Av fuse uppr arm basilic,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36820,Av fusion/forearm vein,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36821,Av fusion direct any site,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36823,Insertion of cannula(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36825,Artery-vein autograft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36830,Artery-vein nonautograft,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36831,Open thrombect av fistula,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36832,Av fistula revision open,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36833,Av fistula revision,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36835,Artery to vein shunt,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","5,851.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36838,Dist revas ligation hemo,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36860,External cannula declotting,APC 5182,RVU Per Case,"$1,362.67 ",OP,415.14,"1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36861,Cannula declotting,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36901,Intro cath dialysis circuit,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36902,Intro cath dialysis circuit,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36903,Intro cath dialysis circuit,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36904,Thrmbc/nfs dialysis circuit,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36905,Thrmbc/nfs dialysis circuit,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,36906,Thrmbc/nfs dialysis circuit,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37140,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37145,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37160,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37180,Revision of circulation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37181,Splice spleen/kidney veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37182,Insert hepatic shunt (tips),APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37183,Remove hepatic shunt (tips),APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","13,714.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37184,Prim art m-thrmbc 1st vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"7,559.11","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37187,Venous mech thrombectomy,APC 5193,RVU Per Case,"$9,732.45 ",OP,"7,559.11","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37188,Ven mechnl thrmbc repeat tx,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","7,559.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37191,Ins endovas vena cava filtr,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37192,Redo endovas vena cava filtr,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37193,Rem endovas vena cava filter,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37195,Thrombolytic therapy stroke,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,415.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37197,Remove intrvas foreign body,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37200,Transcatheter biopsy,APC 5184,RVU Per Case,"$4,622.89 ",OP,"1,229.52","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37211,Thrombolytic art therapy,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37212,Thrombolytic venous therapy,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37213,Thromblytic art/ven therapy,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37214,Cessj therapy cath removal,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37215,Transcath stent cca w/eps,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37217,Stent placemt retro carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37218,Stent placemt ante carotid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37220,Iliac revasc,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37221,Iliac revasc w/stent,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37224,Fem/popl revas w/tla,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37225,Fem/popl revas w/ather,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37226,Fem/popl revasc w/stent,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37227,Fem/popl revasc stnt & ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37228,Tib/per revasc w/tla,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37229,Tib/per revasc w/ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37230,Tib/per revasc w/stent,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37231,Tib/per revasc stent & ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37236,Open/perq place stent 1st,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37238,Open/perq place stent same,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37241,Vasc embolize/occlude venous,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37242,Vasc embolize/occlude artery,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37243,Vasc embolize/occlude organ,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37244,Vasc embolize/occlude bleed,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37246,Trluml balo angiop 1st art,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37248,Trluml balo angiop 1st vein,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37500,Endoscopy ligate perf veins,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","6,956.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37501,Vascular endoscopy procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,"4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37565,Ligation of neck vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37600,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,579.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37605,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37606,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37607,Ligation of a-v fistula,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37609,Temporal artery procedure,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37615,Ligation of neck artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37616,Ligation of chest artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37617,Ligation of abdomen artery,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37618,Ligation of extremity artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37619,Ligation of inf vena cava,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37650,Revision of major vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37660,Revision of major vein,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37700,Revise leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37718,Ligate/strip short leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37722,Ligate/strip long leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37735,Removal of leg veins/lesion,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","6,956.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37760,Ligate leg veins radical,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37761,Ligate leg veins open,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37765,Stab phleb veins xtr 10-20,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37766,Phleb veins - extrem 20+,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37780,Revision of leg vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37785,Ligate/divide/excise vein,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","4,983.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37788,Revascularization penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37790,Penile venous occlusion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,37799,Vascular surgery procedure,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38100,Removal of spleen total,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38101,Removal of spleen partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38102,Removal of spleen total,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38115,Repair of ruptured spleen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38120,Laparoscopy splenectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38129,Laparoscope proc spleen,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38206,Harvest auto stem cells,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38207,Cryopreserve stem cells,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38208,Thaw preserved stem cells,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38209,Wash harvest stem cells,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38210,T-cell depletion of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38211,Tumor cell deplete of harvst,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38212,Rbc depletion of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38213,Platelet deplete of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38214,Volume deplete of harvest,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38215,Harvest stem cell concentrte,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,384.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38220,Dx bone marrow aspirations,APC 5072,RVU Per Case,"$1,363.50 ",OP,480.94,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38221,Dx bone marrow biopsies,APC 5072,RVU Per Case,"$1,363.50 ",OP,480.94,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38222,Dx bone marrow bx & aspir,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38230,Bone marrow harvest allogen,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","4,077.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38232,Bone marrow harvest autolog,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38240,Transplt allo hct/donor,APC 5244,RVU Per Case,"$30,853.81 ",OP,"4,077.73","30,853.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38241,Transplt autol hct/donor,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","4,077.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38242,Transplt allo lymphocytes,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","2,346.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38243,Transplj hematopoietic boost,APC 5242,RVU Per Unit,"$1,321.02 ",OP,"1,321.02","1,321.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38300,Drainage lymph node lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,234.05","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38305,Drainage lymph node lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38308,Incision of lymph channels,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38380,Thoracic duct procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38381,Thoracic duct procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38382,Thoracic duct procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38500,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38505,Needle biopsy lymph nodes,APC 5072,RVU Per Case,"$1,363.50 ",OP,782.08,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38510,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38520,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38525,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38530,Biopsy/removal lymph nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38531,Open bx/exc inguinofem nodes,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","3,060.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38542,Explore deep node(s) neck,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38550,Removal neck/armpit lesion,APC 5091,RVU Per Case,"$3,060.11 ",OP,"3,060.11","4,258.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38555,Removal neck/armpit lesion,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38562,Removal pelvic lymph nodes,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38564,Removal abdomen lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38570,Laparoscopy lymph node biop,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38571,Laparoscopy lymphadenectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38572,Laparoscopy lymphadenectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38573,Laps pelvic lymphadec,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38589,Laparoscope proc lymphatic,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38700,Removal of lymph nodes neck,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38720,Removal of lymph nodes neck,APC 5093,RVU Per Case,"$8,644.27 ",OP,"4,258.79","8,644.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38724,Removal of lymph nodes neck,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38740,Remove armpit lymph nodes,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38745,Remove armpit lymph nodes,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38746,Remove thoracic lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38747,Remove abdominal lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38760,Remove groin lymph nodes,APC 5092,RVU Per Case,"$5,362.86 ",OP,"4,258.79","5,362.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38765,Remove groin lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38770,Remove pelvis lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38780,Remove abdomen lymph nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38792,Ra tracer id of sentinl node,APC 5591,RVU Per Case,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,38999,Blood/lymph system procedure,APC 5241,RVU Per Unit,$384.79 ,OP,384.79,692.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39000,Exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39010,Exploration of chest,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39200,Resect mediastinal cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39220,Resect mediastinal tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39401,Mediastinoscpy w/medstnl bx,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39402,Mediastinoscpy w/lmph nod bx,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39499,Chest procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39501,Repair diaphragm laceration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39503,Repair of diaphragm hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39540,Repair of diaphragm hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39541,Repair of diaphragm hernia,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39545,Revision of diaphragm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39560,Resect diaphragm simple,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39561,Resect diaphragm complex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,39599,Diaphragm surgery procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40490,Biopsy of lip,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40500,Partial excision of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40510,Partial excision of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40520,Partial excision of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40525,Reconstruct lip with flap,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40527,Reconstruct lip with flap,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40530,Partial removal of lip,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40650,Repair lip,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40652,Repair lip,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40654,Repair lip,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40700,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40701,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40702,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40720,Repair cleft lip/nasal,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40761,Repair cleft lip/nasal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40799,Lip surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40800,Drainage of mouth lesion,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40801,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40804,Removal foreign body mouth,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40805,Removal foreign body mouth,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40806,Incision of lip fold,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40808,Biopsy of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40810,Excision of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40812,Excise/repair mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40814,Excise/repair mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40816,Excision of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40818,Excise oral mucosa for graft,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40819,Excise lip or cheek fold,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40820,Treatment of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40830,Repair mouth laceration,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40831,Repair mouth laceration,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40840,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40842,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40843,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40844,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40845,Reconstruction of mouth,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,40899,Mouth surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41000,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41005,Drainage of mouth lesion,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41006,Drainage of mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41007,Drainage of mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41008,Drainage of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41009,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41010,Incision of tongue fold,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41015,Drainage of mouth lesion,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41016,Drainage of mouth lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41017,Drainage of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41018,Drainage of mouth lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41019,Place needles h&n for rt,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41100,Biopsy of tongue,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41105,Biopsy of tongue,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41108,Biopsy of floor of mouth,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41110,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41112,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41113,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41114,Excision of tongue lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41115,Excision of tongue fold,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41116,Excision of mouth lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41120,Partial removal of tongue,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41130,Partial removal of tongue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41135,Tongue and neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41140,Removal of tongue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41145,Tongue removal neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41150,Tongue mouth jaw surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41153,Tongue mouth neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41155,Tongue jaw & neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41250,Repair tongue laceration,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41251,Repair tongue laceration,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41252,Repair tongue laceration,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41510,Tongue to lip surgery,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41512,Tongue suspension,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41520,Reconstruction tongue fold,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41530,Tongue base vol reduction,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41599,Tongue and mouth surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41800,Drainage of gum lesion,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41805,Removal foreign body gum,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41806,Removal foreign body jawbone,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41820,Excision gum each quadrant,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41821,Excision of gum flap,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41822,Excision of gum lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41823,Excision of gum lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41825,Excision of gum lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41826,Excision of gum lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41827,Excision of gum lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41828,Excision of gum lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41830,Removal of gum tissue,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41850,Treatment of gum lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41870,Gum graft,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41872,Repair gum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41874,Repair tooth socket,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,41899,Dental surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42000,Drainage mouth roof lesion,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42100,Biopsy roof of mouth,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42104,Excision lesion mouth roof,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42106,Excision lesion mouth roof,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42107,Excision lesion mouth roof,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42120,Remove palate/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42140,Excision of uvula,APC 5164,RVU Per Case,"$2,651.79 ",OP,"1,512.50","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42145,Repair palate pharynx/uvula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42160,Treatment mouth roof lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42180,Repair palate,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42182,Repair palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42200,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42205,Reconstruct cleft palate,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42210,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42215,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42220,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42225,Reconstruct cleft palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42226,Lengthening of palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42227,Lengthening of palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42235,Repair palate,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42260,Repair nose to lip fistula,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42280,Preparation palate mold,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42281,Insertion palate prosthesis,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42299,Palate/uvula surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42300,Drainage of salivary gland,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42305,Drainage of salivary gland,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42310,Drainage of salivary gland,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42320,Drainage of salivary gland,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42330,Removal of salivary stone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42335,Removal of salivary stone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42340,Removal of salivary stone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42400,Biopsy of salivary gland,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,782.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42405,Biopsy of salivary gland,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42408,Excision of salivary cyst,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42409,Drainage of salivary cyst,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42410,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42415,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42420,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42425,Excise parotid gland/lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42426,Excise parotid gland/lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42440,Excise submaxillary gland,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42450,Excise sublingual gland,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42500,Repair salivary duct,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42505,Repair salivary duct,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42507,Parotid duct diversion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42509,Parotid duct diversion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42510,Parotid duct diversion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42600,Closure of salivary fistula,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42650,Dilation of salivary duct,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42660,Dilation of salivary duct,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42665,Ligation of salivary duct,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42699,Salivary surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42700,Drainage of tonsil abscess,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42720,Drainage of throat abscess,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42725,Drainage of throat abscess,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42800,Biopsy of throat,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42804,Biopsy of upper nose/throat,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42806,Biopsy of upper nose/throat,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42808,Excise pharynx lesion,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42809,Remove pharynx foreign body,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42810,Excision of neck cyst,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42815,Excision of neck cyst,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42820,Remove tonsils and adenoids,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42821,Remove tonsils and adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42825,Removal of tonsils,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42826,Removal of tonsils,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42830,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42831,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42835,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42836,Removal of adenoids,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42842,Extensive surgery of throat,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42844,Extensive surgery of throat,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42845,Extensive surgery of throat,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42860,Excision of tonsil tags,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,429.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42870,Excision of lingual tonsil,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,429.92","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42890,Partial removal of pharynx,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42892,Revision of pharyngeal walls,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42894,Revision of pharyngeal walls,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42900,Repair throat wound,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42950,Reconstruction of throat,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42953,Repair throat esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42955,Surgical opening of throat,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42960,Control throat bleeding,APC 5162,RVU Per Unit,$438.38 ,OP,236.18,438.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42961,Control throat bleeding,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42962,Control throat bleeding,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42970,Control nose/throat bleeding,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,236.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42971,Control nose/throat bleeding,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42972,Control nose/throat bleeding,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,42999,Throat surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43020,Incision of esophagus,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43030,Throat muscle surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"3,290.24","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43045,Incision of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43100,Excision of esophagus lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43101,Excision of esophagus lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43107,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43108,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43112,Esphg tot w/thrcm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43113,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43116,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43117,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43118,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43121,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43122,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43123,Partial removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43124,Removal of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43130,Removal of esophagus pouch,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43135,Removal of esophagus pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43180,Esophagoscopy rigid trnso,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43191,Esophagoscopy rigid trnso dx,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43192,Esophagoscp rig trnso inject,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43193,Esophagoscp rig trnso biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43194,Esophagoscp rig trnso rem fb,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43195,Esophagoscopy rigid balloon,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43196,Esophagoscp guide wire dilat,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43197,Esophagoscopy flex dx brush,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43198,Esophagosc flex trnsn biopsy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43200,Esophagoscopy flexible brush,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43201,Esoph scope w/submucous inj,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43202,Esophagoscopy flex biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43204,Esoph scope w/sclerosis inj,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43205,Esophagus endoscopy/ligation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43206,Esoph optical endomicroscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43210,Egd esophagogastrc fndoplsty,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43211,Esophagoscop mucosal resect,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43212,Esophagoscop stent placement,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43213,Esophagoscopy retro balloon,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43214,Esophagosc dilate balloon 30,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43215,Esophagoscopy flex remove fb,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43216,Esophagoscopy lesion removal,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43217,Esophagoscopy snare les remv,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43220,Esophagoscopy balloon <30mm,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43226,Esoph endoscopy dilation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43227,Esophagoscopy control bleed,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43229,Esophagoscopy lesion ablate,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43231,Esophagoscop ultrasound exam,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43232,Esophagoscopy w/us needle bx,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43233,Egd balloon dil esoph30 mm/>,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43235,Egd diagnostic brush wash,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43236,Uppr gi scope w/submuc inj,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43237,Endoscopic us exam esoph,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43238,Egd us fine needle bx/aspir,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43239,Egd biopsy single/multiple,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43240,Egd w/transmural drain cyst,APC 5303,RVU Per Case,"$2,985.55 ",OP,"1,665.98","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43241,Egd tube/cath insertion,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43242,Egd us fine needle bx/aspir,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43243,Egd injection varices,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43244,Egd varices ligation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43245,Egd dilate stricture,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43246,Egd place gastrostomy tube,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43247,Egd remove foreign body,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43248,Egd guide wire insertion,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43249,Esoph egd dilation <30 mm,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43250,Egd cautery tumor polyp,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43251,Egd remove lesion snare,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43252,Egd optical endomicroscopy,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43253,Egd us transmural injxn/mark,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43254,Egd endo mucosal resection,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43255,Egd control bleeding any,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43257,Egd w/thrml txmnt gerd,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","5,158.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43259,Egd us exam duodenum/jejunum,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43260,Ercp w/specimen collection,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43261,Endo cholangiopancreatograph,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43262,Endo cholangiopancreatograph,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43263,Ercp sphincter pressure meas,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43264,Ercp remove duct calculi,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","3,973.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43265,Ercp lithotripsy calculi,APC 5331,RVU Per Case,"$4,873.06 ",OP,"3,973.57","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43266,Egd endoscopic stent place,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43270,Egd lesion ablation,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43274,Ercp duct stent placement,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43275,Ercp remove forgn body duct,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43276,Ercp stent exchange w/dilate,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43277,Ercp ea duct/ampulla dilate,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43278,Ercp lesion ablate w/dilate,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43279,Lap myotomy heller,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43280,Laparoscopy fundoplasty,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43281,Lap paraesophag hern repair,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43282,Lap paraesoph her rpr w/mesh,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43283,Lap esoph lengthening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43284,Laps esophgl sphnctr agmntj,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43285,Rmvl esophgl sphnctr dev,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43286,Esphg tot w/laps moblj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43287,Esphg dstl 2/3 w/laps moblj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43288,Esphg thrsc moblj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43289,Laparoscope proc esoph,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43300,Repair of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43305,Repair esophagus and fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43310,Repair of esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43312,Repair esophagus and fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43313,Esophagoplasty congenital,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43314,Tracheo-esophagoplasty cong,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43320,Fuse esophagus & stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43325,Revise esophagus & stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43327,Esoph fundoplasty lap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43328,Esoph fundoplasty thor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43330,Esophagomyotomy abdominal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43331,Esophagomyotomy thoracic,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43332,Transab esoph hiat hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43333,Transab esoph hiat hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43334,Transthor diaphrag hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43335,Transthor diaphrag hern rpr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43336,Thorabd diaphr hern repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43337,Thorabd diaphr hern repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43338,Esoph lengthening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43340,Fuse esophagus & intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43341,Fuse esophagus & intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43351,Surgical opening esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43352,Surgical opening esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43360,Gastrointestinal repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43361,Gastrointestinal repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43400,Ligate esophagus veins,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43405,Ligate/staple esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43410,Repair esophagus wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43415,Repair esophagus wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43420,Repair esophagus opening,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43425,Repair esophagus opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43450,Dilate esophagus 1/mult pass,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,092.95",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43453,Dilate esophagus,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,092.95","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43460,Pressure treatment esophagus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43496,Free jejunum flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43499,Esophagus surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43500,Surgical opening of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43501,Surgical repair of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43502,Surgical repair of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43510,Surgical opening of stomach,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43520,Incision of pyloric muscle,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43605,Biopsy of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43610,Excision of stomach lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43611,Excision of stomach lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43620,Removal of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43621,Removal of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43622,Removal of stomach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43631,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43632,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43633,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43634,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43635,Removal of stomach partial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43640,Vagotomy & pylorus repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43641,Vagotomy & pylorus repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43644,Lap gastric bypass/roux-en-y,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43645,Lap gastr bypass incl smll i,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43647,Lap impl electrode antrum,APC 5463,RVU Per Case,"$10,888.82 ",OP,"6,434.45","10,888.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43648,Lap revise/remv eltrd antrum,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43651,Laparoscopy vagus nerve,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43652,Laparoscopy vagus nerve,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43653,Laparoscopy gastrostomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43659,Laparoscope proc stom,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43752,Nasal/orogastric w/tube plmt,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43753,Tx gastro intub w/asp,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43754,Dx gastr intub w/asp spec,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43755,Dx gastr intub w/asp specs,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43756,Dx duod intub w/asp spec,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43757,Dx duod intub w/asp specs,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43761,Reposition gastrostomy tube,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,"1,498.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43762,Rplc gtube no revj trc,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43763,Rplc gtube revj gstrst trc,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43770,Lap place gastr adj device,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43771,Lap revise gastr adj device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43772,Lap rmvl gastr adj device,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43773,Lap replace gastr adj device,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43774,Lap rmvl gastr adj all parts,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43775,Lap sleeve gastrectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43800,Reconstruction of pylorus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43810,Fusion of stomach and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43820,Fusion of stomach and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43825,Fusion of stomach and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43830,Place gastrostomy tube,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","5,158.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43831,Place gastrostomy tube,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43832,Place gastrostomy tube,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43840,Repair of stomach lesion,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43843,Gastroplasty w/o v-band,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43845,Gastroplasty duodenal switch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43846,Gastric bypass for obesity,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43847,Gastric bypass incl small i,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43848,Revision gastroplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43850,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43855,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43860,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43865,Revise stomach-bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43870,Repair stomach opening,APC 5303,RVU Per Case,"$2,985.55 ",OP,"1,665.98","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43880,Repair stomach-bowel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43881,Impl/redo electrd antrum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43882,Revise/remove electrd antrum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43886,Revise gastric port open,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"1,053.46","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43887,Remove gastric port open,APC 5054,RVU Per Case,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43888,Change gastric port open,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"2,811.11","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,43999,Stomach surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44005,Freeing of bowel adhesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44010,Incision of small bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44015,Insert needle cath bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44020,Explore small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44021,Decompress small bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44025,Incision of large bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44050,Reduce bowel obstruction,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44055,Correct malrotation of bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44100,Biopsy of bowel,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,665.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44110,Excise intestine lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44111,Excision of bowel lesion(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44120,Removal of small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44121,Removal of small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44125,Removal of small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44126,Enterectomy w/o taper cong,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44127,Enterectomy w/taper cong,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44128,Enterectomy cong add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44130,Bowel to bowel fusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44132,Enterectomy cadaver donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44133,Enterectomy live donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44135,Intestine transplnt cadaver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44136,Intestine transplant live,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44137,Remove intestinal allograft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44139,Mobilization of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44140,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44141,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44143,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44144,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44145,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44146,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44147,Partial removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44150,Removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44151,Removal of colon/ileostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44155,Removal of colon/ileostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44156,Removal of colon/ileostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44157,Colectomy w/ileoanal anast,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44158,Colectomy w/neo-rectum pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44160,Removal of colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44180,Lap enterolysis,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44186,Lap jejunostomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44187,Lap ileo/jejuno-stomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44188,Lap colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44202,Lap enterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44203,Lap resect s/intestine addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44204,Laparo partial colectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44205,Lap colectomy part w/ileum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44206,Lap part colectomy w/stoma,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44207,L colectomy/coloproctostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44208,L colectomy/coloproctostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44210,Laparo total proctocolectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44211,Lap colectomy w/proctectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44212,Laparo total proctocolectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44213,Lap mobil splenic fl add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44227,Lap close enterostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44238,Laparoscope proc intestine,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44300,Open bowel to skin,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44310,Ileostomy/jejunostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44312,Revision of ileostomy,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44314,Revision of ileostomy,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","3,413.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44316,Devise bowel pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44320,Colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44322,Colostomy with biopsies,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44340,Revision of colostomy,APC 5055,RVU Per Unit,"$3,413.26 ",OP,"3,413.26","4,292.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44345,Revision of colostomy,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44346,Revision of colostomy,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44360,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44361,Small bowel endoscopy/biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44363,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44364,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44365,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44366,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44369,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44370,Small bowel endoscopy/stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44372,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44373,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44376,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44377,Small bowel endoscopy/biopsy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44378,Small bowel endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44379,S bowel endoscope w/stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44380,Small bowel endoscopy br/wa,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44381,Small bowel endoscopy br/wa,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44382,Small bowel endoscopy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"1,901.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44384,Small bowel endoscopy,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44385,Endoscopy of bowel pouch,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44386,Endoscopy bowel pouch/biop,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44388,Colonoscopy thru stoma spx,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44389,Colonoscopy with biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44390,Colonoscopy for foreign body,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44391,Colonoscopy for bleeding,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44392,Colonoscopy & polypectomy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44394,Colonoscopy w/snare,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44401,Colonoscopy with ablation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44402,Colonoscopy w/stent plcmt,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44403,Colonoscopy w/resection,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44404,Colonoscopy w/injection,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44405,Colonoscopy w/dilation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44406,Colonoscopy w/ultrasound,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44407,Colonoscopy w/ndl aspir/bx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44408,Colonoscopy w/decompression,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44500,Intro gastrointestinal tube,APC 5301,RVU Per Unit,$784.57 ,OP,472.44,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44602,Suture small intestine,APC 5303,RVU Per Case,"$2,985.55 ",OP,"2,985.55","2,985.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44603,Suture small intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44604,Suture large intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44605,Repair of bowel lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44615,Intestinal stricturoplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44620,Repair bowel opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44625,Repair bowel opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44626,Repair bowel opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44640,Repair bowel-skin fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44650,Repair bowel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44660,Repair bowel-bladder fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44661,Repair bowel-bladder fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44680,Surgical revision intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44700,Suspend bowel w/prosthesis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44715,Prepare donor intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44720,Prep donor intestine/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44721,Prep donor intestine/artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44799,Unlisted px small intestine,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"4,423.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44800,Excision of bowel pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44820,Excision of mesentery lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44850,Repair of mesentery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44899,Bowel surgery procedure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44900,Drain appendix abscess open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44950,Appendectomy,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44960,Appendectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44970,Laparoscopy appendectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,44979,Laparoscope proc app,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45000,Drainage of pelvic abscess,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45005,Drainage of rectal abscess,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","2,551.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45020,Drainage of rectal abscess,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45100,Biopsy of rectum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45108,Removal of anorectal lesion,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45110,Removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45111,Partial removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45112,Removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45113,Partial proctectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45114,Partial removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45116,Partial removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45119,Remove rectum w/reservoir,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45120,Removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45121,Removal of rectum and colon,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45123,Partial proctectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45126,Pelvic exenteration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45130,Excision of rectal prolapse,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45135,Excision of rectal prolapse,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45136,Excise ileoanal reservior,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45150,Excision of rectal stricture,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45160,Excision of rectal lesion,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45171,Exc rect tum transanal part,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45172,Exc rect tum transanal full,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45190,Destruction rectal tumor,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45300,Proctosigmoidoscopy dx,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45303,Proctosigmoidoscopy dilate,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45305,Proctosigmoidoscopy w/bx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45307,Proctosigmoidoscopy fb,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45308,Proctosigmoidoscopy removal,APC 5313,RVU Per Case,"$2,367.85 ",OP,"1,712.09","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45309,Proctosigmoidoscopy removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45315,Proctosigmoidoscopy removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45317,Proctosigmoidoscopy bleed,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45320,Proctosigmoidoscopy ablate,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45321,Proctosigmoidoscopy volvul,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45327,Proctosigmoidoscopy w/stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,596.38","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45330,Diagnostic sigmoidoscopy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45331,Sigmoidoscopy and biopsy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45332,Sigmoidoscopy w/fb removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,975.12,"1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45333,Sigmoidoscopy & polypectomy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45334,Sigmoidoscopy for bleeding,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45335,Sigmoidoscopy w/submuc inj,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45337,Sigmoidoscopy & decompress,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,975.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45338,Sigmoidoscopy w/tumr remove,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45340,Sig w/tndsc balloon dilation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45341,Sigmoidoscopy w/ultrasound,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45342,Sigmoidoscopy w/us guide bx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45346,Sigmoidoscopy w/ablation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45347,Sigmoidoscopy w/plcmt stent,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45349,Sigmoidoscopy w/resection,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45350,Sgmdsc w/band ligation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45378,Diagnostic colonoscopy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45379,Colonoscopy w/fb removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45380,Colonoscopy and biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45381,Colonoscopy submucous njx,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45382,Colonoscopy w/control bleed,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45384,Colonoscopy w/lesion removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45385,Colonoscopy w/lesion removal,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45386,Colonoscopy w/balloon dilat,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45388,Colonoscopy w/ablation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45389,Colonoscopy w/stent plcmt,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45390,Colonoscopy w/resection,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45391,Colonoscopy w/endoscope us,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45392,Colonoscopy w/endoscopic fnb,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,756.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45393,Colonoscopy w/decompression,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45395,Lap removal of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45397,Lap remove rectum w/pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45398,Colonoscopy w/band ligation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45399,Unlisted procedure colon,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45400,Laparoscopic proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45402,Lap proctopexy w/sig resect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45499,Laparoscope proc rectum,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45500,Repair of rectum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45505,Repair of rectum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45520,Treatment of rectal prolapse,APC 5311,RVU Per Case,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45540,Correct rectal prolapse,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45541,Correct rectal prolapse,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45550,Repair rectum/remove sigmoid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45560,Repair of rectocele,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45562,Exploration/repair of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45563,Exploration/repair of rectum,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45800,Repair rect/bladder fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45805,Repair fistula w/colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45820,Repair rectourethral fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45825,Repair fistula w/colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45900,Reduction of rectal prolapse,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45905,Dilation of anal sphincter,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45910,Dilation of rectal narrowing,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45915,Remove rectal obstruction,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45990,Surg dx exam anorectal,APC 5313,RVU Per Case,"$2,367.85 ",OP,"1,016.91","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,45999,Rectum surgery procedure,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46020,Placement of seton,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46030,Removal of rectal marker,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46040,Incision of rectal abscess,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46045,Incision of rectal abscess,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46050,Incision of anal abscess,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46060,Incision of rectal abscess,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46070,Incision of anal septum,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46080,Incision of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46083,Incise external hemorrhoid,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46200,Removal of anal fissure,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46220,Excise anal ext tag/papilla,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46221,Ligation of hemorrhoid(s),APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46230,Removal of anal tags,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46250,Remove ext hem groups 2+,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46255,Remove int/ext hem 1 group,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46257,Remove in/ex hem grp & fiss,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46258,Remove in/ex hem grp w/fistu,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46260,Remove in/ex hem groups 2+,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46261,Remove in/ex hem grps & fiss,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46262,Remove in/ex hem grps w/fist,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46270,Remove anal fist subq,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46275,Remove anal fist inter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46280,Remove anal fist complex,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46285,Remove anal fist 2 stage,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46288,Repair anal fistula,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46320,Removal of hemorrhoid clot,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","2,551.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46500,Injection into hemorrhoid(s),APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"2,551.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46505,Chemodenervation anal musc,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46600,Diagnostic anoscopy spx,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46601,Diagnostic anoscopy,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46604,Anoscopy and dilation,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46606,Anoscopy and biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,975.12,"1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46607,Diagnostic anoscopy & biopsy,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46608,Anoscopy remove for body,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46610,Anoscopy remove lesion,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46611,Anoscopy,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,712.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46612,Anoscopy remove lesions,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46614,Anoscopy control bleeding,APC 5312,RVU Per Unit,"$1,004.90 ",OP,975.12,"1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46615,Anoscopy,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,133.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46700,Repair of anal stricture,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46705,Repair of anal stricture,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46706,Repr of anal fistula w/glue,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46707,Repair anorectal fist w/plug,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46710,Repr per/vag pouch sngl proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46712,Repr per/vag pouch dbl proc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46715,Rep perf anoper fistu,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46716,Rep perf anoper/vestib fistu,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46730,Construction of absent anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46735,Construction of absent anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46740,Construction of absent anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46742,Repair of imperforated anus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46744,Repair of cloacal anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46746,Repair of cloacal anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46748,Repair of cloacal anomaly,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46750,Repair of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46751,Repair of anal sphincter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46753,Reconstruction of anus,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46754,Removal of suture from anus,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46760,Repair of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46761,Repair of anal sphincter,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","7,591.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46900,Destruction anal lesion(s),APC 5052,RVU Per Unit,$335.15 ,OP,335.15,535.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46910,Destruction anal lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46916,Cryosurgery anal lesion(s),APC 5051,RVU Per Unit,$173.99 ,OP,173.99,218.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46917,Laser surgery anal lesions,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46922,Excision of anal lesion(s),APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46924,Destruction anal lesion(s),APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,091.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46930,Destroy internal hemorrhoids,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46940,Treatment of anal fissure,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","4,460.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46942,Treatment of anal fissure,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46945,Int hrhc lig 1 hroid w/o img,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46946,Int hrhc lig 2+hroid w/o img,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,551.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46947,Hemorrhoidopexy by stapling,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","5,932.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46948,Int hrhc tranal dartlzj 2+,APC 5313,RVU Per Case,"$2,367.85 ",OP,"2,367.85","2,367.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,46999,Anus surgery procedure,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,"1,016.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47000,Needle biopsy of liver,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47010,Open drainage liver lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47015,Inject/aspirate liver cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47100,Wedge biopsy of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47120,Partial removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47122,Extensive removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47125,Partial removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47130,Partial removal of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47133,Removal of donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47135,Transplantation of liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47140,Partial removal donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47141,Partial removal donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47142,Partial removal donor liver,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47143,Prep donor liver whole,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47144,Prep donor liver 3-segment,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47145,Prep donor liver lobe split,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47146,Prep donor liver/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47147,Prep donor liver/arterial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47300,Surgery for liver lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47350,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47360,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47361,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47362,Repair liver wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47370,Laparo ablate liver tumor rf,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47371,Laparo ablate liver cryosurg,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47379,Laparoscope procedure liver,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47380,Open ablate liver tumor rf,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47381,Open ablate liver tumor cryo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47382,Percut ablate liver rf,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47383,Perq abltj lvr cryoablation,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47399,Liver surgery procedure,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47400,Incision of liver duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47420,Incision of bile duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47425,Incision of bile duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47460,Incise bile duct sphincter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47480,Incision of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47490,Incision of gallbladder,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47531,Injection for cholangiogram,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47532,Injection for cholangiogram,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47533,Plmt biliary drainage cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47534,Plmt biliary drainage cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47535,Conversion ext bil drg cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47536,Exchange biliary drg cath,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47537,Removal biliary drg cath,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47538,Perq plmt bile duct stent,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47539,Perq plmt bile duct stent,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47540,Perq plmt bile duct stent,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47541,Plmt access bil tree sm bwl,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47550,Bile duct endoscopy add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47552,Biliary endo perq dx w/speci,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47553,Biliary endoscopy thru skin,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47554,Biliary endoscopy thru skin,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,059.72","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47555,Biliary endoscopy thru skin,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,059.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47556,Biliary endoscopy thru skin,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,059.72","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47562,Laparoscopic cholecystectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47563,Laparo cholecystectomy/graph,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47564,Laparo cholecystectomy/explr,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","10,136.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47570,Laparo cholecystoenterostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47579,Laparoscope proc biliary,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47600,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47605,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47610,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47612,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47620,Removal of gallbladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47700,Exploration of bile ducts,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47701,Bile duct revision,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47711,Excision of bile duct tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47712,Excision of bile duct tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47715,Excision of bile duct cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47720,Fuse gallbladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47721,Fuse upper gi structures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47740,Fuse gallbladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47741,Fuse gallbladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47760,Fuse bile ducts and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47765,Fuse liver ducts & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47780,Fuse bile ducts and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47785,Fuse bile ducts and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47800,Reconstruction of bile ducts,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47801,Placement bile duct support,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47802,Fuse liver duct & intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47900,Suture bile duct injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,47999,Bile tract surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"4,059.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48000,Drainage of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48001,Placement of drain pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48020,Removal of pancreatic stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48100,Biopsy of pancreas open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48102,Needle biopsy pancreas,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48105,Resect/debride pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48120,Removal of pancreas lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48140,Partial removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48145,Partial removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48146,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48148,Removal of pancreatic duct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48150,Partial removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48152,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48153,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48154,Pancreatectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48155,Removal of pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48400,Injection intraop add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48500,Surgery of pancreatic cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48510,Drain pancreatic pseudocyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48520,Fuse pancreas cyst and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48540,Fuse pancreas cyst and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48545,Pancreatorrhaphy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48547,Duodenal exclusion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48548,Fuse pancreas and bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48551,Prep donor pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48552,Prep donor pancreas/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48554,Transpl allograft pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48556,Removal allograft pancreas,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,48999,Pancreas surgery procedure,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49000,Exploration of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49002,Reopening of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49010,Exploration behind abdomen,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49013,Prpertl pel pack hemrrg trma,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49014,Reexploration pelvic wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49020,Drainage abdom abscess open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49040,Drain open abdom abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49060,Drain open retroperi abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49062,Drain to peritoneal cavity,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49082,Abd paracentesis,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49083,Abd paracentesis w/imaging,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49084,Peritoneal lavage,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49180,Biopsy abdominal mass,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49185,Sclerotx fluid collection,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49203,Exc abd tum 5 cm or less,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49204,Exc abd tum over 5 cm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49205,Exc abd tum over 10 cm,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49215,Excise sacral spine tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49250,Excision of umbilicus,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49255,Removal of omentum,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49320,Diag laparo separate proc,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49321,Laparoscopy biopsy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49322,Laparoscopy aspiration,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49323,Laparo drain lymphocele,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49324,Lap insert tunnel ip cath,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49325,Lap revision perm ip cath,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49329,Laparo proc abdm/per/oment,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49402,Remove foreign body adbomen,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49405,Image cath fluid colxn visc,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49406,Image cath fluid peri/retro,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49407,Image cath fluid trns/vgnl,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49411,Ins mark abd/pel for rt perq,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49412,Ins device for rt guide open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49418,Insert tun ip cath perc,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49419,Insert tun ip cath w/port,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","5,851.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49421,Ins tun ip cath for dial opn,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,917.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49422,Remove tunneled ip cath,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49423,Exchange drainage catheter,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","2,334.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49425,Insert abdomen-venous drain,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49426,Revise abdomen-venous shunt,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","4,423.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49428,Ligation of shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49429,Removal of shunt,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49436,Embedded ip cath exit-site,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","2,334.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49440,Place gastrostomy tube perc,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49441,Place duod/jej tube perc,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49442,Place cecostomy tube perc,APC 5312,RVU Per Unit,"$1,004.90 ",OP,"1,004.90","1,004.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49446,Change g-tube to g-j perc,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49450,Replace g/c tube perc,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49451,Replace duod/jej tube perc,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49452,Replace g-j tube perc,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49460,Fix g/colon tube w/device,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49465,Fluoro exam of g/colon tube,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49491,Rpr hern preemie reduc,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49492,Rpr ing hern premie blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49495,Rpr ing hernia baby reduc,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49496,Rpr ing hernia baby blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49500,Rpr ing hernia init reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49501,Rpr ing hernia init blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49505,Prp i/hern init reduc >5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49507,Prp i/hern init block >5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49520,Rerepair ing hernia reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49521,Rerepair ing hernia blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","7,751.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49525,Repair ing hernia sliding,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49540,Repair lumbar hernia,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49550,Rpr rem hernia init reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49553,Rpr fem hernia init blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49555,Rerepair fem hernia reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49557,Rerepair fem hernia blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49560,Rpr ventral hern init reduc,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49561,Rpr ventral hern init block,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49565,Rerepair ventrl hern reduce,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49566,Rerepair ventrl hern block,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49570,Rpr epigastric hern reduce,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49572,Rpr epigastric hern blocked,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49580,Rpr umbil hern reduc < 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49582,Rpr umbil hern block < 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49585,Rpr umbil hern reduc > 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49587,Rpr umbil hern block > 5 yr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49590,Repair spigelian hernia,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49600,Repair umbilical lesion,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49605,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49606,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49610,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49611,Repair umbilical lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49650,Lap ing hernia repair init,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49651,Lap ing hernia repair recur,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49652,Lap vent/abd hernia repair,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49653,Lap vent/abd hern proc comp,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","4,903.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49654,Lap inc hernia repair,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49655,Lap inc hern repair comp,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49656,Lap inc hernia repair recur,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49657,Lap inc hern recur comp,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49659,Laparo proc hernia repair,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49900,Repair of abdominal wall,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49904,Omental flap extra-abdom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49905,Omental flap intra-abdom,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49906,Free omental flap microvasc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,49999,Abdomen surgery procedure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,"4,423.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50010,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50020,Renal abscess open drain,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50040,Drainage of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50045,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50060,Removal of kidney stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50065,Incision of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50070,Incision of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50075,Removal of kidney stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50080,Removal of kidney stone,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,632.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50081,Removal of kidney stone,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,632.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50100,Revise kidney blood vessels,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50120,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50125,Explore and drain kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50130,Removal of kidney stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50135,Exploration of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50200,Renal biopsy perq,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50205,Renal biopsy open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50220,Remove kidney open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50225,Removal kidney open complex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50230,Removal kidney open radical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50234,Removal of kidney & ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50236,Removal of kidney & ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50240,Partial removal of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50250,Cryoablate renal mass open,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50280,Removal of kidney lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50290,Removal of kidney lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50300,Remove cadaver donor kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50320,Remove kidney living donor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50323,Prep cadaver renal allograft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50325,Prep donor renal graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50327,Prep renal graft/venous,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50328,Prep renal graft/arterial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50329,Prep renal graft/ureteral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50340,Removal of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50360,Transplantation of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50365,Transplantation of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50370,Remove transplanted kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50380,Reimplantation of kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50382,Change ureter stent percut,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50384,Remove ureter stent percut,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50385,Change stent via transureth,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50386,Remove stent via transureth,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50387,Change nephroureteral cath,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,498.24","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50389,Remove renal tube w/fluoro,APC 5372,RVU Per Case,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50390,Drainage of kidney lesion,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,"1,229.52",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50391,Instll rx agnt into rnal tub,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50396,Measure kidney pressure,APC 5372,RVU Per Unit,$557.00 ,OP,428.48,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50400,Revision of kidney/ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50405,Revision of kidney/ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50430,Njx px nfrosgrm &/urtrgrm,APC 5372,RVU Per Case,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50431,Njx px nfrosgrm &/urtrgrm,APC 5372,RVU Per Case,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50432,Plmt nephrostomy catheter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50433,Plmt nephroureteral catheter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50434,Convert nephrostomy catheter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50435,Exchange nephrostomy cath,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50436,Dilat xst trc ndurlgc px,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50437,Dilat xst trc new access rcs,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50500,Repair of kidney wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50520,Close kidney-skin fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50525,Close nephrovisceral fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50526,Close nephrovisceral fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50540,Revision of horseshoe kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50541,Laparo ablate renal cyst,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50542,Laparo ablate renal mass,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50543,Laparo partial nephrectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50544,Laparoscopy pyeloplasty,APC 5362,RVU Per Case,"$8,632.26 ",OP,"6,434.45","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50545,Laparo radical nephrectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50546,Laparoscopic nephrectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50547,Laparo removal donor kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50548,Laparo remove w/ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50549,Laparoscope proc renal,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50551,Kidney endoscopy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"1,300.97","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50553,Kidney endoscopy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50555,Kidney endoscopy & biopsy,APC 5376,RVU Per Case,"$8,002.82 ",OP,"1,300.97","8,002.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50557,Kidney endoscopy & treatment,APC 5376,RVU Per Case,"$8,002.82 ",OP,"4,781.15","8,002.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50561,Kidney endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50562,Renal scope w/tumor resect,APC 5376,RVU Per Case,"$8,002.82 ",OP,"1,300.97","8,002.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50570,Kidney endoscopy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50572,Kidney endoscopy,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,300.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50574,Kidney endoscopy & biopsy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50575,Kidney endoscopy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50576,Kidney endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50580,Kidney endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50590,Fragmenting of kidney stone,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","8,721.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50592,Perc rf ablate renal tumor,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,483.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50593,Perc cryo ablate renal tum,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50600,Exploration of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50605,Insert ureteral support,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50610,Removal of ureter stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50620,Removal of ureter stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50630,Removal of ureter stone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50650,Removal of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50660,Removal of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50686,Measure ureter pressure,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50688,Change of ureter tube/stent,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,498.24","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50693,Plmt ureteral stent prq,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50694,Plmt ureteral stent prq,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50695,Plmt ureteral stent prq,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50700,Revision of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50715,Release of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50722,Release of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50725,Release/revise ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50727,Revise ureter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50728,Revise ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50740,Fusion of ureter & kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50750,Fusion of ureter & kidney,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50760,Fusion of ureters,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50770,Splicing of ureters,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50780,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50782,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50783,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50785,Reimplant ureter in bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50800,Implant ureter in bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50810,Fusion of ureter & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50815,Urine shunt to intestine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50820,Construct bowel bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50825,Construct bowel bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50830,Revise urine flow,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50840,Replace ureter by bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50845,Appendico-vesicostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50860,Transplant ureter to skin,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50900,Repair of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50920,Closure ureter/skin fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50930,Closure ureter/bowel fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50940,Release of ureter,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50945,Laparoscopy ureterolithotomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50947,Laparo new ureter/bladder,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50948,Laparo new ureter/bladder,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50949,Laparoscope proc ureter,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50951,Endoscopy of ureter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50953,Endoscopy of ureter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50955,Ureter endoscopy & biopsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50957,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50961,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50970,Ureter endoscopy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50972,Ureter endoscopy & catheter,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50974,Ureter endoscopy & biopsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50976,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,50980,Ureter endoscopy & treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51020,Incise & treat bladder,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51030,Incise & treat bladder,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51040,Incise & drain bladder,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51045,Incise bladder/drain ureter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51050,Removal of bladder stone,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51060,Removal of ureter stone,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51065,Remove ureter calculus,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51080,Drainage of bladder abscess,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51100,Drain bladder by needle,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51101,Drain bladder by trocar/cath,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51102,Drain bl w/cath insertion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51500,Removal of bladder cyst,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51520,Removal of bladder lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51525,Removal of bladder lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51530,Removal of bladder lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51535,Repair of ureter lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51550,Partial removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51555,Partial removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51565,Revise bladder & ureter(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51570,Removal of bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51575,Removal of bladder & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51580,Remove bladder/revise tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51585,Removal of bladder & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51590,Remove bladder/revise tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51595,Remove bladder/revise tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51596,Remove bladder/create pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51597,Removal of pelvic structures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51700,Irrigation of bladder,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51701,Insert bladder catheter,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51702,Insert temp bladder cath,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51703,Insert bladder cath complex,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51705,Change of bladder tube,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,472.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51710,Change of bladder tube,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,498.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51715,Endoscopic injection/implant,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51720,Treatment of bladder lesion,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51725,Simple cystometrogram,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51726,Complex cystometrogram,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,682.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51727,Cystometrogram w/up,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51728,Cystometrogram w/vp,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51729,Cystometrogram w/vp&up,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51736,Urine flow measurement,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51741,Electro-uroflowmetry first,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51784,Anal/urinary muscle study,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51785,Anal/urinary muscle study,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51792,Urinary reflex study,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51798,Us urine capacity measure,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51800,Revision of bladder/urethra,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51820,Revision of urinary tract,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51840,Attach bladder/urethra,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51841,Attach bladder/urethra,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51845,Repair bladder neck,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51860,Repair of bladder wound,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51865,Repair of bladder wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51880,Repair of bladder opening,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51900,Repair bladder/vagina lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51920,Close bladder-uterus fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51925,Hysterectomy/bladder repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51940,Correction of bladder defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51960,Revision of bladder & bowel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51980,Construct bladder opening,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51990,Laparo urethral suspension,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51992,Laparo sling operation,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,51999,Laparoscope proc bla,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52000,Cystoscopy,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,300.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52001,Cystoscopy removal of clots,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,300.97","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52005,Cystoscopy & ureter catheter,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52007,Cystoscopy and biopsy,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52010,Cystoscopy & duct catheter,APC 5372,RVU Per Unit,$557.00 ,OP,557,"1,300.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52204,Cystoscopy w/biopsy(s),APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52214,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52224,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52234,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52235,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52240,Cystoscopy and treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52250,Cystoscopy and radiotracer,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52260,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52265,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52270,Cystoscopy & revise urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52275,Cystoscopy & revise urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52276,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52277,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52281,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52282,Cystoscopy implant stent,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,995.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52283,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52285,Cystoscopy and treatment,APC 5372,RVU Per Unit,$557.00 ,OP,557,"3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52287,Cystoscopy chemodenervation,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52290,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52300,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52301,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52305,Cystoscopy and treatment,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,850.78","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52310,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,300.97","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52315,Cystoscopy and treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52317,Remove bladder stone,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52318,Remove bladder stone,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52320,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52325,Cystoscopy stone removal,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52327,Cystoscopy inject material,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52330,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52332,Cystoscopy and treatment,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52334,Create passage to kidney,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52341,Cysto w/ureter stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52342,Cysto w/up stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52343,Cysto w/renal stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52344,Cysto/uretero stricture tx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52345,Cysto/uretero w/up stricture,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52346,Cystouretero w/renal strict,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52351,Cystouretero & or pyeloscope,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52352,Cystouretero w/stone remove,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52353,Cystouretero w/lithotripsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52354,Cystouretero w/biopsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52355,Cystouretero w/excise tumor,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52356,Cysto/uretero w/lithotripsy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52400,Cystouretero w/congen repr,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52402,Cystourethro cut ejacul duct,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52450,Incision of prostate,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52500,Revision of bladder neck,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52601,Prostatectomy (turp),APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52630,Remove prostate regrowth,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,995.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52640,Relieve bladder contracture,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52647,Laser surgery of prostate,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","8,632.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52648,Laser surgery of prostate,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","8,632.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52649,Prostate laser enucleation,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,52700,Drainage of prostate abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53000,Incision of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53010,Incision of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53020,Incision of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53025,Incision of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53040,Drainage of urethra abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53060,Drainage of urethra abscess,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53080,Drainage of urinary leakage,APC 5372,RVU Per Unit,$557.00 ,OP,557,"3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53085,Drainage of urinary leakage,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53200,Biopsy of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53210,Removal of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53215,Removal of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53220,Treatment of urethra lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53230,Removal of urethra lesion,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53235,Removal of urethra lesion,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53240,Surgery for urethra pouch,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53250,Removal of urethra gland,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53260,Treatment of urethra lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53265,Treatment of urethra lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53270,Removal of urethra gland,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53275,Repair of urethra defect,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53400,Revise urethra stage 1,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53405,Revise urethra stage 2,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53410,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53415,Reconstruction of urethra,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53420,Reconstruct urethra stage 1,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53425,Reconstruct urethra stage 2,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53430,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53431,Reconstruct urethra/bladder,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53440,Male sling procedure,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","15,865.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53442,Remove/revise male sling,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53444,Insert tandem cuff,APC 5378,RVU Per Case,"$17,693.87 ",OP,"15,865.56","17,693.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53445,Insert uro/ves nck sphincter,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53446,Remove uro sphincter,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53447,Remove/replace ur sphincter,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53448,Remov/replc ur sphinctr comp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53449,Repair uro sphincter,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53450,Revision of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53460,Revision of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53500,Urethrlys transvag w/ scope,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53502,Repair of urethra injury,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53505,Repair of urethra injury,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53510,Repair of urethra injury,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,684.70","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53515,Repair of urethra injury,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53520,Repair of urethra defect,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","5,813.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53600,Dilate urethra stricture,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,682.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53601,Dilate urethra stricture,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53605,Dilate urethra stricture,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,850.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53620,Dilate urethra stricture,APC 5372,RVU Per Unit,$557.00 ,OP,557,"3,639.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53621,Dilate urethra stricture,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53660,Dilation of urethra,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,218.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53661,Dilation of urethra,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53665,Dilation of urethra,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53850,Prostatic microwave thermotx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","8,239.83",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53852,Prostatic rf thermotx,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","8,239.83",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53854,Trurl dstrj prst8 tiss rf wv,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53855,Insert prost urethral stent,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53860,Transurethral rf treatment,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,53899,Urology surgery procedure,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54000,Slitting of prepuce,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54001,Slitting of prepuce,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","3,684.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54015,Drain penis lesion,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54050,Destruction penis lesion(s),APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54055,Destruction penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54056,Cryosurgery penis lesion(s),APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54057,Laser surg penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54060,Excision of penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54065,Destruction penis lesion(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,091.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54100,Biopsy of penis,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54105,Biopsy of penis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54110,Treatment of penis lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54111,Treat penis lesion graft,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54112,Treat penis lesion graft,APC 5376,RVU Per Case,"$8,002.82 ",OP,"6,607.35","8,002.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54115,Treatment of penis lesion,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54120,Partial removal of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54125,Removal of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54130,Remove penis & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54135,Remove penis & nodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54150,Circumcision w/regionl block,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54160,Circumcision neonate,APC 5372,RVU Per Unit,$557.00 ,OP,557,"4,116.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54161,Circum 28 days or older,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54162,Lysis penil circumic lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54163,Repair of circumcision,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54164,Frenulotomy of penis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,116.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54200,Treatment of penis lesion,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54205,Treatment of penis lesion,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54220,Treatment of penis lesion,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54231,Dynamic cavernosometry,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,"3,639.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54235,Penile injection,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54240,Penis study,APC 5722,RVU Per Unit,$256.27 ,OP,218.06,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54250,Penis study,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,428.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54300,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54304,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54308,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54312,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54316,Reconstruction of urethra,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54318,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54322,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54324,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54326,Reconstruction of urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54328,Revise penis/urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54332,Revise penis/urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54336,Revise penis/urethra,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54340,Secondary urethral surgery,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54344,Secondary urethral surgery,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54348,Secondary urethral surgery,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54352,Reconstruct urethra/penis,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54360,Penis plastic surgery,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54380,Repair penis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54385,Repair penis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54390,Repair penis and bladder,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54400,Insert semi-rigid prosthesis,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","15,865.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54401,Insert self-contd prosthesis,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54405,Insert multi-comp penis pros,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54406,Remove muti-comp penis pros,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54408,Repair multi-comp penis pros,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54410,Remove/replace penis prosth,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54411,Remov/replc penis pros comp,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","17,693.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54415,Remove self-contd penis pros,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54416,Remv/repl penis contain pros,APC 5378,RVU Per Case,"$17,693.87 ",OP,"17,693.87","27,519.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54417,Remv/replc penis pros compl,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","11,132.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54420,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54430,Revision of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54435,Revision of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54437,Repair corporeal tear,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54438,Replantation of penis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54440,Repair of penis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","6,607.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54450,Preputial stretching,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,682.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54500,Biopsy of testis,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,056.18","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54505,Biopsy of testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54512,Excise lesion testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54520,Removal of testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54522,Orchiectomy partial,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54530,Removal of testis,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54535,Extensive testis surgery,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54550,Exploration for testis,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54560,Exploration for testis,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54600,Reduce testis torsion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54620,Suspension of testis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54640,Orchiopexy ingun/scrot appr,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54650,Orchiopexy (fowler-stephens),APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","3,084.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54660,Revision of testis,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54670,Repair testis injury,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54680,Relocation of testis(es),APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54690,Laparoscopy orchiectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54692,Laparoscopy orchiopexy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54699,Laparoscope proc testis,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54700,Drainage of scrotum,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54800,Biopsy of epididymis,APC 5072,RVU Per Case,"$1,363.50 ",OP,414.36,"1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54830,Remove epididymis lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54840,Remove epididymis lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54860,Removal of epididymis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54861,Removal of epididymis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54865,Explore epididymis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54900,Fusion of spermatic ducts,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,54901,Fusion of spermatic ducts,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55000,Drainage of hydrocele,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55040,Removal of hydrocele,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55041,Removal of hydroceles,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55060,Repair of hydrocele,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55100,Drainage of scrotum abscess,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","2,234.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55110,Explore scrotum,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55120,Removal of scrotum lesion,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55150,Removal of scrotum,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55175,Revision of scrotum,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55180,Revision of scrotum,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55200,Incision of sperm duct,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55250,Removal of sperm duct(s),APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55400,Repair of sperm duct,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55500,Removal of hydrocele,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55520,Removal of sperm cord lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55530,Revise spermatic cord veins,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55535,Revise spermatic cord veins,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55540,Revise hernia & sperm veins,APC 5341,RVU Per Case,"$3,084.99 ",OP,"3,084.99","5,852.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55550,Laparo ligate spermatic vein,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55559,Laparo proc spermatic cord,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55600,Incise sperm duct pouch,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55605,Incise sperm duct pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55650,Remove sperm duct pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55680,Remove sperm pouch lesion,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,713.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55700,Biopsy of prostate,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,126.92","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55705,Biopsy of prostate,APC 5374,RVU Per Case,"$2,981.23 ",OP,"1,126.92","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55706,Prostate saturation sampling,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55720,Drainage of prostate abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55725,Drainage of prostate abscess,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","4,781.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55801,Removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55810,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55812,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55815,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55821,Removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55831,Removal of prostate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55840,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55842,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55845,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55860,Surgical exposure prostate,APC 5375,RVU Per Case,"$4,277.44 ",OP,"3,639.02","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55862,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55865,Extensive prostate surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55866,Laparo radical prostatectomy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55870,Electroejaculation,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,801.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55873,Cryoablate prostate,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","21,783.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55874,Tprnl plmt biodegrdabl matrl,APC 5375,RVU Per Unit,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55875,Transperi needle place pros,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55876,Place rt device/marker pros,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55880,Abltj mal prst8 tiss hifu,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55899,Genital surgery procedure,APC 5371,RVU Per Unit,$257.91 ,OP,218.06,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55920,Place needles pelvic for rt,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55970,Sex transformation m to f,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,55980,Sex transformation f to m,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56405,I & d of vulva/perineum,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56420,Drainage of gland abscess,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56440,Surgery for vulva lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56441,Lysis of labial lesion(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56442,Hymenotomy,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56501,Destroy vulva lesions sim,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","3,493.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56515,Destroy vulva lesion/s compl,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","4,091.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56605,Biopsy of vulva/perineum,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56620,Partial removal of vulva,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56625,Complete removal of vulva,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56630,Extensive vulva surgery,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56631,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56632,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56633,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56634,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56637,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56640,Extensive vulva surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56700,Partial removal of hymen,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56740,Remove vagina gland lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56800,Repair of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56805,Repair clitoris,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56810,Repair of perineum,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56820,Exam of vulva w/scope,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,56821,Exam/biopsy of vulva w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57000,Exploration of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57010,Drainage of pelvic abscess,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57020,Drainage of pelvic fluid,APC 5415,RVU Per Case,"$4,273.21 ",OP,"1,333.83","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57022,I & d vaginal hematoma pp,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,234.05","2,296.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57023,I & d vag hematoma non-ob,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57061,Destroy vag lesions simple,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57065,Destroy vag lesions complex,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57100,Biopsy of vagina,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,"1,333.83",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57105,Biopsy of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57106,Remove vagina wall partial,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57107,Remove vagina tissue part,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57109,Vaginectomy partial w/nodes,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57110,Remove vagina wall complete,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57111,Remove vagina tissue compl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57120,Closure of vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57130,Remove vagina lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57135,Remove vagina lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57150,Treat vagina infection,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57155,Insert uteri tandem/ovoids,APC 5415,RVU Per Case,"$4,273.21 ",OP,"1,333.83","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57156,Ins vag brachytx device,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,272.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57160,Insert pessary/other device,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57170,Fitting of diaphragm/cap,APC 5411,RVU Per Unit,$165.06 ,OP,29.41,165.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57180,Treat vaginal bleeding,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57200,Repair of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57210,Repair vagina/perineum,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57220,Revision of urethra,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57230,Repair of urethral lesion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57240,Anterior colporrhaphy,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57250,Repair rectum & vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57260,Cmbn ant pst colprhy,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57265,Cmbn ap colprhy w/ntrcl rpr,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57268,Repair of bowel bulge,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57270,Repair of bowel pouch,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57280,Suspension of vagina,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57282,Colpopexy extraperitoneal,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57283,Colpopexy intraperitoneal,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57284,Repair paravag defect open,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57285,Repair paravag defect vag,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","6,584.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57287,Revise/remove sling repair,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57288,Repair bladder defect,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57289,Repair bladder & vagina,APC 5416,RVU Per Case,"$6,584.25 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57291,Construction of vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57292,Construct vagina with graft,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57295,Revise vag graft via vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57296,Revise vag graft open abd,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57300,Repair rectum-vagina fistula,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57305,Repair rectum-vagina fistula,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57307,Fistula repair & colostomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57308,Fistula repair transperine,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57310,Repair urethrovaginal lesion,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57311,Repair urethrovaginal lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57320,Repair bladder-vagina lesion,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57330,Repair bladder-vagina lesion,APC 5416,RVU Per Case,"$6,584.25 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57335,Repair vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57400,Dilation of vagina,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57410,Pelvic examination,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57415,Remove vaginal foreign body,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57420,Exam of vagina w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57421,Exam/biopsy of vag w/scope,APC 5413,RVU Per Unit,$613.82 ,OP,580.19,613.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57423,Repair paravag defect lap,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57425,Laparoscopy surg colpopexy,APC 5362,RVU Per Case,"$8,632.26 ",OP,"6,434.45","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57426,Revise prosth vag graft lap,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","6,584.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57452,Exam of cervix w/scope,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57454,Bx/curett of cervix w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57455,Biopsy of cervix w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57456,Endocerv curettage w/scope,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57460,Bx of cervix w/scope leep,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57461,Conz of cervix w/scope leep,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57500,Biopsy of cervix,APC 5413,RVU Per Unit,$613.82 ,OP,580.19,613.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57505,Endocervical curettage,APC 5413,RVU Per Unit,$613.82 ,OP,580.19,613.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57510,Cauterization of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57511,Cryocautery of cervix,APC 5412,RVU Per Unit,$272.78 ,OP,258.38,272.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57513,Laser surgery of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57520,Conization of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57522,Conization of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57530,Removal of cervix,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57531,Removal of cervix radical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57540,Removal of residual cervix,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57545,Remove cervix/repair pelvis,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57550,Removal of residual cervix,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57555,Remove cervix/repair vagina,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57556,Remove cervix repair bowel,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57558,D&c of cervical stump,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57700,Revision of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57720,Revision of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,57800,Dilation of cervical canal,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58100,Biopsy of uterus lining,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,258.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58120,Dilation and curettage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58140,Myomectomy abdom method,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58145,Myomectomy vag method,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58146,Myomectomy abdom complex,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58150,Total hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58152,Total hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58180,Partial hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58200,Extensive hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58210,Extensive hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58240,Removal of pelvis contents,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58260,Vaginal hysterectomy,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58262,Vag hyst including t/o,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58263,Vag hyst w/t/o & vag repair,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58267,Vag hyst w/urinary repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58270,Vag hyst w/enterocele repair,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58275,Hysterectomy/revise vagina,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58280,Hysterectomy/revise vagina,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58285,Extensive hysterectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58290,Vag hyst complex,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58291,Vag hyst incl t/o complex,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58292,Vag hyst t/o & repair compl,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58294,Vag hyst w/enterocele compl,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58301,Remove intrauterine device,APC 5412,RVU Per Case,$272.78 ,OP,272.78,272.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58321,Artificial insemination,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,801.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58322,Artificial insemination,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,801.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58323,Sperm washing,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,801.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58345,Reopen fallopian tube,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58346,Insert heyman uteri capsule,APC 5415,RVU Per Case,"$4,273.21 ",OP,"2,974.23","4,273.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58350,Reopen fallopian tube,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58353,Endometr ablate thermal,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58356,Endometrial cryoablation,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58400,Suspension of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58410,Suspension of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58520,Repair of ruptured uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58540,Revision of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58541,Lsh uterus 250 g or less,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58542,Lsh w/t/o ut 250 g or less,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58543,Lsh uterus above 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58544,Lsh w/t/o uterus above 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58545,Laparoscopic myomectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58546,Laparo-myomectomy complex,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58548,Lap radical hyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58550,Laparo-asst vag hysterectomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","14,122.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58552,Laparo-vag hyst incl t/o,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58553,Laparo-vag hyst complex,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58554,Laparo-vag hyst w/t/o compl,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58555,Hysteroscopy dx sep proc,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58558,Hysteroscopy biopsy,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58559,Hysteroscopy lysis,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","4,278.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58560,Hysteroscopy resect septum,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58561,Hysteroscopy remove myoma,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58562,Hysteroscopy remove fb,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,278.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58563,Hysteroscopy ablation,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","6,813.31",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58565,Hysteroscopy sterilization,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","8,610.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58570,Tlh uterus 250 g or less,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58571,Tlh w/t/o 250 g or less,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58572,Tlh uterus over 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58573,Tlh w/t/o uterus over 250 g,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58575,Laps tot hyst resj mal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58578,Laparo proc uterus,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58579,Hysteroscope procedure,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,"4,278.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58600,Division of fallopian tube,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58605,Division of fallopian tube,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58611,Ligate oviduct(s) add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58615,Occlude fallopian tube(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58660,Laparoscopy lysis,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58661,Laparoscopy remove adnexa,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58662,Laparoscopy excise lesions,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58670,Laparoscopy tubal cautery,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58671,Laparoscopy tubal block,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58672,Laparoscopy fimbrioplasty,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58673,Laparoscopy salpingostomy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58674,Laps abltj uterine fibroids,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58679,Laparo proc oviduct-ovary,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58700,Removal of fallopian tube,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58720,Removal of ovary/tube(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58740,Adhesiolysis tube ovary,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58750,Repair oviduct,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58752,Revise ovarian tube(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58760,Fimbrioplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58770,Create new tubal opening,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58800,Drainage of ovarian cyst(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58805,Drainage of ovarian cyst(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58820,Drain ovary abscess open,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58822,Drain ovary abscess percut,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58825,Transposition ovary(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58900,Biopsy of ovary(s),APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58920,Partial removal of ovary(s),APC 5416,RVU Per Case,"$6,584.25 ",OP,"5,710.44","6,584.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58925,Removal of ovarian cyst(s),APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58940,Removal of ovary(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58943,Removal of ovary(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58950,Resect ovarian malignancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58951,Resect ovarian malignancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58952,Resect ovarian malignancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58953,Tah rad dissect for debulk,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58954,Tah rad debulk/lymph remove,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58956,Bso omentectomy w/tah,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58957,Resect recurrent gyn mal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58958,Resect recur gyn mal w/lym,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58960,Exploration of abdomen,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58970,Retrieval of oocyte,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,801.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58974,Transfer of embryo,APC 5413,RVU Per Unit,$613.82 ,OP,613.82,801.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58976,Transfer of embryo,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,801.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,58999,Genital surgery procedure,APC 5411,RVU Per Unit,$165.06 ,OP,29.41,165.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59000,Amniocentesis diagnostic,APC 5413,RVU Per Unit,$613.82 ,OP,284.88,613.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59001,Amniocentesis therapeutic,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,"1,333.83",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59012,Fetal cord puncture prenatal,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59015,Chorion biopsy,APC 5413,RVU Per Unit,$613.82 ,OP,284.88,613.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59020,Fetal contract stress test,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59025,Fetal non-stress test,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59030,Fetal scalp blood sample,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59070,Transabdom amnioinfus w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59072,Umbilical cord occlud w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59074,Fetal fluid drainage w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59076,Fetal shunt placement w/us,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59100,Remove uterus lesion,APC 5415,RVU Per Case,"$4,273.21 ",OP,"4,273.21","5,710.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59120,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59121,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59130,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59135,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59136,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59140,Treat ectopic pregnancy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59150,Treat ectopic pregnancy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59151,Treat ectopic pregnancy,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","8,722.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59160,D & c after delivery,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,555.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59200,Insert cervical dilator,APC 5412,RVU Per Unit,$272.78 ,OP,272.78,580.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59300,Episiotomy or vaginal repair,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59320,Revision of cervix,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59325,Revision of cervix,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59350,Repair of uterus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59409,Obstetrical care,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59412,Antepartum manipulation,APC 5414,RVU Per Case,"$2,542.11 ",OP,477.99,"2,542.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59414,Deliver placenta,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,974.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59514,Cesarean delivery only,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59525,Remove uterus after cesarean,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59612,Vbac delivery only,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","4,107.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59620,Attempted vbac delivery only,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59812,Treatment of miscarriage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59820,Care of miscarriage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59821,Treatment of miscarriage,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59830,Treat uterus infection,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59840,Abortion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,391.64",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59841,Abortion,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,391.64",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59850,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59851,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59852,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59855,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59856,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59857,Abortion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59866,Abortion (mpr),APC 5412,RVU Per Unit,$272.78 ,OP,272.78,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59870,Evacuate mole of uterus,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","3,709.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59871,Remove cerclage suture,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59897,Fetal invas px w/us,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59898,Laparo proc ob care/deliver,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,59899,Maternity care procedure,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,284.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60000,Drain thyroid/tongue cyst,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60100,Biopsy of thyroid,APC 5071,RVU Per Unit,$602.74 ,OP,414.36,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60200,Remove thyroid lesion,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60210,Partial thyroid excision,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60212,Partial thyroid excision,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60220,Partial removal of thyroid,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60225,Partial removal of thyroid,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60240,Removal of thyroid,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60252,Removal of thyroid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60254,Extensive thyroid surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60260,Repeat thyroid surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60270,Removal of thyroid,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60271,Removal of thyroid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60280,Remove thyroid duct lesion,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60281,Remove thyroid duct lesion,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60300,Aspir/inj thyroid cyst,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60500,Explore parathyroid glands,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60502,Re-explore parathyroids,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60505,Explore parathyroid glands,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60520,Removal of thymus gland,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60521,Removal of thymus gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60522,Removal of thymus gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60540,Explore adrenal gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60545,Explore adrenal gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60600,Remove carotid body lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60605,Remove carotid body lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60650,Laparoscopy adrenalectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60659,Laparo proc endocrine,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","6,434.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,60699,Endocrine surgery procedure,APC 5361,RVU Per Case,"$4,903.99 ",OP,"4,903.99","7,555.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61000,Remove cranial cavity fluid,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61001,Remove cranial cavity fluid,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61020,Remove brain cavity fluid,APC 5443,RVU Per Unit,$797.03 ,OP,599.04,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61026,Injection into brain canal,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61050,Remove brain canal fluid,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,599.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61055,Injection into brain canal,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,599.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61070,Brain canal shunt procedure,APC 5442,RVU Per Unit,$614.97 ,OP,599.04,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61105,Twist drill hole,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61107,Drill skull for implantation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61108,Drill skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61120,Burr hole for puncture,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61140,Pierce skull for biopsy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61150,Pierce skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61151,Pierce skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61154,Pierce skull & remove clot,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61156,Pierce skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61210,Pierce skull implant device,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61215,Insert brain-fluid device,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","9,420.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61250,Pierce skull & explore,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61253,Pierce skull & explore,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61304,Open skull for exploration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61305,Open skull for exploration,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61312,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61313,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61314,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61315,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61316,Implt cran bone flap to abdo,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61320,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61321,Open skull for drainage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61322,Decompressive craniotomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61323,Decompressive lobectomy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61330,Decompress eye socket,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61333,Explore orbit/remove lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61340,Subtemporal decompression,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61343,Incise skull (press relief),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61345,Relieve cranial pressure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61450,Incise skull for surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61458,Incise skull for brain wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61460,Incise skull for surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61500,Removal of skull lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61501,Remove infected skull bone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61510,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61512,Remove brain lining lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61514,Removal of brain abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61516,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61517,Implt brain chemotx add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61518,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61519,Remove brain lining lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61520,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61521,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61522,Removal of brain abscess,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61524,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61526,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61530,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61531,Implant brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61533,Implant brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61534,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61535,Remove brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61536,Removal of brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61537,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61538,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61539,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61540,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61541,Incision of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61543,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61544,Remove & treat brain lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61545,Excision of brain tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61546,Removal of pituitary gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61548,Removal of pituitary gland,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61550,Release of skull seams,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61552,Release of skull seams,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61556,Incise skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61557,Incise skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61558,Excision of skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61559,Excision of skull/sutures,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61563,Excision of skull tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61564,Excision of skull tumor,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61566,Removal of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61567,Incision of brain tissue,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61570,Remove foreign body brain,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61571,Incise skull for brain wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61575,Skull base/brainstem surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61576,Skull base/brainstem surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61580,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61581,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61582,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61583,Craniofacial approach skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61584,Orbitocranial approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61585,Orbitocranial approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61586,Resect nasopharynx skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61590,Infratemporal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61591,Infratemporal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61592,Orbitocranial approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61595,Transtemporal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61596,Transcochlear approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61597,Transcondylar approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61598,Transpetrosal approach/skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61600,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61601,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61605,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61606,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61607,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61608,Resect/excise cranial lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61611,Transect artery sinus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61613,Remove aneurysm sinus,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61615,Resect/excise lesion skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61616,Resect/excise lesion skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61618,Repair dura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61619,Repair dura,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61623,Endovasc tempory vessel occl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"8,600.07","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61624,Transcath occlusion cns,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61626,Transcath occlusion non-cns,APC 5193,RVU Per Case,"$9,732.45 ",OP,"8,600.07","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61630,Intracranial angioplasty,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61635,Intracran angioplsty w/stent,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61645,Perq art m-thrombect &/nfs,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61650,Evasc prlng admn rx agnt 1st,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61651,Evasc prlng admn rx agnt add,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61680,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61682,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61684,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61686,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61690,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61692,Intracranial vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61697,Brain aneurysm repr complx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61698,Brain aneurysm repr complx,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61700,Brain aneurysm repr simple,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61702,Inner skull vessel surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61703,Clamp neck artery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61705,Revise circulation to head,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61708,Revise circulation to head,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61710,Revise circulation to head,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61711,Fusion of skull arteries,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61720,Incise skull/brain surgery,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61735,Incise skull/brain surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61750,Incise skull/brain biopsy,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61751,Brain biopsy w/ct/mr guide,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61760,Implant brain electrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61770,Incise skull for treatment,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61790,Treat trigeminal nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61791,Treat trigeminal tract,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,146.78","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61850,Implant neuroelectrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61860,Implant neuroelectrodes,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61863,Implant neuroelectrode,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61864,Implant neuroelectrde addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61867,Implant neuroelectrode,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61868,Implant neuroelectrde addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61880,Revise/remove neuroelectrode,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61885,Insrt/redo neurostim 1 array,APC 5464,RVU Per Case,"$19,846.62 ",OP,"19,846.62","37,532.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61886,Implant neurostim arrays,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","48,660.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,61888,Revise/remove neuroreceiver,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62000,Treat skull fracture,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62005,Treat skull fracture,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62010,Treatment of head injury,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62100,Repair brain fluid leakage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62115,Reduction of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62117,Reduction of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62120,Repair skull cavity lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62121,Incise skull repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62140,Repair of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62141,Repair of skull defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62142,Remove skull plate/flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62143,Replace skull plate/flap,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62145,Repair of skull & brain,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62146,Repair of skull with graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62147,Repair of skull with graft,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62148,Retr bone flap to fix skull,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62161,Dissect brain w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62162,Remove colloid cyst w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62164,Remove brain tumor w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62165,Remove pituit tumor w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62180,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62190,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62192,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62194,Replace/irrigate catheter,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","2,334.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62200,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62201,Brain cavity shunt w/scope,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62220,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62223,Establish brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62225,Replace/irrigate catheter,APC 5432,RVU Per Case,"$5,524.06 ",OP,"2,334.99","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62230,Replace/revise brain shunt,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","9,420.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62252,Csf shunt reprogram,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,579.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62256,Remove brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62258,Replace brain cavity shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62263,Epidural lysis mult sessions,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62264,Epidural lysis on single day,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62267,Interdiscal perq aspir dx,APC 5071,RVU Per Unit,$602.74 ,OP,602.74,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62268,Drain spinal cord cyst,APC 5443,RVU Per Unit,$797.03 ,OP,599.04,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62269,Needle biopsy spinal cord,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,229.52","1,363.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62270,Dx lmbr spi pnxr,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62272,Ther spi pnxr drg csf,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62273,Inject epidural patch,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,"1,146.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62280,Treat spinal cord lesion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62281,Treat spinal cord lesion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62282,Treat spinal canal lesion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62287,Percutaneous diskectomy,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62292,Njx chemonucleolysis lmbr,APC 5431,RVU Per Case,"$1,700.15 ",OP,599.04,"1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62294,Injection into spinal artery,APC 5443,RVU Per Unit,$797.03 ,OP,599.04,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62302,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62303,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62304,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62305,Myelography lumbar injection,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62320,Njx interlaminar crv/thrc,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62321,Njx interlaminar crv/thrc,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62322,Njx interlaminar lmbr/sac,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62323,Njx interlaminar lmbr/sac,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62324,Njx interlaminar crv/thrc,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62325,Njx interlaminar crv/thrc,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62326,Njx interlaminar lmbr/sac,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62327,Njx interlaminar lmbr/sac,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62328,Dx lmbr spi pnxr w/fluor/ct,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62329,Ther spi pnxr csf fluor/ct,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62350,Implant spinal canal cath,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,177.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62351,Implant spinal canal cath,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62355,Remove spinal canal catheter,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62360,Insert spine infusion device,APC 5471,RVU Per Case,"$16,505.33 ",OP,"16,505.33","22,560.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62361,Implant spine infusion pump,APC 5471,RVU Per Case,"$16,505.33 ",OP,"16,505.33","34,933.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62362,Implant spine infusion pump,APC 5471,RVU Per Case,"$16,505.33 ",OP,"16,505.33","34,933.34",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62365,Remove spine infusion device,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62367,Analyze spine infus pump,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,579.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62368,Analyze sp inf pump w/reprog,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,579.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62369,Anal sp inf pmp w/reprg&fill,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62370,Anl sp inf pmp w/mdreprg&fil,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,62380,Ndsc dcmprn 1 ntrspc lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63001,Remove spine lamina 1/2 crvl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63003,Remove spine lamina 1/2 thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63005,Remove spine lamina 1/2 lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63011,Remove spine lamina 1/2 scrl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63012,Remove lamina/facets lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63015,Remove spine lamina >2 crvcl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63016,Remove spine lamina >2 thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63017,Remove spine lamina >2 lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63020,Neck spine disk surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63030,Low back disk surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63040,Laminotomy single cervical,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63042,Laminotomy single lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63045,Remove spine lamina 1 crvl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63046,Remove spine lamina 1 thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63047,Remove spine lamina 1 lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63050,Cervical laminoplsty 2/> seg,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63051,C-laminoplasty w/graft/plate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63055,Decompress spinal cord thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63056,Decompress spinal cord lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63064,Decompress spinal cord thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63075,Neck spine disk surgery,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","8,843.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63077,Spine disk surgery thorax,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63078,Spine disk surgery thorax,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63081,Remove vert body dcmprn crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63082,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63085,Remove vert body dcmprn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63086,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63087,Remov vertbr dcmprn thrclmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63088,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63090,Remove vert body dcmprn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63091,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63101,Remove vert body dcmprn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63102,Remove vert body dcmprn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63103,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63170,Incise spinal cord tract(s),APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63172,Drainage of spinal cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63173,Drainage of spinal cyst,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63185,Incise spine nrv half segmnt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63190,Incise spine nrv >2 segmnts,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63191,Incise spine accessory nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63194,Incise spine & cord cervical,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63195,Incise spine & cord thoracic,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63196,Incise spine&cord 2 trx crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63197,Incise spine&cord 2 trx thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63198,Incise spin&cord 2 stgs crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63199,Incise spin&cord 2 stgs thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63200,Release spinal cord lumbar,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63250,Revise spinal cord vsls crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63251,Revise spinal cord vsls thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63252,Revise spine cord vsl thrlmb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63265,Excise intraspinl lesion crv,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63266,Excise intrspinl lesion thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63267,Excise intrspinl lesion lmbr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63268,Excise intrspinl lesion scrl,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63270,Excise intrspinl lesion crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63271,Excise intrspinl lesion thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63272,Excise intrspinl lesion lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63273,Excise intrspinl lesion scrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63275,Bx/exc xdrl spine lesn crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63276,Bx/exc xdrl spine lesn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63277,Bx/exc xdrl spine lesn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63278,Bx/exc xdrl spine lesn scrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63280,Bx/exc idrl spine lesn crvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63281,Bx/exc idrl spine lesn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63282,Bx/exc idrl spine lesn lmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63283,Bx/exc idrl spine lesn scrl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63285,Bx/exc idrl imed lesn cervl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63286,Bx/exc idrl imed lesn thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63287,Bx/exc idrl imed lesn thrlmb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63290,Bx/exc xdrl/idrl lsn any lvl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63295,Repair laminectomy defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63300,Remove vert xdrl body crvcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63301,Remove vert xdrl body thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63302,Remove vert xdrl body thrlmb,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63303,Remov vert xdrl bdy lmbr/sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63304,Remove vert idrl body crvcl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63305,Remove vert idrl body thrc,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63306,Remov vert idrl bdy thrclmbr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63307,Remov vert idrl bdy lmbr/sac,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63308,Remove vertebral body add-on,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63600,Remove spinal cord lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63610,Stimulation of spinal cord,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63650,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63655,Implant neuroelectrodes,APC 5464,RVU Per Case,"$19,846.62 ",OP,"16,864.55","19,846.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63661,Remove spine eltrd perq aray,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63662,Remove spine eltrd plate,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63663,Revise spine eltrd perq aray,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","5,970.22",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63664,Revise spine eltrd plate,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63685,Insrt/redo spine n generator,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","36,379.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63688,Revise/remove neuroreceiver,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63700,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63702,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63704,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63706,Repair of spinal herniation,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63707,Repair spinal fluid leakage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63709,Repair spinal fluid leakage,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63710,Graft repair of spine defect,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63740,Install spinal shunt,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63741,Install spinal shunt,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","7,864.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63744,Revision of spinal shunt,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","7,864.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,63746,Removal of spinal shunt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64400,Njx aa&/strd trigeminal nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64405,Njx aa&/strd gr ocpl nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64408,Njx aa&/strd vagus nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64415,Njx aa&/strd brach plexus,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64416,Njx aa&/strd brach plex nfs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64417,Njx aa&/strd axillary nrv,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64418,Njx aa&/strd sprscap nrv,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64420,Njx aa&/strd ntrcost nrv 1,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64421,Njx aa&/strd ntrcost nrv ea,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64425,Njx aa&/strd ii ih nerves,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64430,Njx aa&/strd pudendal nerve,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64435,Njx aa&/strd paracrv nrv,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64445,Njx aa&/strd sciatic nerve,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64446,Njx aa&/strd sciatic nrv nfs,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64447,Njx aa&/strd femoral nerve,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64448,Njx aa&/strd fem nerve nfs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64449,Njx aa&/strd lmbr plex nfs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64450,Njx aa&/strd other pn/branch,APC 5442,RVU Per Unit,$614.97 ,OP,452.95,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64451,Njx aa&/strd nrv nrvtg si jt,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64454,Njx aa&/strd gnclr nrv brnch,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64455,Njx aa&/strd pltr com dg nrv,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64461,Pvb thoracic single inj site,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64463,Pvb thoracic cont infusion,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64479,Njx aa&/strd tfrm epi c/t 1,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64483,Njx aa&/strd tfrm epi l/s 1,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64490,Inj paravert f jnt c/t 1 lev,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64493,Inj paravert f jnt l/s 1 lev,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64505,N block spenopalatine gangl,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64510,N block stellate ganglion,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64517,N block inj hypogas plxs,APC 5443,RVU Per Unit,$797.03 ,OP,452.95,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64520,N block lumbar/thoracic,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64530,N block inj celiac pelus,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64553,Implant neuroelectrodes,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","44,296.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64555,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64561,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","11,331.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64566,Neuroeltrd stim post tibial,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64568,Inc for vagus n elect impl,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64569,Revise/repl vagus n eltrd,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64570,Remove vagus n eltrd,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64575,Implant neuroelectrodes,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","16,864.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64580,Implant neuroelectrodes,APC 5464,RVU Per Case,"$19,846.62 ",OP,"16,864.55","19,846.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64581,Implant neuroelectrodes,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","16,864.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64585,Revise/remove neuroelectrode,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64590,Insrt/redo pn/gastr stimul,APC 5464,RVU Per Case,"$19,846.62 ",OP,"19,846.62","36,379.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64595,Revise/rmv pn/gastr stimul,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64600,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64605,Injection treatment of nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","2,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64610,Injection treatment of nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","2,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64611,Chemodenerv saliv glands,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64612,Destroy nerve face muscle,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64615,Chemodenerv musc migraine,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64616,Chemodenerv musc neck dyston,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64617,Chemodener muscle larynx emg,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64620,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64624,Dstrj nulyt agt gnclr nrv,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64625,Rf abltj nrv nrvtg si jt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64630,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64632,N block inj common digit,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64633,Destroy cerv/thor facet jnt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64635,Destroy lumb/sac facet jnt,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64640,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,146.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64642,Chemodenerv 1 extremity 1-4,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64644,Chemodenerv 1 extrem 5/> mus,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64646,Chemodenerv trunk musc 1-5,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64647,Chemodenerv trunk musc 6/>,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64650,Chemodenerv eccrine glands,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64653,Chemodenerv eccrine glands,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64680,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"1,273.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64681,Injection treatment of nerve,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,"2,437.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64702,Revise finger/toe nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64704,Revise hand/foot nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64708,Revise arm/leg nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64712,Revision of sciatic nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64713,Revision of arm nerve(s),APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64714,Revise low back nerve(s),APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64716,Revision of cranial nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64718,Revise ulnar nerve at elbow,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64719,Revise ulnar nerve at wrist,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64721,Carpal tunnel surgery,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64722,Relieve pressure on nerve(s),APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64726,Release foot/toe nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64732,Incision of brow nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64734,Incision of cheek nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64736,Incision of chin nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64738,Incision of jaw nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64740,Incision of tongue nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64742,Incision of facial nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64744,Incise nerve back of head,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64746,Incise diaphragm nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64755,Incision of stomach nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64760,Incision of vagus nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64763,Incise hip/thigh nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64766,Incise hip/thigh nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64771,Sever cranial nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64772,Incision of spinal nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64774,Remove skin nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64776,Remove digit nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64782,Remove limb nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64784,Remove nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64786,Remove sciatic nerve lesion,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64788,Remove skin nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64790,Removal of nerve lesion,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64792,Removal of nerve lesion,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64795,Biopsy of nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64802,Sympathectomy cervical,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64804,Remove sympathetic nerves,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64809,Remove sympathetic nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64818,Remove sympathetic nerves,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64820,Sympathectomy digital artery,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","3,575.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64821,Remove sympathetic nerves,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64822,Remove sympathetic nerves,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64823,Sympathectomy supfc palmar,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","5,182.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64831,Repair of digit nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64834,Repair of hand or foot nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64835,Repair of hand or foot nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64836,Repair of hand or foot nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64840,Repair of leg nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64856,Repair/transpose nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64857,Repair arm/leg nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64858,Repair sciatic nerve,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64861,Repair of arm nerves,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64862,Repair of low back nerves,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64864,Repair of facial nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64865,Repair of facial nerve,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64866,Fusion of facial/other nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64868,Fusion of facial/other nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64885,Nerve graft head/neck 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64886,Nerve graft head/neck >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64890,Nerve graft hand/foot 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64891,Nerve graft hand/foot >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64892,Nerve graft arm/leg <4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64893,Nerve graft arm/leg >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64895,Nerve graft hand/foot 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64896,Nerve graft hand/foot >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64897,Nerve graft arm/leg 4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64898,Nerve graft arm/leg >4 cm,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64905,Nerve pedicle transfer,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64907,Nerve pedicle transfer,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","6,640.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64910,Nerve repair w/allograft,APC 5432,RVU Per Case,"$5,524.06 ",OP,"3,575.33","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64911,Neurorraphy w/vein autograft,APC 5432,RVU Per Case,"$5,524.06 ",OP,"3,575.33","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64912,Nrv rpr w/nrv algrft 1st,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,64999,Nervous system surgery,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,452.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65091,Revise eye,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65093,Revise eye with implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65101,Removal of eye,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65103,Remove eye/insert implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65105,Remove eye/attach implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65110,Removal of eye,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65112,Remove eye/revise socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65114,Remove eye/revise socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65125,Revise ocular implant,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65130,Insert ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65135,Insert ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65140,Attach ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65150,Revise ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65155,Reinsert ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65175,Removal of ocular implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,203.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65205,Remove foreign body from eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65210,Remove foreign body from eye,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65220,Remove foreign body from eye,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65222,Remove foreign body from eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65235,Remove foreign body from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65260,Remove foreign body from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65265,Remove foreign body from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65270,Repair of eye wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65272,Repair of eye wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65273,Repair of eye wound,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65275,Repair of eye wound,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65280,Repair of eye wound,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,309.75","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65285,Repair of eye wound,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65286,Repair of eye wound,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65290,Repair of eye socket wound,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65400,Removal of eye lesion,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65410,Biopsy of cornea,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65420,Removal of eye lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65426,Removal of eye lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65430,Corneal smear,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65435,Curette/treat cornea,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65436,Curette/treat cornea,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65450,Treatment of corneal lesion,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65600,Revision of cornea,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65710,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65730,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65750,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65755,Corneal transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65756,Corneal trnspl endothelial,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65770,Revise cornea with implant,APC 5493,RVU Per Case,"$7,109.07 ",OP,"7,109.07","10,413.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65772,Correction of astigmatism,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65775,Correction of astigmatism,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65778,Cover eye w/membrane,APC 5502,RVU Per Case,$784.51 ,OP,784.51,784.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65779,Cover eye w/membrane suture,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,203.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65780,Ocular reconst transplant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,665.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65781,Ocular reconst transplant,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,665.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65782,Ocular reconst transplant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,665.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65785,Impltj ntrstrml crnl rng seg,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65800,Drainage of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65810,Drainage of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65815,Drainage of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65820,Relieve inner eye pressure,APC 5492,RVU Per Case,"$3,796.62 ",OP,"1,215.27","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65850,Incision of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65855,Trabeculoplasty laser surg,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65860,Incise inner eye adhesions,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65865,Incise inner eye adhesions,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65870,Incise inner eye adhesions,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65875,Incise inner eye adhesions,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65880,Incise inner eye adhesions,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,049.73","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65900,Remove eye lesion,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65920,Remove implant of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,65930,Remove blood clot from eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66020,Injection treatment of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66030,Injection treatment of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66130,Remove eye lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66150,Glaucoma surgery,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66155,Glaucoma surgery,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66160,Glaucoma surgery,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66170,Glaucoma surgery,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66172,Incision of eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66174,Translum dil eye canal,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66175,Trnslum dil eye canal w/stnt,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66179,Aqueous shunt eye w/o graft,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66180,Aqueous shunt eye w/graft,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,590.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66183,Insert ant drainage device,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66184,Revision of aqueous shunt,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66185,Revise aqueous shunt eye,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","7,590.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66225,Repair/graft eye lesion,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,590.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66250,Follow-up surgery of eye,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66500,Incision of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66505,Incision of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66600,Remove iris and lesion,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66605,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66625,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66630,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66635,Removal of iris,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66680,Repair iris & ciliary body,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66682,Repair iris & ciliary body,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66700,Destruction ciliary body,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66710,Ciliary transsleral therapy,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66711,Ecp ciliary body destruction,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66720,Destruction ciliary body,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66740,Destruction ciliary body,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66761,Revision of iris,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66762,Revision of iris,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66770,Removal of inner eye lesion,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66820,Incision secondary cataract,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66821,After cataract laser surgery,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66825,Reposition intraocular lens,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66830,Removal of lens lesion,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66840,Removal of lens material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,978.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66850,Removal of lens material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,854.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66852,Removal of lens material,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","5,854.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66920,Extraction of lens,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,854.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66930,Extraction of lens,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","5,854.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66940,Extraction of lens,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,978.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66982,Xcapsl ctrc rmvl cplx wo ecp,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66983,Cataract surg w/iol 1 stage,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66984,Xcapsl ctrc rmvl w/o ecp,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66985,Insert lens prosthesis,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66986,Exchange lens prosthesis,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,733.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66987,Xcapsl ctrc rmvl cplx w/ecp,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66988,Xcapsl ctrc rmvl w/ecp,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,66999,Eye surgery procedure,APC 5491,RVU Per Case,"$2,014.88 ",OP,"1,215.27","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67005,Partial removal of eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67010,Partial removal of eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67015,Release of eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67025,Replace eye fluid,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67027,Implant eye drug system,APC 5494,RVU Per Case,"$14,545.35 ",OP,"7,497.01","14,545.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67028,Injection eye drug,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,787.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67030,Incise inner eye strands,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67031,Laser surgery eye strands,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67036,Removal of inner eye fluid,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67039,Laser treatment of retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67040,Laser treatment of retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67041,Vit for macular pucker,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67042,Vit for macular hole,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67043,Vit for membrane dissect,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67101,Repair detached retina crtx,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67105,Repair detached retina pc,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67107,Repair detached retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67108,Repair detached retina,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","7,497.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67110,Repair detached retina,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","3,309.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67113,Repair retinal detach cplx,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67115,Release encircling material,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,309.75","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67120,Remove eye implant material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67121,Remove eye implant material,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67141,Treatment of retina,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,787.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67145,Treatment of retina,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67208,Treatment of retinal lesion,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,"3,309.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67210,Treatment of retinal lesion,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67218,Treatment of retinal lesion,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,309.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67220,Treatment of choroid lesion,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,787.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67221,Ocular photodynamic ther,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,787.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67227,Dstrj extensive retinopathy,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67228,Treatment x10sv retinopathy,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,"1,018.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67229,Tr retinal les preterm inf,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,488.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67250,Reinforce eye wall,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67255,Reinforce/graft eye wall,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","5,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67299,Eye surgery procedure,APC 5491,RVU Per Case,"$2,014.88 ",OP,787.83,"2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67311,Revise eye muscle,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67312,Revise two eye muscles,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67314,Revise eye muscle,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67316,Revise two eye muscles,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67318,Revise eye muscle(s),APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67343,Release eye tissue,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67345,Destroy nerve of eye muscle,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67346,Biopsy eye muscle,APC 5504,RVU Per Case,"$3,203.25 ",OP,"2,881.19","3,203.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67399,Unlisted px extraocular musc,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,"4,262.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67400,Explore/biopsy eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67405,Explore/drain eye socket,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67412,Explore/treat eye socket,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67413,Explore/treat eye socket,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67414,Explr/decompress eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67415,Aspiration orbital contents,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67420,Explore/treat eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67430,Explore/treat eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67440,Explore/drain eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67445,Explr/decompress eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67450,Explore/biopsy eye socket,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67500,Inject/treat eye socket,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67505,Inject/treat eye socket,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67515,Inject/treat eye socket,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67550,Insert eye socket implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67560,Revise eye socket implant,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67570,Decompress optic nerve,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","7,056.40",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67599,Orbit surgery procedure,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67700,Drainage of eyelid abscess,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67710,Incision of eyelid,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67715,Incision of eyelid fold,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67800,Remove eyelid lesion,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67801,Remove eyelid lesions,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67805,Remove eyelid lesions,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67808,Remove eyelid lesion(s),APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67810,Biopsy eyelid & lid margin,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67820,Revise eyelashes,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67825,Revise eyelashes,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67830,Revise eyelashes,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67835,Revise eyelashes,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67840,Remove eyelid lesion,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67850,Treat eyelid lesion,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67875,Closure of eyelid by suture,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"1,458.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67880,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67882,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67900,Repair brow defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67901,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67902,Repair eyelid defect,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67903,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67904,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67906,Repair eyelid defect,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67908,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67909,Revise eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67911,Revise eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67912,Correction eyelid w/implant,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67914,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67915,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67916,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67917,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67921,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67922,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67923,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67924,Repair eyelid defect,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67930,Repair eyelid wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67935,Repair eyelid wound,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67938,Remove eyelid foreign body,APC 5501,RVU Per Unit,$253.20 ,OP,232.5,253.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67950,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67961,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67966,Revision of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67971,Reconstruction of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67973,Reconstruction of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67974,Reconstruction of eyelid,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67975,Reconstruction of eyelid,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,67999,Revision of eyelid,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68020,Incise/drain eyelid lining,APC 5502,RVU Per Unit,$784.51 ,OP,784.51,"3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68040,Treatment of eyelid lesions,APC 5501,RVU Per Unit,$253.20 ,OP,232.5,253.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68100,Biopsy of eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,215.27","1,940.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68110,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","2,881.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68115,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68130,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68135,Remove eyelid lining lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,458.56","1,940.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68200,Treat eyelid by injection,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68320,Revise/graft eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68325,Revise/graft eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68326,Revise/graft eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68328,Revise/graft eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68330,Revise eyelid lining,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68335,Revise/graft eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68340,Separate eyelid adhesions,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68360,Revise eyelid lining,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68362,Revise eyelid lining,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","4,606.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68371,Harvest eye tissue alograft,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,049.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68399,Eyelid lining surgery,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68400,Incise/drain tear gland,APC 5502,RVU Per Unit,$784.51 ,OP,579.95,784.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68420,Incise/drain tear sac,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68440,Incise tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68500,Removal of tear gland,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68505,Partial removal tear gland,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68510,Biopsy of tear gland,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68520,Removal of tear sac,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68525,Biopsy of tear sac,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68530,Clearance of tear duct,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,"3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68540,Remove tear gland lesion,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68550,Remove tear gland lesion,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68700,Repair tear ducts,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68705,Revise tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68720,Create tear sac drain,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68745,Create tear duct drain,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68750,Create tear duct drain,APC 5504,RVU Per Case,"$3,203.25 ",OP,"3,203.25","5,058.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68760,Close tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68761,Close tear duct opening,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68770,Close tear system fistula,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68801,Dilate tear duct opening,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68810,Probe nasolacrimal duct,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,429.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68811,Probe nasolacrimal duct,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68815,Probe nasolacrimal duct,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","3,430.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68816,Probe nl duct w/balloon,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68840,Explore/irrigate tear ducts,APC 5501,RVU Per Unit,$253.20 ,OP,232.5,253.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,68899,Tear duct system surgery,APC 5501,RVU Per Unit,$253.20 ,OP,253.2,579.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69000,Drain external ear lesion,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69005,Drain external ear lesion,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","3,506.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69020,Drain outer ear canal lesion,APC 5071,RVU Per Unit,$602.74 ,OP,288.27,602.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69100,Biopsy of external ear,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,819.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69105,Biopsy of external ear canal,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69110,Remove external ear partial,APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69120,Removal of external ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69140,Remove ear canal lesion(s),APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69145,Remove ear canal lesion(s),APC 5073,RVU Per Case,"$2,296.73 ",OP,"2,296.73","3,025.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69150,Extensive ear canal surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"1,512.50","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69155,Extensive ear/neck surgery,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69200,Clear outer ear canal,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69205,Clear outer ear canal,APC 5072,RVU Per Case,"$1,363.50 ",OP,"1,363.50","4,019.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69209,Remove impacted ear wax uni,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69210,Remove impacted ear wax uni,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69220,Clean out mastoid cavity,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69222,Clean out mastoid cavity,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69300,Revise external ear,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69310,Rebuild outer ear canal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69320,Rebuild outer ear canal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69399,Outer ear surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69420,Incision of eardrum,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69421,Incision of eardrum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69424,Remove ventilating tube,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69433,Create eardrum opening,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,"1,512.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69436,Create eardrum opening,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69440,Exploration of middle ear,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69450,Eardrum revision,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69501,Mastoidectomy,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69502,Mastoidectomy,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,672.97","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69505,Remove mastoid structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69511,Extensive mastoid surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69530,Extensive mastoid surgery,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69535,Remove part of temporal bone,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69540,Remove ear lesion,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","3,290.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69550,Remove ear lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69552,Remove ear lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69554,Remove ear lesion,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69601,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69602,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69603,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69604,Mastoid surgery revision,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69610,Repair of eardrum,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69620,Repair of eardrum,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69631,Repair eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69632,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69633,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69635,Repair eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69636,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69637,Rebuild eardrum structures,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69641,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69642,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69643,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69644,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69645,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69646,Revise middle ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69650,Release middle ear bone,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","4,672.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69660,Revise middle ear bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69661,Revise middle ear bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69662,Revise middle ear bone,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69666,Repair middle ear structures,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69667,Repair middle ear structures,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69670,Remove mastoid air cells,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69676,Remove middle ear nerve,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69700,Close mastoid fistula,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69705,Nps surg dilat eust tube uni,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69706,Nps surg dilat eust tube bi,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69711,Remove/repair hearing aid,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69714,Implant temple bone w/stimul,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,651.26","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69715,Temple bne implnt w/stimulat,APC 5116,RVU Per Case,"$15,377.54 ",OP,"7,651.26","15,377.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69717,Temple bone implant revision,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69718,Revise temple bone implant,APC 5115,RVU Per Case,"$11,934.03 ",OP,"7,651.26","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69720,Release facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69725,Release facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69740,Repair facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69745,Repair facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69799,Middle ear surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69801,Incise inner ear,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69805,Explore inner ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69806,Explore inner ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69905,Remove inner ear,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69910,Remove inner ear & mastoid,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69915,Incise inner ear nerve,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69930,Implant cochlear device,APC 5166,RVU Per Case,"$33,363.18 ",OP,"33,363.18","83,093.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69949,Inner ear surgery procedure,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69950,Incise inner ear nerve,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69955,Release facial nerve,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69960,Release inner ear canal,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","7,651.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69970,Remove inner ear lesion,APC 5165,RVU Per Case,"$4,928.81 ",OP,"4,928.81","4,928.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,69979,Temporal bone surgery,APC 5161,RVU Per Unit,$205.06 ,OP,205.06,491.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70010,Contrast x-ray of brain,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70015,Contrast x-ray of brain,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70030,X-ray eye for foreign body,APC 5521,RVU Per Case,$78.40 ,OP,78.4,133.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70100,X-ray exam of jaw <4views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,195.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70110,X-ray exam of jaw 4/> views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,494.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70120,X-ray exam of mastoids,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70130,X-ray exam of mastoids,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70134,X-ray exam of middle ear,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70140,X-ray exam of facial bones,APC 5521,RVU Per Case,$78.40 ,OP,78.4,219.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70150,X-ray exam of facial bones,APC 5522,RVU Per Case,$105.60 ,OP,105.6,393.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70160,X-ray exam of nasal bones,APC 5521,RVU Per Case,$78.40 ,OP,78.4,160.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70170,X-ray exam of tear duct,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70190,X-ray exam of eye sockets,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70200,X-ray exam of eye sockets,APC 5522,RVU Per Case,$105.60 ,OP,105.6,252.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70210,X-ray exam of sinuses,APC 5521,RVU Per Case,$78.40 ,OP,78.4,178.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70220,X-ray exam of sinuses,APC 5521,RVU Per Case,$78.40 ,OP,78.4,208.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70240,X-ray exam pituitary saddle,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70250,X-ray exam of skull,APC 5522,RVU Per Case,$105.60 ,OP,105.6,219.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70260,X-ray exam of skull,APC 5522,RVU Per Case,$105.60 ,OP,105.6,303.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70300,X-ray exam of teeth,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70310,X-ray exam of teeth,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70320,Full mouth x-ray of teeth,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70328,X-ray exam of jaw joint,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70330,X-ray exam of jaw joints,APC 5521,RVU Per Case,$78.40 ,OP,78.4,249.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70332,X-ray exam of jaw joint,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70336,Magnetic image jaw joint,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70350,X-ray head for orthodontia,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70355,Panoramic x-ray of jaws,APC 5521,RVU Per Case,$78.40 ,OP,78.4,170.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70360,X-ray exam of neck,APC 5521,RVU Per Case,$78.40 ,OP,78.4,154.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70370,Throat x-ray & fluoroscopy,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70371,Speech evaluation complex,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70380,X-ray exam of salivary gland,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70390,X-ray exam of salivary duct,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70450,Ct head/brain w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,829.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70460,Ct head/brain w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,760.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70470,Ct head/brain w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,016.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70480,Ct orbit/ear/fossa w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,180.07",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70481,Ct orbit/ear/fossa w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"2,744.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70482,Ct orbit/ear/fossa w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70486,Ct maxillofacial w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,722.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70487,Ct maxillofacial w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70488,Ct maxillofacial w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70490,Ct soft tissue neck w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,070.58",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70491,Ct soft tissue neck w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,062.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70492,Ct sft tsue nck w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"2,286.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70496,Ct angiography head,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70498,Ct angiography neck,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70540,Mri orbit/face/neck w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70542,Mri orbit/face/neck w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70543,Mri orbt/fac/nck w/o &w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,347.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70544,Mr angiography head w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,445.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70545,Mr angiography head w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70546,Mr angiograph head w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70547,Mr angiography neck w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70548,Mr angiography neck w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70549,Mr angiograph neck w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,998.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70551,Mri brain stem w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,477.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70552,Mri brain stem w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70553,Mri brain stem w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,053.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70554,Fmri brain by tech,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70555,Fmri brain by phys/psych,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70557,Mri brain w/o dye,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70558,Mri brain w/dye,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,70559,Mri brain w/o & w/dye,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71045,X-ray exam chest 1 view,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71046,X-ray exam chest 2 views,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71047,X-ray exam chest 3 views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71048,X-ray exam chest 4+ views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71100,X-ray exam ribs uni 2 views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,473.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71101,X-ray exam unilat ribs/chest,APC 5522,RVU Per Case,$105.60 ,OP,105.6,234.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71110,X-ray exam ribs bil 3 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,250.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71111,X-ray exam ribs/chest4/> vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,295.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71120,X-ray exam breastbone 2/>vws,APC 5521,RVU Per Case,$78.40 ,OP,78.4,198.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71130,X-ray strenoclavic jt 3/>vws,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71250,Ct thorax dx c-,APC 5522,RVU Per Case,$105.60 ,OP,105.6,957,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71260,Ct thorax dx c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,120.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71270,Ct thorax dx c-/c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,131.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71271,Ct thorax lung cancer scr c-,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71275,Ct angiography chest,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"2,406.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71550,Mri chest w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71551,Mri chest w/dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,71552,Mri chest w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72020,X-ray exam of spine 1 view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,141.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72040,X-ray exam neck spine 2-3 vw,APC 5521,RVU Per Case,$78.40 ,OP,78.4,186.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72050,X-ray exam neck spine 4/5vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,234.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72052,X-ray exam neck spine 6/>vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,417.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72070,X-ray exam thorac spine 2vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,476.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72072,X-ray exam thorac spine 3vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,228.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72074,X-ray exam thorac spine4/>vw,APC 5522,RVU Per Case,$105.60 ,OP,105.6,692.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72080,X-ray exam thoracolmb 2/> vw,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72081,X-ray exam entire spi 1 vw,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72082,X-ray exam entire spi 2/3 vw,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72083,X-ray exam entire spi 4/5 vw,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72084,X-ray exam entire spi 6/> vw,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72100,X-ray exam l-s spine 2/3 vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,177.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72110,X-ray exam l-2 spine 4/>vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,236.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72114,X-ray exam l-s spine bending,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72120,X-ray bend only l-s spine,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72125,Ct neck spine w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,064.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72126,Ct neck spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72127,Ct neck spine w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72128,Ct chest spine w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"2,151.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72129,Ct chest spine w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72130,Ct chest spine w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72131,Ct lumbar spine w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,137.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72132,Ct lumbar spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,967.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72133,Ct lumbar spine w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72141,Mri neck spine w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,451.99",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72142,Mri neck spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72146,Mri chest spine w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,566.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72147,Mri chest spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72148,Mri lumbar spine w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,418.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72149,Mri lumbar spine w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72156,Mri neck spine w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,270.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72157,Mri chest spine w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,927.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72158,Mri lumbar spine w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,303.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72170,X-ray exam of pelvis,APC 5522,RVU Per Case,$105.60 ,OP,105.6,115.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72190,X-ray exam of pelvis,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72191,Ct angiograph pelv w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72192,Ct pelvis w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,859.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72193,Ct pelvis w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,989.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72194,Ct pelvis w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,102.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72195,Mri pelvis w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,378.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72196,Mri pelvis w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72197,Mri pelvis w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72200,X-ray exam si joints,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72202,X-ray exam si joints 3/> vws,APC 5522,RVU Per Case,$105.60 ,OP,105.6,189.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72220,X-ray exam sacrum tailbone,APC 5521,RVU Per Case,$78.40 ,OP,78.4,306.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72240,Myelography neck spine,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72255,Myelography thoracic spine,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72265,Myelography l-s spine,APC 5573,RVU Per Case,$693.07 ,OP,693.07,"1,935.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72270,Myelogphy 2/> spine regions,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72285,Discography cerv/thor spine,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,72295,X-ray of lower spine disk,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73000,X-ray exam of collar bone,APC 5521,RVU Per Case,$78.40 ,OP,78.4,162.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73010,X-ray exam of shoulder blade,APC 5522,RVU Per Case,$105.60 ,OP,105.6,167.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73020,X-ray exam of shoulder,APC 5521,RVU Per Case,$78.40 ,OP,78.4,168.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73030,X-ray exam of shoulder,APC 5521,RVU Per Case,$78.40 ,OP,78.4,176.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73040,Contrast x-ray of shoulder,APC 5572,RVU Per Case,$356.73 ,OP,356.73,771.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73050,X-ray exam of shoulders,APC 5521,RVU Per Case,$78.40 ,OP,78.4,333.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73060,X-ray exam of humerus,APC 5521,RVU Per Case,$78.40 ,OP,78.4,152.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73070,X-ray exam of elbow,APC 5521,RVU Per Case,$78.40 ,OP,78.4,193.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73080,X-ray exam of elbow,APC 5521,RVU Per Case,$78.40 ,OP,78.4,139.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73085,Contrast x-ray of elbow,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73090,X-ray exam of forearm,APC 5521,RVU Per Case,$78.40 ,OP,78.4,133.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73092,X-ray exam of arm infant,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73100,X-ray exam of wrist,APC 5521,RVU Per Case,$78.40 ,OP,78.4,143.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73110,X-ray exam of wrist,APC 5521,RVU Per Case,$78.40 ,OP,78.4,129.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73115,Contrast x-ray of wrist,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73120,X-ray exam of hand,APC 5522,RVU Per Case,$105.60 ,OP,105.6,234.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73130,X-ray exam of hand,APC 5521,RVU Per Case,$78.40 ,OP,78.4,150.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73140,X-ray exam of finger(s),APC 5521,RVU Per Case,$78.40 ,OP,78.4,102.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73200,Ct upper extremity w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,246.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73201,Ct upper extremity w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73202,Ct uppr extremity w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73206,Ct angio upr extrm w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73218,Mri upper extremity w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"2,922.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73219,Mri upper extremity w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73220,Mri uppr extremity w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73221,Mri joint upr extrem w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,534.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73222,Mri joint upr extrem w/dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73223,Mri joint upr extr w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,768.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73501,X-ray exam hip uni 1 view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73502,X-ray exam hip uni 2-3 views,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73503,X-ray exam hip uni 4/> views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73521,X-ray exam hips bi 2 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73522,X-ray exam hips bi 3-4 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73523,X-ray exam hips bi 5/> views,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73525,Contrast x-ray of hip,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73551,X-ray exam of femur 1,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73552,X-ray exam of femur 2/>,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73560,X-ray exam of knee 1 or 2,APC 5521,RVU Per Case,$78.40 ,OP,78.4,131.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73562,X-ray exam of knee 3,APC 5521,RVU Per Case,$78.40 ,OP,78.4,140.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73564,X-ray exam knee 4 or more,APC 5522,RVU Per Case,$105.60 ,OP,105.6,195.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73565,X-ray exam of knees,APC 5521,RVU Per Case,$78.40 ,OP,78.4,116.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73580,Contrast x-ray of knee joint,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73590,X-ray exam of lower leg,APC 5521,RVU Per Case,$78.40 ,OP,78.4,142.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73592,X-ray exam of leg infant,APC 5521,RVU Per Case,$78.40 ,OP,78.4,280.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73600,X-ray exam of ankle,APC 5521,RVU Per Case,$78.40 ,OP,78.4,253.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73610,X-ray exam of ankle,APC 5521,RVU Per Case,$78.40 ,OP,78.4,159.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73615,Contrast x-ray of ankle,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73620,X-ray exam of foot,APC 5521,RVU Per Case,$78.40 ,OP,78.4,200.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73630,X-ray exam of foot,APC 5521,RVU Per Case,$78.40 ,OP,78.4,140.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73650,X-ray exam of heel,APC 5521,RVU Per Case,$78.40 ,OP,78.4,144.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73660,X-ray exam of toe(s),APC 5521,RVU Per Case,$78.40 ,OP,78.4,118.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73700,Ct lower extremity w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,"1,787.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73701,Ct lower extremity w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73702,Ct lwr extremity w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73706,Ct angio lwr extr w/o&w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73718,Mri lower extremity w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,563.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73719,Mri lower extremity w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73720,Mri lwr extremity w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"1,492.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73721,Mri jnt of lwr extre w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,518.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73722,Mri joint of lwr extr w/dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,73723,Mri joint lwr extr w/o&w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74018,X-ray exam abdomen 1 view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74019,X-ray exam abdomen 2 views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74021,X-ray exam abdomen 3+ views,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74022,X-ray exam complete abdomen,APC 5522,RVU Per Case,$105.60 ,OP,105.6,252,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74150,Ct abdomen w/o dye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,924.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74160,Ct abdomen w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,231.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74170,Ct abdomen w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,"1,221.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74174,Ct angio abd&pelv w/o&w/dye,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74175,Ct angio abdom w/o & w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74176,Ct abd & pelvis w/o contrast,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74177,Ct abd & pelv w/contrast,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74178,Ct abd & pelv 1/> regns,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74181,Mri abdomen w/o dye,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74182,Mri abdomen w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74183,Mri abdomen w/o & w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,"2,284.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74190,X-ray exam of peritoneum,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74210,X-ray xm phrnx&/crv esoph c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74220,X-ray xm esophagus 1cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,295.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74221,X-ray xm esophagus 2cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74230,X-ray xm swlng funcj c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,568.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74240,X-ray xm upr gi trc 1cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,431.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74246,X-ray xm upr gi trc 2cntrst,APC 5571,RVU Per Case,$173.03 ,OP,173.03,474.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74250,X-ray xm sm int 1cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,316.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74251,X-ray xm sm int 2cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74261,Ct colonography dx,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74262,Ct colonography dx w/dye,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74270,X-ray xm colon 1cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,675.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74280,X-ray xm colon 2cntrst std,APC 5571,RVU Per Case,$173.03 ,OP,173.03,500.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74283,Ther nma rdctj intus/obstrcj,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74290,Contrast x-ray gallbladder,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74400,Urography iv +-kub tomog,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,411.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74410,Urography nfs drip&/bolus,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74415,Urography nfs drip&/bls w/nf,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,639.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74420,Urography rtrgr +-kub,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,397.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74425,Urography antegrade rs&i,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74430,Contrast x-ray bladder,APC 5572,RVU Per Case,$356.73 ,OP,334.58,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74440,X-ray male genital tract,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74445,X-ray exam of penis,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74450,X-ray urethra/bladder,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74455,X-ray urethra/bladder,APC 5523,RVU Per Case,$223.01 ,OP,223.01,299.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74470,X-ray exam of kidney lesion,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74485,Dilation urtr/urt rs&i,APC 5373,RVU Per Case,"$1,737.55 ",OP,"1,737.55","1,737.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74710,X-ray measurement of pelvis,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74712,Mri fetal sngl/1st gestation,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74740,X-ray female genital tract,APC 5523,RVU Per Case,$223.01 ,OP,223.01,"1,538.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,74775,X-ray exam of perineum,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75557,Cardiac mri for morph,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75559,Cardiac mri w/stress img,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75561,Cardiac mri for morph w/dye,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75563,Card mri w/stress img & dye,APC 5573,RVU Per Case,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75571,Ct hrt w/o dye w/ca test,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75572,Ct hrt w/3d image,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75573,Ct hrt w/3d image congen,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75574,Ct angio hrt w/3d image,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75600,Contrast exam thoracic aorta,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75605,Contrast exam thoracic aorta,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75625,Contrast exam abdominl aorta,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75630,X-ray aorta leg arteries,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,687.18","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75635,Ct angio abdominal arteries,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75705,Artery x-rays spine,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75710,Artery x-rays arm/leg,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75716,Artery x-rays arms/legs,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75726,Artery x-rays abdomen,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75731,Artery x-rays adrenal gland,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75733,Artery x-rays adrenals,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75736,Artery x-rays pelvis,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75741,Artery x-rays lung,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75743,Artery x-rays lungs,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75746,Artery x-rays lung,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75756,Artery x-rays chest,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75801,Lymph vessel x-ray arm/leg,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75803,Lymph vessel x-ray arms/legs,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75805,Lymph vessel x-ray trunk,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75807,Lymph vessel x-ray trunk,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75809,Nonvascular shunt x-ray,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75810,Vein x-ray spleen/liver,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75820,Vein x-ray arm/leg,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75822,Vein x-ray arms/legs,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75825,Vein x-ray trunk,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75827,Vein x-ray chest,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75831,Vein x-ray kidney,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75833,Vein x-ray kidneys,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75840,Vein x-ray adrenal gland,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75842,Vein x-ray adrenal glands,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75860,Vein x-ray neck,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75870,Vein x-ray skull,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75872,Vein x-ray skull epidural,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75880,Vein x-ray eye socket,APC 5181,RVU Per Case,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75885,Vein x-ray liver w/hemodynam,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75887,Vein x-ray liver w/o hemodyn,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75889,Vein x-ray liver w/hemodynam,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75891,Vein x-ray liver,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75893,Venous sampling by catheter,APC 5184,RVU Per Case,"$4,622.89 ",OP,"4,622.89","4,622.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75898,Follow-up angiography,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75956,Xray endovasc thor ao repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75957,Xray endovasc thor ao repr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75958,Xray place prox ext thor ao,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,75959,Xray place dist ext thor ao,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76000,Fluoroscopy <1 hr phys/qhp,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,232.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76010,X-ray nose to rectum,APC 5521,RVU Per Case,$78.40 ,OP,78.4,126.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76080,X-ray exam of fistula,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76098,X-ray exam surgical specimen,APC 5524,RVU Per Case,$467.96 ,OP,59.28,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76100,X-ray exam of body section,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76101,Complex body section x-ray,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76102,Complex body section x-rays,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76120,Cine/video x-rays,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76145,Med physic dos eval rad exps,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76380,Cat scan follow-up study,APC 5521,RVU Per Case,$78.40 ,OP,78.4,643.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76390,Mr spectroscopy,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76391,Mr elastography,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76496,Fluoroscopic procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76497,Ct procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76498,Mri procedure,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76499,Radiographic procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76506,Echo exam of head,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76510,Oph us dx b-scan&quan a-scan,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76511,Oph us dx quan a-scan only,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76512,Oph us dx b-scan,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76513,Oph us dx ant sgm us uni/bi,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76514,Echo exam of eye thickness,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76516,Echo exam of eye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76519,Echo exam of eye,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76529,Echo exam of eye,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76536,Us exam of head and neck,APC 5522,RVU Per Case,$105.60 ,OP,105.6,294.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76604,Us exam chest,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76641,Ultrasound breast complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76642,Ultrasound breast limited,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76700,Us exam abdom complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,397.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76705,Echo exam of abdomen,APC 5522,RVU Per Case,$105.60 ,OP,105.6,534.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76706,Us abdl aorta screen aaa,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76770,Us exam abdo back wall comp,APC 5522,RVU Per Case,$105.60 ,OP,105.6,287.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76775,Us exam abdo back wall lim,APC 5522,RVU Per Case,$105.60 ,OP,105.6,558.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76776,Us exam k transpl w/doppler,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76800,Us exam spinal canal,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76801,Ob us < 14 wks single fetus,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,400.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76805,Ob us >= 14 wks sngl fetus,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,302.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76811,Ob us detailed sngl fetus,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,533,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76813,Ob us nuchal meas 1 gest,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76815,Ob us limited fetus(s),APC 5522,RVU Per Case,$105.60 ,OP,105.6,262.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76816,Ob us follow-up per fetus,APC 5522,RVU Per Case,$105.60 ,OP,105.6,374.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76817,Transvaginal us obstetric,APC 5522,RVU Per Case,$105.60 ,OP,105.6,305.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76818,Fetal biophys profile w/nst,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,343.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76819,Fetal biophys profil w/o nst,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76820,Umbilical artery echo,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76821,Middle cerebral artery echo,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76825,Echo exam of fetal heart,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76826,Echo exam of fetal heart,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76827,Echo exam of fetal heart,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76828,Echo exam of fetal heart,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76830,Transvaginal us non-ob,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,247.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76831,Echo exam uterus,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76856,Us exam pelvic complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,321.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76857,Us exam pelvic limited,APC 5522,RVU Per Case,$105.60 ,OP,105.6,265.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76870,Us exam scrotum,APC 5522,RVU Per Case,$105.60 ,OP,105.6,263.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76872,Us transrectal,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,891.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76873,Echograp trans r pros study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76881,Us compl joint r-t w/img,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76882,Us lmtd jt/nonvasc xtr strux,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76885,Us exam infant hips dynamic,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76886,Us exam infant hips static,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76936,Echo guide for artery repair,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76975,Gi endoscopic ultrasound,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76977,Us bone density measure,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76978,Us trgt dyn mbubb 1st les,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76981,Use parenchyma,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76982,Use 1st target lesion,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,76999,Echo examination procedure,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77046,Mri breast c- unilateral,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77047,Mri breast c- bilateral,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77053,X-ray of mammary duct,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77054,X-ray of mammary ducts,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77063,Breast tomosynthesis bi,Lab Services,Per Unit,$23.23 ,OP,23.23,23.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77065,Dx mammo incl cad uni,Lab Services,Per Unit,$83.47 ,OP,83.47,83.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77066,Dx mammo incl cad bi,Lab Services,Per Unit,$106.70 ,OP,106.7,106.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77067,Scr mammo bi incl cad,Lab Services,Per Unit,$88.24 ,OP,88.24,88.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77071,X-ray stress view,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77072,X-rays for bone age,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77073,X-rays bone length studies,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77074,X-rays bone survey limited,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77075,X-rays bone survey complete,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77076,X-rays bone survey infant,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77077,Joint survey single view,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77078,Ct bone density axial,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77080,Dxa bone density axial,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77081,Dxa bone density/peripheral,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77084,Magnetic image bone marrow,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77085,Dxa bone density study,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77086,Fracture assessment via dxa,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77280,Set radiation therapy field,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,"1,135.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77285,Set radiation therapy field,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77290,Set radiation therapy field,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,"2,127.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77295,3-d radiotherapy plan,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","2,465.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77299,Radiation therapy planning,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77300,Radiation therapy dose plan,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,186.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77301,Radiotherapy dose plan imrt,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77306,Telethx isodose plan simple,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77307,Telethx isodose plan cplx,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77316,Brachytx isodose plan simple,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77317,Brachytx isodose intermed,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77318,Brachytx isodose complex,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77321,Special teletx port plan,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77331,Special radiation dosimetry,APC 5611,RVU Per Unit,$122.95 ,OP,102.17,122.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77332,Radiation treatment aid(s),APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77333,Radiation treatment aid(s),APC 5611,RVU Per Unit,$122.95 ,OP,122.95,659.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77334,Radiation treatment aid(s),APC 5612,RVU Per Unit,$328.21 ,OP,328.21,464.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77336,Radiation physics consult,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,218.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77338,Design mlc device for imrt,APC 5612,RVU Per Unit,$328.21 ,OP,328.21,328.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77370,Radiation physics consult,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77371,Srs multisource,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77372,Srs linear based,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77373,Sbrt delivery,APC 5626,RVU Per Unit,"$1,680.14 ",OP,"1,680.14","1,680.14",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77385,Ntsty modul rad tx dlvr smpl,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77386,Ntsty modul rad tx dlvr cplx,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77399,External radiation dosimetry,APC 5611,RVU Per Unit,$122.95 ,OP,122.95,122.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77401,Radiation treatment delivery,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77402,Radiation treatment delivery,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77407,Radiation treatment delivery,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77412,Radiation treatment delivery,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,490.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77423,Neutron beam tx complex,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77424,Io rad tx delivery by x-ray,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77425,Io rad tx deliver by elctrns,APC 5627,RVU Per Case,"$7,532.45 ",OP,"7,532.45","7,532.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77470,Special radiation treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77520,Proton trmt simple w/o comp,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77522,Proton trmt simple w/comp,APC 5625,RVU Per Unit,"$1,257.79 ",OP,"1,257.79","1,257.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77523,Proton trmt intermediate,APC 5625,RVU Per Unit,"$1,257.79 ",OP,"1,257.79","1,257.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77525,Proton treatment complex,APC 5625,RVU Per Unit,"$1,257.79 ",OP,"1,257.79","1,257.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77600,Hyperthermia treatment,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77605,Hyperthermia treatment,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77610,Hyperthermia treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77615,Hyperthermia treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77620,Hyperthermia treatment,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77750,Infuse radioactive materials,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77761,Apply intrcav radiat simple,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77762,Apply intrcav radiat interm,APC 5623,RVU Per Unit,$525.78 ,OP,525.78,525.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77763,Apply intrcav radiat compl,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77767,Hdr rdncl skn surf brachytx,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77768,Hdr rdncl skn surf brachytx,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77770,Hdr rdncl ntrstl/icav brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77771,Hdr rdncl ntrstl/icav brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77772,Hdr rdncl ntrstl/icav brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77778,Apply interstit radiat compl,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77789,Apply surf ldr radionuclide,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,77799,Radium/radioisotope therapy,APC 5621,RVU Per Unit,$116.82 ,OP,116.82,116.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78012,Thyroid uptake measurement,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78013,Thyroid imaging w/blood flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78014,Thyroid imaging w/blood flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78015,Thyroid met imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78016,Thyroid met imaging/studies,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78018,Thyroid met imaging body,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78070,Parathyroid planar imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,609.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78071,Parathyrd planar w/wo subtrj,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78072,Parathyrd planar w/spect&ct,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78075,Adrenal cortex & medulla img,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78099,Endocrine nuclear procedure,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78102,Bone marrow imaging ltd,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78103,Bone marrow imaging mult,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78104,Bone marrow imaging body,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78110,Plasma volume single,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78111,Plasma volume multiple,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78120,Red cell mass single,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78121,Red cell mass multiple,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78122,Blood volume,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78130,Red cell survival study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78140,Red cell sequestration,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78185,Spleen imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78191,Platelet survival,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78195,Lymph system imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78199,Blood/lymph nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78201,Liver imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78202,Liver imaging with flow,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78215,Liver and spleen imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78216,Liver & spleen image/flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78226,Hepatobiliary system imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78227,Hepatobil syst image w/drug,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78230,Salivary gland imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78231,Serial salivary imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78232,Salivary gland function exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78258,Esophageal motility study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78261,Gastric mucosa imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78262,Gastroesophageal reflux exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78264,Gastric emptying imag study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,902.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78265,Gastric emptying imag study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78266,Gastric emptying imag study,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78267,Breath tst attain/anal c-14,Lab Services,Per Unit,$11.06 ,OP,11.06,11.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78268,Breath test analysis c-14,Lab Services,Per Unit,$94.41 ,OP,94.41,94.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78278,Acute gi blood loss imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78282,Gi protein loss exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78290,Meckels divert exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78291,Leveen/shunt patency exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78299,Gi nuclear procedure,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78300,Bone imaging limited area,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,101.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78305,Bone imaging multiple areas,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78306,Bone imaging whole body,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,737.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78315,Bone imaging 3 phase,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,717.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78399,Musculoskeletal nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78414,Non-imaging heart function,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78428,Cardiac shunt imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78429,Myocrd img pet 1 std w/ct,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78430,Myocrd img pet rst/strs w/ct,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78431,Myocrd img pet rst&strs ct,APC 1522,RVU Per Unit,"$2,180.92 ",OP,"2,180.92","2,180.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78432,Myocrd img pet 2rtracer,APC 1523,RVU Per Unit,"$2,665.46 ",OP,"2,665.46","2,665.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78433,Myocrd img pet 2rtracer ct,APC 1523,RVU Per Unit,"$2,665.46 ",OP,"2,665.46","2,665.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78445,Vascular flow imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78451,Ht muscle image spect sing,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78452,Ht muscle image spect mult,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78453,Ht muscle image planar sing,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78454,Ht musc image planar mult,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78456,Acute venous thrombus image,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78457,Venous thrombosis imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78458,Ven thrombosis images bilat,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78459,Myocrd img pet single study,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78466,Heart infarct image,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78468,Heart infarct image (ef),APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78469,Heart infarct image (3d),APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78472,Gated heart planar single,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,150.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78473,Gated heart multiple,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,"1,535.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78481,Heart first pass single,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78483,Heart first pass multiple,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78491,Myocrd img pet 1std rst/strs,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78492,Myocrd img pet mlt rst&strs,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78494,Heart image spect,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78499,Cardiovascular nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78579,Lung ventilation imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78580,Lung perfusion imaging,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78582,Lung ventilat&perfus imaging,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78597,Lung perfusion differential,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78598,Lung perf&ventilat diferentl,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78599,Respiratory nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78600,Brain image < 4 views,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78601,Brain image w/flow < 4 views,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78605,Brain image 4+ views,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78606,Brain image w/flow 4 + views,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78608,Brain imaging (pet),APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78610,Brain flow imaging only,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78630,Cerebrospinal fluid scan,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78635,Csf ventriculography,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78645,Csf shunt evaluation,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78650,Csf leakage imaging,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78660,Nuclear exam of tear flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78699,Nervous system nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78700,Kidney imaging morphol,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78701,Kidney imaging with flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78707,K flow/funct image w/o drug,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,"1,550.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78708,K flow/funct image w/drug,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,"2,347.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78709,K flow/funct image multiple,APC 5592,RVU Per Unit,$474.27 ,OP,474.27,474.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78725,Kidney function study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78740,Ureteral reflux study,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78761,Testicular imaging w/flow,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78799,Genitourinary nuclear exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78800,Rp loclzj tum 1 area 1 d img,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78801,Rp loclzj tum 2+area 1+d img,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78802,Rp loclzj tum whbdy 1 d img,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78803,Rp loclzj tum spect 1 area,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78804,Rp loclzj tum whbdy 2+d img,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78808,Iv inj ra drug dx study,APC 5591,RVU Per Case,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78811,Pet image ltd area,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78812,Pet image skull-thigh,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78813,Pet image full body,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78814,Pet image w/ct lmtd,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78815,Pet image w/ct skull-thigh,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78816,Pet image w/ct full body,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78830,Rp loclzj tum spect w/ct 1,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78831,Rp loclzj tum spect 2 areas,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78832,Rp loclzj tum spect w/ct 2,APC 5594,RVU Per Unit,"$1,434.57 ",OP,"1,434.57","1,434.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,78999,Nuclear diagnostic exam,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79005,Nuclear rx oral admin,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79101,Nuclear rx iv admin,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79200,Nuclear rx intracav admin,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79300,Nuclr rx interstit colloid,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79403,Hematopoietic nuclear tx,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79440,Nuclear rx intra-articular,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79445,Nuclear rx intra-arterial,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,79999,Nuclear medicine therapy,APC 5661,RVU Per Unit,$241.91 ,OP,241.91,241.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80047,Metabolic panel ionized ca,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80048,Metabolic panel total ca,Lab Services,Per Unit,$8.46 ,OP,8.46,75.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80051,Electrolyte panel,Lab Services,Per Unit,$7.01 ,OP,7.01,122.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80053,Comprehen metabolic panel,Lab Services,Per Unit,$10.56 ,OP,10.56,110.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80055,Obstetric panel,Lab Services,Per Unit,$47.81 ,OP,47.81,198.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80061,Lipid panel,Lab Services,Per Unit,$13.39 ,OP,13.39,115.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80069,Renal function panel,Lab Services,Per Unit,$8.68 ,OP,8.68,126.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80074,Acute hepatitis panel,Lab Services,Per Unit,$47.63 ,OP,47.63,293.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80076,Hepatic function panel,Lab Services,Per Unit,$8.17 ,OP,8.17,126.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80081,Obstetric panel,Lab Services,Per Unit,$74.86 ,OP,74.86,74.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80143,Drug assay acetaminophen,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80145,Drug assay adalimumab,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80150,Assay of amikacin,Lab Services,Per Unit,$15.08 ,OP,15.08,15.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80151,Drug assay amiodarone,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80155,Drug assay caffeine,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80156,Assay carbamazepine total,Lab Services,Per Unit,$14.57 ,OP,14.57,89.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80157,Assay carbamazepine free,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80158,Drug assay cyclosporine,Lab Services,Per Unit,$18.05 ,OP,18.05,191.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80159,Drug assay clozapine,Lab Services,Per Unit,$20.15 ,OP,20.15,20.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80161,Asy carbamazepin 10-11-epxid,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80162,Assay of digoxin total,Lab Services,Per Unit,$13.28 ,OP,13.28,85.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80163,Assay of digoxin free,Lab Services,Per Unit,$13.28 ,OP,13.28,13.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80164,Assay dipropylacetic acd tot,Lab Services,Per Unit,$13.54 ,OP,13.54,79.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80165,Dipropylacetic acid free,Lab Services,Per Unit,$13.54 ,OP,13.54,13.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80167,Drug assay felbamate,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80168,Assay of ethosuximide,Lab Services,Per Unit,$16.34 ,OP,16.34,16.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80169,Drug assay everolimus,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80170,Assay of gentamicin,Lab Services,Per Unit,$16.38 ,OP,16.38,111,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80171,Drug screen quant gabapentin,Lab Services,Per Unit,$21.67 ,OP,21.67,21.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80173,Assay of haloperidol,Lab Services,Per Unit,$15.78 ,OP,15.78,15.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80175,Drug screen quan lamotrigine,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80176,Assay of lidocaine,Lab Services,Per Unit,$14.69 ,OP,14.69,14.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80177,Drug scrn quan levetiracetam,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80178,Assay of lithium,Lab Services,Per Unit,$6.61 ,OP,6.61,57.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80179,Drug assay salicylate,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80180,Drug scrn quan mycophenolate,Lab Services,Per Unit,$18.05 ,OP,18.05,18.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80181,Drug assay flecainide,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80183,Drug scrn quant oxcarbazepin,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80184,Assay of phenobarbital,Lab Services,Per Unit,$15.30 ,OP,15.3,113.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80185,Assay of phenytoin total,Lab Services,Per Unit,$13.25 ,OP,13.25,88.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80186,Assay of phenytoin free,Lab Services,Per Unit,$13.76 ,OP,13.76,13.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80187,Drug assay posaconazole,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80188,Assay of primidone,Lab Services,Per Unit,$16.59 ,OP,16.59,16.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80189,Drug assay itraconzaole,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80190,Assay of procainamide,Lab Services,Per Unit,$60.00 ,OP,60,60,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80192,Assay of procainamide,Lab Services,Per Unit,$16.75 ,OP,16.75,16.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80193,Drug assay leflunomide,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80194,Assay of quinidine,Lab Services,Per Unit,$14.60 ,OP,14.6,14.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80195,Assay of sirolimus,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80197,Assay of tacrolimus,Lab Services,Per Unit,$13.73 ,OP,13.73,13.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80198,Assay of theophylline,Lab Services,Per Unit,$14.14 ,OP,14.14,121.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80199,Drug screen quant tiagabine,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80200,Assay of tobramycin,Lab Services,Per Unit,$16.13 ,OP,16.13,16.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80201,Assay of topiramate,Lab Services,Per Unit,$11.92 ,OP,11.92,11.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80202,Assay of vancomycin,Lab Services,Per Unit,$13.54 ,OP,13.54,88.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80203,Drug screen quant zonisamide,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80204,Drug assay methotrexate,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80210,Drug assay rufinamide,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80230,Drug assay infliximab,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80235,Drug assay lacosamide,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80280,Drug assay vedolizumab,Lab Services,Per Unit,$38.57 ,OP,38.57,38.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80285,Drug assay voriconazole,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80299,Quantitative assay drug,Lab Services,Per Unit,$18.64 ,OP,18.64,18.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80305,Drug test prsmv dir opt obs,Lab Services,Per Unit,$12.60 ,OP,12.6,12.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80306,Drug test prsmv instrmnt,Lab Services,Per Unit,$17.14 ,OP,17.14,17.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80307,Drug test prsmv chem anlyzr,Lab Services,Per Unit,$62.14 ,OP,62.14,62.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80400,Acth stimulation panel,Lab Services,Per Unit,$32.62 ,OP,32.62,32.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80402,Acth stimulation panel,Lab Services,Per Unit,$86.96 ,OP,86.96,86.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80406,Acth stimulation panel,Lab Services,Per Unit,$78.26 ,OP,78.26,78.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80408,Aldosterone suppression eval,Lab Services,Per Unit,$125.50 ,OP,125.5,125.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80410,Calcitonin stimul panel,Lab Services,Per Unit,$80.37 ,OP,80.37,80.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80412,Crh stimulation panel,Lab Services,Per Unit,$801.62 ,OP,801.62,801.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80414,Testosterone response panel,Lab Services,Per Unit,$51.64 ,OP,51.64,51.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80415,Tot estradiol response panel,Lab Services,Per Unit,$55.89 ,OP,55.89,55.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80416,Renin stimulation panel,Lab Services,Per Unit,$209.32 ,OP,209.32,209.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80417,Renin stimulation panel,Lab Services,Per Unit,$43.99 ,OP,43.99,43.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80418,Pituitary evaluation panel,Lab Services,Per Unit,$579.48 ,OP,579.48,579.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80420,Dexamethasone panel,Lab Services,Per Unit,$161.88 ,OP,161.88,161.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80422,Glucagon tolerance panel,Lab Services,Per Unit,$46.07 ,OP,46.07,46.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80424,Glucagon tolerance panel,Lab Services,Per Unit,$50.50 ,OP,50.5,50.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80426,Gonadotropin hormone panel,Lab Services,Per Unit,$148.41 ,OP,148.41,148.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80428,Growth hormone panel,Lab Services,Per Unit,$66.70 ,OP,66.7,66.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80430,Growth hormone panel,Lab Services,Per Unit,$129.33 ,OP,129.33,129.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80432,Insulin suppression panel,Lab Services,Per Unit,$165.61 ,OP,165.61,165.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80434,Insulin tolerance panel,Lab Services,Per Unit,$285.03 ,OP,285.03,285.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80435,Insulin tolerance panel,Lab Services,Per Unit,$103.00 ,OP,103,103,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80436,Metyrapone panel,Lab Services,Per Unit,$91.16 ,OP,91.16,91.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80438,Trh stimulation panel,Lab Services,Per Unit,$50.41 ,OP,50.41,50.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80439,Trh stimulation panel,Lab Services,Per Unit,$67.21 ,OP,67.21,67.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80500,Lab pathology consultation,APC 5671,RVU Per Case,$48.22 ,OP,15.72,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,80502,Lab pathology consultation,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81000,Urinalysis nonauto w/scope,Lab Services,Per Unit,$4.02 ,OP,4.02,33.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81001,Urinalysis auto w/scope,Lab Services,Per Unit,$3.17 ,OP,3.17,33.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81002,Urinalysis nonauto w/o scope,Lab Services,Per Unit,$3.48 ,OP,3.48,22.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81003,Urinalysis auto w/o scope,Lab Services,Per Unit,$2.25 ,OP,2.25,25.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81005,Urinalysis,Lab Services,Per Unit,$2.17 ,OP,2.17,2.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81007,Urine screen for bacteria,Lab Services,Per Unit,$29.98 ,OP,29.98,29.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81015,Microscopic exam of urine,Lab Services,Per Unit,$3.05 ,OP,3.05,33.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81020,Urinalysis glass test,Lab Services,Per Unit,$4.70 ,OP,4.7,4.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81025,Urine pregnancy test,Lab Services,Per Unit,$8.61 ,OP,8.61,62.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81050,Urinalysis volume measure,Lab Services,Per Unit,$3.64 ,OP,3.64,12.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81105,Hpa-1 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81106,Hpa-2 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81107,Hpa-3 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81108,Hpa-4 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81109,Hpa-5 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81110,Hpa-6 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81111,Hpa-9 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81112,Hpa-15 genotyping,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81120,Idh1 common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81121,Idh2 common variants,Lab Services,Per Unit,$295.79 ,OP,295.79,295.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81161,Dmd dup/delet analysis,Lab Services,Per Unit,$279.00 ,OP,279,279,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81162,Brca1&2 gen full seq dup/del,Lab Services,Per Unit,"$1,824.88 ",OP,"1,824.88","1,824.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81163,Brca1&2 gene full seq alys,Lab Services,Per Unit,$468.00 ,OP,468,468,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81164,Brca1&2 gen ful dup/del alys,Lab Services,Per Unit,$584.23 ,OP,584.23,584.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81165,Brca1 gene full seq alys,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81166,Brca1 gene full dup/del alys,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81167,Brca2 gene full dup/del alys,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81168,Ccnd1/igh translocation alys,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81170,Abl1 gene,Lab Services,Per Unit,$300.00 ,OP,300,300,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81171,Aff2 gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81172,Aff2 gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81173,Ar gene full gene sequence,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81174,Ar gene known famil variant,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81175,Asxl1 full gene sequence,Lab Services,Per Unit,$676.50 ,OP,676.5,676.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81176,Asxl1 gene target seq alys,Lab Services,Per Unit,$241.90 ,OP,241.9,241.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81177,Atn1 gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81178,Atxn1 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81179,Atxn2 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81180,Atxn3 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81181,Atxn7 gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81182,Atxn8os gen detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81183,Atxn10 gene detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81184,Cacna1a gen detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81185,Cacna1a gene full gene seq,Lab Services,Per Unit,$846.27 ,OP,846.27,846.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81186,Cacna1a gen known famil vrnt,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81187,Cnbp gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81188,Cstb gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81189,Cstb gene full gene sequence,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81190,Cstb gene known famil vrnt,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81191,Ntrk1 translocation analysis,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81192,Ntrk2 translocation analysis,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81193,Ntrk3 translocation analysis,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81194,Ntrk translocation analysis,Lab Services,Per Unit,$518.28 ,OP,518.28,518.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81200,Aspa gene,Lab Services,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81201,Apc gene full sequence,Lab Services,Per Unit,$780.00 ,OP,780,780,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81202,Apc gene known fam variants,Lab Services,Per Unit,$280.00 ,OP,280,280,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81203,Apc gene dup/delet variants,Lab Services,Per Unit,$200.00 ,OP,200,200,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81204,Ar gene charac alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81205,Bckdhb gene,Lab Services,Per Unit,$94.99 ,OP,94.99,94.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81206,Bcr/abl1 gene major bp,Lab Services,Per Unit,$163.96 ,OP,163.96,163.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81207,Bcr/abl1 gene minor bp,Lab Services,Per Unit,$144.84 ,OP,144.84,144.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81208,Bcr/abl1 gene other bp,Lab Services,Per Unit,$214.62 ,OP,214.62,214.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81209,Blm gene,Lab Services,Per Unit,$39.31 ,OP,39.31,39.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81210,Braf gene,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81212,Brca1&2 185&5385&6174 vrnt,Lab Services,Per Unit,$440.00 ,OP,440,440,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81215,Brca1 gene known famil vrnt,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81216,Brca2 gene full seq alys,Lab Services,Per Unit,$185.12 ,OP,185.12,185.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81217,Brca2 gene known famil vrnt,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81218,Cebpa gene full sequence,Lab Services,Per Unit,$241.90 ,OP,241.9,241.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81219,Calr gene com variants,Lab Services,Per Unit,$121.63 ,OP,121.63,121.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81220,Cftr gene com variants,Lab Services,Per Unit,$556.60 ,OP,556.6,556.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81221,Cftr gene known fam variants,Lab Services,Per Unit,$97.22 ,OP,97.22,97.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81222,Cftr gene dup/delet variants,Lab Services,Per Unit,$435.07 ,OP,435.07,435.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81223,Cftr gene full sequence,Lab Services,Per Unit,$499.00 ,OP,499,499,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81224,Cftr gene intron poly t,Lab Services,Per Unit,$168.75 ,OP,168.75,168.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81225,Cyp2c19 gene com variants,Lab Services,Per Unit,$291.36 ,OP,291.36,291.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81226,Cyp2d6 gene com variants,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81227,Cyp2c9 gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81228,Cytogen micrarray copy nmbr,Lab Services,Per Unit,$900.00 ,OP,900,900,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81229,Cytogen m array copy no&snp,Lab Services,Per Unit,"$1,160.00 ",OP,"1,160.00","1,160.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81230,Cyp3a4 gene common variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81231,Cyp3a5 gene common variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81232,Dpyd gene common variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81233,Btk gene common variants,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81234,Dmpk gene detc abnor allele,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81235,Egfr gene com variants,Lab Services,Per Unit,$324.58 ,OP,324.58,324.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81236,Ezh2 gene full gene sequence,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81237,Ezh2 gene common variants,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81238,F9 full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81239,Dmpk gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81240,F2 gene,Lab Services,Per Unit,$65.69 ,OP,65.69,65.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81241,F5 gene,Lab Services,Per Unit,$73.37 ,OP,73.37,73.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81242,Fancc gene,Lab Services,Per Unit,$36.62 ,OP,36.62,36.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81243,Fmr1 gene detection,Lab Services,Per Unit,$57.04 ,OP,57.04,57.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81244,Fmr1 gene charac alleles,Lab Services,Per Unit,$44.89 ,OP,44.89,44.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81245,Flt3 gene,Lab Services,Per Unit,$165.51 ,OP,165.51,165.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81246,Flt3 gene analysis,Lab Services,Per Unit,$83.00 ,OP,83,83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81247,G6pd gene alys cmn variant,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81248,G6pd known familial variant,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81249,G6pd full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81250,G6pc gene,Lab Services,Per Unit,$58.49 ,OP,58.49,58.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81251,Gba gene,Lab Services,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81252,Gjb2 gene full sequence,Lab Services,Per Unit,$101.12 ,OP,101.12,101.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81253,Gjb2 gene known fam variants,Lab Services,Per Unit,$61.52 ,OP,61.52,61.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81254,Gjb6 gene com variants,Lab Services,Per Unit,$35.00 ,OP,35,35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81255,Hexa gene,Lab Services,Per Unit,$51.45 ,OP,51.45,51.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81256,Hfe gene,Lab Services,Per Unit,$65.36 ,OP,65.36,65.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81257,Hba1/hba2 gene,Lab Services,Per Unit,$102.26 ,OP,102.26,102.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81258,Hba1/hba2 gene fam vrnt,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81259,Hba1/hba2 full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81260,Ikbkap gene,Lab Services,Per Unit,$39.31 ,OP,39.31,39.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81261,Igh gene rearrange amp meth,Lab Services,Per Unit,$197.99 ,OP,197.99,197.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81262,Igh gene rearrang dir probe,Lab Services,Per Unit,$68.55 ,OP,68.55,68.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81263,Igh vari regional mutation,Lab Services,Per Unit,$294.52 ,OP,294.52,294.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81264,Igk rearrangeabn clonal pop,Lab Services,Per Unit,$172.73 ,OP,172.73,172.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81265,Str markers specimen anal,Lab Services,Per Unit,$233.07 ,OP,233.07,233.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81266,Str markers spec anal addl,Lab Services,Per Unit,$304.81 ,OP,304.81,304.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81267,Chimerism anal no cell selec,Lab Services,Per Unit,$207.46 ,OP,207.46,207.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81268,Chimerism anal w/cell select,Lab Services,Per Unit,$260.79 ,OP,260.79,260.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81269,Hba1/hba2 gene dup/del vrnts,Lab Services,Per Unit,$202.40 ,OP,202.4,202.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81270,Jak2 gene,Lab Services,Per Unit,$91.66 ,OP,91.66,91.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81271,Htt gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81272,Kit gene targeted seq analys,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81273,Kit gene analys d816 variant,Lab Services,Per Unit,$124.87 ,OP,124.87,124.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81274,Htt gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81275,Kras gene variants exon 2,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81276,Kras gene addl variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81277,Cytogenomic neo microra alys,Lab Services,Per Unit,"$1,160.00 ",OP,"1,160.00","1,160.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81278,Igh@/bcl2 translocation alys,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81279,Jak2 gene trgt sequence alys,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81283,Ifnl3 gene,Lab Services,Per Unit,$73.37 ,OP,73.37,73.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81284,Fxn gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81285,Fxn gene charac alleles,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81286,Fxn gene full gene sequence,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81287,Mgmt gene prmtr mthyltn alys,Lab Services,Per Unit,$124.64 ,OP,124.64,124.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81288,Mlh1 gene,Lab Services,Per Unit,$192.32 ,OP,192.32,192.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81289,Fxn gene known famil variant,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81290,Mcoln1 gene,Lab Services,Per Unit,$39.31 ,OP,39.31,39.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81291,Mthfr gene,Lab Services,Per Unit,$65.34 ,OP,65.34,65.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81292,Mlh1 gene full seq,Lab Services,Per Unit,$675.40 ,OP,675.4,675.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81293,Mlh1 gene known variants,Lab Services,Per Unit,$331.00 ,OP,331,331,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81294,Mlh1 gene dup/delete variant,Lab Services,Per Unit,$202.40 ,OP,202.4,202.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81295,Msh2 gene full seq,Lab Services,Per Unit,$381.70 ,OP,381.7,381.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81296,Msh2 gene known variants,Lab Services,Per Unit,$337.73 ,OP,337.73,337.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81297,Msh2 gene dup/delete variant,Lab Services,Per Unit,$213.30 ,OP,213.3,213.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81298,Msh6 gene full seq,Lab Services,Per Unit,$641.85 ,OP,641.85,641.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81299,Msh6 gene known variants,Lab Services,Per Unit,$308.00 ,OP,308,308,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81300,Msh6 gene dup/delete variant,Lab Services,Per Unit,$238.00 ,OP,238,238,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81301,Microsatellite instability,Lab Services,Per Unit,$348.56 ,OP,348.56,348.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81302,Mecp2 gene full seq,Lab Services,Per Unit,$527.87 ,OP,527.87,527.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81303,Mecp2 gene known variant,Lab Services,Per Unit,$120.00 ,OP,120,120,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81304,Mecp2 gene dup/delet variant,Lab Services,Per Unit,$150.00 ,OP,150,150,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81305,Myd88 gene p.leu265pro vrnt,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81306,Nudt15 gene common variants,Lab Services,Per Unit,$291.36 ,OP,291.36,291.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81307,Palb2 gene full gene seq,Lab Services,Per Unit,$676.50 ,OP,676.5,676.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81308,Palb2 gene known famil vrnt,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81309,Pik3ca gene trgt seq alys,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81310,Npm1 gene,Lab Services,Per Unit,$246.52 ,OP,246.52,246.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81311,Nras gene variants exon 2&3,Lab Services,Per Unit,$295.79 ,OP,295.79,295.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81312,Pabpn1 gene detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81313,Pca3/klk3 antigen,Lab Services,Per Unit,$255.05 ,OP,255.05,255.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81314,Pdgfra gene,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81315,Pml/raralpha com breakpoints,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81316,Pml/raralpha 1 breakpoint,Lab Services,Per Unit,$207.31 ,OP,207.31,207.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81317,Pms2 gene full seq analysis,Lab Services,Per Unit,$676.50 ,OP,676.5,676.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81318,Pms2 known familial variants,Lab Services,Per Unit,$331.00 ,OP,331,331,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81319,Pms2 gene dup/delet variants,Lab Services,Per Unit,$203.50 ,OP,203.5,203.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81320,Plcg2 gene common variants,Lab Services,Per Unit,$291.36 ,OP,291.36,291.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81321,Pten gene full sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81322,Pten gene known fam variant,Lab Services,Per Unit,$46.60 ,OP,46.6,46.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81323,Pten gene dup/delet variant,Lab Services,Per Unit,$300.00 ,OP,300,300,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81324,Pmp22 gene dup/delet,Lab Services,Per Unit,$758.36 ,OP,758.36,758.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81325,Pmp22 gene full sequence,Lab Services,Per Unit,$769.58 ,OP,769.58,769.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81326,Pmp22 gene known fam variant,Lab Services,Per Unit,$46.60 ,OP,46.6,46.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81327,Sept9 gen prmtr mthyltn alys,Lab Services,Per Unit,$192.00 ,OP,192,192,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81328,Slco1b1 gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81329,Smn1 gene dos/deletion alys,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81330,Smpd1 gene common variants,Lab Services,Per Unit,$47.00 ,OP,47,47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81331,Snrpn/ube3a gene,Lab Services,Per Unit,$51.07 ,OP,51.07,51.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81332,Serpina1 gene,Lab Services,Per Unit,$43.65 ,OP,43.65,43.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81333,Tgfbi gene common variants,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81334,Runx1 gene targeted seq alys,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81335,Tpmt gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81336,Smn1 gene full gene sequence,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81337,Smn1 gen nown famil seq vrnt,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81338,Mpl gene common variants,Lab Services,Per Unit,$150.33 ,OP,150.33,150.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81339,Mpl gene seq alys exon 10,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81340,Trb@ gene rearrange amplify,Lab Services,Per Unit,$208.92 ,OP,208.92,208.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81341,Trb@ gene rearrange dirprobe,Lab Services,Per Unit,$49.59 ,OP,49.59,49.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81342,Trg gene rearrangement anal,Lab Services,Per Unit,$201.50 ,OP,201.5,201.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81343,Ppp2r2b gen detc abnor allel,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81344,Tbp gene detc abnor alleles,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81345,Tert gene targeted seq alys,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81346,Tyms gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81347,Sf3b1 gene common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81348,Srsf2 gene common variants,Lab Services,Per Unit,$175.40 ,OP,175.4,175.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81350,Ugt1a1 gene common variants,Lab Services,Per Unit,$234.00 ,OP,234,234,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81351,Tp53 gene full gene sequence,Lab Services,Per Unit,$641.85 ,OP,641.85,641.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81352,Tp53 gene trgt sequence alys,Lab Services,Per Unit,$329.51 ,OP,329.51,329.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81353,Tp53 gene known famil vrnt,Lab Services,Per Unit,$308.00 ,OP,308,308,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81355,Vkorc1 gene,Lab Services,Per Unit,$88.20 ,OP,88.2,88.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81357,U2af1 gene common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81360,Zrsr2 gene common variants,Lab Services,Per Unit,$193.25 ,OP,193.25,193.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81361,Hbb gene com variants,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81362,Hbb gene known fam variant,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81363,Hbb gene dup/del variants,Lab Services,Per Unit,$202.40 ,OP,202.4,202.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81364,Hbb full gene sequence,Lab Services,Per Unit,$324.58 ,OP,324.58,324.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81370,Hla i & ii typing lr,Lab Services,Per Unit,$402.12 ,OP,402.12,402.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81371,Hla i & ii type verify lr,Lab Services,Per Unit,$404.52 ,OP,404.52,404.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81372,Hla i typing complete lr,Lab Services,Per Unit,$403.59 ,OP,403.59,403.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81373,Hla i typing 1 locus lr,Lab Services,Per Unit,$127.43 ,OP,127.43,127.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81374,Hla i typing 1 antigen lr,Lab Services,Per Unit,$74.33 ,OP,74.33,74.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81375,Hla ii typing ag equiv lr,Lab Services,Per Unit,$220.74 ,OP,220.74,220.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81376,Hla ii typing 1 locus lr,Lab Services,Per Unit,$122.22 ,OP,122.22,122.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81377,Hla ii type 1 ag equiv lr,Lab Services,Per Unit,$94.74 ,OP,94.74,94.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81378,Hla i & ii typing hr,Lab Services,Per Unit,$345.57 ,OP,345.57,345.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81379,Hla i typing complete hr,Lab Services,Per Unit,$335.38 ,OP,335.38,335.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81380,Hla i typing 1 locus hr,Lab Services,Per Unit,$177.25 ,OP,177.25,177.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81381,Hla i typing 1 allele hr,Lab Services,Per Unit,$169.90 ,OP,169.9,169.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81382,Hla ii typing 1 loc hr,Lab Services,Per Unit,$123.68 ,OP,123.68,123.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81383,Hla ii typing 1 allele hr,Lab Services,Per Unit,$109.13 ,OP,109.13,109.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81400,Mopath procedure level 1,Lab Services,Per Unit,$63.96 ,OP,63.96,63.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81401,Mopath procedure level 2,Lab Services,Per Unit,$137.00 ,OP,137,137,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81402,Mopath procedure level 3,Lab Services,Per Unit,$150.33 ,OP,150.33,150.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81403,Mopath procedure level 4,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81404,Mopath procedure level 5,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81405,Mopath procedure level 6,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81406,Mopath procedure level 7,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81407,Mopath procedure level 8,Lab Services,Per Unit,$846.27 ,OP,846.27,846.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81408,Mopath procedure level 9,Lab Services,Per Unit,"$2,000.00 ",OP,"2,000.00","2,000.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81410,Aortic dysfunction/dilation,Lab Services,Per Unit,$504.00 ,OP,504,504,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81411,Aortic dysfunction/dilation,Lab Services,Per Unit,"$1,350.19 ",OP,"1,350.19","1,350.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81412,Ashkenazi jewish assoc dis,Lab Services,Per Unit,"$2,448.56 ",OP,"2,448.56","2,448.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81413,Car ion chnnlpath inc 10 gns,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81414,Car ion chnnlpath inc 2 gns,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81415,Exome sequence analysis,Lab Services,Per Unit,"$4,780.00 ",OP,"4,780.00","4,780.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81416,Exome sequence analysis,Lab Services,Per Unit,"$12,000.00 ",OP,"12,000.00","12,000.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81417,Exome re-evaluation,Lab Services,Per Unit,$320.00 ,OP,320,320,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81419,Epilepsy gen seq alys panel,Lab Services,Per Unit,"$2,448.56 ",OP,"2,448.56","2,448.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81420,Fetal chrmoml aneuploidy,Lab Services,Per Unit,$759.05 ,OP,759.05,759.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81422,Fetal chrmoml microdeltj,Lab Services,Per Unit,$759.05 ,OP,759.05,759.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81425,Genome sequence analysis,Lab Services,Per Unit,"$5,031.20 ",OP,"5,031.20","5,031.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81426,Genome sequence analysis,Lab Services,Per Unit,"$2,709.95 ",OP,"2,709.95","2,709.95",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81427,Genome re-evaluation,Lab Services,Per Unit,"$2,337.65 ",OP,"2,337.65","2,337.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81430,Hearing loss sequence analys,Lab Services,Per Unit,"$1,625.00 ",OP,"1,625.00","1,625.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81431,Hearing loss dup/del analys,Lab Services,Per Unit,$679.57 ,OP,679.57,679.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81432,Hrdtry brst ca-rlatd dsordrs,Lab Services,Per Unit,$679.05 ,OP,679.05,679.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81433,Hrdtry brst ca-rlatd dsordrs,Lab Services,Per Unit,$438.93 ,OP,438.93,438.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81434,Hereditary retinal disorders,Lab Services,Per Unit,$597.91 ,OP,597.91,597.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81435,Hereditary colon ca dsordrs,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81436,Hereditary colon ca dsordrs,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81437,Heredtry nurondcrn tum dsrdr,Lab Services,Per Unit,$438.93 ,OP,438.93,438.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81438,Heredtry nurondcrn tum dsrdr,Lab Services,Per Unit,$438.93 ,OP,438.93,438.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81439,Hrdtry cardmypy gene panel,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81440,Mitochondrial gene,Lab Services,Per Unit,"$3,324.00 ",OP,"3,324.00","3,324.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81442,Noonan spectrum disorders,Lab Services,Per Unit,"$2,143.60 ",OP,"2,143.60","2,143.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81443,Genetic tstg severe inh cond,Lab Services,Per Unit,"$2,448.56 ",OP,"2,448.56","2,448.56",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81445,Targeted genomic seq analys,Lab Services,Per Unit,$597.91 ,OP,597.91,597.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81448,Hrdtry perph neurphy panel,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81450,Targeted genomic seq analys,Lab Services,Per Unit,$759.53 ,OP,759.53,759.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81455,Targeted genomic seq analys,Lab Services,Per Unit,"$2,919.60 ",OP,"2,919.60","2,919.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81460,Whole mitochondrial genome,Lab Services,Per Unit,"$1,287.00 ",OP,"1,287.00","1,287.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81465,Whole mitochondrial genome,Lab Services,Per Unit,$936.00 ,OP,936,936,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81470,X-linked intellectual dblt,Lab Services,Per Unit,$914.00 ,OP,914,914,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81471,X-linked intellectual dblt,Lab Services,Per Unit,$914.00 ,OP,914,914,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81490,Autoimmune rheumatoid arthr,Lab Services,Per Unit,$840.65 ,OP,840.65,840.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81493,Cor artery disease mrna,Lab Services,Per Unit,"$1,050.00 ",OP,"1,050.00","1,050.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81500,Onco (ovar) two proteins,Lab Services,Per Unit,$260.50 ,OP,260.5,260.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81503,Onco (ovar) five proteins,Lab Services,Per Unit,$897.00 ,OP,897,897,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81504,Oncology tissue of origin,Lab Services,Per Unit,$520.00 ,OP,520,520,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81506,Endo assay seven anal,Lab Services,Per Unit,$68.92 ,OP,68.92,68.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81507,Fetal aneuploidy trisom risk,Lab Services,Per Unit,$795.00 ,OP,795,795,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81508,Ftl cgen abnor two proteins,Lab Services,Per Unit,$54.30 ,OP,54.3,54.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81509,Ftl cgen abnor 3 proteins,Lab Services,Per Unit,"$1,487.37 ",OP,"1,487.37","1,487.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81510,Ftl cgen abnor three anal,Lab Services,Per Unit,$55.54 ,OP,55.54,55.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81511,Ftl cgen abnor four anal,Lab Services,Per Unit,$153.50 ,OP,153.5,153.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81512,Ftl cgen abnor five anal,Lab Services,Per Unit,$69.52 ,OP,69.52,69.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81513,Nfct ds bv rna vag flu alg,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81514,Nfct ds bv&vaginitis dna alg,Lab Services,Per Unit,$262.99 ,OP,262.99,262.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81518,Onc brst mrna 11 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81519,Oncology breast mrna,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81520,Onc breast mrna 58 genes,Lab Services,Per Unit,"$2,510.21 ",OP,"2,510.21","2,510.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81521,Onc breast mrna 70 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81522,Onc breast mrna 12 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81525,Oncology colon mrna,Lab Services,Per Unit,"$3,116.00 ",OP,"3,116.00","3,116.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81528,Oncology colorectal scr,Lab Services,Per Unit,$508.87 ,OP,508.87,508.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81529,Onc cutan mlnma mrna 31 gene,Lab Services,Per Unit,"$7,193.00 ",OP,"7,193.00","7,193.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81535,Oncology gynecologic,Lab Services,Per Unit,$579.46 ,OP,579.46,579.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81536,Oncology gynecologic,Lab Services,Per Unit,$177.56 ,OP,177.56,177.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81538,Oncology lung,Lab Services,Per Unit,"$2,871.00 ",OP,"2,871.00","2,871.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81539,Oncology prostate prob score,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81540,Oncology tum unknown origin,Lab Services,Per Unit,"$3,750.00 ",OP,"3,750.00","3,750.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81541,Onc prostate mrna 46 genes,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81542,Onc prostate mrna 22 cnt gen,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81546,Onc thyr mrna 10-196 gen alg,Lab Services,Per Unit,"$3,600.00 ",OP,"3,600.00","3,600.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81551,Onc prostate 3 genes,Lab Services,Per Unit,"$2,030.00 ",OP,"2,030.00","2,030.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81552,Onc uveal mlnma mrna 15 gene,Lab Services,Per Unit,"$7,776.00 ",OP,"7,776.00","7,776.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81554,Pulm ds ipf mrna 190 gen alg,Lab Services,Per Unit,"$5,500.00 ",OP,"5,500.00","5,500.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81595,Cardiology hrt trnspl mrna,Lab Services,Per Unit,"$3,240.00 ",OP,"3,240.00","3,240.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,81596,Nfct ds chrnc hcv 6 assays,Lab Services,Per Unit,$72.19 ,OP,72.19,72.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82009,Test for acetone/ketones,Lab Services,Per Unit,$4.52 ,OP,4.52,39.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82010,Acetone assay,Lab Services,Per Unit,$8.17 ,OP,8.17,8.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82013,Acetylcholinesterase assay,Lab Services,Per Unit,$12.29 ,OP,12.29,12.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82016,Acylcarnitines qual,Lab Services,Per Unit,$16.49 ,OP,16.49,16.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82017,Acylcarnitines quant,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82024,Assay of acth,Lab Services,Per Unit,$38.62 ,OP,38.62,38.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82030,Assay of adp & amp,Lab Services,Per Unit,$25.80 ,OP,25.8,25.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82040,Assay of serum albumin,Lab Services,Per Unit,$4.95 ,OP,4.95,47.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82042,Other source albumin quan ea,Lab Services,Per Unit,$7.78 ,OP,7.78,37.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82043,Ur albumin quantitative,Lab Services,Per Unit,$5.78 ,OP,5.78,56.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82044,Ur albumin semiquantitative,Lab Services,Per Unit,$6.23 ,OP,6.23,6.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82045,Albumin ischemia modified,Lab Services,Per Unit,$33.94 ,OP,33.94,33.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82075,Assay of breath ethanol,Lab Services,Per Unit,$30.00 ,OP,30,59.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82077,Assay spec xcp ur&breath ia,Lab Services,Per Unit,$17.27 ,OP,17.27,17.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82085,Assay of aldolase,Lab Services,Per Unit,$9.71 ,OP,9.71,127.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82088,Assay of aldosterone,Lab Services,Per Unit,$40.75 ,OP,40.75,40.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82103,Alpha-1-antitrypsin total,Lab Services,Per Unit,$13.44 ,OP,13.44,76.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82104,Alpha-1-antitrypsin pheno,Lab Services,Per Unit,$14.46 ,OP,14.46,14.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82105,Alpha-fetoprotein serum,Lab Services,Per Unit,$16.77 ,OP,16.77,96.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82106,Alpha-fetoprotein amniotic,Lab Services,Per Unit,$17.00 ,OP,17,17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82107,Alpha-fetoprotein l3,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82108,Assay of aluminum,Lab Services,Per Unit,$25.48 ,OP,25.48,25.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82120,Amines vaginal fluid qual,Lab Services,Per Unit,$5.99 ,OP,5.99,5.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82127,Amino acid single qual,Lab Services,Per Unit,$14.18 ,OP,14.18,14.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82128,Amino acids mult qual,Lab Services,Per Unit,$13.87 ,OP,13.87,13.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82131,Amino acids single quant,Lab Services,Per Unit,$22.98 ,OP,22.98,213.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82135,Assay aminolevulinic acid,Lab Services,Per Unit,$16.45 ,OP,16.45,16.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82136,Amino acids quant 2-5,Lab Services,Per Unit,$19.61 ,OP,19.61,19.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82139,Amino acids quan 6 or more,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82140,Assay of ammonia,Lab Services,Per Unit,$14.57 ,OP,14.57,149.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82143,Amniotic fluid scan,Lab Services,Per Unit,$9.35 ,OP,9.35,9.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82150,Assay of amylase,Lab Services,Per Unit,$6.48 ,OP,6.48,69.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82154,Androstanediol glucuronide,Lab Services,Per Unit,$28.83 ,OP,28.83,28.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82157,Assay of androstenedione,Lab Services,Per Unit,$29.28 ,OP,29.28,29.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82160,Assay of androsterone,Lab Services,Per Unit,$25.55 ,OP,25.55,25.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82163,Assay of angiotensin ii,Lab Services,Per Unit,$20.52 ,OP,20.52,20.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82164,Angiotensin i enzyme test,Lab Services,Per Unit,$14.60 ,OP,14.6,14.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82172,Assay of apolipoprotein,Lab Services,Per Unit,$21.09 ,OP,21.09,65.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82175,Assay of arsenic,Lab Services,Per Unit,$18.97 ,OP,18.97,18.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82180,Assay of ascorbic acid,Lab Services,Per Unit,$9.89 ,OP,9.89,9.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82190,Atomic absorption,Lab Services,Per Unit,$15.90 ,OP,15.9,15.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82232,Assay of beta-2 protein,Lab Services,Per Unit,$16.18 ,OP,16.18,16.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82239,Bile acids total,Lab Services,Per Unit,$17.12 ,OP,17.12,17.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82240,Bile acids cholylglycine,Lab Services,Per Unit,$26.58 ,OP,26.58,26.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82247,Bilirubin total,Lab Services,Per Unit,$5.02 ,OP,5.02,42.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82248,Bilirubin direct,Lab Services,Per Unit,$5.02 ,OP,5.02,29.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82252,Fecal bilirubin test,Lab Services,Per Unit,$4.56 ,OP,4.56,4.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82261,Assay of biotinidase,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82270,Occult blood feces,Lab Services,Per Unit,$4.38 ,OP,4.38,26.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82271,Occult blood other sources,Lab Services,Per Unit,$5.32 ,OP,5.32,5.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82272,Occult bld feces 1-3 tests,Lab Services,Per Unit,$4.23 ,OP,4.23,4.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82274,Assay test for blood fecal,Lab Services,Per Unit,$15.92 ,OP,15.92,15.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82286,Assay of bradykinin,Lab Services,Per Unit,$5.16 ,OP,5.16,5.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82300,Assay of cadmium,Lab Services,Per Unit,$23.64 ,OP,23.64,23.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82306,Vitamin d 25 hydroxy,Lab Services,Per Unit,$29.60 ,OP,29.6,29.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82308,Assay of calcitonin,Lab Services,Per Unit,$26.79 ,OP,26.79,26.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82310,Assay of calcium,Lab Services,Per Unit,$5.16 ,OP,5.16,46.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82330,Assay of calcium,Lab Services,Per Unit,$13.68 ,OP,13.68,145.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82331,Calcium infusion test,Lab Services,Per Unit,$13.34 ,OP,13.34,13.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82340,Assay of calcium in urine,Lab Services,Per Unit,$6.03 ,OP,6.03,61.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82355,Calculus analysis qual,Lab Services,Per Unit,$11.58 ,OP,11.58,137.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82360,Calculus assay quant,Lab Services,Per Unit,$12.87 ,OP,12.87,96.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82365,Calculus spectroscopy,Lab Services,Per Unit,$12.90 ,OP,12.9,67.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82370,X-ray assay calculus,Lab Services,Per Unit,$12.52 ,OP,12.52,12.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82373,Assay c-d transfer measure,Lab Services,Per Unit,$18.06 ,OP,18.06,18.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82374,Assay blood carbon dioxide,Lab Services,Per Unit,$4.88 ,OP,4.88,4.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82375,Assay carboxyhb quant,Lab Services,Per Unit,$12.32 ,OP,12.32,55.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82376,Assay carboxyhb qual,Lab Services,Per Unit,$14.07 ,OP,14.07,14.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82378,Carcinoembryonic antigen,Lab Services,Per Unit,$18.96 ,OP,18.96,146,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82379,Assay of carnitine,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82380,Assay of carotene,Lab Services,Per Unit,$9.22 ,OP,9.22,9.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82382,Assay urine catecholamines,Lab Services,Per Unit,$27.30 ,OP,27.3,27.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82383,Assay blood catecholamines,Lab Services,Per Unit,$29.08 ,OP,29.08,29.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82384,Assay three catecholamines,Lab Services,Per Unit,$25.25 ,OP,25.25,115.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82387,Assay of cathepsin-d,Lab Services,Per Unit,$18.06 ,OP,18.06,18.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82390,Assay of ceruloplasmin,Lab Services,Per Unit,$10.74 ,OP,10.74,63.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82397,Chemiluminescent assay,Lab Services,Per Unit,$14.12 ,OP,14.12,14.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82415,Assay of chloramphenicol,Lab Services,Per Unit,$12.67 ,OP,12.67,12.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82435,Assay of blood chloride,Lab Services,Per Unit,$4.60 ,OP,4.6,11.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82436,Assay of urine chloride,Lab Services,Per Unit,$5.75 ,OP,5.75,5.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82438,Assay other fluid chlorides,Lab Services,Per Unit,$5.00 ,OP,5,5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82441,Test for chlorohydrocarbons,Lab Services,Per Unit,$6.01 ,OP,6.01,6.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82465,Assay bld/serum cholesterol,Lab Services,Per Unit,$4.35 ,OP,4.35,40.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82480,Assay serum cholinesterase,Lab Services,Per Unit,$7.87 ,OP,7.87,85.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82482,Assay rbc cholinesterase,Lab Services,Per Unit,$9.81 ,OP,9.81,9.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82485,Assay chondroitin sulfate,Lab Services,Per Unit,$20.65 ,OP,20.65,20.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82495,Assay of chromium,Lab Services,Per Unit,$20.28 ,OP,20.28,20.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82507,Assay of citrate,Lab Services,Per Unit,$27.80 ,OP,27.8,27.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82523,Collagen crosslinks,Lab Services,Per Unit,$18.68 ,OP,18.68,18.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82525,Assay of copper,Lab Services,Per Unit,$12.41 ,OP,12.41,12.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82528,Assay of corticosterone,Lab Services,Per Unit,$22.52 ,OP,22.52,22.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82530,Cortisol free,Lab Services,Per Unit,$16.71 ,OP,16.71,16.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82533,Total cortisol,Lab Services,Per Unit,$16.30 ,OP,16.3,154.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82540,Assay of creatine,Lab Services,Per Unit,$4.64 ,OP,4.64,4.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82542,Col chromotography qual/quan,Lab Services,Per Unit,$24.09 ,OP,24.09,24.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82550,Assay of ck (cpk),Lab Services,Per Unit,$6.51 ,OP,6.51,50.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82552,Assay of cpk in blood,Lab Services,Per Unit,$13.39 ,OP,13.39,79.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82553,Creatine mb fraction,Lab Services,Per Unit,$11.55 ,OP,11.55,77.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82554,Creatine isoforms,Lab Services,Per Unit,$11.87 ,OP,11.87,11.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82565,Assay of creatinine,Lab Services,Per Unit,$5.12 ,OP,5.12,39.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82570,Assay of urine creatinine,Lab Services,Per Unit,$5.18 ,OP,5.18,31.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82575,Creatinine clearance test,Lab Services,Per Unit,$9.46 ,OP,9.46,104.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82585,Assay of cryofibrinogen,Lab Services,Per Unit,$14.14 ,OP,14.14,14.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82595,Assay of cryoglobulin,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82600,Assay of cyanide,Lab Services,Per Unit,$19.40 ,OP,19.4,19.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82607,Vitamin b-12,Lab Services,Per Unit,$15.08 ,OP,15.08,93.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82608,B-12 binding capacity,Lab Services,Per Unit,$14.32 ,OP,14.32,14.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82610,Cystatin c,Lab Services,Per Unit,$18.52 ,OP,18.52,18.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82615,Test for urine cystines,Lab Services,Per Unit,$9.55 ,OP,9.55,9.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82626,Dehydroepiandrosterone,Lab Services,Per Unit,$25.27 ,OP,25.27,25.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82627,Dehydroepiandrosterone,Lab Services,Per Unit,$22.23 ,OP,22.23,150.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82633,Desoxycorticosterone,Lab Services,Per Unit,$30.98 ,OP,30.98,30.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82634,Deoxycortisol,Lab Services,Per Unit,$29.28 ,OP,29.28,29.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82638,Assay of dibucaine number,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82642,Dihydrotestosterone,Lab Services,Per Unit,$29.28 ,OP,29.28,29.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82652,Vit d 1 25-dihydroxy,Lab Services,Per Unit,$38.50 ,OP,38.5,314.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82656,Pancreatic elastase fecal,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82657,Enzyme cell activity,Lab Services,Per Unit,$22.17 ,OP,22.17,22.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82658,Enzyme cell activity ra,Lab Services,Per Unit,$44.03 ,OP,44.03,44.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82664,Electrophoretic test,Lab Services,Per Unit,$61.50 ,OP,61.5,61.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82668,Assay of erythropoietin,Lab Services,Per Unit,$18.79 ,OP,18.79,18.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82670,Assay of total estradiol,Lab Services,Per Unit,$27.94 ,OP,27.94,182.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82671,Assay of estrogens,Lab Services,Per Unit,$32.30 ,OP,32.3,32.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82672,Assay of estrogen,Lab Services,Per Unit,$21.70 ,OP,21.7,122.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82677,Assay of estriol,Lab Services,Per Unit,$24.18 ,OP,24.18,89.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82679,Assay of estrone,Lab Services,Per Unit,$24.95 ,OP,24.95,24.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82681,Assay dir meas fr estradiol,Lab Services,Per Unit,$27.94 ,OP,27.94,27.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82693,Assay of ethylene glycol,Lab Services,Per Unit,$14.90 ,OP,14.9,14.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82696,Assay of etiocholanolone,Lab Services,Per Unit,$26.24 ,OP,26.24,26.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82705,Fats/lipids feces qual,Lab Services,Per Unit,$5.10 ,OP,5.1,5.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82710,Fats/lipids feces quant,Lab Services,Per Unit,$16.80 ,OP,16.8,16.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82715,Assay of fecal fat,Lab Services,Per Unit,$22.97 ,OP,22.97,22.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82725,Assay of blood fatty acids,Lab Services,Per Unit,$18.77 ,OP,18.77,18.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82726,Long chain fatty acids,Lab Services,Per Unit,$19.75 ,OP,19.75,19.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82728,Assay of ferritin,Lab Services,Per Unit,$13.63 ,OP,13.63,97.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82731,Assay of fetal fibronectin,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82735,Assay of fluoride,Lab Services,Per Unit,$18.54 ,OP,18.54,18.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82746,Assay of folic acid serum,Lab Services,Per Unit,$14.70 ,OP,14.7,76.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82747,Assay of folic acid rbc,Lab Services,Per Unit,$17.65 ,OP,17.65,188.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82757,Assay of semen fructose,Lab Services,Per Unit,$17.34 ,OP,17.34,17.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82759,Assay of rbc galactokinase,Lab Services,Per Unit,$21.48 ,OP,21.48,21.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82760,Assay of galactose,Lab Services,Per Unit,$11.20 ,OP,11.2,11.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82775,Assay galactose transferase,Lab Services,Per Unit,$21.07 ,OP,21.07,21.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82776,Galactose transferase test,Lab Services,Per Unit,$11.74 ,OP,11.74,11.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82777,Galectin-3,Lab Services,Per Unit,$44.25 ,OP,44.25,44.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82784,Assay iga/igd/igg/igm each,Lab Services,Per Unit,$9.30 ,OP,9.3,81.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82785,Assay of ige,Lab Services,Per Unit,$16.46 ,OP,16.46,94.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82787,Igg 1 2 3 or 4 each,Lab Services,Per Unit,$8.02 ,OP,8.02,8.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82800,Blood ph,Lab Services,Per Unit,$11.00 ,OP,11,11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82803,Blood gases any combination,Lab Services,Per Unit,$26.07 ,OP,26.07,109.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82805,Blood gases w/o2 saturation,Lab Services,Per Unit,$78.77 ,OP,78.77,177.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82810,Blood gases o2 sat only,Lab Services,Per Unit,$9.77 ,OP,9.77,14.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82820,Hemoglobin-oxygen affinity,Lab Services,Per Unit,$13.34 ,OP,13.34,13.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82930,Gastric analy w/ph ea spec,Lab Services,Per Unit,$6.71 ,OP,6.71,6.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82938,Gastrin test,Lab Services,Per Unit,$17.69 ,OP,17.69,17.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82941,Assay of gastrin,Lab Services,Per Unit,$17.63 ,OP,17.63,17.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82943,Assay of glucagon,Lab Services,Per Unit,$14.29 ,OP,14.29,14.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82945,Glucose other fluid,Lab Services,Per Unit,$3.93 ,OP,3.93,66.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82946,Glucagon tolerance test,Lab Services,Per Unit,$17.77 ,OP,17.77,17.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82947,Assay glucose blood quant,Lab Services,Per Unit,$3.93 ,OP,3.93,34.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82948,Reagent strip/blood glucose,Lab Services,Per Unit,$5.04 ,OP,5.04,18.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82950,Glucose test,Lab Services,Per Unit,$4.75 ,OP,4.75,49.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82951,Glucose tolerance test (gtt),Lab Services,Per Unit,$12.87 ,OP,12.87,102.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82952,Gtt-added samples,Lab Services,Per Unit,$3.92 ,OP,3.92,46.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82955,Assay of g6pd enzyme,Lab Services,Per Unit,$9.70 ,OP,9.7,9.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82960,Test for g6pd enzyme,Lab Services,Per Unit,$6.05 ,OP,6.05,6.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82962,Glucose blood test,Lab Services,Per Unit,$3.28 ,OP,3.28,15.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82963,Assay of glucosidase,Lab Services,Per Unit,$21.48 ,OP,21.48,21.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82965,Assay of gdh enzyme,Lab Services,Per Unit,$13.15 ,OP,13.15,13.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82977,Assay of ggt,Lab Services,Per Unit,$7.20 ,OP,7.2,64.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82978,Assay of glutathione,Lab Services,Per Unit,$15.45 ,OP,15.45,15.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82979,Assay rbc glutathione,Lab Services,Per Unit,$9.44 ,OP,9.44,9.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,82985,Assay of glycated protein,Lab Services,Per Unit,$16.76 ,OP,16.76,16.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83001,Assay of gonadotropin (fsh),Lab Services,Per Unit,$18.58 ,OP,18.58,108.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83002,Assay of gonadotropin (lh),Lab Services,Per Unit,$18.52 ,OP,18.52,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83003,Assay growth hormone (hgh),Lab Services,Per Unit,$16.67 ,OP,16.67,16.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83006,Growth stimulation gene 2,Lab Services,Per Unit,$75.60 ,OP,75.6,75.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83009,H pylori (c-13) blood,Lab Services,Per Unit,$67.36 ,OP,67.36,67.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83010,Assay of haptoglobin quant,Lab Services,Per Unit,$12.58 ,OP,12.58,12.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83012,Assay of haptoglobins,Lab Services,Per Unit,$26.89 ,OP,26.89,26.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83013,H pylori (c-13) breath,Lab Services,Per Unit,$67.36 ,OP,67.36,67.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83014,H pylori drug admin,Lab Services,Per Unit,$7.86 ,OP,7.86,7.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83015,Heavy metal qual any anal,Lab Services,Per Unit,$20.94 ,OP,20.94,20.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83018,Heavy metal quant each nes,Lab Services,Per Unit,$21.96 ,OP,21.96,21.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83020,Hemoglobin electrophoresis,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83021,Hemoglobin chromotography,Lab Services,Per Unit,$18.06 ,OP,18.06,18.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83026,Hemoglobin copper sulfate,Lab Services,Per Unit,$4.01 ,OP,4.01,4.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83030,Fetal hemoglobin chemical,Lab Services,Per Unit,$10.74 ,OP,10.74,10.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83033,Fetal hemoglobin assay qual,Lab Services,Per Unit,$8.00 ,OP,8,8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83036,Glycosylated hemoglobin test,Lab Services,Per Unit,$9.71 ,OP,9.71,66.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83037,Glycosylated hb home device,Lab Services,Per Unit,$9.71 ,OP,9.71,9.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83045,Blood methemoglobin test,Lab Services,Per Unit,$6.49 ,OP,6.49,6.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83050,Blood methemoglobin assay,Lab Services,Per Unit,$8.20 ,OP,8.2,30.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83051,Assay of plasma hemoglobin,Lab Services,Per Unit,$7.31 ,OP,7.31,7.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83060,Blood sulfhemoglobin assay,Lab Services,Per Unit,$8.80 ,OP,8.8,8.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83065,Assay of hemoglobin heat,Lab Services,Per Unit,$9.00 ,OP,9,9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83068,Hemoglobin stability screen,Lab Services,Per Unit,$9.47 ,OP,9.47,9.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83069,Assay of urine hemoglobin,Lab Services,Per Unit,$3.95 ,OP,3.95,3.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83070,Assay of hemosiderin qual,Lab Services,Per Unit,$4.75 ,OP,4.75,4.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83080,Assay of b hexosaminidase,Lab Services,Per Unit,$16.87 ,OP,16.87,16.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83088,Assay of histamine,Lab Services,Per Unit,$29.53 ,OP,29.53,29.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83090,Assay of homocystine,Lab Services,Per Unit,$17.92 ,OP,17.92,139.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83150,Assay of homovanillic acid,Lab Services,Per Unit,$22.41 ,OP,22.41,22.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83491,Assay of corticosteroids 17,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83497,Assay of 5-hiaa,Lab Services,Per Unit,$12.90 ,OP,12.9,12.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83498,Assay of progesterone 17-d,Lab Services,Per Unit,$27.17 ,OP,27.17,27.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83500,Assay free hydroxyproline,Lab Services,Per Unit,$22.65 ,OP,22.65,22.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83505,Assay total hydroxyproline,Lab Services,Per Unit,$24.30 ,OP,24.3,24.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83516,Immunoassay nonantibody,Lab Services,Per Unit,$11.53 ,OP,11.53,130.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83518,Immunoassay dipstick,Lab Services,Per Unit,$9.64 ,OP,9.64,9.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83519,Ria nonantibody,Lab Services,Per Unit,$18.40 ,OP,18.4,18.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83520,Immunoassay quant nos nonab,Lab Services,Per Unit,$17.27 ,OP,17.27,118.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83525,Assay of insulin,Lab Services,Per Unit,$11.43 ,OP,11.43,67.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83527,Assay of insulin,Lab Services,Per Unit,$12.95 ,OP,12.95,12.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83528,Assay of intrinsic factor,Lab Services,Per Unit,$19.82 ,OP,19.82,19.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83540,Assay of iron,Lab Services,Per Unit,$6.47 ,OP,6.47,52.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83550,Iron binding test,Lab Services,Per Unit,$8.74 ,OP,8.74,63.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83570,Assay of idh enzyme,Lab Services,Per Unit,$8.85 ,OP,8.85,8.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83582,Assay of ketogenic steroids,Lab Services,Per Unit,$15.47 ,OP,15.47,15.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83586,Assay 17- ketosteroids,Lab Services,Per Unit,$12.80 ,OP,12.8,12.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83593,Fractionation ketosteroids,Lab Services,Per Unit,$28.50 ,OP,28.5,28.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83605,Assay of lactic acid,Lab Services,Per Unit,$11.57 ,OP,11.57,11.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83615,Lactate (ld) (ldh) enzyme,Lab Services,Per Unit,$6.04 ,OP,6.04,38.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83625,Assay of ldh enzymes,Lab Services,Per Unit,$12.79 ,OP,12.79,12.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83630,Lactoferrin fecal (qual),Lab Services,Per Unit,$19.70 ,OP,19.7,19.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83631,Lactoferrin fecal (quant),Lab Services,Per Unit,$19.63 ,OP,19.63,19.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83632,Placental lactogen,Lab Services,Per Unit,$20.22 ,OP,20.22,20.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83633,Test urine for lactose,Lab Services,Per Unit,$11.25 ,OP,11.25,11.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83655,Assay of lead,Lab Services,Per Unit,$12.11 ,OP,12.11,51.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83661,L/s ratio fetal lung,Lab Services,Per Unit,$21.99 ,OP,21.99,21.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83662,Foam stability fetal lung,Lab Services,Per Unit,$18.91 ,OP,18.91,18.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83663,Fluoro polarize fetal lung,Lab Services,Per Unit,$18.91 ,OP,18.91,18.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83664,Lamellar bdy fetal lung,Lab Services,Per Unit,$19.32 ,OP,19.32,19.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83670,Assay of lap enzyme,Lab Services,Per Unit,$9.81 ,OP,9.81,9.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83690,Assay of lipase,Lab Services,Per Unit,$6.89 ,OP,6.89,62.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83695,Assay of lipoprotein(a),Lab Services,Per Unit,$14.32 ,OP,14.32,14.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83698,Assay lipoprotein pla2,Lab Services,Per Unit,$46.31 ,OP,46.31,46.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83700,Lipopro bld electrophoretic,Lab Services,Per Unit,$11.26 ,OP,11.26,11.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83701,Lipoprotein bld hr fraction,Lab Services,Per Unit,$33.86 ,OP,33.86,33.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83704,Lipoprotein bld quan part,Lab Services,Per Unit,$34.19 ,OP,34.19,34.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83718,Assay of lipoprotein,Lab Services,Per Unit,$8.19 ,OP,8.19,8.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83719,Assay of blood lipoprotein,Lab Services,Per Unit,$12.75 ,OP,12.75,12.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83721,Assay of blood lipoprotein,Lab Services,Per Unit,$10.50 ,OP,10.5,31.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83722,Lipoprtn dir meas sd ldl chl,Lab Services,Per Unit,$34.19 ,OP,34.19,34.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83727,Assay of lrh hormone,Lab Services,Per Unit,$17.19 ,OP,17.19,17.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83735,Assay of magnesium,Lab Services,Per Unit,$6.70 ,OP,6.7,49.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83775,Assay malate dehydrogenase,Lab Services,Per Unit,$7.37 ,OP,7.37,7.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83785,Assay of manganese,Lab Services,Per Unit,$26.65 ,OP,26.65,26.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83789,Mass spectrometry qual/quan,Lab Services,Per Unit,$24.11 ,OP,24.11,24.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83825,Assay of mercury,Lab Services,Per Unit,$16.26 ,OP,16.26,16.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83835,Assay of metanephrines,Lab Services,Per Unit,$16.94 ,OP,16.94,16.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83857,Assay of methemalbumin,Lab Services,Per Unit,$10.74 ,OP,10.74,10.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83861,Microfluid analy tears,Lab Services,Per Unit,$22.48 ,OP,22.48,22.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83864,Mucopolysaccharides,Lab Services,Per Unit,$28.50 ,OP,28.5,28.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83872,Assay synovial fluid mucin,Lab Services,Per Unit,$5.86 ,OP,5.86,5.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83873,Assay of csf protein,Lab Services,Per Unit,$17.20 ,OP,17.2,17.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83874,Assay of myoglobin,Lab Services,Per Unit,$12.92 ,OP,12.92,88.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83876,Assay myeloperoxidase,Lab Services,Per Unit,$50.86 ,OP,50.86,50.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83880,Assay of natriuretic peptide,Lab Services,Per Unit,$39.26 ,OP,39.26,117.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83883,Assay nephelometry not spec,Lab Services,Per Unit,$13.60 ,OP,13.6,13.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83885,Assay of nickel,Lab Services,Per Unit,$24.51 ,OP,24.51,24.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83915,Assay of nucleotidase,Lab Services,Per Unit,$11.15 ,OP,11.15,11.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83916,Oligoclonal bands,Lab Services,Per Unit,$27.39 ,OP,27.39,27.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83918,Organic acids total quant,Lab Services,Per Unit,$23.60 ,OP,23.6,23.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83919,Organic acids qual each,Lab Services,Per Unit,$16.45 ,OP,16.45,16.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83921,Organic acid single quant,Lab Services,Per Unit,$21.21 ,OP,21.21,145.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83930,Assay of blood osmolality,Lab Services,Per Unit,$6.61 ,OP,6.61,6.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83935,Assay of urine osmolality,Lab Services,Per Unit,$6.82 ,OP,6.82,6.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83937,Assay of osteocalcin,Lab Services,Per Unit,$29.85 ,OP,29.85,29.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83945,Assay of oxalate,Lab Services,Per Unit,$14.45 ,OP,14.45,14.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83950,Oncoprotein her-2/neu,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83951,Oncoprotein dcp,Lab Services,Per Unit,$64.41 ,OP,64.41,64.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83970,Assay of parathormone,Lab Services,Per Unit,$41.28 ,OP,41.28,150.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83986,Assay ph body fluid nos,Lab Services,Per Unit,$3.58 ,OP,3.58,42.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83987,Exhaled breath condensate,Lab Services,Per Unit,$3.58 ,OP,3.58,3.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,83993,Assay for calprotectin fecal,Lab Services,Per Unit,$19.63 ,OP,19.63,19.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84030,Assay of blood pku,Lab Services,Per Unit,$5.50 ,OP,5.5,5.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84035,Assay of phenylketones,Lab Services,Per Unit,$3.98 ,OP,3.98,3.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84060,Assay acid phosphatase,Lab Services,Per Unit,$7.64 ,OP,7.64,7.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84066,Assay prostate phosphatase,Lab Services,Per Unit,$9.66 ,OP,9.66,52.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84075,Assay alkaline phosphatase,Lab Services,Per Unit,$5.18 ,OP,5.18,49.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84078,Assay alkaline phosphatase,Lab Services,Per Unit,$8.26 ,OP,8.26,8.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84080,Assay alkaline phosphatases,Lab Services,Per Unit,$14.78 ,OP,14.78,14.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84081,Assay phosphatidylglycerol,Lab Services,Per Unit,$16.52 ,OP,16.52,16.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84085,Assay of rbc pg6d enzyme,Lab Services,Per Unit,$9.44 ,OP,9.44,9.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84087,Assay phosphohexose enzymes,Lab Services,Per Unit,$10.73 ,OP,10.73,10.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84100,Assay of phosphorus,Lab Services,Per Unit,$4.74 ,OP,4.74,30.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84105,Assay of urine phosphorus,Lab Services,Per Unit,$5.78 ,OP,5.78,5.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84106,Test for porphobilinogen,Lab Services,Per Unit,$5.82 ,OP,5.82,5.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84110,Assay of porphobilinogen,Lab Services,Per Unit,$8.44 ,OP,8.44,8.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84112,Eval amniotic fluid protein,Lab Services,Per Unit,$98.11 ,OP,98.11,98.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84119,Test urine for porphyrins,Lab Services,Per Unit,$13.36 ,OP,13.36,13.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84120,Assay of urine porphyrins,Lab Services,Per Unit,$14.71 ,OP,14.71,14.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84126,Assay of feces porphyrins,Lab Services,Per Unit,$39.11 ,OP,39.11,39.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84132,Assay of serum potassium,Lab Services,Per Unit,$4.76 ,OP,4.76,26.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84133,Assay of urine potassium,Lab Services,Per Unit,$4.73 ,OP,4.73,4.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84134,Assay of prealbumin,Lab Services,Per Unit,$14.59 ,OP,14.59,134.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84135,Assay of pregnanediol,Lab Services,Per Unit,$21.27 ,OP,21.27,21.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84138,Assay of pregnanetriol,Lab Services,Per Unit,$21.05 ,OP,21.05,21.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84140,Assay of pregnenolone,Lab Services,Per Unit,$20.67 ,OP,20.67,20.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84143,Assay of 17-hydroxypregneno,Lab Services,Per Unit,$22.81 ,OP,22.81,22.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84144,Assay of progesterone,Lab Services,Per Unit,$20.86 ,OP,20.86,106.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84145,Procalcitonin (pct),Lab Services,Per Unit,$27.22 ,OP,27.22,27.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84146,Assay of prolactin,Lab Services,Per Unit,$19.38 ,OP,19.38,102.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84150,Assay of prostaglandin,Lab Services,Per Unit,$41.77 ,OP,41.77,41.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84152,Assay of psa complexed,Lab Services,Per Unit,$18.39 ,OP,18.39,18.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84153,Assay of psa total,Lab Services,Per Unit,$18.39 ,OP,18.39,85.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84154,Assay of psa free,Lab Services,Per Unit,$18.39 ,OP,18.39,137.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84155,Assay of protein serum,Lab Services,Per Unit,$3.67 ,OP,3.67,57.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84156,Assay of protein urine,Lab Services,Per Unit,$3.67 ,OP,3.67,61.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84157,Assay of protein other,Lab Services,Per Unit,$4.00 ,OP,4,58.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84160,Assay of protein any source,Lab Services,Per Unit,$5.61 ,OP,5.61,5.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84163,Pappa serum,Lab Services,Per Unit,$15.05 ,OP,15.05,15.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84165,Protein e-phoresis serum,Lab Services,Per Unit,$10.74 ,OP,10.74,98.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84166,Protein e-phoresis/urine/csf,Lab Services,Per Unit,$17.83 ,OP,17.83,17.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84181,Western blot test,Lab Services,Per Unit,$17.03 ,OP,17.03,17.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84182,Protein western blot test,Lab Services,Per Unit,$29.21 ,OP,29.21,29.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84202,Assay rbc protoporphyrin,Lab Services,Per Unit,$14.35 ,OP,14.35,14.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84203,Test rbc protoporphyrin,Lab Services,Per Unit,$9.74 ,OP,9.74,9.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84206,Assay of proinsulin,Lab Services,Per Unit,$26.69 ,OP,26.69,26.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84207,Assay of vitamin b-6,Lab Services,Per Unit,$28.10 ,OP,28.1,28.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84210,Assay of pyruvate,Lab Services,Per Unit,$14.48 ,OP,14.48,14.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84220,Assay of pyruvate kinase,Lab Services,Per Unit,$9.44 ,OP,9.44,9.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84228,Assay of quinine,Lab Services,Per Unit,$11.63 ,OP,11.63,11.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84233,Assay of estrogen,Lab Services,Per Unit,$87.88 ,OP,87.88,87.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84234,Assay of progesterone,Lab Services,Per Unit,$64.88 ,OP,64.88,64.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84235,Assay of endocrine hormone,Lab Services,Per Unit,$71.23 ,OP,71.23,71.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84238,Assay nonendocrine receptor,Lab Services,Per Unit,$36.57 ,OP,36.57,36.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84244,Assay of renin,Lab Services,Per Unit,$21.99 ,OP,21.99,21.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84252,Assay of vitamin b-2,Lab Services,Per Unit,$20.24 ,OP,20.24,20.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84255,Assay of selenium,Lab Services,Per Unit,$25.53 ,OP,25.53,25.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84260,Assay of serotonin,Lab Services,Per Unit,$30.98 ,OP,30.98,30.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84270,Assay of sex hormone globul,Lab Services,Per Unit,$21.73 ,OP,21.73,21.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84275,Assay of sialic acid,Lab Services,Per Unit,$13.44 ,OP,13.44,13.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84285,Assay of silica,Lab Services,Per Unit,$25.21 ,OP,25.21,25.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84295,Assay of serum sodium,Lab Services,Per Unit,$4.81 ,OP,4.81,27.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84300,Assay of urine sodium,Lab Services,Per Unit,$5.06 ,OP,5.06,5.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84302,Assay of sweat sodium,Lab Services,Per Unit,$4.86 ,OP,4.86,4.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84305,Assay of somatomedin,Lab Services,Per Unit,$21.26 ,OP,21.26,21.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84307,Assay of somatostatin,Lab Services,Per Unit,$18.28 ,OP,18.28,18.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84311,Spectrophotometry,Lab Services,Per Unit,$8.10 ,OP,8.1,8.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84315,Body fluid specific gravity,Lab Services,Per Unit,$3.28 ,OP,3.28,3.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84375,Chromatogram assay sugars,Lab Services,Per Unit,$39.00 ,OP,39,39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84376,Sugars single qual,Lab Services,Per Unit,$5.50 ,OP,5.5,5.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84377,Sugars multiple qual,Lab Services,Per Unit,$5.50 ,OP,5.5,5.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84378,Sugars single quant,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84379,Sugars multiple quant,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84392,Assay of urine sulfate,Lab Services,Per Unit,$5.49 ,OP,5.49,5.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84402,Assay of free testosterone,Lab Services,Per Unit,$25.47 ,OP,25.47,124.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84403,Assay of total testosterone,Lab Services,Per Unit,$25.81 ,OP,25.81,89.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84410,Testosterone bioavailable,Lab Services,Per Unit,$51.28 ,OP,51.28,51.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84425,Assay of vitamin b-1,Lab Services,Per Unit,$21.23 ,OP,21.23,100.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84430,Assay of thiocyanate,Lab Services,Per Unit,$11.63 ,OP,11.63,11.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84431,Thromboxane urine,Lab Services,Per Unit,$35.11 ,OP,35.11,35.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84432,Assay of thyroglobulin,Lab Services,Per Unit,$16.06 ,OP,16.06,16.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84436,Assay of total thyroxine,Lab Services,Per Unit,$6.87 ,OP,6.87,68.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84437,Assay of neonatal thyroxine,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84439,Assay of free thyroxine,Lab Services,Per Unit,$9.02 ,OP,9.02,89.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84442,Assay of thyroid activity,Lab Services,Per Unit,$14.78 ,OP,14.78,14.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84443,Assay thyroid stim hormone,Lab Services,Per Unit,$16.80 ,OP,16.8,88.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84445,Assay of tsi globulin,Lab Services,Per Unit,$50.86 ,OP,50.86,50.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84446,Assay of vitamin e,Lab Services,Per Unit,$14.18 ,OP,14.18,14.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84449,Assay of transcortin,Lab Services,Per Unit,$18.00 ,OP,18,18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84450,Transferase (ast) (sgot),Lab Services,Per Unit,$5.18 ,OP,5.18,43.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84460,Alanine amino (alt) (sgpt),Lab Services,Per Unit,$5.30 ,OP,5.3,53.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84466,Assay of transferrin,Lab Services,Per Unit,$12.76 ,OP,12.76,137.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84478,Assay of triglycerides,Lab Services,Per Unit,$5.74 ,OP,5.74,47.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84479,Assay of thyroid (t3 or t4),Lab Services,Per Unit,$6.47 ,OP,6.47,51.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84480,Assay triiodothyronine (t3),Lab Services,Per Unit,$14.18 ,OP,14.18,70.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84481,Free assay (ft-3),Lab Services,Per Unit,$16.94 ,OP,16.94,203.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84482,T3 reverse,Lab Services,Per Unit,$15.76 ,OP,15.76,15.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84484,Assay of troponin quant,Lab Services,Per Unit,$12.47 ,OP,12.47,101.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84485,Assay duodenal fluid trypsin,Lab Services,Per Unit,$7.20 ,OP,7.2,7.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84488,Test feces for trypsin,Lab Services,Per Unit,$7.30 ,OP,7.3,7.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84490,Assay of feces for trypsin,Lab Services,Per Unit,$9.93 ,OP,9.93,9.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84510,Assay of tyrosine,Lab Services,Per Unit,$10.63 ,OP,10.63,10.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84512,Assay of troponin qual,Lab Services,Per Unit,$10.09 ,OP,10.09,18.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84520,Assay of urea nitrogen,Lab Services,Per Unit,$3.95 ,OP,3.95,35.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84525,Urea nitrogen semi-quant,Lab Services,Per Unit,$5.13 ,OP,5.13,5.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84540,Assay of urine/urea-n,Lab Services,Per Unit,$5.56 ,OP,5.56,5.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84545,Urea-n clearance test,Lab Services,Per Unit,$7.20 ,OP,7.2,7.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84550,Assay of blood/uric acid,Lab Services,Per Unit,$4.52 ,OP,4.52,40.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84560,Assay of urine/uric acid,Lab Services,Per Unit,$5.08 ,OP,5.08,5.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84577,Assay of feces/urobilinogen,Lab Services,Per Unit,$16.80 ,OP,16.8,16.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84578,Test urine urobilinogen,Lab Services,Per Unit,$4.47 ,OP,4.47,4.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84580,Assay of urine urobilinogen,Lab Services,Per Unit,$9.55 ,OP,9.55,9.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84583,Assay of urine urobilinogen,Lab Services,Per Unit,$6.05 ,OP,6.05,6.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84585,Assay of urine vma,Lab Services,Per Unit,$15.50 ,OP,15.5,15.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84586,Assay of vip,Lab Services,Per Unit,$35.33 ,OP,35.33,35.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84588,Assay of vasopressin,Lab Services,Per Unit,$33.94 ,OP,33.94,33.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84590,Assay of vitamin a,Lab Services,Per Unit,$11.61 ,OP,11.61,11.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84591,Assay of nos vitamin,Lab Services,Per Unit,$17.06 ,OP,17.06,17.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84597,Assay of vitamin k,Lab Services,Per Unit,$13.72 ,OP,13.72,13.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84600,Assay of volatiles,Lab Services,Per Unit,$17.11 ,OP,17.11,17.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84620,Xylose tolerance test,Lab Services,Per Unit,$12.91 ,OP,12.91,12.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84630,Assay of zinc,Lab Services,Per Unit,$11.39 ,OP,11.39,11.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84681,Assay of c-peptide,Lab Services,Per Unit,$20.81 ,OP,20.81,20.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84702,Chorionic gonadotropin test,Lab Services,Per Unit,$15.05 ,OP,15.05,119.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84703,Chorionic gonadotropin assay,Lab Services,Per Unit,$7.52 ,OP,7.52,74.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84704,Hcg free betachain test,Lab Services,Per Unit,$15.29 ,OP,15.29,15.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,84830,Ovulation tests,Lab Services,Per Unit,$12.70 ,OP,12.7,12.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85002,Bleeding time test,Lab Services,Per Unit,$4.82 ,OP,4.82,57.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85004,Automated diff wbc count,Lab Services,Per Unit,$6.47 ,OP,6.47,23.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85007,Bl smear w/diff wbc count,Lab Services,Per Unit,$3.80 ,OP,3.8,25.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85008,Bl smear w/o diff wbc count,Lab Services,Per Unit,$3.43 ,OP,3.43,7.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85009,Manual diff wbc count b-coat,Lab Services,Per Unit,$5.07 ,OP,5.07,5.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85013,Spun microhematocrit,Lab Services,Per Unit,$7.00 ,OP,7,7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85014,Hematocrit,Lab Services,Per Unit,$2.37 ,OP,2.37,24.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85018,Hemoglobin,Lab Services,Per Unit,$2.37 ,OP,2.37,24.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85025,Complete cbc w/auto diff wbc,Lab Services,Per Unit,$7.77 ,OP,7.77,56.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85027,Complete cbc automated,Lab Services,Per Unit,$6.47 ,OP,6.47,51.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85032,Manual cell count each,Lab Services,Per Unit,$4.31 ,OP,4.31,4.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85041,Automated rbc count,Lab Services,Per Unit,$3.02 ,OP,3.02,3.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85044,Manual reticulocyte count,Lab Services,Per Unit,$4.31 ,OP,4.31,52.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85045,Automated reticulocyte count,Lab Services,Per Unit,$3.99 ,OP,3.99,44.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85046,Reticyte/hgb concentrate,Lab Services,Per Unit,$5.57 ,OP,5.57,5.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85048,Automated leukocyte count,Lab Services,Per Unit,$2.54 ,OP,2.54,41.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85049,Automated platelet count,Lab Services,Per Unit,$4.48 ,OP,4.48,35.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85055,Reticulated platelet assay,Lab Services,Per Unit,$35.74 ,OP,35.74,35.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85097,Bone marrow interpretation,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85130,Chromogenic substrate assay,Lab Services,Per Unit,$11.89 ,OP,11.89,11.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85170,Blood clot retraction,Lab Services,Per Unit,$16.30 ,OP,16.3,16.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85175,Blood clot lysis time,Lab Services,Per Unit,$20.37 ,OP,20.37,20.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85210,Clot factor ii prothrom spec,Lab Services,Per Unit,$12.98 ,OP,12.98,12.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85220,Blooc clot factor v test,Lab Services,Per Unit,$17.65 ,OP,17.65,17.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85230,Clot factor vii proconvertin,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85240,Clot factor viii ahg 1 stage,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85244,Clot factor viii reltd antgn,Lab Services,Per Unit,$20.42 ,OP,20.42,20.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85245,Clot factor viii vw ristoctn,Lab Services,Per Unit,$22.94 ,OP,22.94,22.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85246,Clot factor viii vw antigen,Lab Services,Per Unit,$22.94 ,OP,22.94,22.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85247,Clot factor viii multimetric,Lab Services,Per Unit,$22.94 ,OP,22.94,22.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85250,Clot factor ix ptc/chrstmas,Lab Services,Per Unit,$19.04 ,OP,19.04,19.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85260,Clot factor x stuart-power,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85270,Clot factor xi pta,Lab Services,Per Unit,$17.90 ,OP,17.9,17.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85280,Clot factor xii hageman,Lab Services,Per Unit,$19.35 ,OP,19.35,19.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85290,Clot factor xiii fibrin stab,Lab Services,Per Unit,$16.34 ,OP,16.34,16.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85291,Clot factor xiii fibrin scrn,Lab Services,Per Unit,$9.11 ,OP,9.11,9.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85292,Clot factor fletcher fact,Lab Services,Per Unit,$18.93 ,OP,18.93,18.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85293,Clot factor wght kininogen,Lab Services,Per Unit,$18.93 ,OP,18.93,18.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85300,Antithrombin iii activity,Lab Services,Per Unit,$11.85 ,OP,11.85,11.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85301,Antithrombin iii antigen,Lab Services,Per Unit,$10.81 ,OP,10.81,10.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85302,Clot inhibit prot c antigen,Lab Services,Per Unit,$12.01 ,OP,12.01,12.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85303,Clot inhibit prot c activity,Lab Services,Per Unit,$13.84 ,OP,13.84,13.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85305,Clot inhibit prot s total,Lab Services,Per Unit,$11.61 ,OP,11.61,11.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85306,Clot inhibit prot s free,Lab Services,Per Unit,$15.32 ,OP,15.32,15.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85307,Assay activated protein c,Lab Services,Per Unit,$15.32 ,OP,15.32,15.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85335,Factor inhibitor test,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85337,Thrombomodulin,Lab Services,Per Unit,$17.27 ,OP,17.27,17.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85345,Coagulation time lee & white,Lab Services,Per Unit,$4.69 ,OP,4.69,4.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85347,Coagulation time activated,Lab Services,Per Unit,$4.28 ,OP,4.28,4.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85348,Coagulation time otr method,Lab Services,Per Unit,$4.49 ,OP,4.49,4.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85360,Euglobulin lysis,Lab Services,Per Unit,$8.41 ,OP,8.41,8.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85362,Fibrin degradation products,Lab Services,Per Unit,$6.89 ,OP,6.89,6.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85366,Fibrinogen test,Lab Services,Per Unit,$80.46 ,OP,80.46,80.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85370,Fibrinogen test,Lab Services,Per Unit,$12.43 ,OP,12.43,108.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85378,Fibrin degrade semiquant,Lab Services,Per Unit,$9.72 ,OP,9.72,231.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85379,Fibrin degradation quant,Lab Services,Per Unit,$10.18 ,OP,10.18,89.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85380,Fibrin degradj d-dimer,Lab Services,Per Unit,$10.18 ,OP,10.18,91.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85384,Fibrinogen activity,Lab Services,Per Unit,$9.72 ,OP,9.72,93.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85385,Fibrinogen antigen,Lab Services,Per Unit,$14.46 ,OP,14.46,14.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85390,Fibrinolysins screen i&r,Lab Services,Per Unit,$15.48 ,OP,15.48,15.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85397,Clotting funct activity,Lab Services,Per Unit,$30.86 ,OP,30.86,30.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85400,Fibrinolytic plasmin,Lab Services,Per Unit,$7.71 ,OP,7.71,7.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85410,Fibrinolytic antiplasmin,Lab Services,Per Unit,$7.71 ,OP,7.71,7.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85415,Fibrinolytic plasminogen,Lab Services,Per Unit,$17.19 ,OP,17.19,17.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85420,Fibrinolytic plasminogen,Lab Services,Per Unit,$6.53 ,OP,6.53,6.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85421,Fibrinolytic plasminogen,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85441,Heinz bodies direct,Lab Services,Per Unit,$4.20 ,OP,4.2,4.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85445,Heinz bodies induced,Lab Services,Per Unit,$6.82 ,OP,6.82,6.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85460,Hemoglobin fetal,Lab Services,Per Unit,$7.73 ,OP,7.73,192.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85461,Hemoglobin fetal,Lab Services,Per Unit,$9.36 ,OP,9.36,47.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85475,Hemolysin acid,Lab Services,Per Unit,$8.87 ,OP,8.87,8.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85520,Heparin assay,Lab Services,Per Unit,$13.09 ,OP,13.09,13.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85525,Heparin neutralization,Lab Services,Per Unit,$11.84 ,OP,11.84,11.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85530,Heparin-protamine tolerance,Lab Services,Per Unit,$13.09 ,OP,13.09,13.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85536,Iron stain peripheral blood,Lab Services,Per Unit,$6.88 ,OP,6.88,6.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85540,Wbc alkaline phosphatase,Lab Services,Per Unit,$8.60 ,OP,8.6,8.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85547,Rbc mechanical fragility,Lab Services,Per Unit,$8.60 ,OP,8.6,8.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85549,Muramidase,Lab Services,Per Unit,$18.75 ,OP,18.75,18.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85555,Rbc osmotic fragility,Lab Services,Per Unit,$7.47 ,OP,7.47,7.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85557,Rbc osmotic fragility,Lab Services,Per Unit,$13.36 ,OP,13.36,13.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85576,Blood platelet aggregation,Lab Services,Per Unit,$24.91 ,OP,24.91,48.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85597,Phospholipid pltlt neutraliz,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85598,Hexagnal phosph pltlt neutrl,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85610,Prothrombin time,Lab Services,Per Unit,$4.29 ,OP,4.29,39.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85611,Prothrombin test,Lab Services,Per Unit,$3.94 ,OP,3.94,3.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85612,Viper venom prothrombin time,Lab Services,Per Unit,$17.49 ,OP,17.49,17.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85613,Russell viper venom diluted,Lab Services,Per Unit,$9.58 ,OP,9.58,75.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85635,Reptilase test,Lab Services,Per Unit,$9.85 ,OP,9.85,9.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85651,Rbc sed rate nonautomated,Lab Services,Per Unit,$4.27 ,OP,4.27,31.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85652,Rbc sed rate automated,Lab Services,Per Unit,$2.70 ,OP,2.7,32.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85660,Rbc sickle cell test,Lab Services,Per Unit,$5.51 ,OP,5.51,59.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85670,Thrombin time plasma,Lab Services,Per Unit,$5.77 ,OP,5.77,5.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85675,Thrombin time titer,Lab Services,Per Unit,$6.85 ,OP,6.85,6.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85705,Thromboplastin inhibition,Lab Services,Per Unit,$9.63 ,OP,9.63,9.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85730,Thromboplastin time partial,Lab Services,Per Unit,$6.01 ,OP,6.01,38.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85732,Thromboplastin time partial,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,85810,Blood viscosity examination,Lab Services,Per Unit,$11.67 ,OP,11.67,11.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86000,Agglutinins febrile antigen,Lab Services,Per Unit,$6.98 ,OP,6.98,6.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86001,Allergen specific igg,Lab Services,Per Unit,$7.82 ,OP,7.82,45.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86003,Allg spec ige crude xtrc ea,Lab Services,Per Unit,$5.22 ,OP,5.22,26.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86005,Allg spec ige multiallg scr,Lab Services,Per Unit,$7.97 ,OP,7.97,7.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86008,Allg spec ige recomb ea,Lab Services,Per Unit,$17.93 ,OP,17.93,17.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86021,Wbc antibody identification,Lab Services,Per Unit,$15.05 ,OP,15.05,15.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86022,Platelet antibodies,Lab Services,Per Unit,$18.37 ,OP,18.37,18.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86023,Immunoglobulin assay,Lab Services,Per Unit,$12.46 ,OP,12.46,12.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86038,Antinuclear antibodies,Lab Services,Per Unit,$12.09 ,OP,12.09,79.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86039,Antinuclear antibodies (ana),Lab Services,Per Unit,$11.16 ,OP,11.16,104.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86060,Antistreptolysin o titer,Lab Services,Per Unit,$7.30 ,OP,7.3,80.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86063,Antistreptolysin o screen,Lab Services,Per Unit,$5.77 ,OP,5.77,5.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86077,Phys blood bank serv xmatch,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86078,Phys blood bank serv reactj,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86079,Phys blood bank serv authrj,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86140,C-reactive protein,Lab Services,Per Unit,$5.18 ,OP,5.18,39.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86141,C-reactive protein hs,Lab Services,Per Unit,$12.95 ,OP,12.95,68.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86146,Beta-2 glycoprotein antibody,Lab Services,Per Unit,$25.45 ,OP,25.45,25.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86147,Cardiolipin antibody ea ig,Lab Services,Per Unit,$25.45 ,OP,25.45,53.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86148,Anti-phospholipid antibody,Lab Services,Per Unit,$16.07 ,OP,16.07,16.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86152,Cell enumeration & id,Lab Services,Per Unit,$250.78 ,OP,250.78,250.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86155,Chemotaxis assay,Lab Services,Per Unit,$15.99 ,OP,15.99,15.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86156,Cold agglutinin screen,Lab Services,Per Unit,$8.07 ,OP,8.07,8.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86157,Cold agglutinin titer,Lab Services,Per Unit,$8.06 ,OP,8.06,67.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86160,Complement antigen,Lab Services,Per Unit,$12.00 ,OP,12,88.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86161,Complement/function activity,Lab Services,Per Unit,$12.00 ,OP,12,12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86162,Complement total (ch50),Lab Services,Per Unit,$20.32 ,OP,20.32,63.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86171,Complement fixation each,Lab Services,Per Unit,$10.01 ,OP,10.01,10.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86200,Ccp antibody,Lab Services,Per Unit,$12.95 ,OP,12.95,12.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86215,Deoxyribonuclease antibody,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86225,Dna antibody native,Lab Services,Per Unit,$13.74 ,OP,13.74,174.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86226,Dna antibody single strand,Lab Services,Per Unit,$12.11 ,OP,12.11,12.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86235,Nuclear antigen antibody,Lab Services,Per Unit,$17.93 ,OP,17.93,103.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86255,Fluorescent antibody screen,Lab Services,Per Unit,$12.05 ,OP,12.05,75.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86256,Fluorescent antibody titer,Lab Services,Per Unit,$12.05 ,OP,12.05,88.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86277,Growth hormone antibody,Lab Services,Per Unit,$15.74 ,OP,15.74,15.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86280,Hemagglutination inhibition,Lab Services,Per Unit,$8.19 ,OP,8.19,8.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86294,Immunoassay tumor qual,Lab Services,Per Unit,$25.57 ,OP,25.57,25.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86300,Immunoassay tumor ca 15-3,Lab Services,Per Unit,$20.81 ,OP,20.81,144.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86301,Immunoassay tumor ca 19-9,Lab Services,Per Unit,$20.81 ,OP,20.81,130.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86304,Immunoassay tumor ca 125,Lab Services,Per Unit,$20.81 ,OP,20.81,147.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86305,Human epididymis protein 4,Lab Services,Per Unit,$20.81 ,OP,20.81,20.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86308,Heterophile antibody screen,Lab Services,Per Unit,$5.18 ,OP,5.18,45.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86309,Heterophile antibody titer,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86310,Heterophile antibody absrbj,Lab Services,Per Unit,$7.37 ,OP,7.37,7.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86316,Immunoassay tumor other,Lab Services,Per Unit,$20.81 ,OP,20.81,151.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86317,Immunoassay infectious agent,Lab Services,Per Unit,$14.99 ,OP,14.99,47.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86318,Ia infectious agent antibody,Lab Services,Per Unit,$18.09 ,OP,18.09,57.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86320,Serum immunoelectrophoresis,Lab Services,Per Unit,$29.92 ,OP,29.92,29.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86325,Other immunoelectrophoresis,Lab Services,Per Unit,$23.13 ,OP,23.13,23.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86327,Immunoelectrophoresis assay,Lab Services,Per Unit,$29.92 ,OP,29.92,29.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86328,Ia nfct ab sarscov2 covid19,Lab Services,Per Unit,$45.23 ,OP,45.23,45.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86329,Immunodiffusion nes,Lab Services,Per Unit,$14.05 ,OP,14.05,14.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86331,Immunodiffusion ouchterlony,Lab Services,Per Unit,$11.98 ,OP,11.98,49.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86332,Immune complex assay,Lab Services,Per Unit,$24.37 ,OP,24.37,24.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86334,Immunofix e-phoresis serum,Lab Services,Per Unit,$22.34 ,OP,22.34,242.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86335,Immunfix e-phorsis/urine/csf,Lab Services,Per Unit,$29.35 ,OP,29.35,29.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86336,Inhibin a,Lab Services,Per Unit,$15.59 ,OP,15.59,15.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86337,Insulin antibodies,Lab Services,Per Unit,$21.41 ,OP,21.41,21.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86340,Intrinsic factor antibody,Lab Services,Per Unit,$15.08 ,OP,15.08,15.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86341,Islet cell antibody,Lab Services,Per Unit,$23.57 ,OP,23.57,23.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86343,Leukocyte histamine release,Lab Services,Per Unit,$12.46 ,OP,12.46,12.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86344,Leukocyte phagocytosis,Lab Services,Per Unit,$10.39 ,OP,10.39,10.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86352,Cell function assay w/stim,Lab Services,Per Unit,$135.86 ,OP,135.86,135.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86353,Lymphocyte transformation,Lab Services,Per Unit,$49.03 ,OP,49.03,49.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86355,B cells total count,Lab Services,Per Unit,$37.73 ,OP,37.73,37.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86356,Mononuclear cell antigen,Lab Services,Per Unit,$26.78 ,OP,26.78,26.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86357,Nk cells total count,Lab Services,Per Unit,$37.73 ,OP,37.73,37.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86359,T cells total count,Lab Services,Per Unit,$37.73 ,OP,37.73,37.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86360,T cell absolute count/ratio,Lab Services,Per Unit,$46.98 ,OP,46.98,46.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86361,T cell absolute count,Lab Services,Per Unit,$26.78 ,OP,26.78,26.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86367,Stem cells total count,Lab Services,Per Unit,$77.78 ,OP,77.78,77.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86376,Microsomal antibody each,Lab Services,Per Unit,$14.55 ,OP,14.55,93.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86382,Neutralization test viral,Lab Services,Per Unit,$16.91 ,OP,16.91,16.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86384,Nitroblue tetrazolium dye,Lab Services,Per Unit,$13.61 ,OP,13.61,13.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86386,Nuclear matrix protein 22,Lab Services,Per Unit,$21.78 ,OP,21.78,21.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86403,Particle agglut antbdy scrn,Lab Services,Per Unit,$11.54 ,OP,11.54,103.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86406,Particle agglut antbdy titr,Lab Services,Per Unit,$10.64 ,OP,10.64,10.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86408,Neutrlzg antb sarscov2 scr,Lab Services,Per Unit,$42.13 ,OP,42.13,42.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86409,Neutrlzg antb sarscov2 titer,Lab Services,Per Unit,$79.61 ,OP,79.61,79.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86413,Sars-cov-2 antb quantitative,Lab Services,Per Unit,$51.43 ,OP,51.43,51.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86430,Rheumatoid factor test qual,Lab Services,Per Unit,$6.14 ,OP,6.14,40.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86431,Rheumatoid factor quant,Lab Services,Per Unit,$5.67 ,OP,5.67,72.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86480,Tb test cell immun measure,Lab Services,Per Unit,$61.98 ,OP,61.98,61.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86481,Tb ag response t-cell susp,Lab Services,Per Unit,$100.00 ,OP,100,100,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86485,Skin test candida,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86486,Skin test nos antigen,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86490,Coccidioidomycosis skin test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86510,Histoplasmosis skin test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86580,Tb intradermal test,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86590,Streptokinase antibody,Lab Services,Per Unit,$12.66 ,OP,12.66,12.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86592,Syphilis test non-trep qual,Lab Services,Per Unit,$4.27 ,OP,4.27,29.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86593,Syphilis test non-trep quant,Lab Services,Per Unit,$4.40 ,OP,4.4,4.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86602,Antinomyces antibody,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86603,Adenovirus antibody,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86606,Aspergillus antibody,Lab Services,Per Unit,$15.05 ,OP,15.05,15.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86609,Bacterium antibody,Lab Services,Per Unit,$12.88 ,OP,12.88,12.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86611,Bartonella antibody,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86612,Blastomyces antibody,Lab Services,Per Unit,$12.90 ,OP,12.9,12.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86615,Bordetella antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86617,Lyme disease antibody,Lab Services,Per Unit,$15.49 ,OP,15.49,87.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86618,Lyme disease antibody,Lab Services,Per Unit,$17.03 ,OP,17.03,146.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86619,Borrelia antibody,Lab Services,Per Unit,$13.38 ,OP,13.38,13.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86622,Brucella antibody,Lab Services,Per Unit,$8.93 ,OP,8.93,8.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86625,Campylobacter antibody,Lab Services,Per Unit,$13.12 ,OP,13.12,13.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86628,Candida antibody,Lab Services,Per Unit,$12.01 ,OP,12.01,12.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86631,Chlamydia antibody,Lab Services,Per Unit,$11.82 ,OP,11.82,11.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86632,Chlamydia igm antibody,Lab Services,Per Unit,$12.68 ,OP,12.68,12.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86635,Coccidioides antibody,Lab Services,Per Unit,$11.47 ,OP,11.47,11.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86638,Q fever antibody,Lab Services,Per Unit,$12.12 ,OP,12.12,12.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86641,Cryptococcus antibody,Lab Services,Per Unit,$14.41 ,OP,14.41,14.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86644,Cmv antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,74.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86645,Cmv antibody igm,Lab Services,Per Unit,$16.85 ,OP,16.85,74.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86648,Diphtheria antibody,Lab Services,Per Unit,$15.21 ,OP,15.21,15.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86651,Encephalitis californ antbdy,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86652,Encephaltis east eqne anbdy,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86653,Encephaltis st louis antbody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86654,Encephaltis west eqne antbdy,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86658,Enterovirus antibody,Lab Services,Per Unit,$13.03 ,OP,13.03,13.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86663,Epstein-barr antibody,Lab Services,Per Unit,$13.12 ,OP,13.12,57.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86664,Epstein-barr nuclear antigen,Lab Services,Per Unit,$15.29 ,OP,15.29,93.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86665,Epstein-barr capsid vca,Lab Services,Per Unit,$18.14 ,OP,18.14,60.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86666,Ehrlichia antibody,Lab Services,Per Unit,$10.18 ,OP,10.18,10.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86668,Francisella tularensis,Lab Services,Per Unit,$14.16 ,OP,14.16,14.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86671,Fungus nes antibody,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86674,Giardia lamblia antibody,Lab Services,Per Unit,$14.72 ,OP,14.72,14.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86677,Helicobacter pylori antibody,Lab Services,Per Unit,$16.85 ,OP,16.85,103.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86682,Helminth antibody,Lab Services,Per Unit,$13.01 ,OP,13.01,13.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86684,Hemophilus influenza antibdy,Lab Services,Per Unit,$15.84 ,OP,15.84,15.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86687,Htlv-i antibody,Lab Services,Per Unit,$9.09 ,OP,9.09,9.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86688,Htlv-ii antibody,Lab Services,Per Unit,$14.00 ,OP,14,14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86689,Htlv/hiv confirmj antibody,Lab Services,Per Unit,$19.35 ,OP,19.35,19.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86692,Hepatitis delta agent antbdy,Lab Services,Per Unit,$17.16 ,OP,17.16,17.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86694,Herpes simplex nes antbdy,Lab Services,Per Unit,$14.39 ,OP,14.39,14.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86695,Herpes simplex type 1 test,Lab Services,Per Unit,$13.19 ,OP,13.19,73.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86696,Herpes simplex type 2 test,Lab Services,Per Unit,$19.35 ,OP,19.35,53.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86698,Histoplasma antibody,Lab Services,Per Unit,$13.79 ,OP,13.79,13.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86701,Hiv-1antibody,Lab Services,Per Unit,$8.89 ,OP,8.89,52.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86702,Hiv-2 antibody,Lab Services,Per Unit,$13.52 ,OP,13.52,13.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86703,Hiv-1/hiv-2 1 result antbdy,Lab Services,Per Unit,$13.71 ,OP,13.71,96.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86704,Hep b core antibody total,Lab Services,Per Unit,$12.05 ,OP,12.05,152.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86705,Hep b core antibody igm,Lab Services,Per Unit,$11.77 ,OP,11.77,11.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86706,Hep b surface antibody,Lab Services,Per Unit,$10.74 ,OP,10.74,88.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86707,Hepatitis be antibody,Lab Services,Per Unit,$11.57 ,OP,11.57,11.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86708,Hepatitis a antibody,Lab Services,Per Unit,$12.39 ,OP,12.39,115.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86709,Hepatitis a igm antibody,Lab Services,Per Unit,$11.26 ,OP,11.26,153.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86710,Influenza virus antibody,Lab Services,Per Unit,$13.55 ,OP,13.55,13.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86711,John cunningham antibody,Lab Services,Per Unit,$16.89 ,OP,16.89,16.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86713,Legionella antibody,Lab Services,Per Unit,$15.30 ,OP,15.3,15.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86717,Leishmania antibody,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86720,Leptospira antibody,Lab Services,Per Unit,$16.20 ,OP,16.2,16.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86723,Listeria monocytogenes,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86727,Lymph choriomeningitis ab,Lab Services,Per Unit,$12.87 ,OP,12.87,12.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86732,Mucormycosis antibody,Lab Services,Per Unit,$15.00 ,OP,15,15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86735,Mumps antibody,Lab Services,Per Unit,$13.05 ,OP,13.05,13.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86738,Mycoplasma antibody,Lab Services,Per Unit,$13.24 ,OP,13.24,13.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86741,Neisseria meningitidis,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86744,Nocardia antibody,Lab Services,Per Unit,$15.99 ,OP,15.99,15.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86747,Parvovirus antibody,Lab Services,Per Unit,$15.03 ,OP,15.03,76.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86750,Malaria antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86753,Protozoa antibody nos,Lab Services,Per Unit,$12.39 ,OP,12.39,12.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86756,Respiratory virus antibody,Lab Services,Per Unit,$15.89 ,OP,15.89,253.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86757,Rickettsia antibody,Lab Services,Per Unit,$19.35 ,OP,19.35,19.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86759,Rotavirus antibody,Lab Services,Per Unit,$18.23 ,OP,18.23,18.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86762,Rubella antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,82.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86765,Rubeola antibody,Lab Services,Per Unit,$12.88 ,OP,12.88,12.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86768,Salmonella antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86769,Sars-cov-2 covid-19 antibody,Lab Services,Per Unit,$42.13 ,OP,42.13,42.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86771,Shigella antibody,Lab Services,Per Unit,$24.48 ,OP,24.48,24.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86774,Tetanus antibody,Lab Services,Per Unit,$14.80 ,OP,14.8,14.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86777,Toxoplasma antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,27.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86778,Toxoplasma antibody igm,Lab Services,Per Unit,$14.41 ,OP,14.41,14.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86780,Treponema pallidum,Lab Services,Per Unit,$13.24 ,OP,13.24,13.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86784,Trichinella antibody,Lab Services,Per Unit,$12.56 ,OP,12.56,12.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86787,Varicella-zoster antibody,Lab Services,Per Unit,$12.88 ,OP,12.88,162.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86788,West nile virus ab igm,Lab Services,Per Unit,$16.85 ,OP,16.85,16.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86789,West nile virus antibody,Lab Services,Per Unit,$14.39 ,OP,14.39,14.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86790,Virus antibody nos,Lab Services,Per Unit,$12.88 ,OP,12.88,12.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86793,Yersinia antibody,Lab Services,Per Unit,$13.19 ,OP,13.19,13.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86794,Zika virus igm antibody,Lab Services,Per Unit,$16.85 ,OP,16.85,16.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86800,Thyroglobulin antibody,Lab Services,Per Unit,$15.91 ,OP,15.91,65.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86803,Hepatitis c ab test,Lab Services,Per Unit,$14.27 ,OP,14.27,83.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86804,Hep c ab test confirm,Lab Services,Per Unit,$15.49 ,OP,15.49,15.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86805,Lymphocytotoxicity assay,Lab Services,Per Unit,$189.51 ,OP,189.51,189.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86806,Lymphocytotoxicity assay,Lab Services,Per Unit,$47.59 ,OP,47.59,47.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86807,Cytotoxic antibody screening,Lab Services,Per Unit,$78.65 ,OP,78.65,78.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86808,Cytotoxic antibody screening,Lab Services,Per Unit,$29.68 ,OP,29.68,29.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86812,Hla typing a b or c,Lab Services,Per Unit,$25.81 ,OP,25.81,70.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86813,Hla typing a b or c,Lab Services,Per Unit,$58.00 ,OP,58,58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86816,Hla typing dr/dq,Lab Services,Per Unit,$30.17 ,OP,30.17,30.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86817,Hla typing dr/dq,Lab Services,Per Unit,$106.14 ,OP,106.14,106.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86821,Lymphocyte culture mixed,Lab Services,Per Unit,$36.56 ,OP,36.56,36.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86825,Hla x-math non-cytotoxic,Lab Services,Per Unit,$109.49 ,OP,109.49,109.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86826,Hla x-match noncytotoxc addl,Lab Services,Per Unit,$36.53 ,OP,36.53,36.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86828,Hla class i&ii antibody qual,Lab Services,Per Unit,$64.19 ,OP,64.19,64.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86829,Hla class i/ii antibody qual,Lab Services,Per Unit,$64.19 ,OP,64.19,64.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86830,Hla class i phenotype qual,Lab Services,Per Unit,$95.52 ,OP,95.52,95.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86831,Hla class ii phenotype qual,Lab Services,Per Unit,$81.88 ,OP,81.88,81.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86832,Hla class i high defin qual,Lab Services,Per Unit,$323.75 ,OP,323.75,323.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86833,Hla class ii high defin qual,Lab Services,Per Unit,$325.80 ,OP,325.8,325.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86834,Hla class i semiquant panel,Lab Services,Per Unit,$357.56 ,OP,357.56,357.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86835,Hla class ii semiquant panel,Lab Services,Per Unit,$322.96 ,OP,322.96,322.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86850,Rbc antibody screen,APC 5671,RVU Per Case,$48.22 ,OP,48.22,56.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86860,Rbc antibody elution,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86870,Rbc antibody identification,APC 5673,RVU Per Case,$282.25 ,OP,282.25,297.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86880,Coombs test direct,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86885,Coombs test indirect qual,APC 5672,RVU Per Case,$144.55 ,OP,90,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86886,Coombs test indirect titer,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86890,Autologous blood process,APC 5672,RVU Per Case,$144.55 ,OP,144.55,254.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86891,Autologous blood op salvage,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86900,Blood typing serologic abo,APC 5734,RVU Per Case,$108.49 ,OP,23.28,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86901,Blood typing serologic rh(d),APC 5732,RVU Per Case,$32.79 ,OP,25.24,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86902,Blood type antigen donor ea,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86904,Blood typing patient serum,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86905,Blood typing rbc antigens,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86906,Bld typing serologic rh phnt,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86920,Compatibility test spin,APC 5672,RVU Per Case,$144.55 ,OP,44.61,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86921,Compatibility test incubate,APC 5672,RVU Per Case,$144.55 ,OP,40.26,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86922,Compatibility test antiglob,APC 5672,RVU Per Case,$144.55 ,OP,55.93,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86923,Compatibility test electric,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86927,Plasma fresh frozen,APC 5672,RVU Per Unit,$144.55 ,OP,50.47,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86930,Frozen blood prep,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86931,Frozen blood thaw,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86932,Frozen blood freeze/thaw,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86940,Hemolysins/agglutinins auto,Lab Services,Per Unit,$8.77 ,OP,8.77,8.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86941,Hemolysins/agglutinins,Lab Services,Per Unit,$12.11 ,OP,12.11,45.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86945,Blood product/irradiation,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86950,Leukacyte transfusion,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86960,Vol reduction of blood/prod,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86965,Pooling blood platelets,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86970,Rbc pretx incubatj w/chemicl,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86971,Rbc pretx incubatj w/enzymes,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86972,Rbc pretx incubatj w/density,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86975,Rbc serum pretx incubj drugs,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86976,Rbc serum pretx id dilution,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86977,Rbc serum pretx incubj/inhib,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86978,Rbc pretreatment serum,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86985,Split blood or products,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,86999,Transfusion procedure,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87003,Small animal inoculation,Lab Services,Per Unit,$16.84 ,OP,16.84,16.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87015,Specimen infect agnt concntj,Lab Services,Per Unit,$6.68 ,OP,6.68,6.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87040,Blood culture for bacteria,Lab Services,Per Unit,$10.32 ,OP,10.32,75.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87045,Feces culture aerobic bact,Lab Services,Per Unit,$9.44 ,OP,9.44,78.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87046,Stool cultr aerobic bact ea,Lab Services,Per Unit,$9.44 ,OP,9.44,30.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87070,Culture othr specimn aerobic,Lab Services,Per Unit,$8.62 ,OP,8.62,74.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87071,Culture aerobic quant other,Lab Services,Per Unit,$9.89 ,OP,9.89,84.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87073,Culture bacteria anaerobic,Lab Services,Per Unit,$9.66 ,OP,9.66,9.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87075,Cultr bacteria except blood,Lab Services,Per Unit,$9.47 ,OP,9.47,109.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87076,Culture anaerobe ident each,Lab Services,Per Unit,$8.08 ,OP,8.08,34.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87077,Culture aerobic identify,Lab Services,Per Unit,$8.08 ,OP,8.08,60.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87081,Culture screen only,Lab Services,Per Unit,$6.63 ,OP,6.63,79.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87084,Culture of specimen by kit,Lab Services,Per Unit,$27.07 ,OP,27.07,27.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87086,Urine culture/colony count,Lab Services,Per Unit,$8.07 ,OP,8.07,64.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87088,Urine bacteria culture,Lab Services,Per Unit,$8.09 ,OP,8.09,52.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87101,Skin fungi culture,Lab Services,Per Unit,$7.71 ,OP,7.71,7.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87102,Fungus isolation culture,Lab Services,Per Unit,$8.41 ,OP,8.41,127.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87103,Blood fungus culture,Lab Services,Per Unit,$20.46 ,OP,20.46,20.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87106,Fungi identification yeast,Lab Services,Per Unit,$10.32 ,OP,10.32,10.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87107,Fungi identification mold,Lab Services,Per Unit,$10.32 ,OP,10.32,10.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87109,Mycoplasma,Lab Services,Per Unit,$15.39 ,OP,15.39,15.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87110,Chlamydia culture,Lab Services,Per Unit,$19.60 ,OP,19.6,66.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87116,Mycobacteria culture,Lab Services,Per Unit,$10.80 ,OP,10.8,168.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87118,Mycobacteric identification,Lab Services,Per Unit,$14.61 ,OP,14.61,14.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87140,Culture type immunofluoresc,Lab Services,Per Unit,$5.57 ,OP,5.57,5.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87143,Culture typing glc/hplc,Lab Services,Per Unit,$12.52 ,OP,12.52,12.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87147,Culture type immunologic,Lab Services,Per Unit,$5.18 ,OP,5.18,55.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87149,Dna/rna direct probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87150,Dna/rna amplified probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87152,Culture type pulse field gel,Lab Services,Per Unit,$7.74 ,OP,7.74,7.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87153,Dna/rna sequencing,Lab Services,Per Unit,$115.36 ,OP,115.36,115.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87158,Culture typing added method,Lab Services,Per Unit,$7.74 ,OP,7.74,7.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87164,Dark field examination,Lab Services,Per Unit,$10.74 ,OP,10.74,10.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87166,Dark field examination,Lab Services,Per Unit,$11.30 ,OP,11.3,11.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87168,Macroscopic exam arthropod,Lab Services,Per Unit,$4.27 ,OP,4.27,4.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87169,Macroscopic exam parasite,Lab Services,Per Unit,$4.31 ,OP,4.31,4.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87172,Pinworm exam,Lab Services,Per Unit,$4.27 ,OP,4.27,4.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87176,Tissue homogenization cultr,Lab Services,Per Unit,$5.88 ,OP,5.88,5.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87177,Ova and parasites smears,Lab Services,Per Unit,$8.90 ,OP,8.9,68.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87181,Microbe susceptible diffuse,Lab Services,Per Unit,$4.75 ,OP,4.75,15.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87184,Microbe susceptible disk,Lab Services,Per Unit,$7.48 ,OP,7.48,43.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87185,Microbe susceptible enzyme,Lab Services,Per Unit,$4.75 ,OP,4.75,4.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87186,Microbe susceptible mic,Lab Services,Per Unit,$8.65 ,OP,8.65,46.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87187,Microbe susceptible mlc,Lab Services,Per Unit,$40.17 ,OP,40.17,40.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87188,Microbe suscept macrobroth,Lab Services,Per Unit,$6.64 ,OP,6.64,6.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87190,Microbe suscept mycobacteri,Lab Services,Per Unit,$7.31 ,OP,7.31,7.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87197,Bactericidal level serum,Lab Services,Per Unit,$15.02 ,OP,15.02,15.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87205,Smear gram stain,Lab Services,Per Unit,$4.27 ,OP,4.27,26.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87206,Smear fluorescent/acid stai,Lab Services,Per Unit,$5.39 ,OP,5.39,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87207,Smear special stain,Lab Services,Per Unit,$5.99 ,OP,5.99,5.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87209,Smear complex stain,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87210,Smear wet mount saline/ink,Lab Services,Per Unit,$5.82 ,OP,5.82,45.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87220,Tissue exam for fungi,Lab Services,Per Unit,$4.27 ,OP,4.27,93.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87230,Assay toxin or antitoxin,Lab Services,Per Unit,$19.74 ,OP,19.74,185.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87250,Virus inoculate eggs/animal,Lab Services,Per Unit,$19.56 ,OP,19.56,19.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87252,Virus inoculation tissue,Lab Services,Per Unit,$26.07 ,OP,26.07,157.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87253,Virus inoculate tissue addl,Lab Services,Per Unit,$20.20 ,OP,20.2,20.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87254,Virus inoculation shell via,Lab Services,Per Unit,$19.56 ,OP,19.56,19.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87255,Genet virus isolate hsv,Lab Services,Per Unit,$33.86 ,OP,33.86,33.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87260,Adenovirus ag if,Lab Services,Per Unit,$14.43 ,OP,14.43,14.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87265,Pertussis ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87267,Enterovirus antibody dfa,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87269,Giardia ag if,Lab Services,Per Unit,$13.61 ,OP,13.61,13.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87270,Chlamydia trachomatis ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,49.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87271,Cytomegalovirus dfa,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87272,Cryptosporidium ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87273,Herpes simplex 2 ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87274,Herpes simplex 1 ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87275,Influenza b ag if,Lab Services,Per Unit,$12.25 ,OP,12.25,12.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87276,Influenza a ag if,Lab Services,Per Unit,$16.07 ,OP,16.07,36.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87278,Legion pneumophilia ag if,Lab Services,Per Unit,$15.60 ,OP,15.6,15.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87279,Parainfluenza ag if,Lab Services,Per Unit,$16.43 ,OP,16.43,16.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87280,Respiratory syncytial ag if,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87281,Pneumocystis carinii ag if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87283,Rubeola ag if,Lab Services,Per Unit,$60.80 ,OP,60.8,60.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87285,Treponema pallidum ag if,Lab Services,Per Unit,$12.18 ,OP,12.18,12.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87290,Varicella zoster ag if,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87299,Antibody detection nos if,Lab Services,Per Unit,$16.10 ,OP,16.1,16.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87300,Ag detection polyval if,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87301,Adenovirus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87305,Aspergillus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87320,Chylmd trach ag ia,Lab Services,Per Unit,$15.00 ,OP,15,40.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87324,Clostridium ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,104.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87327,Cryptococcus neoform ag ia,Lab Services,Per Unit,$13.42 ,OP,13.42,13.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87328,Cryptosporidium ag ia,Lab Services,Per Unit,$13.82 ,OP,13.82,51.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87329,Giardia ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,32.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87332,Cytomegalovirus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87335,E coli 0157 ag ia,Lab Services,Per Unit,$12.66 ,OP,12.66,12.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87336,Entamoeb hist dispr ag ia,Lab Services,Per Unit,$16.00 ,OP,16,38.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87337,Entamoeb hist group ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,37.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87338,Hpylori stool ag ia,Lab Services,Per Unit,$14.38 ,OP,14.38,14.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87339,H pylori ag ia,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87340,Hepatitis b surface ag ia,Lab Services,Per Unit,$10.33 ,OP,10.33,74.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87341,Hepatitis b surface ag ia,Lab Services,Per Unit,$10.33 ,OP,10.33,10.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87350,Hepatitis be ag ia,Lab Services,Per Unit,$11.53 ,OP,11.53,11.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87380,Hepatitis delta agent ag ia,Lab Services,Per Unit,$18.36 ,OP,18.36,18.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87385,Histoplasma capsul ag ia,Lab Services,Per Unit,$13.25 ,OP,13.25,13.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87389,Hiv-1 ag w/hiv-1&2 ab ag ia,Lab Services,Per Unit,$24.08 ,OP,24.08,24.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87390,Hiv-1 ag ia,Lab Services,Per Unit,$24.06 ,OP,24.06,58.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87391,Hiv-2 ag ia,Lab Services,Per Unit,$21.90 ,OP,21.9,21.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87400,Influenza a/b each ag ia,Lab Services,Per Unit,$14.13 ,OP,14.13,68.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87420,Resp syncytial virus ag ia,Lab Services,Per Unit,$13.91 ,OP,13.91,109.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87425,Rotavirus ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,132.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87426,Sarscov coronavirus ag ia,Lab Services,Per Unit,$35.33 ,OP,35.33,35.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87427,Shiga-like toxin ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,111.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87428,Sarscov & inf vir a&b ag ia,Lab Services,Per Unit,$63.59 ,OP,63.59,63.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87430,Strep a ag ia,Lab Services,Per Unit,$16.81 ,OP,16.81,39.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87449,Nos each organism ag ia,Lab Services,Per Unit,$11.98 ,OP,11.98,41.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87451,Polyvalent mult org ea ag ia,Lab Services,Per Unit,$10.51 ,OP,10.51,10.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87471,Bartonella dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87472,Bartonella dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87475,Lyme dis dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87476,Lyme dis dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87480,Candida dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87481,Candida dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87482,Candida dna quant,Lab Services,Per Unit,$55.74 ,OP,55.74,55.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87483,Cns dna amp probe type 12-25,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87485,Chylmd pneum dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87486,Chylmd pneum dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87487,Chylmd pneum dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87490,Chylmd trach dna dir probe,Lab Services,Per Unit,$22.75 ,OP,22.75,105.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87491,Chylmd trach dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,56.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87492,Chylmd trach dna quant,Lab Services,Per Unit,$53.47 ,OP,53.47,53.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87493,C diff amplified probe,Lab Services,Per Unit,$37.27 ,OP,37.27,37.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87495,Cytomeg dna dir probe,Lab Services,Per Unit,$30.03 ,OP,30.03,30.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87496,Cytomeg dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87497,Cytomeg dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87498,Enterovirus probe&revrs trns,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87500,Vanomycin dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87501,Influenza dna amp prob 1+,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87502,Influenza dna amp probe,Lab Services,Per Unit,$95.80 ,OP,95.8,95.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87503,Influenza dna amp prob addl,Lab Services,Per Unit,$29.22 ,OP,29.22,29.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87505,Nfct agent detection gi,Lab Services,Per Unit,$128.29 ,OP,128.29,128.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87506,Iadna-dna/rna probe tq 6-11,Lab Services,Per Unit,$262.99 ,OP,262.99,262.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87507,Iadna-dna/rna probe tq 12-25,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87510,Gardner vag dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87511,Gardner vag dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87512,Gardner vag dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87516,Hepatitis b dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87517,Hepatitis b dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87520,Hepatitis c rna dir probe,Lab Services,Per Unit,$31.22 ,OP,31.22,31.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87521,Hepatitis c probe&rvrs trnsc,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87522,Hepatitis c revrs trnscrpj,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87525,Hepatitis g dna dir probe,Lab Services,Per Unit,$29.80 ,OP,29.8,29.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87526,Hepatitis g dna amp probe,Lab Services,Per Unit,$39.26 ,OP,39.26,39.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87527,Hepatitis g dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87528,Hsv dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87529,Hsv dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87530,Hsv dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87531,Hhv-6 dna dir probe,Lab Services,Per Unit,$58.00 ,OP,58,58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87532,Hhv-6 dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87533,Hhv-6 dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87534,Hiv-1 dna dir probe,Lab Services,Per Unit,$21.92 ,OP,21.92,21.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87535,Hiv-1 probe&reverse trnscrpj,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87536,Hiv-1 quant&revrse trnscrpj,Lab Services,Per Unit,$85.10 ,OP,85.1,85.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87537,Hiv-2 dna dir probe,Lab Services,Per Unit,$21.92 ,OP,21.92,21.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87538,Hiv-2 probe&revrse trnscripj,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87539,Hiv-2 quant&revrse trnscripj,Lab Services,Per Unit,$58.62 ,OP,58.62,58.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87540,Legion pneumo dna dir prob,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87541,Legion pneumo dna amp prob,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87542,Legion pneumo dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87550,Mycobacteria dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87551,Mycobacteria dna amp probe,Lab Services,Per Unit,$48.24 ,OP,48.24,48.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87552,Mycobacteria dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87555,M.tuberculo dna dir probe,Lab Services,Per Unit,$26.88 ,OP,26.88,26.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87556,M.tuberculo dna amp probe,Lab Services,Per Unit,$41.68 ,OP,41.68,41.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87557,M.tuberculo dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87560,M.avium-intra dna dir prob,Lab Services,Per Unit,$27.29 ,OP,27.29,27.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87561,M.avium-intra dna amp prob,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87562,M.avium-intra dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87563,M. genitalium amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87580,M.pneumon dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87581,M.pneumon dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87582,M.pneumon dna quant,Lab Services,Per Unit,$302.62 ,OP,302.62,302.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87590,N.gonorrhoeae dna dir prob,Lab Services,Per Unit,$26.88 ,OP,26.88,105.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87591,N.gonorrhoeae dna amp prob,Lab Services,Per Unit,$35.09 ,OP,35.09,56.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87592,N.gonorrhoeae dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87623,Hpv low-risk types,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87624,Hpv high-risk types,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87625,Hpv types 16 & 18 only,Lab Services,Per Unit,$40.55 ,OP,40.55,40.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87631,Resp virus 3-5 targets,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87632,Resp virus 6-11 targets,Lab Services,Per Unit,$218.06 ,OP,218.06,218.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87633,Resp virus 12-25 targets,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87634,Rsv dna/rna amp probe,Lab Services,Per Unit,$70.20 ,OP,70.2,70.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87635,Sars-cov-2 covid-19 amp prb,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87636,Sarscov2 & inf a&b amp prb,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87637,Sarscov2&inf a&b&rsv amp prb,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87640,Staph a dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87641,Mr-staph dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87650,Strep a dna dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87651,Strep a dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87652,Strep a dna quant,Lab Services,Per Unit,$41.76 ,OP,41.76,41.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87653,Strep b dna amp probe,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87660,Trichomonas vagin dir probe,Lab Services,Per Unit,$20.05 ,OP,20.05,20.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87661,Trichomonas vaginalis amplif,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87662,Zika virus dna/rna amp probe,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87797,Detect agent nos dna dir,Lab Services,Per Unit,$30.03 ,OP,30.03,30.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87798,Detect agent nos dna amp,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87799,Detect agent nos dna quant,Lab Services,Per Unit,$42.84 ,OP,42.84,42.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87800,Detect agnt mult dna direc,Lab Services,Per Unit,$43.67 ,OP,43.67,43.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87801,Detect agnt mult dna ampli,Lab Services,Per Unit,$70.20 ,OP,70.2,70.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87802,Strep b assay w/optic,Lab Services,Per Unit,$12.73 ,OP,12.73,12.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87803,Clostridium toxin a w/optic,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87804,Influenza assay w/optic,Lab Services,Per Unit,$16.55 ,OP,16.55,63.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87806,Hiv w/hiv1&2 antb w/optic,Lab Services,Per Unit,$32.77 ,OP,32.77,32.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87807,Rsv assay w/optic,Lab Services,Per Unit,$13.10 ,OP,13.1,13.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87808,Trichomonas assay w/optic,Lab Services,Per Unit,$15.29 ,OP,15.29,15.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87809,Adenovirus assay w/optic,Lab Services,Per Unit,$21.76 ,OP,21.76,21.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87810,Chylmd trach assay w/optic,Lab Services,Per Unit,$35.29 ,OP,35.29,35.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87811,Sars-cov-2 covid19 w/optic,Lab Services,Per Unit,$41.38 ,OP,41.38,41.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87850,N. gonorrhoeae assay w/optic,Lab Services,Per Unit,$24.56 ,OP,24.56,24.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87880,Strep a assay w/optic,Lab Services,Per Unit,$16.53 ,OP,16.53,45.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87899,Agent nos assay w/optic,Lab Services,Per Unit,$16.07 ,OP,16.07,27.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87900,Phenotype infect agent drug,Lab Services,Per Unit,$130.35 ,OP,130.35,130.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87901,Genotype dna hiv reverse t,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87902,Genotype dna/rna hep c,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87903,Phenotype dna hiv w/culture,Lab Services,Per Unit,$488.66 ,OP,488.66,488.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87904,Phenotype dna hiv w/clt add,Lab Services,Per Unit,$26.07 ,OP,26.07,26.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87905,Sialidase enzyme assay,Lab Services,Per Unit,$12.22 ,OP,12.22,12.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87906,Genotype dna/rna hiv,Lab Services,Per Unit,$128.73 ,OP,128.73,128.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87910,Genotype cytomegalovirus,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,87912,Genotype dna hepatitis b,Lab Services,Per Unit,$257.45 ,OP,257.45,257.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88104,Cytopath fl nongyn smears,APC 5732,RVU Per Case,$32.79 ,OP,32.79,74.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88106,Cytopath fl nongyn filter,APC 5731,RVU Per Case,$23.91 ,OP,23.91,62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88108,Cytopath concentrate tech,APC 5732,RVU Per Case,$32.79 ,OP,32.39,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88112,Cytopath cell enhance tech,APC 5671,RVU Per Case,$48.22 ,OP,48.22,52.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88120,Cytp urne 3-5 probes ea spec,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88121,Cytp urine 3-5 probes cmptr,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88125,Forensic cytopathology,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88130,Sex chromatin identification,Lab Services,Per Unit,$17.98 ,OP,17.98,17.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88140,Sex chromatin identification,Lab Services,Per Unit,$7.99 ,OP,7.99,7.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88142,Cytopath c/v thin layer,Lab Services,Per Unit,$20.26 ,OP,20.26,53.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88143,Cytopath c/v thin layer redo,Lab Services,Per Unit,$23.04 ,OP,23.04,23.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88147,Cytopath c/v automated,Lab Services,Per Unit,$50.56 ,OP,50.56,50.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88148,Cytopath c/v auto rescreen,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88150,Cytopath c/v manual,Lab Services,Per Unit,$15.15 ,OP,15.15,29.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88152,Cytopath c/v auto redo,Lab Services,Per Unit,$27.64 ,OP,27.64,27.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88153,Cytopath c/v redo,Lab Services,Per Unit,$24.03 ,OP,24.03,24.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88155,Cytopath c/v index add-on,Lab Services,Per Unit,$14.65 ,OP,14.65,14.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88160,Cytopath smear other source,APC 5731,RVU Per Case,$23.91 ,OP,23.91,44.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88161,Cytopath smear other source,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88162,Cytopath smear other source,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88164,Cytopath tbs c/v manual,Lab Services,Per Unit,$15.15 ,OP,15.15,37.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88165,Cytopath tbs c/v redo,Lab Services,Per Unit,$42.22 ,OP,42.22,42.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88166,Cytopath tbs c/v auto redo,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88167,Cytopath tbs c/v select,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88172,Cytp dx eval fna 1st ea site,APC 5672,RVU Per Case,$144.55 ,OP,144.55,185.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88173,Cytopath eval fna report,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88174,Cytopath c/v auto in fluid,Lab Services,Per Unit,$25.37 ,OP,25.37,25.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88175,Cytopath c/v auto fluid redo,Lab Services,Per Unit,$26.61 ,OP,26.61,67.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88182,Cell marker study,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88184,Flowcytometry/ tc 1 marker,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88199,Cytopathology procedure,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88230,Tissue culture lymphocyte,Lab Services,Per Unit,$116.49 ,OP,116.49,116.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88233,Tissue culture skin/biopsy,Lab Services,Per Unit,$140.73 ,OP,140.73,140.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88235,Tissue culture placenta,Lab Services,Per Unit,$150.30 ,OP,150.3,150.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88237,Tissue culture bone marrow,Lab Services,Per Unit,$143.75 ,OP,143.75,143.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88239,Tissue culture tumor,Lab Services,Per Unit,$147.52 ,OP,147.52,147.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88240,Cell cryopreserve/storage,Lab Services,Per Unit,$13.07 ,OP,13.07,13.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88241,Frozen cell preparation,Lab Services,Per Unit,$12.09 ,OP,12.09,12.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88245,Chromosome analysis 20-25,Lab Services,Per Unit,$173.17 ,OP,173.17,173.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88248,Chromosome analysis 50-100,Lab Services,Per Unit,$173.17 ,OP,173.17,173.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88249,Chromosome analysis 100,Lab Services,Per Unit,$173.17 ,OP,173.17,173.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88261,Chromosome analysis 5,Lab Services,Per Unit,$264.34 ,OP,264.34,264.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88262,Chromosome analysis 15-20,Lab Services,Per Unit,$125.49 ,OP,125.49,125.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88263,Chromosome analysis 45,Lab Services,Per Unit,$150.29 ,OP,150.29,150.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88264,Chromosome analysis 20-25,Lab Services,Per Unit,$144.61 ,OP,144.61,144.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88267,Chromosome analys placenta,Lab Services,Per Unit,$188.57 ,OP,188.57,188.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88269,Chromosome analys amniotic,Lab Services,Per Unit,$173.66 ,OP,173.66,173.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88271,Cytogenetics dna probe,Lab Services,Per Unit,$21.42 ,OP,21.42,21.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88272,Cytogenetics 3-5,Lab Services,Per Unit,$40.70 ,OP,40.7,40.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88273,Cytogenetics 10-30,Lab Services,Per Unit,$34.81 ,OP,34.81,34.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88274,Cytogenetics 25-99,Lab Services,Per Unit,$42.38 ,OP,42.38,42.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88275,Cytogenetics 100-300,Lab Services,Per Unit,$51.19 ,OP,51.19,51.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88280,Chromosome karyotype study,Lab Services,Per Unit,$33.47 ,OP,33.47,33.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88283,Chromosome banding study,Lab Services,Per Unit,$68.60 ,OP,68.6,68.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88285,Chromosome count additional,Lab Services,Per Unit,$26.91 ,OP,26.91,26.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88289,Chromosome study additional,Lab Services,Per Unit,$34.43 ,OP,34.43,34.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88299,Cytogenetic study,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88300,Surgical path gross,APC 5731,RVU Per Case,$23.91 ,OP,23.91,45.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88302,Tissue exam by pathologist,APC 5731,RVU Per Case,$23.91 ,OP,23.91,73.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88304,Tissue exam by pathologist,APC 5671,RVU Per Case,$48.22 ,OP,48.22,91.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88305,Tissue exam by pathologist,APC 5671,RVU Per Case,$48.22 ,OP,48.22,109.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88307,Tissue exam by pathologist,APC 5673,RVU Per Case,$282.25 ,OP,75.98,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88309,Tissue exam by pathologist,APC 5674,RVU Per Case,$635.86 ,OP,528.45,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88312,Special stains group 1,APC 5671,RVU Per Case,$48.22 ,OP,48.22,82.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88313,Special stains group 2,APC 5732,RVU Per Case,$32.79 ,OP,32.79,55.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88319,Enzyme histochemistry,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88321,Microslide consultation,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88323,Microslide consultation,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88325,Comprehensive review of data,APC 5672,RVU Per Case,$144.55 ,OP,141.52,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88329,Path consult introp,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88331,Path consult intraop 1 bloc,APC 5672,RVU Per Case,$144.55 ,OP,144.55,152.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88333,Intraop cyto path consult 1,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88342,Immunohisto antb 1st stain,APC 5672,RVU Per Case,$144.55 ,OP,144.55,156.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88344,Immunohisto antibody slide,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88346,Immunofluor antb 1st stain,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88348,Electron microscopy,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88355,Analysis skeletal muscle,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88356,Analysis nerve,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88358,Analysis tumor,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88360,Tumor immunohistochem/manual,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88361,Tumor immunohistochem/comput,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88362,Nerve teasing preparations,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88363,Xm archive tissue molec anal,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88365,Insitu hybridization (fish),APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88366,Insitu hybridization (fish),APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88367,Insitu hybridization auto,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88368,Insitu hybridization manual,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88374,M/phmtrc alys ishquant/semiq,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88377,M/phmtrc alys ishquant/semiq,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88399,Surgical pathology procedure,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88720,Bilirubin total transcut,Lab Services,Per Unit,$5.02 ,OP,5.02,5.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88738,Hgb quant transcutaneous,Lab Services,Per Unit,$5.02 ,OP,5.02,5.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88740,Transcutaneous carboxyhb,Lab Services,Per Unit,$9.37 ,OP,9.37,9.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,88741,Transcutaneous methb,Lab Services,Per Unit,$9.37 ,OP,9.37,9.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89049,Chct for mal hyperthermia,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89050,Body fluid cell count,Lab Services,Per Unit,$4.72 ,OP,4.72,80.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89051,Body fluid cell count,Lab Services,Per Unit,$5.60 ,OP,5.6,81.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89055,Leukocyte assessment fecal,Lab Services,Per Unit,$4.27 ,OP,4.27,48.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89060,Exam synovial fluid crystals,Lab Services,Per Unit,$7.33 ,OP,7.33,73.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89125,Specimen fat stain,Lab Services,Per Unit,$5.88 ,OP,5.88,5.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89160,Exam feces for meat fibers,Lab Services,Per Unit,$4.85 ,OP,4.85,36.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89190,Nasal smear for eosinophils,Lab Services,Per Unit,$5.79 ,OP,5.79,5.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89220,Sputum specimen collection,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89230,Collect sweat for test,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89240,Pathology lab procedure,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89250,Cultr oocyte/embryo <4 days,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89251,Cultr oocyte/embryo <4 days,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89253,Embryo hatching,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89254,Oocyte identification,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89255,Prepare embryo for transfer,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89257,Sperm identification,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89258,Cryopreservation embryo(s),APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89259,Cryopreservation sperm,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89260,Sperm isolation simple,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89261,Sperm isolation complex,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89264,Identify sperm tissue,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89268,Insemination of oocytes,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89272,Extended culture of oocytes,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89280,Assist oocyte fertilization,APC 5674,RVU Per Case,$635.86 ,OP,635.86,635.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89281,Assist oocyte fertilization,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89290,Biopsy oocyte polar body,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89291,Biopsy oocyte polar body,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89300,Semen analysis w/huhner,Lab Services,Per Unit,$9.84 ,OP,9.84,9.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89310,Semen analysis w/count,Lab Services,Per Unit,$8.61 ,OP,8.61,8.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89320,Semen anal vol/count/mot,Lab Services,Per Unit,$12.31 ,OP,12.31,207.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89321,Semen anal sperm detection,Lab Services,Per Unit,$12.05 ,OP,12.05,35.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89322,Semen anal strict criteria,Lab Services,Per Unit,$15.50 ,OP,15.5,15.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89325,Sperm antibody test,Lab Services,Per Unit,$10.67 ,OP,10.67,10.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89329,Sperm evaluation test,Lab Services,Per Unit,$19.59 ,OP,19.59,19.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89330,Evaluation cervical mucus,Lab Services,Per Unit,$10.38 ,OP,10.38,10.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89331,Retrograde ejaculation anal,Lab Services,Per Unit,$19.59 ,OP,19.59,19.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89335,Cryopreserve testicular tiss,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89337,Cryopreservation oocyte(s),APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89342,Storage/year embryo(s),APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89343,Storage/year sperm/semen,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89344,Storage/year reprod tissue,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89346,Storage/year oocyte(s),APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89352,Thawing cryopresrved embryo,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89353,Thawing cryopresrved sperm,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89354,Thaw cryoprsvrd reprod tiss,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89356,Thawing cryopresrved oocyte,APC 5672,RVU Per Case,$144.55 ,OP,144.55,144.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,89398,Unlisted reprod med lab proc,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90371,Hep b ig im,APC 1630,Per Unit,$130.31 ,OP,130.31,130.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90375,Rabies ig im/sc,APC 9133,Per Unit,$267.30 ,OP,267.3,267.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90376,Rabies ig heat treated,APC 9134,Per Unit,$287.38 ,OP,287.38,287.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90378,Rsv mab im 50mg,APC 9003,Per Unit,"$1,185.67 ",OP,"1,185.67","1,185.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90385,Rh ig minidose im,APC 9063,Per Unit,$151.41 ,OP,151.41,151.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90396,Varicella-zoster ig im,APC 9135,Per Unit,"$1,965.97 ",OP,"1,965.97","1,965.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90471,Immunization admin,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90473,Immune admin oral/nasal,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90630,Flu vacc iiv4 no preserv id,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90653,Iiv adjuvant vaccine im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90654,Flu vacc iiv3 no preserv id,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90655,Iiv3 vacc no prsv 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90656,Iiv3 vacc no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90657,Iiv3 vaccine splt 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90660,Laiv3 vaccine intranasal,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90661,Cciiv3 vac no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90662,Iiv no prsv increased ag im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90670,Pcv13 vaccine im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90672,Laiv4 vaccine intranasal,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90673,Riv3 vaccine no preserv im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90674,Cciiv4 vac no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90675,Rabies vaccine im,APC 9139,Per Unit,$327.53 ,OP,327.53,327.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90676,Rabies vaccine id,APC 9140,Per Unit,$189.63 ,OP,189.63,189.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90682,Riv4 vacc recombinant dna im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90685,Iiv4 vacc no prsv 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90686,Iiv4 vacc no prsv 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90687,Iiv4 vaccine splt 0.25 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90688,Iiv4 vaccine splt 0.5 ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90689,Vacc iiv4 no prsrv 0.25ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90694,Vacc aiiv4 no prsrv 0.5ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90732,Ppsv23 vacc 2 yrs+ subq/im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90739,Hepb vacc 2 dose adult im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90740,Hepb vacc 3 dose immunsup im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90743,Hepb vacc 2 dose adolesc im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90744,Hepb vacc 3 dose ped/adol im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90746,Hepb vaccine 3 dose adult im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90747,Hepb vacc 4 dose immunsup im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90756,Cciiv4 vacc abx free im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90791,Psych diagnostic evaluation,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90792,Psych diag eval w/med srvcs,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90832,Psytx w pt 30 minutes,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90834,Psytx w pt 45 minutes,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90837,Psytx w pt 60 minutes,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90839,Psytx crisis initial 60 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90845,Psychoanalysis,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90846,Family psytx w/o pt 50 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90847,Family psytx w/pt 50 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90849,Multiple family group psytx,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90853,Group psychotherapy,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90865,Narcosynthesis,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90867,Tcranial magn stim tx plan,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90868,Tcranial magn stim tx deli,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90869,Tcran magn stim redetemine,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90870,Electroconvulsive therapy,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90880,Hypnotherapy,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90899,Psychiatric service/therapy,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90901,Biofeedback train any meth,Lab Services,Per Unit,$19.59 ,OP,19.59,19.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90912,Bfb training 1st 15 min,Lab Services,Per Unit,$43.33 ,OP,43.33,43.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90913,Bfb training ea addl 15 min,Lab Services,Per Unit,$24.51 ,OP,24.51,24.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90935,Hemodialysis one evaluation,APC 5401,RVU Per Unit,$634.11 ,OP,634.11,634.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,90945,Dialysis one evaluation,APC 5024,RVU Per Unit,$352.49 ,OP,352.49,352.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91010,Esophagus motility study,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91020,Gastric motility studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91022,Duodenal motility study,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91030,Acid perfusion of esophagus,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91034,Gastroesophageal reflux test,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91035,G-esoph reflx tst w/electrod,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91037,Esoph imped function test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91038,Esoph imped funct test > 1hr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91040,Esoph balloon distension tst,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91065,Breath hydrogen/methane test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91110,Gi tract capsule endoscopy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91111,Esophageal capsule endoscopy,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91112,Gi wireless capsule measure,APC 5301,RVU Per Unit,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91117,Colon motility 6 hr study,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91120,Rectal sensation test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91122,Anal pressure record,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91132,Electrogastrography,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91133,Electrogastrography w/test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91200,Liver elastography,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91299,Gastroenterology procedure,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91300,Sarscov2 vac 30mcg/0.3ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91301,Sarscov2 vac 100mcg/0.5ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,91303,Sarscov2 vac ad26 .5ml im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92002,Eye exam new patient,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92004,Eye exam new patient,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92012,Eye exam establish patient,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92014,Eye exam&tx estab pt 1/>vst,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92018,New eye exam & treatment,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92019,Eye exam & treatment,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92020,Special eye evaluation,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92025,Corneal topography,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92060,Special eye evaluation,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92065,Orthoptic/pleoptic training,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92081,Visual field examination(s),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92082,Visual field examination(s),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92083,Visual field examination(s),APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92132,Cmptr ophth dx img ant segmt,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92133,Cmptr ophth img optic nerve,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92134,Cptr ophth dx img post segmt,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92136,Ophthalmic biometry,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92145,Corneal hysteresis deter,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92201,Opscpy extnd rta draw uni/bi,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92202,Opscpy extnd on/mac draw,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92227,Img rta detcj/mntr ds staff,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92228,Img rta detc/mntr ds phy/qhp,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92229,Img rta detc/mntr ds poc aly,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92230,Eye exam with photos,APC 5723,RVU Per Case,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92235,Fluorescein angrph uni/bi,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92240,Icg angiography uni/bi,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92242,Fluorescein icg angiography,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92250,Eye exam with photos,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92260,Ophthalmoscopy/dynamometry,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92265,Eye muscle evaluation,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92270,Electro-oculography,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92273,Full field erg w/i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92274,Multifocal erg w/i&r,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92283,Color vision examination,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92284,Dark adaptation eye exam,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92285,Eye photography,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92286,Internal eye photography,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92287,Internal eye photography,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92311,Contact lens fitting,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92312,Contact lens fitting,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92313,Contact lens fitting,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92315,Rx cntact lens aphakia 1 eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92316,Rx cntact lens aphakia 2 eye,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92317,Rx corneoscleral cntact lens,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92325,Modification of contact lens,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92326,Replacement of contact lens,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92352,Fit aphakia spectcl monofocl,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92353,Fit aphakia spectcl multifoc,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92354,Fit spectacles single system,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92355,Fit spectacles compound lens,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92358,Aphakia prosth service temp,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92371,Repair & adjust spectacles,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92499,Eye service or procedure,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92502,Ear and throat examination,APC 5162,RVU Per Unit,$438.38 ,OP,438.38,438.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92507,Speech/hearing therapy,Lab Services,Per Unit,$75.75 ,OP,75.75,75.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92508,Speech/hearing therapy,Lab Services,Per Unit,$23.07 ,OP,23.07,23.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92511,Nasopharyngoscopy,APC 5151,RVU Per Unit,$159.31 ,OP,159.31,159.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92512,Nasal function studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92516,Facial nerve function test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92517,Vemp test i&r cervical,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92518,Vemp test i&r ocular,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92519,Vemp tst i&r cervical&ocular,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92520,Laryngeal function studies,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92521,Evaluation of speech fluency,Lab Services,Per Unit,$132.47 ,OP,132.47,132.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92522,Evaluate speech production,Lab Services,Per Unit,$111.22 ,OP,111.22,111.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92523,Speech sound lang comprehen,Lab Services,Per Unit,$227.69 ,OP,227.69,227.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92524,Behavral qualit analys voice,Lab Services,Per Unit,$108.89 ,OP,108.89,108.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92526,Oral function therapy,Lab Services,Per Unit,$83.51 ,OP,83.51,83.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92537,Caloric vstblr test w/rec,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92538,Caloric vstblr test w/rec,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92540,Basic vestibular evaluation,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92541,Spontaneous nystagmus test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92542,Positional nystagmus test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92544,Optokinetic nystagmus test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92545,Oscillating tracking test,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92546,Sinusoidal rotational test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92548,Cdp-sot 6 cond w/i&r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92549,Cdp-sot 6 cond w/i&r mct&adt,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92550,Tympanometry & reflex thresh,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92552,Pure tone audiometry air,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92553,Audiometry air & bone,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92555,Speech threshold audiometry,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92556,Speech audiometry complete,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92557,Comprehensive hearing test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92561,Bekesy audiometry diagnosis,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92562,Loudness balance test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92563,Tone decay hearing test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92564,Sisi hearing test,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92565,Stenger test pure tone,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92567,Tympanometry,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92568,Acoustic refl threshold tst,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92570,Acoustic immitance testing,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92571,Filtered speech hearing test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92572,Staggered spondaic word test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92575,Sensorineural acuity test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92576,Synthetic sentence test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92577,Stenger test speech,APC 5723,RVU Per Case,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92579,Visual audiometry (vra),APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92582,Conditioning play audiometry,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92583,Select picture audiometry,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92584,Electrocochleography,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92587,Evoked auditory test limited,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92588,Evoked auditory tst complete,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92596,Ear protector evaluation,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92597,Oral speech device eval,Lab Services,Per Unit,$70.53 ,OP,70.53,70.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92601,Cochlear implt f/up exam <7,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92602,Reprogram cochlear implt <7,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92603,Cochlear implt f/up exam 7/>,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92604,Reprogram cochlear implt 7/>,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92607,Ex for speech device rx 1hr,Lab Services,Per Unit,$122.72 ,OP,122.72,122.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92608,Ex for speech device rx addl,Lab Services,Per Unit,$49.31 ,OP,49.31,49.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92609,Use of speech device service,Lab Services,Per Unit,$102.45 ,OP,102.45,102.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92610,Evaluate swallowing function,Lab Services,Per Unit,$69.06 ,OP,69.06,69.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92611,Motion fluoroscopy/swallow,Lab Services,Per Unit,$90.57 ,OP,90.57,90.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92612,Endoscopy swallow (fees) vid,Lab Services,Per Unit,$65.56 ,OP,65.56,65.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92614,Laryngoscopic sensory vid,Lab Services,Per Unit,$64.93 ,OP,64.93,64.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92616,Fees w/laryngeal sense test,Lab Services,Per Unit,$97.82 ,OP,97.82,97.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92620,Auditory function 60 min,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92625,Tinnitus assessment,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92626,Eval aud funcj 1st hour,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92640,Aud brainstem implt programg,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92651,Aep hearing status deter i&r,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92652,Aep thrshld est mlt freq i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92653,Aep neurodiagnostic i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92700,Ent procedure/service,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92920,Prq cardiac angioplast 1 art,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92924,Prq card angio/athrect 1 art,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92928,Prq card stent w/angio 1 vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92933,Prq card stent/ath/angio,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92937,Prq revasc byp graft 1 vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92941,Prq card revasc mi 1 vsl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92943,Prq card revasc chronic 1vsl,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92950,Heart/lung resuscitation cpr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92953,Temporary external pacing,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92960,Cardioversion electric ext,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92961,Cardioversion electric int,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92970,Cardioassist internal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92971,Cardioassist external,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92975,Dissolve clot heart vessel,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92977,Dissolve clot heart vessel,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92986,Revision of aortic valve,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92987,Revision of mitral valve,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92990,Revision of pulmonary valve,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,92997,Pul art balloon repr percut,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93005,Electrocardiogram tracing,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93017,Cardiovascular stress test,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93024,Cardiac drug stress test,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93025,Microvolt t-wave assess,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93041,Rhythm ecg tracing,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93050,Art pressure waveform analys,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93225,Ecg monit/reprt up to 48 hrs,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93226,Ecg monit/reprt up to 48 hrs,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93229,Remote 30 day ecg tech supp,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93242,Ext ecg>48hr<7d recording,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93243,Ext ecg>48hr<7d scan a/r,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93246,Ext ecg>7d<15d recording,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93247,Ext ecg>7d<15d scan a/r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93260,Prgrmg dev eval impltbl sys,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93261,Interrogate subq defib,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93270,Remote 30 day ecg rev/report,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93271,Ecg/monitoring and analysis,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93278,Ecg/signal-averaged,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93279,Prgrmg dev eval pm/ldls pm,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93280,Pm device progr eval dual,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93281,Pm device progr eval multi,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93282,Prgrmg eval implantable dfb,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93283,Prgrmg eval implantable dfb,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93284,Prgrmg eval implantable dfb,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93285,Prgrmg dev eval scrms ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93288,Interrog evl pm/ldls pm ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93289,Interrog device eval heart,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93290,Interrog dev eval icpms ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93291,Interrog dev eval scrms ip,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93292,Wcd device interrogate,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93293,Pm phone r-strip device eval,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93296,Rem interrog evl pm/ids,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93303,Echo transthoracic,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93304,Echo transthoracic,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93306,Tte w/doppler complete,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93307,Tte w/o doppler complete,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93308,Tte f-up or lmtd,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93312,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93313,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93315,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93316,Echo transesophageal,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93318,Echo transesophageal intraop,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93350,Stress tte only,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93351,Stress tte complete,APC 5524,RVU Per Unit,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93451,Right heart cath,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93452,Left hrt cath w/ventrclgrphy,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93453,R&l hrt cath w/ventriclgrphy,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93454,Coronary artery angio s&i,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93455,Coronary art/grft angio s&i,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93456,R hrt coronary artery angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93457,R hrt art/grft angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93458,L hrt artery/ventricle angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93459,L hrt art/grft angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93460,R&l hrt art/ventricle angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93461,R&l hrt art/ventricle angio,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93503,Insert/place heart catheter,APC 5182,RVU Per Case,"$1,362.67 ",OP,"1,362.67","1,362.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93505,Biopsy of heart lining,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93530,Rt heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93531,R & l heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93532,R & l heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93533,R & l heart cath congenital,APC 5191,RVU Per Case,"$2,809.39 ",OP,"2,809.39","2,809.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93580,Transcath closure of asd,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93581,Transcath closure of vsd,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93582,Perq transcath closure pda,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93583,Perq transcath septal reduxn,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93590,Perq transcath cls mitral,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93591,Perq transcath cls aortic,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93600,Bundle of his recording,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93602,Intra-atrial recording,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93603,Right ventricular recording,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93610,Intra-atrial pacing,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93612,Intraventricular pacing,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93615,Esophageal recording,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93616,Esophageal recording,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93618,Heart rhythm pacing,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93619,Electrophysiology evaluation,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93620,Electrophysiology evaluation,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93624,Electrophysiologic study,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93642,Electrophysiology evaluation,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93650,Ablate heart dysrhythm focus,APC 5212,RVU Per Case,"$5,890.55 ",OP,"5,890.55","5,890.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93653,Ep & ablate supravent arrhyt,APC 5213,RVU Per Case,"$20,800.81 ",OP,"20,800.81","20,800.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93654,Ep & ablate ventric tachy,APC 5213,RVU Per Case,"$20,800.81 ",OP,"20,800.81","20,800.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93656,Tx atrial fib pulm vein isol,APC 5213,RVU Per Case,"$20,800.81 ",OP,"20,800.81","20,800.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93660,Tilt table evaluation,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93668,Peripheral vascular rehab,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93701,Bioimpedance cv analysis,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93702,Bis xtracell fluid analysis,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93724,Analyze pacemaker system,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93740,Temperature gradient studies,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93745,Set-up cardiovert-defibrill,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93750,Interrogation vad in person,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93786,Ambl bp mntr w/sw rec only,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93788,Ambl bp mntr w/sw a/r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93797,Cardiac rehab,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93798,Cardiac rehab/monitor,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93799,Cardiovascular procedure,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93880,Extracranial bilat study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93882,Extracranial uni/ltd study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93886,Intracranial complete study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93888,Intracranial limited study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93890,Tcd vasoreactivity study,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93892,Tcd emboli detect w/o inj,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93893,Tcd emboli detect w/inj,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93922,Upr/l xtremity art 2 levels,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93923,Upr/lxtr art stdy 3+ lvls,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93924,Lwr xtr vasc stdy bilat,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93925,Lower extremity study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93926,Lower extremity study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93930,Upper extremity study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93931,Upper extremity study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93970,Extremity study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93971,Extremity study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93975,Vascular study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93976,Vascular study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93978,Vascular study,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93979,Vascular study,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93980,Penile vascular study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93981,Penile vascular study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93985,Dup-scan hemo compl bi std,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93986,Dup-scan hemo compl uni std,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93990,Doppler flow testing,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,93998,Noninvas vasc dx study proc,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94002,Vent mgmt inpat init day,APC 5801,RVU Per Unit,$470.26 ,OP,470.26,470.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94003,Vent mgmt inpat subq day,APC 5801,RVU Per Unit,$470.26 ,OP,470.26,470.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94010,Breathing capacity test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94011,Spirometry up to 2 yrs old,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94012,Spirmtry w/brnchdil inf-2 yr,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94013,Meas lung vol thru 2 yrs,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94014,Patient recorded spirometry,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94015,Patient recorded spirometry,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94016,Review patient spirometry,Lab Services,Per Unit,$24.70 ,OP,24.7,24.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94060,Evaluation of wheezing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94070,Evaluation of wheezing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94150,Vital capacity test,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94200,Lung function test (mbc/mvv),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94375,Respiratory flow volume loop,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94450,Hypoxia response curve,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94452,Hast w/report,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94453,Hast w/oxygen titrate,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94610,Surfactant admin thru tube,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94617,Exercise tst brncspsm w/ecg,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94618,Pulmonary stress testing,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94619,Exercise tst brncspsm wo ecg,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94621,Cardiopulm exercise testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94640,Airway inhalation treatment,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94642,Aerosol inhalation treatment,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94644,Cbt 1st hour,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94660,Pos airway pressure cpap,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94662,Neg press ventilation cnp,APC 5801,RVU Per Unit,$470.26 ,OP,470.26,470.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94664,Evaluate pt use of inhaler,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94667,Chest wall manipulation,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94668,Chest wall manipulation,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94669,Mechanical chest wall oscill,APC 5791,RVU Per Case,$182.07 ,OP,182.07,182.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94680,Exhaled air analysis o2,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94681,Exhaled air analysis o2/co2,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94690,Exhaled air analysis,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94726,Pulm funct tst plethysmograp,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94727,Pulm function test by gas,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94728,Airwy resist by oscillometry,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94762,Measure blood oxygen level,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94772,Breath recording infant,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94775,Ped home apnea rec hk-up,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94776,Ped home apnea rec downld,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94780,Cars/bd tst inft-12mo 60 min,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,94799,Pulmonary service/procedure,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95004,Percut allergy skin tests,APC 5724,RVU Per Case,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95012,Exhaled nitric oxide meas,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95017,Perq & icut allg test venoms,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95018,Perq&ic allg test drugs/biol,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95024,Icut allergy test drug/bug,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95027,Icut allergy titrate-airborn,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95028,Icut allergy test-delayed,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95044,Allergy patch tests,APC 5724,RVU Per Case,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95052,Photo patch test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95056,Photosensitivity tests,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95060,Eye allergy tests,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95065,Nose allergy test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95070,Bronchial allergy tests,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95076,Ingest challenge ini 120 min,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95115,Immunotherapy one injection,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95117,Immunotherapy injections,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95144,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95145,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95146,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95147,Antigen therapy services,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95148,Antigen therapy services,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95149,Antigen therapy services,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95165,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95170,Antigen therapy services,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95180,Rapid desensitization,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95199,Allergy immunology services,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95249,Cont gluc mntr pt prov eqp,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95250,Cont gluc mntr phys/qhp eqp,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95700,Eeg cont rec w/vid eeg tech,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95705,Eeg w/o vid 2-12 hr unmntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95706,Eeg wo vid 2-12hr intmt mntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95707,Eeg w/o vid 2-12hr cont mntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95708,Eeg wo vid ea 12-26hr unmntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95709,Eeg w/o vid ea 12-26hr intmt,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95710,Eeg w/o vid ea 12-26hr cont,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95711,Veeg 2-12 hr unmonitored,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95712,Veeg 2-12 hr intmt mntr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95713,Veeg 2-12 hr cont mntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95714,Veeg ea 12-26 hr unmntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95715,Veeg ea 12-26hr intmt mntr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95716,Veeg ea 12-26hr cont mntr,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95782,Polysom <6 yrs 4/> paramtrs,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95783,Polysom <6 yrs cpap/bilvl,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95800,Slp stdy unattended,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95801,Slp stdy unatnd w/anal,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95803,Actigraphy testing,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95805,Multiple sleep latency test,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95806,Sleep study unatt&resp efft,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95807,Sleep study attended,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95808,Polysom any age 1-3> param,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95810,Polysom 6/> yrs 4/> param,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95811,Polysom 6/>yrs cpap 4/> parm,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95812,Eeg 41-60 minutes,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95813,Eeg extnd mntr 61-119 min,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95816,Eeg awake and drowsy,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95819,Eeg awake and asleep,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95822,Eeg coma or sleep only,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95824,Eeg cerebral death only,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95836,Ecog impltd brn npgt <30 d,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95851,Range of motion measurements,Lab Services,Per Unit,$7.59 ,OP,7.59,7.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95852,Range of motion measurements,Lab Services,Per Unit,$5.52 ,OP,5.52,5.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95857,Cholinesterase challenge,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95860,Muscle test one limb,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95861,Muscle test 2 limbs,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95863,Muscle test 3 limbs,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95864,Muscle test 4 limbs,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95865,Muscle test larynx,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95866,Muscle test hemidiaphragm,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95867,Muscle test cran nerv unilat,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95868,Muscle test cran nerve bilat,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95869,Muscle test thor paraspinal,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95870,Muscle test nonparaspinal,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95872,Muscle test one fiber,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95875,Limb exercise test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95905,Motor &/ sens nrve cndj test,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95907,Nvr cndj tst 1-2 studies,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95908,Nrv cndj tst 3-4 studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95909,Nrv cndj tst 5-6 studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95910,Nrv cndj test 7-8 studies,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95911,Nrv cndj test 9-10 studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95912,Nrv cndj test 11-12 studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95913,Nrv cndj test 13/> studies,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95921,Autonomic nrv parasym inervj,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95922,Autonomic nrv adrenrg inervj,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95923,Autonomic nrv syst funj test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95924,Ans parasymp & symp w/tilt,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95925,Somatosensory testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95926,Somatosensory testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95927,Somatosensory testing,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95928,C motor evoked uppr limbs,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95929,C motor evoked lwr limbs,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95930,Visual ep test cns w/i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95933,Blink reflex test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95937,Neuromuscular junction test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95938,Somatosensory testing,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95939,C motor evoked upr&lwr limbs,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95943,Parasymp&symp hrt rate test,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95954,Eeg monitoring/giving drugs,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95958,Eeg monitoring/function test,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95961,Electrode stimulation brain,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95965,Meg spontaneous,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95966,Meg evoked single,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95970,Alys npgt w/o prgrmg,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95971,Alys smpl sp/pn npgt w/prgrm,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95972,Alys cplx sp/pn npgt w/prgrm,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95976,Alys smpl cn npgt prgrmg,APC 5741,RVU Per Unit,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95977,Alys cplx cn npgt prgrmg,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95981,Io anal gast n-stim subsq,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95982,Io ga n-stim subsq w/reprog,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95983,Alys brn npgt prgrmg 15 min,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95990,Spin/brain pump refil & main,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95991,Spin/brain pump refil & main,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95992,Canalith repositioning proc,Lab Services,Per Unit,$36.73 ,OP,36.73,36.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,95999,Neurological procedure,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96000,Motion analysis video/3d,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96001,Motion test w/ft press meas,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96002,Dynamic surface emg,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96003,Dynamic fine wire emg,APC 5722,RVU Per Case,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96105,Assessment of aphasia,Lab Services,Per Unit,$98.92 ,OP,98.92,98.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96112,Devel tst phys/qhp 1st hr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96116,Nubhvl xm phys/qhp 1st hr,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96125,Cognitive test by hc pro,Lab Services,Per Unit,$103.76 ,OP,103.76,103.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96127,Brief emotional/behav assmt,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96130,Psycl tst eval phys/qhp 1st,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96132,Nrpsyc tst eval phys/qhp 1st,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96136,Psycl/nrpsyc tst phy/qhp 1st,APC 5734,RVU Per Unit,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96138,Psycl/nrpsyc tech 1st,APC 5735,RVU Per Unit,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96146,Psycl/nrpsyc tst auto result,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96156,Hlth bhv assmt/reassessment,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96158,Hlth bhv ivntj indiv 1st 30,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96160,Pt-focused hlth risk assmt,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96161,Caregiver health risk assmt,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96164,Hlth bhv ivntj grp 1st 30,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96167,Hlth bhv ivntj fam 1st 30,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96360,Hydration iv infusion init,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96361,Hydrate iv infusion add-on,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96365,Ther/proph/diag iv inf init,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96366,Ther/proph/diag iv inf addon,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96367,Tx/proph/dg addl seq iv inf,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96369,Sc ther infusion up to 1 hr,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96370,Sc ther infusion addl hr,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96371,Sc ther infusion reset pump,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96372,Ther/proph/diag inj sc/im,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96373,Ther/proph/diag inj ia,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96374,Ther/proph/diag inj iv push,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96375,Tx/pro/dx inj new drug addon,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96377,Applicaton on-body injector,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96379,Ther/prop/diag inj/inf proc,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96401,Chemo anti-neopl sq/im,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96402,Chemo hormon antineopl sq/im,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96405,Chemo intralesional up to 7,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96406,Chemo intralesional over 7,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96409,Chemo iv push sngl drug,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96411,Chemo iv push addl drug,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96413,Chemo iv infusion 1 hr,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96415,Chemo iv infusion addl hr,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96416,Chemo prolong infuse w/pump,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96417,Chemo iv infus each addl seq,APC 5692,RVU Per Unit,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96420,Chemo ia push tecnique,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96422,Chemo ia infusion up to 1 hr,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96423,Chemo ia infuse each addl hr,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96425,Chemotherapy infusion method,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96440,Chemotherapy intracavitary,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96446,Chemotx admn prtl cavity,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96450,Chemotherapy into cns,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96521,Refill/maint portable pump,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96522,Refill/maint pump/resvr syst,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96523,Irrig drug delivery device,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96542,Chemotherapy injection,APC 5693,RVU Per Unit,$197.21 ,OP,197.21,197.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96549,Chemotherapy unspecified,APC 5691,RVU Per Case,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96567,Pdt dstr prmlg les skn,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96573,Pdt dstr prmlg les phys/qhp,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96574,Dbrdmt prmlg les w/pdt,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96900,Ultraviolet light therapy,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96910,Photochemotherapy with uv-b,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96912,Photochemotherapy with uv-a,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96913,Photochemotherapy uv-a or b,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96920,Laser tx skin < 250 sq cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96921,Laser tx skin 250-500 sq cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96922,Laser tx skin >500 sq cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,96999,Dermatological procedure,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97012,Mechanical traction therapy,Lab Services,Per Unit,$14.55 ,OP,14.55,41.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97016,Vasopneumatic device therapy,Lab Services,Per Unit,$11.78 ,OP,11.78,22.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97018,Paraffin bath therapy,Lab Services,Per Unit,$5.69 ,OP,5.69,52.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97022,Whirlpool therapy,Lab Services,Per Unit,$17.16 ,OP,17.16,40.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97024,Diathermy eg microwave,Lab Services,Per Unit,$6.96 ,OP,6.96,6.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97026,Infrared therapy,Lab Services,Per Unit,$6.32 ,OP,6.32,65.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97028,Ultraviolet therapy,Lab Services,Per Unit,$7.98 ,OP,7.98,7.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97032,Electrical stimulation,Lab Services,Per Unit,$14.55 ,OP,14.55,54.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97033,Electric current therapy,Lab Services,Per Unit,$19.67 ,OP,19.67,53.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97034,Contrast bath therapy,Lab Services,Per Unit,$14.42 ,OP,14.42,14.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97035,Ultrasound therapy,Lab Services,Per Unit,$14.10 ,OP,14.1,47.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97036,Hydrotherapy,Lab Services,Per Unit,$33.09 ,OP,33.09,33.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97110,Therapeutic exercises,Lab Services,Per Unit,$29.26 ,OP,29.26,61.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97112,Neuromuscular reeducation,Lab Services,Per Unit,$33.86 ,OP,33.86,40.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97113,Aquatic therapy/exercises,Lab Services,Per Unit,$36.67 ,OP,36.67,84.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97116,Gait training therapy,Lab Services,Per Unit,$29.26 ,OP,29.26,41.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97124,Massage therapy,Lab Services,Per Unit,$28.22 ,OP,28.22,79.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97129,Ther ivntj 1st 15 min,Lab Services,Per Unit,$23.04 ,OP,23.04,23.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97130,Ther ivntj ea addl 15 min,Lab Services,Per Unit,$22.35 ,OP,22.35,22.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97140,Manual therapy 1/> regions,Lab Services,Per Unit,$26.97 ,OP,26.97,56.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97150,Group therapeutic procedures,Lab Services,Per Unit,$17.53 ,OP,17.53,49.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97151,Bhv id assmt by phys/qhp,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97152,Bhv id suprt assmt by 1 tech,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97153,Adaptive behavior tx by tech,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97154,Grp adapt bhv tx by tech,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97155,Adapt behavior tx phys/qhp,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97156,Fam adapt bhv tx gdn phy/qhp,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97157,Mult fam adapt bhv tx gdn,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97158,Grp adapt bhv tx by phy/qhp,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97161,Pt eval low complex 20 min,Lab Services,Per Unit,$98.12 ,OP,98.12,98.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97162,Pt eval mod complex 30 min,Lab Services,Per Unit,$98.12 ,OP,98.12,98.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97163,Pt eval high complex 45 min,Lab Services,Per Unit,$98.12 ,OP,98.12,98.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97164,Pt re-eval est plan care,Lab Services,Per Unit,$66.97 ,OP,66.97,66.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97165,Ot eval low complex 30 min,Lab Services,Per Unit,$95.26 ,OP,95.26,95.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97166,Ot eval mod complex 45 min,Lab Services,Per Unit,$95.26 ,OP,95.26,95.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97167,Ot eval high complex 60 min,Lab Services,Per Unit,$95.26 ,OP,95.26,95.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97168,Ot re-eval est plan care,Lab Services,Per Unit,$64.11 ,OP,64.11,64.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97530,Therapeutic activities,Lab Services,Per Unit,$37.50 ,OP,37.5,56.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97533,Sensory integration,Lab Services,Per Unit,$57.03 ,OP,57.03,178.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97535,Self care mngment training,Lab Services,Per Unit,$32.44 ,OP,32.44,43.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97537,Community/work reintegration,Lab Services,Per Unit,$31.26 ,OP,31.26,31.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97542,Wheelchair mngment training,Lab Services,Per Unit,$31.58 ,OP,31.58,46.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97597,Rmvl devital tis 20 cm/<,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97602,Wound(s) care non-selective,APC 5051,RVU Per Case,$173.99 ,OP,68.84,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97605,Neg press wound tx <=50 cm,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97606,Neg press wound tx >50 cm,APC 5052,RVU Per Case,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97607,Neg press wnd tx <=50 sq cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97608,Neg press wound tx >50 cm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97610,Low frequency non-thermal us,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97750,Physical performance test,Lab Services,Per Unit,$33.07 ,OP,33.07,79.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97755,Assistive technology assess,Lab Services,Per Unit,$37.42 ,OP,37.42,37.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97760,Orthotic mgmt&traing 1st enc,Lab Services,Per Unit,$47.55 ,OP,47.55,47.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97761,Prosthetic traing 1st enc,Lab Services,Per Unit,$40.55 ,OP,40.55,40.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97763,Orthc/prostc mgmt sbsq enc,Lab Services,Per Unit,$51.94 ,OP,51.94,51.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97802,Medical nutrition indiv in,Lab Services,Per Unit,$36.18 ,OP,36.18,36.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97803,Med nutrition indiv subseq,Lab Services,Per Unit,$31.17 ,OP,31.17,31.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97804,Medical nutrition group,Lab Services,Per Unit,$16.45 ,OP,16.45,16.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97810,Acupunct w/o stimul 15 min,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,97813,Acupunct w/stimul 15 min,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98925,Osteopath manj 1-2 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98926,Osteopath manj 3-4 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98927,Osteopath manj 5-6 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98928,Osteopath manj 7-8 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98929,Osteopath manj 9-10 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98940,Chiropract manj 1-2 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98941,Chiropract manj 3-4 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98942,Chiropractic manj 5 regions,APC 5811,RVU Per Case,$25.73 ,OP,25.73,25.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98966,Hc pro phone call 5-10 min,Lab Services,Per Unit,$12.73 ,OP,12.73,12.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98967,Hc pro phone call 11-20 min,Lab Services,Per Unit,$25.14 ,OP,25.14,25.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98968,Hc pro phone call 21-30 min,Lab Services,Per Unit,$37.46 ,OP,37.46,37.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98970,Qnhp ol dig assmt&mgmt 5-10,Lab Services,Per Unit,$11.36 ,OP,11.36,11.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98971,Qnhp ol dig assmt&mgmt 11-20,Lab Services,Per Unit,$20.31 ,OP,20.31,20.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,98972,Qnhp ol dig assmt&mgmt 21+,Lab Services,Per Unit,$32.41 ,OP,32.41,32.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99170,Anogenital exam child w imag,APC 5411,RVU Per Unit,$165.06 ,OP,165.06,165.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99184,Hypothermia ill neonate,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99190,Special pump services,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99191,Special pump services,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99192,Special pump services,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99195,Phlebotomy,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99281,Emergency dept visit,APC 5021,RVU Per Case,$70.35 ,OP,70.35,70.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99282,Emergency dept visit,APC 5022,RVU Per Case,$127.52 ,OP,127.52,127.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99283,Emergency dept visit,APC 5023,RVU Per Case,$224.44 ,OP,224.44,224.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99284,Emergency dept visit,APC 5024,RVU Per Case,$352.49 ,OP,352.49,352.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99285,Emergency dept visit,APC 5025,RVU Per Case,$505.98 ,OP,505.98,505.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99291,Critical care first hour,APC 5041,RVU Per Case,$671.26 ,OP,671.26,671.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99356,Prolng svc i/p/obs 1st hour,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99357,Prolng svc i/p/obs ea addl,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99406,Behav chng smoking 3-10 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99407,Behav chng smoking > 10 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99453,Rem mntr physiol param setup,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99454,Rem mntr physiol param dev,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99460,Init nb em per day hosp,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99462,Sbsq nb em per day hosp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99463,Same day nb discharge,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99465,Nb resuscitation,APC 5781,RVU Per Unit,$544.54 ,OP,544.54,544.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99468,Neonate crit care initial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99469,Neonate crit care subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99471,Ped critical care initial,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99472,Ped critical care subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99473,Self-meas bp pt educaj/train,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99475,Ped crit care age 2-5 init,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99476,Ped crit care age 2-5 subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99477,Init day hosp neonate care,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99478,Ic lbw inf < 1500 gm subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99479,Ic lbw inf 1500-2500 g subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99480,Ic inf pbw 2501-5000 g subsq,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99483,Assmt & care pln pt cog imp,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99484,Care mgmt svc bhvl hlth cond,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99487,Cplx chrnc care 1st 60 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99490,Chrnc care mgmt svc 1st 20,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99492,1st psyc collab care mgmt,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99493,Sbsq psyc collab care mgmt,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99495,Trans care mgmt 14 day disch,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99496,Trans care mgmt 7 day disch,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,99497,Advncd care plan 30 min,APC 5822,RVU Per Case,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0001A,Adm sarscov2 30mcg/0.3ml 1st,APC 9397,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0001U,Rbc dna hea 35 ag 11 bld grp,Lab Services,Per Unit,$720.00 ,OP,720,720,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0002A,Adm sarscov2 30mcg/0.3ml 2nd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0002M,Liver dis 10 assays w/ash,Lab Services,Per Unit,$503.40 ,OP,503.4,503.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0002U,Onc clrct 3 ur metab alg plp,Lab Services,Per Unit,$25.00 ,OP,25,25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0003A,Adm sarscov2 30mcg/0.3ml 3rd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0003M,Liver dis 10 assays w/nash,Lab Services,Per Unit,$503.40 ,OP,503.4,503.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0003U,Onc ovar 5 prtn ser alg scor,Lab Services,Per Unit,$950.00 ,OP,950,950,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0004M,Scoliosis dna alys,Lab Services,Per Unit,$79.00 ,OP,79,79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0005U,Onco prst8 3 gene ur alg,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0006M,Onc hep gene risk classifier,Lab Services,Per Unit,$150.00 ,OP,150,150,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0007M,Onc gastro 51 gene nomogram,Lab Services,Per Unit,$375.00 ,OP,375,375,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0007U,Rx test prsmv ur w/def conf,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0008U,Hpylori detcj abx rstnc dna,Lab Services,Per Unit,$597.91 ,OP,597.91,597.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0009U,Onc brst ca erbb2 amp/nonamp,Lab Services,Per Unit,$107.00 ,OP,107,107,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0010U,Nfct ds strn typ whl gen seq,Lab Services,Per Unit,$427.26 ,OP,427.26,427.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0011A,Adm sarscov2 100mcg/0.5ml1st,APC 9397,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0011M,Onc prst8 ca mrna 12 gen alg,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0011U,Rx mntr lc-ms/ms oral fluid,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0012A,Adm sarscov2 100mcg/0.5ml2nd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0012M,Onc mrna 5 gen rsk urthl ca,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0012U,Germln do gene reargmt detcj,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0013A,Adm sarscov2 100mcg/0.5ml3rd,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0013M,Onc mrna 5 gen recr urthl ca,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0013U,Onc sld org neo gene reargmt,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0014M,Liver ds alys 3 bmrk srm alg,Lab Services,Per Unit,$176.19 ,OP,176.19,176.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0014U,Hem hmtlmf neo gene reargmt,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0016U,Onc hmtlmf neo rna bcr/abl1,Lab Services,Per Unit,$163.96 ,OP,163.96,163.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0017U,Onc hmtlmf neo jak2 mut dna,Lab Services,Per Unit,$91.66 ,OP,91.66,91.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0018U,Onc thyr 10 microrna seq alg,Lab Services,Per Unit,"$3,002.09 ",OP,"3,002.09","3,002.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0019U,Onc rna tiss predict alg,Lab Services,Per Unit,"$3,675.00 ",OP,"3,675.00","3,675.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0021U,Onc prst8 detcj 8 autoantb,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0022U,Trgt gen seq dna&rna 23 gene,Lab Services,Per Unit,"$1,950.00 ",OP,"1,950.00","1,950.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0023U,Onc aml dna detcj/nondetcj,Lab Services,Per Unit,$248.51 ,OP,248.51,248.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0024U,Glyca nuc mr spectrsc quan,Lab Services,Per Unit,$34.19 ,OP,34.19,34.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0025U,Tenofovir liq chrom ur quan,Lab Services,Per Unit,$85.77 ,OP,85.77,85.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0026U,Onc thyr dna&mrna 112 genes,Lab Services,Per Unit,"$3,600.00 ",OP,"3,600.00","3,600.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0027U,Jak2 gene trgt seq alys,Lab Services,Per Unit,$121.91 ,OP,121.91,121.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0029U,Rx metab advrs trgt seq alys,Lab Services,Per Unit,$742.27 ,OP,742.27,742.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0030U,Rx metab warf trgt seq alys,Lab Services,Per Unit,$134.13 ,OP,134.13,134.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0031A,Adm sarscov2 vac ad26 .5ml,APC 9398,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0031U,Cyp1a2 gene,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0032U,Comt gene,Lab Services,Per Unit,$174.81 ,OP,174.81,174.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0033U,Htr2a htr2c genes,Lab Services,Per Unit,$349.62 ,OP,349.62,349.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0034U,Tpmt nudt15 genes,Lab Services,Per Unit,$466.17 ,OP,466.17,466.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0035U,Neuro csf prion prtn qual,Lab Services,Per Unit,$540.99 ,OP,540.99,540.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0036U,Xome tum & nml spec seq alys,Lab Services,Per Unit,"$4,780.00 ",OP,"4,780.00","4,780.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0037U,Trgt gen seq dna 324 genes,Lab Services,Per Unit,"$3,500.00 ",OP,"3,500.00","3,500.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0038U,Vitamin d srm microsamp quan,Lab Services,Per Unit,$29.60 ,OP,29.6,29.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0039U,Dna antb 2strand hi avidity,Lab Services,Per Unit,$13.74 ,OP,13.74,13.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0040U,Bcr/abl1 gene major bp quan,Lab Services,Per Unit,$409.90 ,OP,409.9,409.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0041U,B brgdrferi antb 5 prtn igm,Lab Services,Per Unit,$17.21 ,OP,17.21,17.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0042U,B brgdrferi antb 12 prtn igg,Lab Services,Per Unit,$17.21 ,OP,17.21,17.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0043U,Tbrf b grp antb 4 prtn igm,Lab Services,Per Unit,$14.86 ,OP,14.86,14.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0044U,Tbrf b grp antb 4 prtn igg,Lab Services,Per Unit,$14.86 ,OP,14.86,14.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0045U,Onc brst dux carc is 12 gene,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0046U,Flt3 gene itd variants quan,Lab Services,Per Unit,$407.43 ,OP,407.43,407.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0047U,Onc prst8 mrna 17 gene alg,Lab Services,Per Unit,"$3,873.00 ",OP,"3,873.00","3,873.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0048U,Onc sld org neo dna 468 gene,Lab Services,Per Unit,"$2,919.60 ",OP,"2,919.60","2,919.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0049U,Npm1 gene analysis quan,Lab Services,Per Unit,$407.43 ,OP,407.43,407.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0050U,Trgt gen seq dna 194 genes,Lab Services,Per Unit,"$2,916.60 ",OP,"2,916.60","2,916.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0051U,Rx mntr lc-ms/ms ur 31 pnl,Lab Services,Per Unit,$193.71 ,OP,193.71,193.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0052U,Lpoprtn bld w/5 maj classes,Lab Services,Per Unit,$33.86 ,OP,33.86,33.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0053U,Onc prst8 ca fish alys 4 gen,Lab Services,Per Unit,"$2,030.00 ",OP,"2,030.00","2,030.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0054U,Rx mntr 14+ drugs & sbsts,Lab Services,Per Unit,$148.96 ,OP,148.96,148.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0055U,Card hrt trnspl 96 dna seq,Lab Services,Per Unit,"$3,240.00 ",OP,"3,240.00","3,240.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0056U,Hem aml dna gene reargmt,Lab Services,Per Unit,"$2,515.60 ",OP,"2,515.60","2,515.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0058U,Onc merkel cll carc srm quan,Lab Services,Per Unit,$322.96 ,OP,322.96,322.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0059U,Onc merkel cll carc srm +/-,Lab Services,Per Unit,$322.96 ,OP,322.96,322.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0060U,Twn zyg gen seq alys chrms2,Lab Services,Per Unit,$759.05 ,OP,759.05,759.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0061U,Tc meas 5 bmrk sfdi m-s alys,Lab Services,Per Unit,$25.10 ,OP,25.1,25.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0062U,Ai sle igg&igm alys 80 bmrk,Lab Services,Per Unit,$380.72 ,OP,380.72,380.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0063U,Neuro autism 32 amines alg,Lab Services,Per Unit,$750.00 ,OP,750,750,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0064U,Antb tp total&rpr ia qual,Lab Services,Per Unit,$31.33 ,OP,31.33,31.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0065U,Syfls tst nontreponemal antb,Lab Services,Per Unit,$18.09 ,OP,18.09,18.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0066U,Pamg-1 ia cervico-vag fluid,Lab Services,Per Unit,$15.29 ,OP,15.29,15.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0067U,Onc brst imhchem prfl 4 bmrk,Lab Services,Per Unit,"$1,897.00 ",OP,"1,897.00","1,897.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0068U,Candida species pnl amp prb,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0069U,Onc clrct microrna mir-31-3p,Lab Services,Per Unit,$380.00 ,OP,380,380,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0070U,Cyp2d6 gen com&slct rar vrnt,Lab Services,Per Unit,$676.37 ,OP,676.37,676.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0071T,Us leiomyomata ablate <200,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0071U,Cyp2d6 full gene sequence,Lab Services,Per Unit,$600.00 ,OP,600,600,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0072T,Us leiomyomata ablate >200,APC 5414,RVU Per Case,"$2,542.11 ",OP,"2,542.11","2,542.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0072U,Cyp2d6 gen cyp2d6-2d7 hybrid,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0073U,Cyp2d6 gen cyp2d7-2d6 hybrid,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0074U,Cyp2d6 nonduplicated gene,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0075T,Perq stent/chest vert art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0075U,Cyp2d6 5' gene dup/mlt,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0076T,S&i stent/chest vert art,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0076U,Cyp2d6 3' gene dup/mlt,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0077U,Ig paraprotein qual bld/ur,Lab Services,Per Unit,$43.43 ,OP,43.43,43.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0078U,Pain mgt opi use gnotyp pnl,Lab Services,Per Unit,$450.91 ,OP,450.91,450.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0080U,Onc lng 5 clin rsk factr alg,Lab Services,Per Unit,"$3,520.00 ",OP,"3,520.00","3,520.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0082U,Rx test def 90+ rx/sbsts ur,Lab Services,Per Unit,$246.92 ,OP,246.92,246.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0083U,Onc rspse chemo cntrst tomog,Lab Services,Per Unit,$167.35 ,OP,167.35,167.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0084U,Rbc dna gnotyp 10 bld groups,Lab Services,Per Unit,$720.00 ,OP,720,720,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0086U,Nfct ds bact&fng org id 6+,Lab Services,Per Unit,$200.00 ,OP,200,200,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0087U,Crd hrt trnspl mrna 1283 gen,Lab Services,Per Unit,"$3,159.42 ",OP,"3,159.42","3,159.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0088U,Trnsplj kdn algrft rej 1494,Lab Services,Per Unit,"$3,159.42 ",OP,"3,159.42","3,159.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0089U,Onc mlnma prame & linc00518,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0090U,Onc cutan mlnma mrna 23 gene,Lab Services,Per Unit,"$1,755.00 ",OP,"1,755.00","1,755.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0092U,Onc lng 3 prtn bmrk plsm alg,Lab Services,Per Unit,"$2,488.00 ",OP,"2,488.00","2,488.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0093U,Rx mntr 65 com drugs urine,Lab Services,Per Unit,$62.14 ,OP,62.14,62.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0094U,Genome rapid sequence alys,Lab Services,Per Unit,"$7,582.20 ",OP,"7,582.20","7,582.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0095U,Inflm ee elisa alys alg,Lab Services,Per Unit,$771.98 ,OP,771.98,771.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0096U,Hpv hi risk types male urine,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0097U,Gi pathogen 22 targets,Lab Services,Per Unit,$363.04 ,OP,363.04,363.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0101T,Extracorp shockwv tx hi enrg,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0102T,Extracorp shockwv tx anesth,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0105U,Neph ckd mult eclia tum nec,Lab Services,Per Unit,$950.00 ,OP,950,950,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0106T,Touch quant sensory test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0106U,Gstr emptg 7 timed brth spec,Lab Services,Per Unit,$874.49 ,OP,874.49,874.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0107T,Vibrate quant sensory test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0107U,C diff tox ag detcj ia stool,Lab Services,Per Unit,$16.00 ,OP,16,16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0108T,Cool quant sensory test,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0108U,Gi barrett esoph 9 prtn bmrk,Lab Services,Per Unit,"$2,513.25 ",OP,"2,513.25","2,513.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0109T,Heat quant sensory test,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0109U,Id aspergillus dna 4 species,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0110T,Nos quant sensory test,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0110U,Rx mntr 1+oral onc rx&sbsts,Lab Services,Per Unit,$27.11 ,OP,27.11,27.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0111U,Onc colon ca kras&nras alys,Lab Services,Per Unit,$682.29 ,OP,682.29,682.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0112U,Iadi 16s&18s rrna genes,Lab Services,Per Unit,$356.13 ,OP,356.13,356.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0113U,Onc prst8 pca3&tmprss2-erg,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0114U,Gi barretts esoph vim&ccna1,Lab Services,Per Unit,"$1,938.01 ",OP,"1,938.01","1,938.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0115U,Respir iadna 18 viral&2 bact,Lab Services,Per Unit,$275.35 ,OP,275.35,275.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0116U,Rx mntr nzm ia 35+oral flu,Lab Services,Per Unit,$246.92 ,OP,246.92,246.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0117U,Pain mgmt 11 endogenous anal,Lab Services,Per Unit,$840.65 ,OP,840.65,840.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0118U,Trnsplj don-drv cll-fr dna,Lab Services,Per Unit,"$2,753.25 ",OP,"2,753.25","2,753.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0119U,Crd ceramides liq chrom plsm,Lab Services,Per Unit,$83.76 ,OP,83.76,83.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0120U,Onc b cll lymphm mrna 58 gen,Lab Services,Per Unit,"$2,510.21 ",OP,"2,510.21","2,510.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0121U,Sc dis vcam-1 whole blood,Lab Services,Per Unit,$509.20 ,OP,509.2,509.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0122U,Sc dis p-selectin whl blood,Lab Services,Per Unit,$526.23 ,OP,526.23,526.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0123U,Mchnl fragility rbc prflg,Lab Services,Per Unit,$357.63 ,OP,357.63,357.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0130U,Hered colon ca do mrna pnl,Lab Services,Per Unit,$584.90 ,OP,584.9,584.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0131U,Hered brst ca rltd do pnl 13,Lab Services,Per Unit,$710.00 ,OP,710,710,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0132U,Hered ova ca rltd do pnl 17,Lab Services,Per Unit,$741.64 ,OP,741.64,741.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0133U,Hered prst8 ca rltd do 11,Lab Services,Per Unit,$690.29 ,OP,690.29,690.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0134U,Hered pan ca mrna pnl 18 gen,Lab Services,Per Unit,$748.39 ,OP,748.39,748.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0135U,Hered gyn ca mrna pnl 12 gen,Lab Services,Per Unit,$700.56 ,OP,700.56,700.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0136U,Atm mrna seq alys,Lab Services,Per Unit,$407.43 ,OP,407.43,407.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0137U,Palb2 mrna seq alys,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0138U,Brca1 brca2 mrna seq alys,Lab Services,Per Unit,$468.33 ,OP,468.33,468.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0145U,Drug assay 65+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0146U,Drug assay 80+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0147U,Drug assay 85+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0148U,Drug assay 100+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0149U,Drug assay 60+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0150U,Drug assay 120+ rx/metablt,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0154U,Onc urthl ca rna fgfr3 gene,Lab Services,Per Unit,$482.14 ,OP,482.14,482.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0155U,Onc brst ca dna pik3ca gene,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0166U,Liver ds 10 biochem asy srm,Lab Services,Per Unit,$503.40 ,OP,503.4,503.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0167U,Chornc gonadotropin hcg ia,Lab Services,Per Unit,$7.52 ,OP,7.52,7.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0169U,Nudt15&tpmt gene com vrnt,Lab Services,Per Unit,$466.17 ,OP,466.17,466.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0170U,Neuro asd rna next gen seq,Lab Services,Per Unit,"$1,755.00 ",OP,"1,755.00","1,755.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0172U,Onc sld tum alys brca1 brca2,Lab Services,Per Unit,"$3,030.00 ",OP,"3,030.00","3,030.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0176U,Cdtb&vinculin igg antb ia,Lab Services,Per Unit,$64.19 ,OP,64.19,64.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0177U,Onc brst ca dna pik3ca 11,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0181U,Co gnotyp aqp1 exon 1,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0182U,Crom gnotyp cd55 exons 1-10,Lab Services,Per Unit,$301.35 ,OP,301.35,301.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0183U,Di gnotyp slc4a1 exon 19,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0184T,Exc rectal tumor endoscopic,APC 5331,RVU Per Case,"$4,873.06 ",OP,"4,873.06","4,873.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0184U,Do gnotyp art4 exon 2,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0185U,Fut1 gnotyp fut1 exon 4,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0186U,Fut2 gnotyp fut2 exon 2,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0187U,Fy gnotyp ackr1 exons 1-2,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0188U,Ge gnotyp gypc exons 1-4,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0189U,Gypa gnotyp ntrns 1 5 exon 2,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0190U,Gypb gnotyp ntrns 1 5 seux 3,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0191T,Insert ant segment drain int,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0191U,In gnotyp cd44 exons 2 3 6,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0192U,Jk gnotyp slc14a1 exon 9,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0193U,Jr gnotyp abcg2 exons 2-26,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0194U,Kel gnotyp kel exon 8,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0195U,Klf1 targeted sequencing,Lab Services,Per Unit,$375.25 ,OP,375.25,375.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0196U,Lu gnotyp bcam exon 3,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0197U,Lw gnotyp icam4 exon 1,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0198T,Ocular blood flow measure,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0198U,Rhd&rhce gntyp rhd1-10&rhce5,Lab Services,Per Unit,$282.88 ,OP,282.88,282.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0199U,Sc gnotyp ermap exons 4 12,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0200T,Perq sacral augmt unilat inj,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0200U,Xk gnotyp xk exons 1-3,Lab Services,Per Unit,$274.83 ,OP,274.83,274.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0201T,Perq sacral augmt bilat inj,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0201U,Yt gnotyp ache exon 2,Lab Services,Per Unit,$185.20 ,OP,185.2,185.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0202T,Post vert arthrplst 1 lumbar,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0202U,Nfct ds 22 trgt sars-cov-2,Lab Services,Per Unit,$416.78 ,OP,416.78,416.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0203U,Ai ibd mrna xprsn prfl 17,Lab Services,Per Unit,$760.00 ,OP,760,760,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0204U,Onc thyr mrna xprsn alys 593,Lab Services,Per Unit,"$2,919.60 ",OP,"2,919.60","2,919.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0205U,Oph amd alys 3 gene variants,Lab Services,Per Unit,$47.00 ,OP,47,47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0207T,Clear eyelid gland w/heat,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0208T,Audiometry air only,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0209T,Audiometry air & bone,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0210T,Speech audiometry threshold,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0210U,Syphilis tst antb ia quan,Lab Services,Per Unit,$18.63 ,OP,18.63,18.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0211T,Speech audiom thresh & recog,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0212T,Compre audiometry evaluation,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0213T,Njx paravert w/us cer/thor,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0216T,Njx paravert w/us lumb/sac,APC 5443,RVU Per Unit,$797.03 ,OP,797.03,797.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0218U,Neuro musc dys dmd seq alys,Lab Services,Per Unit,"$2,279.00 ",OP,"2,279.00","2,279.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0219T,Plmt post facet implt cerv,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0220T,Plmt post facet implt thor,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0221T,Plmt post facet implt lumb,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0224U,Antibody sars-cov-2 titer(s),Lab Services,Per Unit,$42.13 ,OP,42.13,42.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0226U,Svnt sarscov2 elisa plsm srm,Lab Services,Per Unit,$42.28 ,OP,42.28,42.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0232T,Njx platelet plasma,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0234T,Trluml perip athrc renal art,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0235T,Trluml perip athrc visceral,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0236T,Trluml perip athrc abd aorta,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0237T,Trluml perip athrc brchiocph,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0238T,Trluml perip athrc iliac art,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0239U,Trgt gen seq alys pnl 311+,Lab Services,Per Unit,"$3,500.00 ",OP,"3,500.00","3,500.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0240U,Nfct ds vir resp rna 3 trgt,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0241U,Nfct ds vir resp rna 4 trgt,Lab Services,Per Unit,$142.63 ,OP,142.63,142.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0242U,Trgt gen seq alys pnl 55-74,Lab Services,Per Unit,"$5,000.00 ",OP,"5,000.00","5,000.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0253T,Insert aqueous drain device,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0263T,Im b1 mrw cel ther cmpl,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0264T,Im b1 mrw cel ther xcl hrvst,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0265T,Im b1 mrw cel ther hrvst onl,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0266T,Implt/rpl crtd sns dev total,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0267T,Implt/rpl crtd sns dev lead,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0268T,Implt/rpl crtd sns dev gen,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0269T,Rev/remvl crtd sns dev total,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0270T,Rev/remvl crtd sns dev lead,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0271T,Rev/remvl crtd sns dev gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0272T,Interrogate crtd sns dev,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0273T,Interrogate crtd sns w/pgrmg,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0274T,Perq lamot/lam crv/thrc,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0275T,Perq lamot/lam lumbar,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0278T,Tempr,APC 5721,RVU Per Case,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0308T,Insj ocular telescope prosth,APC 5495,RVU Per Case,"$20,124.53 ",OP,"20,124.53","20,124.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0312T,Laps impltj nstim vagus,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0313T,Laps rmvl nstim array vagus,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0314T,Laps rmvl vgl arry&pls gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0315T,Rmvl vagus nerve pls gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0316T,Replc vagus nerve pls gen,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0317T,Elec alys vagus nrv pls gen,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0330T,Tear film img uni/bi w/i&r,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0331T,Heart symp image plnr,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0332T,Heart symp image plnr spect,APC 5593,RVU Per Unit,"$1,265.57 ",OP,"1,265.57","1,265.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0335T,Insj sinus tarsi implant,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0338T,Trnscth renal symp denrv unl,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0339T,Trnscth renal symp denrv bil,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0342T,Thxp apheresis w/hdl delip,APC 5243,RVU Per Unit,"$3,912.88 ",OP,"3,912.88","3,912.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0345T,Transcath mtral vlve repair,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0347T,Ins bone device for rsa,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0348T,Rsa spine exam,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0349T,Rsa upper extr exam,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0350T,Rsa lower extr exam,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0355T,Gi tract capsule endoscopy,APC 5302,RVU Per Case,"$1,574.78 ",OP,"1,574.78","1,574.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0356T,Insrt drug device for iop,APC 5692,RVU Per Case,$60.06 ,OP,60.06,60.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0358T,Bia whole body,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0362T,Bhv id suprt assmt ea 15 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0373T,Adapt bhv tx ea 15 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0379T,Vis field assmnt tech suppt,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0394T,Hdr elctrnc skn surf brchytx,APC 5622,RVU Per Unit,$234.21 ,OP,234.21,234.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0395T,Hdr elctr ntrst/ntrcv brchtx,APC 5624,RVU Per Unit,$686.56 ,OP,686.56,686.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0398T,Mrgfus strtctc les abltj,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0402T,Colgn cross-link crn med sep,APC 5503,RVU Per Case,"$1,940.45 ",OP,"1,940.45","1,940.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0404T,Trnscrv uterin fibroid abltj,APC 5416,RVU Per Case,"$6,584.25 ",OP,"6,584.25","6,584.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0408T,Insj/rplc cardiac modulj sys,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0409T,Insj/rplc car modulj pls gn,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0410T,Insj/rplc car modulj atr elt,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0411T,Insj/rplc car modulj vnt elt,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0412T,Rmvl cardiac modulj pls gen,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0413T,Rmvl car modulj tranvns elt,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0414T,Rmvl & rpl car modulj pls gn,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0415T,Repos car modulj tranvns elt,APC 5181,RVU Per Unit,$524.87 ,OP,524.87,524.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0416T,Reloc skin pocket pls gen,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0417T,Prgrmg eval cardiac modulj,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0418T,Interro eval cardiac modulj,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0419T,Dstrj neurofibroma xtnsv,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0420T,Dstrj neurofibroma xtnsv,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0421T,Waterjet prostate abltj cmpl,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,002.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0422T,Tactile breast img uni/bi,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0424T,Insj/rplc nstim apnea compl,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0425T,Insj/rplc nstim apnea sen ld,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0426T,Insj/rplc nstim apnea stm ld,APC 5463,RVU Per Case,"$10,888.82 ",OP,"10,888.82","10,888.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0427T,Insj/rplc nstim apnea pls gn,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0428T,Rmvl nstim apnea pls gen,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0429T,Rmvl nstim apnea sen ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0430T,Rmvl nstim apnea stimj ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0431T,Rmvl/rplc nstim apnea pls gn,APC 5465,RVU Per Case,"$28,534.20 ",OP,"28,534.20","28,534.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0432T,Repos nstim apnea stimj ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0433T,Repos nstim apnea sensing ld,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0434T,Interro eval npgs apnea,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0435T,Prgrmg eval npgs apnea 1 ses,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0436T,Prgrmg eval npgs apnea study,APC 5724,RVU Per Unit,$891.38 ,OP,891.38,891.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0440T,Abltj perc uxtr/perph nrv,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0441T,Abltj perc lxtr/perph nrv,APC 5431,RVU Per Case,"$1,700.15 ",OP,"1,700.15","1,700.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0442T,Abltj perc plex/trncl nrv,APC 5432,RVU Per Case,"$5,524.06 ",OP,"5,524.06","5,524.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0446T,Insj impltbl glucose sensor,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0447T,Rmvl impltbl glucose sensor,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0448T,Remvl insj impltbl gluc sens,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0449T,Insj aqueous drain dev 1st,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0451T,Insj/rplcmt aortic ventr sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0452T,Insj/rplcmt dev vasc seal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0453T,Insj/rplcmt mech-elec ntrfce,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0454T,Insj/rplcmt subq electrode,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0455T,Remvl aortic ventr cmpl sys,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0456T,Remvl aortic dev vasc seal,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0457T,Remvl mech-elec skin ntrfce,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0458T,Remvl subq electrode,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0459T,Relocaj rplcmt aortic ventr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0460T,Repos aortic ventr dev eltrd,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0461T,Repos aortic contrpulsj dev,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0462T,Prgrmg eval aortic ventr sys,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0463T,Interrog aortic ventr sys,APC 5743,RVU Per Unit,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0464T,Visual ep test for glaucoma,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0465T,Supchrdl njx rx w/o supply,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0467T,Revj/rplmnt ch respir eltrd,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0468T,Rmvl ch wal respir eltrd/ra,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0472T,Prgrmg io rta eltrd ra,APC 5743,RVU Per Case,$264.04 ,OP,264.04,264.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0473T,Reprgrmg io rta eltrd ra,APC 5742,RVU Per Case,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0476T,Rec ftl car sgl elec tr data,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0477T,Rec ftl car sgl xrtj alys,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0479T,Fxjl abl lsr 1st 100 sq cm,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0481T,Njx autol wbc concentrate,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0483T,Tmvi percutaneous approach,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0484T,Tmvi transthoracic exposure,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0485T,Oct mid ear i&r unilateral,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0486T,Oct mid ear i&r bilateral,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0487T,Trvg biomchn mapg w/reprt,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0491T,Abl lsr opn wnd 1st 20 sqcm,APC 5052,RVU Per Unit,$335.15 ,OP,335.15,335.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0494T,Prep & cannulj cdvr don lung,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0495T,Mntr cdvr don lng 1st 2 hrs,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0496T,Mntr cdvr don lng ea addl hr,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0497T,Xtrnl pt act ecg in-off conn,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0499T,Cysto f/urtl strix/stenosis,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0503T,Cor ffr alys gnrj ffr mdl,APC 1511,RVU Per Unit,$921.12 ,OP,921.12,921.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0505T,Ev fempop artl revsc,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0506T,Mac pgmt opt dns meas hfp,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0507T,Near ifr 2img mibmn glnd i&r,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0508T,Pls echo us b1 dns meas tib,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0509T,Pattern erg w/i&r,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0510T,Rmvl sinus tarsi implant,APC 5113,RVU Per Case,"$2,742.89 ",OP,"2,742.89","2,742.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0511T,Rmvl&rinsj sinus tarsi implt,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0512T,Esw integ wnd hlg 1st wnd,APC 5051,RVU Per Unit,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0515T,Insj wcs lv compl sys,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0516T,Insj wcs lv eltrd only,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0517T,Insj wcs lv pg compnt,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0518T,Rmvl pg compnt wcs,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0519T,Rmvl & rplcmt pg compnt wcs,APC 5221,RVU Per Unit,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0520T,Rmvl&rplcmt pg wcs new eltrd,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0521T,Interrog dev eval wcs ip,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0522T,Prgrmg dev eval wcs ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0524T,Ev cath dir chem abltj w/img,APC 5183,RVU Per Case,"$2,773.19 ",OP,"2,773.19","2,773.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0525T,Insj/rplcmt compl iims,APC 5223,RVU Per Case,"$10,078.61 ",OP,"10,078.61","10,078.61",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0526T,Insj/rplcmt iims eltrd only,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0527T,Insj/rplcmt iims implt mntr,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0528T,Prgrmg dev eval iims ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0529T,Interrog dev eval iims ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0530T,Removal complete iims,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0531T,Removal iims electrode only,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0532T,Removal iims implt mntr only,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0534T,Cont rec mvmt do setup&train,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0535T,Cont rec mvmt do reprt cnfig,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0540T,Car-t cll admn autologous,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0541T,Myocardial imaging mcg,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0543T,Ta mv rpr w/artif chord tend,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0544T,Tcat mv annulus rcnstj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0545T,Tcat tv annulus rcnstj,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0548T,Tprnl balo cntnc dev bi,APC 5377,RVU Per Case,"$11,132.85 ",OP,"11,132.85","11,132.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0549T,Tprnl balo cntnc dev uni,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0550T,Tprnl balo cntnc dev rmvl ea,APC 5374,RVU Per Case,"$2,981.23 ",OP,"2,981.23","2,981.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0551T,Tprnl balo cntnc dev adjmt,APC 5371,RVU Per Unit,$257.91 ,OP,257.91,257.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0555T,B1 str&fx rsk transmis data,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0556T,B1 str & fx rsk assessment,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0558T,Ct scan f/biomchn ct alys,APC 5521,RVU Per Unit,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0559T,Antmc mdl 3d print 1st cmpnt,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0561T,Antmc guide 3d print 1st gd,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0563T,Evac meibomian glnd heat bi,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0564T,Onc chemo rx cytotox csc 14,APC 5671,RVU Per Case,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0565T,Autol cell implt adps hrvg,APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0566T,Autol cell implt adps njx,APC 5441,RVU Per Unit,$253.09 ,OP,253.09,253.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0569T,Ttvr perq appr 1st prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0570T,Ttvr perq ea addl prosth,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0571T,Insj/rplcmt icds ss eltrd,APC 5232,RVU Per Case,"$31,823.63 ",OP,"31,823.63","31,823.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0572T,Insertion ss dfb electrode,APC 5222,RVU Per Case,"$7,900.53 ",OP,"7,900.53","7,900.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0573T,Removal ss dfb electrode,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0574T,Repos prev ss impl dfb eltrd,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0575T,Prgrmg dev eval icds ss ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0576T,Interrog dev eval icds ss ip,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0577T,Ephys eval icds ss,APC 5211,RVU Per Case,"$1,078.37 ",OP,"1,078.37","1,078.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0579T,Rem interrog dev icds tech,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0580T,Rmvl ss impl dfb pg only,APC 5221,RVU Per Case,"$3,334.01 ",OP,"3,334.01","3,334.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0583T,Tmpst auto tube dlvr sys,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0584T,Perq islet cell transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0585T,Laps islet cell transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0586T,Open islet cell transplant,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0587T,Perq impltj/rplcmt isdns ptn,APC 5462,RVU Per Case,"$5,970.22 ",OP,"5,970.22","5,970.22",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0588T,Revision/removal isdns ptn,APC 5461,RVU Per Case,"$3,174.04 ",OP,"3,174.04","3,174.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0589T,Elec alys smpl prgrmg iins,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0590T,Elec alys cplx prgrmg iins,APC 5742,RVU Per Unit,$97.21 ,OP,97.21,97.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0594T,Osteot hum xtrnl lngth dev,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0596T,Temp fml iu vlv-pmp 1st insj,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0597T,Temp fml iu valve-pmp rplcmt,APC 5372,RVU Per Unit,$557.00 ,OP,557,557,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0598T,Ncntc r-t fluor wnd img 1st,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0600T,Ire abltj 1+tum organ perq,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0601T,Ire abltj 1+tumors open,APC 5362,RVU Per Case,"$8,632.26 ",OP,"8,632.26","8,632.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0604T,Rem oct rta dev setup&educaj,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0605T,Rem oct rta techl sprt min 8,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0607T,Rem mntr pulm flu mntr setup,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0608T,Rem mntr pulm flu mntr alys,APC 5741,RVU Per Unit,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0609T,Mrs disc pain acquisj data,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0611T,Mrs disc pain alg alys data,APC 5523,RVU Per Unit,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0614T,Rmvl&rplcmt ss impl dfb pg,APC 5231,RVU Per Case,"$22,327.84 ",OP,"22,327.84","22,327.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0615T,Eye mvmt alys w/o calbrj i&r,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0616T,Insertion of iris prosthesis,APC 5491,RVU Per Case,"$2,014.88 ",OP,"2,014.88","2,014.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0617T,Insj iris prosth w/rmvl&insj,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0618T,Insj iris prosth sec io lens,APC 5492,RVU Per Case,"$3,796.62 ",OP,"3,796.62","3,796.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0619T,Cysto w/prst8 commissurotomy,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0620T,Evasc ven artlz tibl/prnl vn,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0627T,Perq njx algc fluor lmbr 1st,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0629T,Perq njx algc ct lmbr 1st,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0631T,Tc vis lit hyperspectral img,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0632T,Perq tcat us abltj nrv p-art,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0633T,Ct breast w/3d uni c-,APC 5522,RVU Per Case,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0634T,Ct breast w/3d uni c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0635T,Ct breast w/3d uni c-/c+,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0636T,Ct breast w/3d bi c-,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0637T,Ct breast w/3d bi c+,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,0638T,Ct breast w/3d bi c-/c+,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0425,Ground mileage,Therapy,Per Unit,$7.47 ,OP,7.47,7.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0426,Als 1,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0427,Als1-emergency,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0428,Bls,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0429,Bls-emergency,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0430,Fixed wing air transport,Therapy,Per Case,"$3,147.91 ",OP,"3,147.91","3,147.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0431,Rotary wing air transport,Therapy,Per Case,"$3,659.92 ",OP,"3,659.92","3,659.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0432,Pi volunteer ambulance co,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0433,Als 2,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0434,Specialty care transport,Therapy,Per Case,$231.98 ,OP,231.98,231.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0435,Fixed wing air mileage,Therapy,Per Unit,$8.93 ,OP,8.93,8.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A0436,Rotary wing air mileage,Therapy,Per Unit,$23.83 ,OP,23.83,23.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A4563,Vag inser rectal control sys,Durable Medical Equipment,Per Unit,"$1,372.71 ",OP,"1,372.71","1,372.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9513,Lutetium lu 177 dotatat ther,APC 9067,Per Unit,$274.33 ,OP,274.33,274.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9517,I131 iodide cap- rx,APC 1064,Per Unit,$20.12 ,OP,20.12,20.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9527,Iodine i-125 sodium iodide,APC 2632,Per Unit,$30.66 ,OP,30.66,30.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9530,I131 iodide sol- rx,APC 1150,Per Unit,$13.34 ,OP,13.34,13.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9543,Y90 ibritumomab- rx,APC 1643,Per Unit,"$59,793.85 ",OP,"59,793.85","59,793.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9563,P32 na phosphate,APC 1675,Per Unit,$458.34 ,OP,458.34,458.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9590,Iodine i-131 iobenguane 1mci,APC 9339,Per Unit,$320.12 ,OP,320.12,320.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9591,Fluoroestradiol f 18,APC 9370,Per Unit,$644.83 ,OP,644.83,644.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9592,Copper cu 64 dotatate diag,APC 9383,Per Unit,$918.21 ,OP,918.21,918.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9600,Sr89 strontium,APC 0701,Per Unit,"$3,975.00 ",OP,"3,975.00","3,975.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9604,Sm 153 lexidronam,APC 1295,Per Unit,"$17,259.85 ",OP,"17,259.85","17,259.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,A9606,Radium ra223 dichloride ther,APC 1745,Per Unit,$145.65 ,OP,145.65,145.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1052,Hemostatic agent- gi- topic,APC 2031,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1062,Intravertebral fx aug impl,APC 2032,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1716,Brachytx- non-str- gold-198,APC 2645,Per Unit,$330.76 ,OP,330.76,330.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1717,Brachytx- non-str-hdr ir-192,APC 2646,Per Unit,$383.90 ,OP,383.9,383.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1719,Brachytx- ns- non-hdrir-192,APC 2647,Per Unit,$323.97 ,OP,323.97,323.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1734,Orth/devic/drug bn/bn-tis/bn,APC 2026,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1748,Endoscope- single- ugi,APC 2029,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1823,Gen- neuro- trans sen/stim,APC 2993,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1824,Generator- ccm- implant,APC 2024,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1825,Gen- neuro- carot sinus baro,APC 2030,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1839,Iris prosthesis,APC 2028,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C1982,Cath- pressure-valve-occlu,APC 2025,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2596,Probe- robotic- water-jet,APC 2027,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2616,Brachytx- non-str-yttrium-90,APC 2616,Per Unit,"$19,955.81 ",OP,"19,955.81","19,955.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2634,Brachytx- non-str- ha- i-125,APC 2634,Per Unit,$169.87 ,OP,169.87,169.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2635,Brachytx- non-str- ha- p-103,APC 2635,Per Unit,$52.25 ,OP,52.25,52.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2636,Brachy linear- non-str-p-103,APC 2636,Per Unit,$36.02 ,OP,36.02,36.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2638,Brachytx- stranded- i-125,APC 2638,Per Unit,$42.90 ,OP,42.9,42.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2639,Brachytx- non-stranded-i-125,APC 2639,Per Unit,$39.11 ,OP,39.11,39.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2640,Brachytx- stranded- p-103,APC 2640,Per Unit,$100.65 ,OP,100.65,100.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2641,Brachytx- non-stranded-p-103,APC 2641,Per Unit,$79.72 ,OP,79.72,79.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2642,Brachytx- stranded- c-131,APC 2642,Per Unit,$82.43 ,OP,82.43,82.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2643,Brachytx- non-stranded-c-131,APC 2643,Per Unit,$92.16 ,OP,92.16,92.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2645,Brachytx planar- p-103,APC 2648,Per Unit,$5.38 ,OP,5.38,5.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2698,Brachytx- stranded- nos,APC 2698,Per Unit,$42.90 ,OP,42.9,42.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C2699,Brachytx- non-stranded- nos,APC 2699,Per Unit,$36.02 ,OP,36.02,36.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C5271,Low cost skin substitute app,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C5273,Low cost skin substitute app,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C5275,Low cost skin substitute app,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C5277,Low cost skin substitute app,APC 5053,RVU Per Unit,$507.97 ,OP,507.97,507.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8900,Mra w/cont- abd,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8901,Mra w/o cont- abd,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8902,Mra w/o fol w/cont- abd,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8903,Mri w/cont- breast- uni,APC 5571,RVU Per Case,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8905,Mri w/o fol w/cont- brst- un,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8906,Mri w/cont- breast- bi,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8908,Mri w/o fol w/cont- breast-,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8909,Mra w/cont- chest,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8910,Mra w/o cont- chest,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8911,Mra w/o fol w/cont- chest,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8912,Mra w/cont- lwr ext,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8913,Mra w/o cont- lwr ext,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8914,Mra w/o fol w/cont- lwr ext,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8918,Mra w/cont- pelvis,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8919,Mra w/o cont- pelvis,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8920,Mra w/o fol w/cont- pelvis,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8921,Tte w or w/o fol w/cont- com,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8922,Tte w or w/o fol w/cont- f/u,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8923,2d tte w or w/o fol w/con-co,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8924,2d tte w or w/o fol w/con-fu,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8925,2d tee w or w/o fol w/con-in,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8926,Tee w or w/o fol w/cont-cong,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8927,Tee w or w/o fol w/cont- mon,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8928,Tte w or w/o fol w/con-stres,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8929,Tte w or wo fol wcon-doppler,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8930,Tte w or w/o contr- cont ecg,APC 5573,RVU Per Unit,$693.07 ,OP,693.07,693.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8931,Mra- w/dye- spinal canal,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8932,Mra- w/o dye- spinal canal,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8933,Mra- w/o&w/dye- spinal canal,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8934,Mra- w/dye- upper extremity,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8935,Mra- w/o dye- upper extr,APC 5523,RVU Per Case,$223.01 ,OP,223.01,223.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8936,Mra- w/o&w/dye- upper extr,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C8957,Prolonged iv inf- req pump,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9046,Cocaine hcl nasal solution,APC 9307,Per Unit,$1.33 ,OP,1.33,1.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9047,Injection- caplacizumab-yhdp,APC 9199,Per Unit,$691.29 ,OP,691.29,691.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9067,Gallium ga-68 dotatoc,APC 9323,Per Unit,$8.64 ,OP,8.64,8.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9248,Inj- clevidipine butyrate,APC 9087,Per Unit,$2.91 ,OP,2.91,2.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9250,Artiss fibrin sealant,APC 1848,Per Unit,$156.84 ,OP,156.84,156.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9257,Bevacizumab injection,APC 1281,Per Unit,$1.76 ,OP,1.76,1.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9460,Injection- cangrelor,APC 9460,Per Unit,$16.32 ,OP,16.32,16.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9462,Injection- delafloxacin,APC 9462,Per Unit,$0.37 ,OP,0.37,0.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9482,Sotalol hydrochloride iv,APC 9482,Per Unit,$17.58 ,OP,17.58,17.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9488,Conivaptan hcl,APC 9488,Per Unit,$43.94 ,OP,43.94,43.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9600,Perc drug-el cor stent sing,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9602,Perc d-e cor stent ather s,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9604,Perc d-e cor revasc t cabg s,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9606,Perc d-e cor revasc w ami s,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9607,Perc d-e cor revasc chro sin,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9725,Place endorectal app,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9727,Insert palate implants,APC 5163,RVU Per Case,"$1,310.96 ",OP,"1,310.96","1,310.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9728,Place device/marker- non pro,APC 5613,RVU Per Unit,"$1,223.16 ",OP,"1,223.16","1,223.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9733,Non-ophthalmic fva,APC 5572,RVU Per Case,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9734,U/s trtmt- not leiomyomata,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9739,Cystoscopy prostatic imp 1-3,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9740,Cysto impl 4 or more,APC 5376,RVU Per Case,"$8,002.82 ",OP,"8,002.82","8,002.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9752,Intraosseous des lumb/sacrum,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9757,Spine/lumbar disk surgery,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9761,Cysto- litho- vacuum kidney,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9762,Cardiac mri seg dys strain,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9763,Cardiac mri seg dys stress,APC 5524,RVU Per Case,$467.96 ,OP,467.96,467.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9764,Revasc intravasc lithotripsy,APC 5192,RVU Per Case,"$4,803.59 ",OP,"4,803.59","4,803.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9765,Revasc intra lithotrip-stent,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9766,Revasc intra lithotrip-ather,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9767,Revasc lithotrip-stent-ather,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9769,Cysto w/temp pros implant,APC 5375,RVU Per Case,"$4,277.44 ",OP,"4,277.44","4,277.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9771,Nsl/sins cryo post nasal tis,APC 5164,RVU Per Case,"$2,651.79 ",OP,"2,651.79","2,651.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9772,Revasc lithotrip tibi/perone,APC 5193,RVU Per Case,"$9,732.45 ",OP,"9,732.45","9,732.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9773,Revasc lithotr-stent tib/per,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9774,Revasc lithotr-ather tib/per,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9775,Revasc lith-sten-ath tib/per,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,C9803,Hopd covid-19 spec collect,APC 5731,RVU Per Case,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0150,Comprehensve oral evaluation,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0240,Intraoral occlusal film,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0250,Extraoral 2d project image,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0251,Extraoral posterior image,APC 5521,RVU Per Case,$78.40 ,OP,78.4,78.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0270,Dental bitewing single image,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0272,Dental bitewings two images,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0274,Bitewings four images,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0277,Vert bitewings 7 to 8 images,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0460,Pulp vitality test,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D0600,Non-ionizing diag proc,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1510,Space maintainer fxd unilat,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1516,Fixed bilat space maint- max,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1517,Fixed bilat space maint- man,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1520,Remove unilat space maintain,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1526,Remove bilat space main- max,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1527,Remove bilat space main- man,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1551,Recement space maint - max,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1552,Recement space maint - man,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1553,Recement unilat space maint,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D1575,Dist space maint- fixed unil,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D2999,Dental unspec restorative pr,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D3460,Endodontic endosseous implan,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D3999,Endodontic procedure,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4260,Osseous surgery 4 or more,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4263,Bone replce graft first site,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4264,Bone replce graft each add,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4268,Surgical revision procedure,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4270,Pedicle soft tissue graft pr,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4273,Auto tissue graft 1st tooth,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4355,Full mouth debridement,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D4381,Localized delivery antimicro,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D5911,Facial moulage sectional,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D5912,Facial moulage complete,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D5983,Radiation applicator,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D5984,Radiation shield,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D5985,Radiation cone locator,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D5987,Commissure splint,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D6920,Dental connector bar,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7111,Extraction coronal remnants,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7140,Extraction erupted tooth/exr,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7210,Rem imp tooth w mucoper flp,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7220,Impact tooth remov soft tiss,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7230,Impact tooth remov part bony,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7240,Impact tooth remov comp bony,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7241,Impact tooth rem bony w/comp,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7250,Tooth root removal,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7260,Oral antral fistula closure,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7261,Primary closure sinus perf,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7291,Transseptal fiberotomy,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D7940,Reshaping bone orthognathic,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D9930,Treatment of complications,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D9944,Occ guard- hard- full arch,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D9945,Occ guard- soft- full arch,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D9946,Occ guard- hard- part arch,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D9950,Occlusion analysis,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D9951,Limited occlusal adjustment,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,D9952,Complete occlusal adjustment,APC 5871,RVU Per Unit,"$1,350.45 ",OP,"1,350.45","1,350.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0008,Admin influenza virus vac,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0009,Admin pneumococcal vaccine,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0010,Admin hepatitis b vaccine,APC 5691,RVU Per Unit,$38.76 ,OP,38.76,38.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0027,Semen analysis,Lab Services,Per Unit,$6.50 ,OP,6.5,6.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0101,Ca screen-pelvic/breast exam,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0103,Psa screening,Lab Services,Per Unit,$19.31 ,OP,19.31,19.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0104,Ca screen-flexi sigmoidscope,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0105,Colorectal scrn- hi risk ind,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0106,Colon ca screen-barium enema,APC 5571,RVU Per Unit,$173.03 ,OP,173.03,173.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0108,Diab manage trn per indiv,Lab Services,Per Unit,$54.47 ,OP,54.47,54.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0109,Diab manage trn ind/group,Lab Services,Per Unit,$15.18 ,OP,15.18,15.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0117,Glaucoma scrn hgh risk direc,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0118,Glaucoma scrn hgh risk direc,APC 5732,RVU Per Unit,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0120,Colon ca scrn- barium enema,APC 5572,RVU Per Unit,$356.73 ,OP,356.73,356.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0121,Colon ca scrn not hi rsk ind,APC 5311,RVU Per Unit,$769.11 ,OP,769.11,769.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0123,Screen cerv/vag thin layer,Lab Services,Per Unit,$20.26 ,OP,20.26,20.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0127,Trim nail(s),APC 5733,RVU Per Case,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0129,Partial hosp prog service,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0130,Single energy x-ray study,APC 5522,RVU Per Unit,$105.60 ,OP,105.6,105.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0143,Scr c/v cyto-thinlayer-rescr,Lab Services,Per Unit,$27.05 ,OP,27.05,27.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0144,Scr c/v cyto-thinlayer-rescr,Lab Services,Per Unit,$43.97 ,OP,43.97,43.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0145,Scr c/v cyto-thinlayer-rescr,Lab Services,Per Unit,$26.49 ,OP,26.49,26.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0147,Scr c/v cyto- automated sys,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0148,Scr c/v cyto- autosys- rescr,Lab Services,Per Unit,$31.94 ,OP,31.94,31.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0166,Extrnl counterpulse- per tx,APC 5734,RVU Per Case,$108.49 ,OP,108.49,108.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0175,Opps service-sched team conf,APC 5024,RVU Per Unit,$352.49 ,OP,352.49,352.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0176,Opps/php-activity therapy,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0186,Dstry eye lesn-fdr vssl tech,APC 5481,RVU Per Unit,$488.28 ,OP,488.28,488.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0235,Pet not otherwise specified,APC 5591,RVU Per Unit,$365.46 ,OP,365.46,365.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0237,Therapeutic procd strg endur,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0238,Oth resp proc- indiv,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0239,Oth resp proc- group,APC 5732,RVU Per Unit,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0245,Initial foot exam pt lops,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0246,Followup eval of foot pt lop,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0247,Routine footcare pt w lops,APC 5051,RVU Per Case,$173.99 ,OP,173.99,173.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0248,Demonstrate use home inr mon,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0249,Provide inr test mater/equip,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0257,Unsched dialysis esrd pt hos,APC 5401,RVU Per Unit,$634.11 ,OP,634.11,634.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0260,Inj for sacroiliac jt anesth,APC 5442,RVU Per Unit,$614.97 ,OP,614.97,614.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0270,Mnt subs tx for change dx,Lab Services,Per Unit,$26.49 ,OP,26.49,26.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0271,Group mnt 2 or more 30 mins,Lab Services,Per Unit,$13.98 ,OP,13.98,13.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0276,Pild/placebo control clin tr,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0277,Hbot- full body chamber- 30m,APC 5061,RVU Per Unit,$115.59 ,OP,115.59,115.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0279,Tomosynthesis- mammo,Lab Services,Per Unit,$23.23 ,OP,23.23,23.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0281,Elec stim unattend for press,Lab Services,Per Unit,$12.74 ,OP,12.74,12.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0283,Elec stim other than wound,Lab Services,Per Unit,$12.74 ,OP,12.74,12.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0293,Non-cov surg proc-clin trial,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0294,Non-cov proc- clinical trial,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0296,Visit to determ ldct elig,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0302,Pre-op service lvrs complete,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0303,Pre-op service lvrs 10-15dos,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0304,Pre-op service lvrs 1-9 dos,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0305,Post op service lvrs min 6,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0306,Cbc/diffwbc w/o platelet,Lab Services,Per Unit,$7.77 ,OP,7.77,7.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0307,Cbc without platelet,Lab Services,Per Unit,$6.47 ,OP,6.47,6.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0328,Fecal blood scrn immunoassay,Lab Services,Per Unit,$18.05 ,OP,18.05,18.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0329,Electromagntic tx for ulcers,Lab Services,Per Unit,$10.46 ,OP,10.46,10.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0341,Percutaneous islet celltrans,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0342,Laparoscopy islet cell trans,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0343,Laparotomy islet cell transp,APC 5881,RVU Per Case,"$8,474.54 ",OP,"8,474.54","8,474.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0379,Direct refer hospital observ,APC 5025,RVU Per Case,$505.98 ,OP,505.98,505.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0380,Lev 1 hosp type b ed visit,APC 5031,RVU Per Case,$68.36 ,OP,68.36,68.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0381,Lev 2 hosp type b ed visit,APC 5032,RVU Per Case,$92.46 ,OP,92.46,92.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0382,Lev 3 hosp type b ed visit,APC 5033,RVU Per Case,$175.37 ,OP,175.37,175.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0383,Lev 4 hosp type b ed visit,APC 5034,RVU Per Case,$221.52 ,OP,221.52,221.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0384,Lev 5 hosp type b ed visit,APC 5035,RVU Per Case,$308.54 ,OP,308.54,308.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0390,Trauma respons w/hosp criti,APC 5045,RVU Per Unit,$913.52 ,OP,913.52,913.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0396,Alcohol/subs interv 15-30mn,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0397,Alcohol/subs interv >30 min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0398,Home sleep test/type 2 porta,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0399,Home sleep test/type 3 porta,APC 5721,RVU Per Unit,$135.23 ,OP,135.23,135.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0400,Home sleep test/type 4 porta,APC 5722,RVU Per Unit,$256.27 ,OP,256.27,256.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0402,Initial preventive exam,APC 5012,RVU Per Unit,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0404,Ekg tracing for initial prev,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0410,Grp psych partial hosp 45-50,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0411,Inter active grp psych parti,APC 5853,RVU Per Case,$252.43 ,OP,252.43,252.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0412,Open tx iliac spine uni/bil,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0413,Pelvic ring fracture uni/bil,APC 5114,RVU Per Case,"$6,071.26 ",OP,"6,071.26","6,071.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0414,Pelvic ring fx treat int fix,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0415,Open tx post pelvic fxcture,APC 5115,RVU Per Case,"$11,934.03 ",OP,"11,934.03","11,934.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0416,Prostate biopsy- any mthd,APC 5673,RVU Per Case,$282.25 ,OP,282.25,282.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0420,Ed svc ckd ind per session,Lab Services,Per Unit,$111.79 ,OP,111.79,111.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0421,Ed svc ckd grp per session,Lab Services,Per Unit,$26.73 ,OP,26.73,26.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0422,Intens cardiac rehab w/exerc,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0423,Intens cardiac rehab no exer,APC 5771,RVU Per Unit,$112.48 ,OP,112.48,112.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0424,Pulmonary rehab w exer,APC 5733,RVU Per Unit,$53.94 ,OP,53.94,53.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0429,Dermal filler injection(s),APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0432,Eia hiv-1/hiv-2 screen,Lab Services,Per Unit,$19.57 ,OP,19.57,19.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0433,Elisa hiv-1/hiv-2 screen,Lab Services,Per Unit,$18.29 ,OP,18.29,18.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0435,Oral hiv-1/hiv-2 screen,Lab Services,Per Unit,$11.98 ,OP,11.98,11.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0438,Ppps- initial visit,Lab Services,Per Unit,$163.74 ,OP,163.74,163.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0439,Ppps- subseq visit,Lab Services,Per Unit,$129.00 ,OP,129,129,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0442,Annual alcohol screen 15 min,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0443,Brief alcohol misuse counsel,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0444,Depression screen annual,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0445,High inten beh couns std 30m,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0446,Intens behave ther cardio dx,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0447,Behavior counsel obesity 15m,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0451,Devlopment test interpt&rep,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0455,Fecal microbiota prep instil,APC 5301,RVU Per Case,$784.57 ,OP,784.57,784.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0460,Autologous prp for ulcers,APC 5054,RVU Per Unit,"$1,662.33 ",OP,"1,662.33","1,662.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0463,Hospital outpt clinic visit,APC 5012,RVU Per Case,$115.07 ,OP,115.07,115.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0471,Ven blood coll snf/hha,Lab Services,Per Unit,$5.00 ,OP,5,5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0472,Hep c screen high risk/other,Lab Services,Per Unit,$46.35 ,OP,46.35,46.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0473,Group behave couns 2-10,APC 5821,RVU Per Unit,$25.42 ,OP,25.42,25.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0475,Hiv combination assay,Lab Services,Per Unit,$24.08 ,OP,24.08,24.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0476,Hpv combo assay ca screen,Lab Services,Per Unit,$35.09 ,OP,35.09,35.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0480,Drug test def 1-7 classes,Lab Services,Per Unit,$114.43 ,OP,114.43,114.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0481,Drug test def 8-14 classes,Lab Services,Per Unit,$156.59 ,OP,156.59,156.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0482,Drug test def 15-21 classes,Lab Services,Per Unit,$198.74 ,OP,198.74,198.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0483,Drug test def 22+ classes,Lab Services,Per Unit,$246.92 ,OP,246.92,246.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0498,Chemo extend iv infus w/pump,APC 5694,RVU Per Unit,$301.15 ,OP,301.15,301.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0499,Hepb screen high risk indiv,Lab Services,Per Unit,$28.27 ,OP,28.27,28.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0516,Insert drug del implant- >=4,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0517,Remove drug implant,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0518,Remove w insert drug implant,APC 5735,RVU Per Case,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G0659,Drug test def simple all cl,Lab Services,Per Unit,$62.14 ,OP,62.14,62.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2000,Blinded conv. tx mdd clin tr,APC 5723,RVU Per Unit,$472.70 ,OP,472.7,472.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2011,Alcohol/sub misuse assess,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2065,Clin mang h risk dx 30,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2066,Inter devc remote 30d,APC 5741,RVU Per Case,$36.00 ,OP,36,36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2082,Visit esketamine 56m or less,APC 1508,RVU Per Unit,$630.39 ,OP,630.39,630.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2083,Visit esketamine- > 56m,APC 1511,RVU Per Unit,$921.12 ,OP,921.12,921.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2086,Off base opioid tx 70min,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2087,Off base opioid tx- 60 m,APC 5823,RVU Per Unit,$129.49 ,OP,129.49,129.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2170,Avf by tissue w thermal e,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2171,Avf use magnetic/art/ven,APC 5194,RVU Per Case,"$15,567.36 ",OP,"15,567.36","15,567.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2214,Init/sub psych care m 1st 30,APC 5822,RVU Per Unit,$72.56 ,OP,72.56,72.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2250,Remot img sub by pt- non e/m,Lab Services,Per Unit,$9.24 ,OP,9.24,9.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2251,Brief chkin- 5-10- non-e/m,Lab Services,Per Unit,$13.05 ,OP,13.05,13.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,G2252,Brief chkin by md/qhp- 11-20,Lab Services,Per Unit,$25.14 ,OP,25.14,25.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0121,Inj.- omadacycline- 1 mg,APC 9311,Per Unit,$3.30 ,OP,3.3,3.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0129,Abatacept injection,APC 9230,Per Unit,$45.27 ,OP,45.27,45.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0135,Adalimumab injection,APC 1083,Per Unit,"$1,581.57 ",OP,"1,581.57","1,581.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0178,Aflibercept injection,APC 1420,Per Unit,$917.94 ,OP,917.94,917.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0179,Inj- brolucizumab-dbll- 1 mg,APC 9340,Per Unit,$312.01 ,OP,312.01,312.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0180,Agalsidase beta injection,APC 9208,Per Unit,$198.14 ,OP,198.14,198.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0185,Inj.- aprepitant- 1 mg,APC 9463,Per Unit,$1.69 ,OP,1.69,1.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0202,Injection- alemtuzumab,APC 1809,Per Unit,"$2,086.32 ",OP,"2,086.32","2,086.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0207,Amifostine,APC 7000,Per Unit,"$1,135.69 ",OP,"1,135.69","1,135.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0220,Alglucosidase alfa injection,APC 9234,Per Unit,$117.07 ,OP,117.07,117.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0221,Lumizyme injection,APC 1413,Per Unit,$180.35 ,OP,180.35,180.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0222,Inj.- patisiran- 0.1 mg,APC 9180,Per Unit,$97.75 ,OP,97.75,97.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0223,Inj givosiran 0.5 mg,APC 9343,Per Unit,$106.76 ,OP,106.76,106.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0256,Alpha 1 proteinase inhibitor,APC 0901,Per Unit,$4.54 ,OP,4.54,4.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0257,Glassia injection,APC 1415,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0287,Amphotericin b lipid complex,APC 9024,Per Unit,$9.50 ,OP,9.5,9.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0289,Amphotericin b liposome inj,APC 0736,Per Unit,$28.75 ,OP,28.75,28.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0291,Inj.- plazomicin- 5 mg,APC 9183,Per Unit,$3.05 ,OP,3.05,3.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0300,Amobarbital 125 mg inj,APC 1341,Per Unit,$125.22 ,OP,125.22,125.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0390,Chloroquine injection,APC 9352,Per Unit,$165.22 ,OP,165.22,165.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0401,Inj aripiprazole ext rel 1mg,APC 1468,Per Unit,$6.01 ,OP,6.01,6.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0475,Baclofen 10 mg injection,APC 9032,Per Unit,$177.43 ,OP,177.43,177.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0480,Basiliximab,APC 1683,Per Unit,"$4,013.08 ",OP,"4,013.08","4,013.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0485,Belatacept injection,APC 9286,Per Unit,$3.80 ,OP,3.8,3.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0490,Belimumab injection,APC 1353,Per Unit,$47.57 ,OP,47.57,47.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0517,Inj.- benralizumab- 1 mg,APC 9466,Per Unit,$170.80 ,OP,170.8,170.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0558,Peng benzathine/procaine inj,APC 9088,Per Unit,$11.79 ,OP,11.79,11.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0561,Penicillin g benzathine inj,APC 1829,Per Unit,$14.95 ,OP,14.95,14.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0565,Inj- bezlotoxumab- 10 mg,APC 9490,Per Unit,$39.77 ,OP,39.77,39.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0570,Buprenorphine implant 74.2mg,APC 9058,Per Unit,"$1,311.75 ",OP,"1,311.75","1,311.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0584,Injection- burosumab-twza 1m,APC 9187,Per Unit,$369.11 ,OP,369.11,369.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0585,Injection-onabotulinumtoxina,APC 0902,Per Unit,$6.09 ,OP,6.09,6.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0586,Abobotulinumtoxina,APC 1289,Per Unit,$8.41 ,OP,8.41,8.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0587,Inj- rimabotulinumtoxinb,APC 9018,Per Unit,$12.05 ,OP,12.05,12.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0588,Incobotulinumtoxin a,APC 9278,Per Unit,$5.05 ,OP,5.05,5.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0594,Busulfan injection,APC 1178,Per Unit,$1.71 ,OP,1.71,1.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0596,Injection- ruconest,APC 9445,Per Unit,$29.97 ,OP,29.97,29.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0597,C-1 esterase- berinert,APC 9269,Per Unit,$57.39 ,OP,57.39,57.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0598,C-1 esterase- cinryze,APC 9251,Per Unit,$58.93 ,OP,58.93,58.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0599,Inj.- haegarda 10 units,APC 9015,Per Unit,$10.25 ,OP,10.25,10.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0600,Edetate calcium disodium inj,APC 1274,Per Unit,"$5,708.59 ",OP,"5,708.59","5,708.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0630,Calcitonin salmon injection,APC 1433,Per Unit,"$3,100.79 ",OP,"3,100.79","3,100.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0638,Canakinumab injection,APC 1311,Per Unit,$115.61 ,OP,115.61,115.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0641,Inj levoleucovorin nos 0.5mg,APC 1236,Per Unit,$0.09 ,OP,0.09,0.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0642,Injection- khapzory- 0.5 mg,APC 9334,Per Unit,$1.86 ,OP,1.86,1.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0691,Inj lefamulin 1 mg,APC 9332,Per Unit,$0.72 ,OP,0.72,0.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0695,Inj ceftolozane tazobactam,APC 9452,Per Unit,$6.64 ,OP,6.64,6.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0712,Ceftaroline fosamil inj,APC 1824,Per Unit,$3.51 ,OP,3.51,3.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0714,Ceftazidime and avibactam,APC 1825,Per Unit,$92.39 ,OP,92.39,92.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0716,Centruroides immune f(ab),APC 1431,Per Unit,"$5,190.15 ",OP,"5,190.15","5,190.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0717,Certolizumab pegol inj 1mg,APC 1474,Per Unit,$6.27 ,OP,6.27,6.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0740,Cidofovir injection,APC 9033,Per Unit,$563.76 ,OP,563.76,563.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0742,Inj imip 4 cilas 4 releb 2mg,APC 9362,Per Unit,$2.32 ,OP,2.32,2.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0745,Inj codeine phosphate /30 mg,APC 9393,Per Unit,$135.64 ,OP,135.64,135.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0775,Collagenase- clost hist inj,APC 1340,Per Unit,$56.66 ,OP,56.66,56.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0791,Inj crizanlizumab-tmca 5mg,APC 9359,Per Unit,$123.29 ,OP,123.29,123.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0795,Corticorelin ovine triflutal,APC 1684,Per Unit,$9.67 ,OP,9.67,9.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0840,Crotalidae poly immune fab,APC 9274,Per Unit,"$2,743.36 ",OP,"2,743.36","2,743.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0841,Inj crotalidae im f(ab)2 eq,APC 9188,Per Unit,"$1,189.81 ",OP,"1,189.81","1,189.81",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0850,Cytomegalovirus imm iv /vial,APC 0903,Per Unit,"$1,538.70 ",OP,"1,538.70","1,538.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0875,Injection- dalbavancin,APC 1823,Per Unit,$15.89 ,OP,15.89,15.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0881,Darbepoetin alfa- non-esrd,APC 1685,Per Unit,$3.15 ,OP,3.15,3.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0882,Darbepoetin alfa- esrd use,APC 1482,Per Unit,$3.15 ,OP,3.15,3.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0883,Argatroban nonesrd use 1mg,APC 1859,Per Unit,$1.20 ,OP,1.2,1.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0884,Argatroban esrd dialysis 1mg,APC 9065,Per Unit,$1.20 ,OP,1.2,1.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0885,Epoetin alfa- non-esrd,APC 1686,Per Unit,$8.15 ,OP,8.15,8.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0888,Epoetin beta non esrd,APC 9077,Per Unit,$1.51 ,OP,1.51,1.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0894,Decitabine injection,APC 9231,Per Unit,$3.45 ,OP,3.45,3.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0896,Inj luspatercept-aamt 0.25mg,APC 9347,Per Unit,$36.85 ,OP,36.85,36.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J0897,Denosumab injection,APC 9272,Per Unit,$21.19 ,OP,21.19,21.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1095,Injection- dexamethasone 9%,APC 9172,Per Unit,$1.04 ,OP,1.04,1.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1096,Dexametha opth insert 0.1 mg,APC 9308,Per Unit,$133.30 ,OP,133.3,133.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1162,Digoxin immune fab (ovine),APC 1687,Per Unit,"$4,128.19 ",OP,"4,128.19","4,128.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1190,Dexrazoxane hcl injection,APC 0726,Per Unit,$192.33 ,OP,192.33,192.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1201,Inj. cetirizine hcl 0.5mg,APC 9361,Per Unit,$15.38 ,OP,15.38,15.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1212,Dimethyl sulfoxide 50% 50 ml,APC 1832,Per Unit,$637.11 ,OP,637.11,637.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1290,Ecallantide injection,APC 9263,Per Unit,$503.88 ,OP,503.88,503.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1300,Eculizumab injection,APC 9236,Per Unit,$229.23 ,OP,229.23,229.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1301,Injection- edaravone- 1 mg,APC 9493,Per Unit,$20.51 ,OP,20.51,20.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1303,Inj.- ravulizumab-cwvz 10 mg,APC 9312,Per Unit,$224.68 ,OP,224.68,224.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1322,Elosulfase alfa- injection,APC 1480,Per Unit,$250.33 ,OP,250.33,250.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1364,Erythro lactobionate /500 mg,APC 1669,Per Unit,$77.75 ,OP,77.75,77.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1410,Inj estrogen conjugate 25 mg,APC 9038,Per Unit,$341.46 ,OP,341.46,341.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1427,Inj. viltolarsen,APC 9386,Per Unit,$59.05 ,OP,59.05,59.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1429,Inj golodirsen 10 mg,APC 9356,Per Unit,$166.21 ,OP,166.21,166.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1430,Ethanolamine oleate 100 mg,APC 1688,Per Unit,$444.10 ,OP,444.1,444.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1437,Inj. fe derisomaltose 10 mg,APC 9388,Per Unit,$24.87 ,OP,24.87,24.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1438,Etanercept injection,APC 1608,Per Unit,$790.78 ,OP,790.78,790.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1439,Inj ferric carboxymaltos 1mg,APC 9441,Per Unit,$1.12 ,OP,1.12,1.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1442,Inj filgrastim excl biosimil,APC 1469,Per Unit,$0.97 ,OP,0.97,0.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1447,Inj tbo filgrastim 1 microg,APC 1748,Per Unit,$0.46 ,OP,0.46,0.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1451,Fomepizole- 15 mg,APC 1689,Per Unit,$5.98 ,OP,5.98,5.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1453,Fosaprepitant injection,APC 9242,Per Unit,$0.24 ,OP,0.24,0.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1454,Inj fosnetupitant- palonoset,APC 9099,Per Unit,$571.22 ,OP,571.22,571.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1455,Foscarnet sodium injection,APC 1849,Per Unit,$72.86 ,OP,72.86,72.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1458,Galsulfase injection,APC 9224,Per Unit,$411.92 ,OP,411.92,411.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1459,Inj ivig privigen 500 mg,APC 1214,Per Unit,$44.48 ,OP,44.48,44.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1460,Gamma globulin 1 cc inj,APC 1850,Per Unit,$44.13 ,OP,44.13,44.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1554,Inj. asceniv,APC 9392,Per Unit,$481.77 ,OP,481.77,481.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1555,Inj cuvitru- 100 mg,APC 9034,Per Unit,$14.50 ,OP,14.5,14.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1556,Inj- imm glob bivigam- 500mg,APC 9130,Per Unit,$70.49 ,OP,70.49,70.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1557,Gammaplex injection,APC 9270,Per Unit,$48.53 ,OP,48.53,48.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1558,Inj. xembify- 100 mg,APC 9372,Per Unit,$13.61 ,OP,13.61,13.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1559,Hizentra injection,APC 1312,Per Unit,$11.58 ,OP,11.58,11.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1560,Gamma globulin > 10 cc inj,APC 1851,Per Unit,$441.31 ,OP,441.31,441.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1561,Gamunex-c/gammaked,APC 0948,Per Unit,$48.22 ,OP,48.22,48.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1566,Immune globulin- powder,APC 2731,Per Unit,$65.49 ,OP,65.49,65.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1568,Octagam injection,APC 0943,Per Unit,$41.63 ,OP,41.63,41.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1569,Gammagard liquid injection,APC 0944,Per Unit,$44.49 ,OP,44.49,44.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1571,Hepagam b im injection,APC 0946,Per Unit,$70.94 ,OP,70.94,70.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1572,Flebogamma injection,APC 0947,Per Unit,$36.80 ,OP,36.8,36.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1573,Hepagam b intravenous- inj,APC 1138,Per Unit,$71.24 ,OP,71.24,71.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1575,Hyqvia 100mg immuneglobulin,APC 1826,Per Unit,$15.16 ,OP,15.16,15.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1595,Injection glatiramer acetate,APC 1015,Per Unit,$141.29 ,OP,141.29,141.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1602,Golimumab for iv use 1mg,APC 1475,Per Unit,$16.82 ,OP,16.82,16.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1610,Glucagon hydrochloride/1 mg,APC 9042,Per Unit,$171.74 ,OP,171.74,171.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1628,Inj.- guselkumab- 1 mg,APC 9029,Per Unit,$82.56 ,OP,82.56,82.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1632,Inj.- brexanolone- 1 mg,APC 9333,Per Unit,$74.65 ,OP,74.65,74.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1640,Hemin- 1 mg,APC 1690,Per Unit,$26.64 ,OP,26.64,26.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1670,Tetanus immune globulin inj,APC 1670,Per Unit,$441.70 ,OP,441.7,441.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1726,Makena- 10 mg,APC 9074,Per Unit,$16.82 ,OP,16.82,16.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1729,Inj hydroxyprogst capoat nos,APC 9318,Per Unit,$21.54 ,OP,21.54,21.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1738,Inj. meloxicam 1 mg,APC 9371,Per Unit,$3.18 ,OP,3.18,3.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1740,Ibandronate sodium injection,APC 9229,Per Unit,$37.09 ,OP,37.09,37.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1742,Ibutilide fumarate injection,APC 9044,Per Unit,$205.06 ,OP,205.06,205.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1744,Icatibant injection,APC 1443,Per Unit,$204.96 ,OP,204.96,204.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1745,Infliximab not biosimil 10mg,APC 7043,Per Unit,$39.53 ,OP,39.53,39.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1746,Inj.- ibalizumab-uiyk- 10 mg,APC 9189,Per Unit,$66.39 ,OP,66.39,66.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1750,Inj iron dextran,APC 1237,Per Unit,$15.84 ,OP,15.84,15.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1786,Imuglucerase injection,APC 1327,Per Unit,$44.05 ,OP,44.05,44.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1823,Inj. inebilizumab-cdon- 1 mg,APC 9394,Per Unit,$458.21 ,OP,458.21,458.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1826,Interferon beta-1a inj,APC 1852,Per Unit,"$2,293.85 ",OP,"2,293.85","2,293.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1830,Interferon beta-1b / .25 mg,APC 0910,Per Unit,$406.24 ,OP,406.24,406.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1833,Injection- isavuconazonium,APC 9456,Per Unit,$0.83 ,OP,0.83,0.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1930,Lanreotide injection,APC 9237,Per Unit,$67.64 ,OP,67.64,67.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1931,Laronidase injection,APC 9209,Per Unit,$34.75 ,OP,34.75,34.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1943,Inj.- aristada initio- 1 mg,APC 9179,Per Unit,$3.05 ,OP,3.05,3.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1944,Aripirazole lauroxil 1 mg,APC 9470,Per Unit,$2.99 ,OP,2.99,2.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J1950,Leuprolide acetate /3.75 mg,APC 0800,Per Unit,"$1,406.37 ",OP,"1,406.37","1,406.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2182,Injection- mepolizumab- 1mg,APC 9473,Per Unit,$28.29 ,OP,28.29,28.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2186,Inj.- meropenem- vaborbactam,APC 9178,Per Unit,$1.76 ,OP,1.76,1.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2248,Micafungin sodium injection,APC 9227,Per Unit,$0.97 ,OP,0.97,0.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2265,Minocycline hydrochloride,APC 1853,Per Unit,$2.00 ,OP,2,2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2278,Ziconotide injection,APC 1694,Per Unit,$8.69 ,OP,8.69,8.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2315,Naltrexone- depot form,APC 0759,Per Unit,$3.53 ,OP,3.53,3.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2323,Natalizumab injection,APC 9126,Per Unit,$23.24 ,OP,23.24,23.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2326,Inj- nusinersen- 0.1mg,APC 9489,Per Unit,"$1,122.13 ",OP,"1,122.13","1,122.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2350,Injection- ocrelizumab- 1 mg,APC 9494,Per Unit,$58.29 ,OP,58.29,58.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2353,Octreotide injection- depot,APC 1207,Per Unit,$205.37 ,OP,205.37,205.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2357,Omalizumab injection,APC 9300,Per Unit,$37.67 ,OP,37.67,37.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2358,Olanzapine long-acting inj,APC 1331,Per Unit,$2.91 ,OP,2.91,2.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2407,Injection- oritavancin,APC 1660,Per Unit,$23.63 ,OP,23.63,23.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2425,Palifermin injection,APC 1696,Per Unit,$23.93 ,OP,23.93,23.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2426,Paliperidone palmitate inj,APC 9255,Per Unit,$12.66 ,OP,12.66,12.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2502,Inj- pasireotide long acting,APC 9454,Per Unit,$359.03 ,OP,359.03,359.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2504,Pegademase bovine- 25 iu,APC 1739,Per Unit,$4.06 ,OP,4.06,4.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2505,Injection- pegfilgrastim 6mg,APC 9119,Per Unit,"$2,221.63 ",OP,"2,221.63","2,221.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2507,Pegloticase injection,APC 9281,Per Unit,"$2,960.91 ",OP,"2,960.91","2,960.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2515,Pentobarbital sodium inj,APC 1854,Per Unit,$26.41 ,OP,26.41,26.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2547,Injection- peramivir,APC 9451,Per Unit,$1.68 ,OP,1.68,1.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2560,Phenobarbital sodium inj,APC 9069,Per Unit,$40.22 ,OP,40.22,40.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2562,Plerixafor injection,APC 9252,Per Unit,$382.85 ,OP,382.85,382.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2597,Inj desmopressin acetate,APC 1440,Per Unit,$9.40 ,OP,9.4,9.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2724,Protein c concentrate,APC 1139,Per Unit,$15.13 ,OP,15.13,15.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2760,Phentolaine mesylate inj,APC 1458,Per Unit,$416.00 ,OP,416,416,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2770,Quinupristin/dalfopristin,APC 2770,Per Unit,$444.67 ,OP,444.67,444.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2778,Ranibizumab injection,APC 9233,Per Unit,$318.47 ,OP,318.47,318.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2783,Rasburicase,APC 0738,Per Unit,$315.06 ,OP,315.06,315.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2786,Injection- reslizumab- 1mg,APC 9481,Per Unit,$10.11 ,OP,10.11,10.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2792,Rho(d) immune globulin h- sd,APC 1609,Per Unit,$31.42 ,OP,31.42,31.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2794,Inj risperdal consta- 0.5 mg,APC 9125,Per Unit,$11.04 ,OP,11.04,11.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2796,Romiplostim injection,APC 9245,Per Unit,$83.47 ,OP,83.47,83.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2798,Inj.- perseris- 0.5 mg,APC 9181,Per Unit,$10.69 ,OP,10.69,10.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2820,Sargramostim injection,APC 0731,Per Unit,$51.55 ,OP,51.55,51.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2840,Inj sebelipase alfa 1 mg,APC 9478,Per Unit,$539.91 ,OP,539.91,539.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2850,Inj secretin synthetic human,APC 1700,Per Unit,$34.78 ,OP,34.78,34.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2860,Injection- siltuximab,APC 9455,Per Unit,$124.09 ,OP,124.09,124.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2941,Somatropin injection,APC 9319,Per Unit,$36.54 ,OP,36.54,36.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2993,Reteplase injection,APC 9005,Per Unit,"$2,506.51 ",OP,"2,506.51","2,506.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J2997,Alteplase recombinant,APC 7048,Per Unit,$87.75 ,OP,87.75,87.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3031,Inj.- fremanezumab-vfrm 1 mg,APC 9197,Per Unit,$2.34 ,OP,2.34,2.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3032,Inj. eptinezumab-jjmr 1 mg,APC 9357,Per Unit,$15.64 ,OP,15.64,15.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3060,Inj- taliglucerase alfa 10 u,APC 9294,Per Unit,$41.32 ,OP,41.32,41.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3090,Inj tedizolid phosphate,APC 1662,Per Unit,$1.60 ,OP,1.6,1.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3095,Telavancin injection,APC 9258,Per Unit,$6.16 ,OP,6.16,6.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3101,Tenecteplase injection,APC 9002,Per Unit,$134.74 ,OP,134.74,134.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3111,Inj. romosozumab-aqqg 1 mg,APC 9327,Per Unit,$9.34 ,OP,9.34,9.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3145,Testosterone undecanoate 1mg,APC 9078,Per Unit,$1.63 ,OP,1.63,1.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3240,Thyrotropin injection,APC 9108,Per Unit,"$1,837.25 ",OP,"1,837.25","1,837.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3241,Inj. teprotumumab-trbw 10 mg,APC 9355,Per Unit,$315.88 ,OP,315.88,315.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3243,Tigecycline injection,APC 9228,Per Unit,$1.12 ,OP,1.12,1.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3245,Inj.- tildrakizumab- 1 mg,APC 9306,Per Unit,$134.08 ,OP,134.08,134.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3246,Tirofiban hcl,APC 7041,Per Unit,$3.83 ,OP,3.83,3.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3262,Tocilizumab injection,APC 9264,Per Unit,$5.55 ,OP,5.55,5.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3285,Treprostinil injection,APC 1701,Per Unit,$59.68 ,OP,59.68,59.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3304,Inj triamcinolone ace xr 1mg,APC 9469,Per Unit,$17.75 ,OP,17.75,17.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3315,Triptorelin pamoate,APC 9122,Per Unit,$379.90 ,OP,379.9,379.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3316,Inj.- triptorelin xr 3.75 mg,APC 9016,Per Unit,"$3,120.11 ",OP,"3,120.11","3,120.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3357,Ustekinumab sub cu inj- 1 mg,APC 9261,Per Unit,$176.65 ,OP,176.65,176.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3358,Ustekinumab- iv inject- 1 mg,APC 9487,Per Unit,$11.68 ,OP,11.68,11.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3380,Injection- vedolizumab,APC 1489,Per Unit,$21.28 ,OP,21.28,21.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3385,Velaglucerase alfa,APC 9271,Per Unit,$359.29 ,OP,359.29,359.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3396,Verteporfin injection,APC 1203,Per Unit,$11.25 ,OP,11.25,11.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J3398,Inj luxturna 1 billion vec g,APC 9070,Per Unit,"$2,953.71 ",OP,"2,953.71","2,953.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7168,Prothrombin complex kcentra,APC 9132,Per Unit,$1.99 ,OP,1.99,1.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7169,Inj andexxa- 10 mg,APC 9198,Per Unit,$289.93 ,OP,289.93,289.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7170,Inj.- emicizumab-kxwh 0.5 mg,APC 9257,Per Unit,$48.88 ,OP,48.88,48.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7175,Inj- factor x- (human)- 1iu,APC 1857,Per Unit,$8.20 ,OP,8.2,8.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7178,Inj human fibrinogen con nos,APC 1478,Per Unit,$1.30 ,OP,1.3,1.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7179,Vonvendi inj 1 iu vwf:rco,APC 9059,Per Unit,$1.85 ,OP,1.85,1.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7180,Factor xiii anti-hem factor,APC 1416,Per Unit,$9.14 ,OP,9.14,9.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7181,Factor xiii recomb a-subunit,APC 1746,Per Unit,$15.87 ,OP,15.87,15.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7182,Factor viii recomb novoeight,APC 1856,Per Unit,$1.51 ,OP,1.51,1.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7183,Wilate injection,APC 1352,Per Unit,$1.16 ,OP,1.16,1.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7185,Xyntha inj,APC 1268,Per Unit,$1.33 ,OP,1.33,1.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7186,Antihemophilic viii/vwf comp,APC 1213,Per Unit,$1.14 ,OP,1.14,1.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7187,Humate-p- inj,APC 1704,Per Unit,$1.26 ,OP,1.26,1.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7188,Factor viii recomb obizur,APC 1827,Per Unit,$3.19 ,OP,3.19,3.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7189,Factor viia recomb novoseven,APC 1705,Per Unit,$2.33 ,OP,2.33,2.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7190,Factor viii,APC 0925,Per Unit,$1.12 ,OP,1.12,1.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7192,Factor viii recombinant nos,APC 0927,Per Unit,$1.43 ,OP,1.43,1.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7193,Factor ix non-recombinant,APC 0931,Per Unit,$1.17 ,OP,1.17,1.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7194,Factor ix complex,APC 0928,Per Unit,$1.54 ,OP,1.54,1.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7195,Factor ix recombinant nos,APC 0932,Per Unit,$1.61 ,OP,1.61,1.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7197,Antithrombin iii injection,APC 1263,Per Unit,$3.20 ,OP,3.2,3.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7198,Anti-inhibitor,APC 0929,Per Unit,$2.21 ,OP,2.21,2.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7200,Factor ix recombinan rixubis,APC 1467,Per Unit,$1.54 ,OP,1.54,1.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7201,Factor ix alprolix recomb,APC 1486,Per Unit,$3.28 ,OP,3.28,3.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7202,Factor ix idelvion inj,APC 9171,Per Unit,$4.59 ,OP,4.59,4.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7203,Factor ix recomb gly rebinyn,APC 9468,Per Unit,$4.23 ,OP,4.23,4.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7204,Inj recombin esperoct per iu,APC 9354,Per Unit,$2.23 ,OP,2.23,2.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7205,Factor viii fc fusion recomb,APC 1656,Per Unit,$2.15 ,OP,2.15,2.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7207,Factor viii pegylated recomb,APC 1844,Per Unit,$1.92 ,OP,1.92,1.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7208,Inj. jivi 1 iu,APC 9299,Per Unit,$2.10 ,OP,2.1,2.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7209,Factor viii nuwiq recomb 1iu,APC 1846,Per Unit,$1.24 ,OP,1.24,1.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7210,Inj- afstyla- 1 i.u.,APC 9043,Per Unit,$1.36 ,OP,1.36,1.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7211,Inj- kovaltry- 1 i.u.,APC 9075,Per Unit,$1.24 ,OP,1.24,1.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7212,Factor viia recomb sevenfact,APC 9395,Per Unit,$2.27 ,OP,2.27,2.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7308,Aminolevulinic acid hcl top,APC 7308,Per Unit,$392.48 ,OP,392.48,392.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7311,Inj.- retisert- 0.01 mg,APC 9225,Per Unit,$339.00 ,OP,339,339,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7312,Dexamethasone intra implant,APC 9256,Per Unit,$199.69 ,OP,199.69,199.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7313,Inj.- iluvien- 0.01 mg,APC 9450,Per Unit,$490.95 ,OP,490.95,490.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7314,Inj.- yutiq- 0.01 mg,APC 9328,Per Unit,$513.16 ,OP,513.16,513.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7316,Inj- ocriplasmin- 0.125 mg,APC 9298,Per Unit,"$1,046.93 ",OP,"1,046.93","1,046.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7318,Inj- durolane 1 mg,APC 9174,Per Unit,$17.23 ,OP,17.23,17.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7320,Genvisc 850- inj- 1mg,APC 9079,Per Unit,$16.92 ,OP,16.92,16.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7322,Hymovis injection 1 mg,APC 9471,Per Unit,$31.67 ,OP,31.67,31.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7323,Euflexxa inj per dose,APC 0875,Per Unit,$138.82 ,OP,138.82,138.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7324,Orthovisc inj per dose,APC 0877,Per Unit,$148.74 ,OP,148.74,148.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7325,Synvisc or synvisc-one,APC 0874,Per Unit,$11.24 ,OP,11.24,11.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7326,Gel-one,APC 1417,Per Unit,"$1,219.00 ",OP,"1,219.00","1,219.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7327,Monovisc inj per dose,APC 1747,Per Unit,$762.80 ,OP,762.8,762.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7328,Gelsyn-3 injection 0.1 mg,APC 1862,Per Unit,$2.18 ,OP,2.18,2.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7329,Inj- trivisc 1 mg,APC 9196,Per Unit,$19.12 ,OP,19.12,19.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7331,Synojoynt- inj.- 1 mg,APC 9337,Per Unit,$18.02 ,OP,18.02,18.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7336,Capsaicin 8% patch,APC 9071,Per Unit,$3.23 ,OP,3.23,3.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7340,Carbidopa levodopa ent 100ml,APC 9320,Per Unit,$211.70 ,OP,211.7,211.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7342,Ciprofloxacin otic susp 6 mg,APC 9479,Per Unit,$29.98 ,OP,29.98,29.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7345,Aminolevulinic acid- 10% gel,APC 9301,Per Unit,$1.59 ,OP,1.59,1.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7351,Inj bimatoprost itc imp1mcg,APC 9351,Per Unit,$205.63 ,OP,205.63,205.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7352,Afamelanotide implant- 1 mg,APC 9396,Per Unit,"$3,218.90 ",OP,"3,218.90","3,218.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7402,Mometasone sinus sinuva,APC 9346,Per Unit,$10.56 ,OP,10.56,10.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7501,Azathioprine parenteral,APC 0887,Per Unit,$245.02 ,OP,245.02,245.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7504,Lymphocyte immune globulin,APC 0890,Per Unit,"$2,355.53 ",OP,"2,355.53","2,355.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7511,Antithymocyte globuln rabbit,APC 9104,Per Unit,$837.42 ,OP,837.42,837.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J7525,Tacrolimus injection,APC 9006,Per Unit,$219.33 ,OP,219.33,219.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J8560,Etoposide oral 50 mg,APC 0802,Per Unit,$75.63 ,OP,75.63,75.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J8655,Oral netupitant- palonosetro,APC 9448,Per Unit,$315.59 ,OP,315.59,315.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J8670,Rolapitant- oral- 1mg,APC 1761,Per Unit,$1.75 ,OP,1.75,1.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9015,Aldesleukin injection,APC 0807,Per Unit,"$3,795.26 ",OP,"3,795.26","3,795.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9017,Arsenic trioxide injection,APC 9012,Per Unit,$13.11 ,OP,13.11,13.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9019,Erwinaze injection,APC 9289,Per Unit,$427.27 ,OP,427.27,427.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9022,Inj- atezolizumab-10 mg,APC 9483,Per Unit,$79.75 ,OP,79.75,79.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9023,Injection- avelumab- 10 mg,APC 9491,Per Unit,$86.19 ,OP,86.19,86.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9025,Azacitidine injection,APC 1709,Per Unit,$0.93 ,OP,0.93,0.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9027,Clofarabine injection,APC 1710,Per Unit,$53.15 ,OP,53.15,53.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9032,Injection- belinostat- 10mg,APC 1658,Per Unit,$42.77 ,OP,42.77,42.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9033,Inj.- treanda 1 mg,APC 9243,Per Unit,$22.01 ,OP,22.01,22.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9034,Inj.- bendeka 1 mg,APC 1861,Per Unit,$19.65 ,OP,19.65,19.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9035,Bevacizumab injection,APC 9214,Per Unit,$70.41 ,OP,70.41,70.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9036,Inj. belrapzo/bendamustine,APC 9313,Per Unit,$21.47 ,OP,21.47,21.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9037,Inj belantamab mafodont blmf,APC 9384,Per Unit,$42.78 ,OP,42.78,42.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9039,Injection- blinatumomab,APC 9449,Per Unit,$123.88 ,OP,123.88,123.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9041,Inj.- velcade 0.1 mg,APC 9207,Per Unit,$45.16 ,OP,45.16,45.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9042,Brentuximab vedotin inj,APC 9287,Per Unit,$189.34 ,OP,189.34,189.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9043,Cabazitaxel injection,APC 9276,Per Unit,$189.00 ,OP,189,189,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9044,Inj- bortezomib- nos- 0.1 mg,APC 9192,Per Unit,$18.31 ,OP,18.31,18.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9047,Injection- carfilzomib- 1 mg,APC 9295,Per Unit,$41.10 ,OP,41.1,41.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9050,Carmustine injection,APC 0812,Per Unit,"$1,234.46 ",OP,"1,234.46","1,234.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9055,Cetuximab injection,APC 9215,Per Unit,$66.71 ,OP,66.71,66.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9057,Inj.- copanlisib- 1 mg,APC 9030,Per Unit,$80.96 ,OP,80.96,80.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9065,Inj cladribine per 1 mg,APC 0858,Per Unit,$18.02 ,OP,18.02,18.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9070,Cyclophosphamide 100 mg inj,APC 1408,Per Unit,$29.15 ,OP,29.15,29.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9119,Inj.- cemiplimab-rwlc- 1 mg,APC 9304,Per Unit,$27.54 ,OP,27.54,27.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9120,Dactinomycin injection,APC 0752,Per Unit,$890.64 ,OP,890.64,890.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9144,Daratumumab- hyaluronidase,APC 9378,Per Unit,$45.10 ,OP,45.1,45.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9145,Injection- daratumumab 10 mg,APC 9476,Per Unit,$57.55 ,OP,57.55,57.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9150,Daunorubicin injection,APC 0820,Per Unit,$40.36 ,OP,40.36,40.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9153,Inj daunorubicin- cytarabine,APC 9302,Per Unit,$202.60 ,OP,202.6,202.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9155,Degarelix injection,APC 1296,Per Unit,$4.12 ,OP,4.12,4.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9173,Inj.- durvalumab- 10 mg,APC 9492,Per Unit,$76.86 ,OP,76.86,76.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9176,Injection- elotuzumab- 1mg,APC 9477,Per Unit,$6.77 ,OP,6.77,6.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9177,Inj enfort vedo-ejfv 0.25mg,APC 9364,Per Unit,$30.17 ,OP,30.17,30.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9179,Eribulin mesylate injection,APC 1426,Per Unit,$123.93 ,OP,123.93,123.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9198,Inj. infugem- 100 mg,APC 9387,Per Unit,$34.00 ,OP,34,34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9202,Goserelin acetate implant,APC 0810,Per Unit,$525.21 ,OP,525.21,525.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9203,Gemtuzumab ozogamicin 0.1 mg,APC 9495,Per Unit,$207.99 ,OP,207.99,207.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9204,Inj mogamulizumab-kpkc- 1 mg,APC 9182,Per Unit,$210.05 ,OP,210.05,210.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9205,Inj irinotecan liposome 1 mg,APC 9474,Per Unit,$57.20 ,OP,57.2,57.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9207,Ixabepilone injection,APC 9240,Per Unit,$112.12 ,OP,112.12,112.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9210,Inj.- emapalumab-lzsg- 1 mg,APC 9310,Per Unit,$376.03 ,OP,376.03,376.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9214,Interferon alfa-2b inj,APC 0836,Per Unit,$33.24 ,OP,33.24,33.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9217,Leuprolide acetate suspnsion,APC 9217,Per Unit,$139.09 ,OP,139.09,139.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9223,Inj. lurbinectedin- 0.1 mg,APC 9389,Per Unit,$174.03 ,OP,174.03,174.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9225,Vantas implant,APC 1711,Per Unit,"$5,166.29 ",OP,"5,166.29","5,166.29",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9226,Supprelin la implant,APC 1142,Per Unit,"$43,467.03 ",OP,"43,467.03","43,467.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9227,Inj. isatuximab-irfc 10 mg,APC 9377,Per Unit,$67.60 ,OP,67.6,67.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9228,Ipilimumab injection,APC 9284,Per Unit,$158.65 ,OP,158.65,158.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9229,Inj inotuzumab ozogam 0.1 mg,APC 9028,Per Unit,"$2,371.62 ",OP,"2,371.62","2,371.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9230,Mechlorethamine hcl inj,APC 0751,Per Unit,$11.74 ,OP,11.74,11.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9245,Inj melpha hydroch nos 50 mg,APC 0840,Per Unit,$208.41 ,OP,208.41,208.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9246,Inj.- evomela- 1 mg,APC 9375,Per Unit,$18.20 ,OP,18.2,18.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9261,Nelarabine injection,APC 0825,Per Unit,$155.90 ,OP,155.9,155.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9262,Inj- omacetaxine mep- 0.01mg,APC 9297,Per Unit,$3.30 ,OP,3.3,3.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9264,Paclitaxel protein bound,APC 1712,Per Unit,$14.08 ,OP,14.08,14.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9266,Pegaspargase injection,APC 0843,Per Unit,"$21,561.05 ",OP,"21,561.05","21,561.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9268,Pentostatin injection,APC 0844,Per Unit,"$1,880.67 ",OP,"1,880.67","1,880.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9269,Inj. tagraxofusp-erzs 10 mcg,APC 9309,Per Unit,$290.37 ,OP,290.37,290.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9270,Plicamycin (mithramycin) inj,APC 9093,Per Unit,$115.40 ,OP,115.4,115.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9271,Inj pembrolizumab,APC 1490,Per Unit,$52.75 ,OP,52.75,52.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9280,Mitomycin injection,APC 1232,Per Unit,$38.63 ,OP,38.63,38.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9281,Mitomycin instillation,APC 9374,Per Unit,$281.88 ,OP,281.88,281.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9285,Inj- olaratumab- 10 mg,APC 9485,Per Unit,$52.07 ,OP,52.07,52.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9293,Mitoxantrone hydrochl / 5 mg,APC 0864,Per Unit,$26.29 ,OP,26.29,26.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9295,Injection- necitumumab- 1 mg,APC 9475,Per Unit,$5.74 ,OP,5.74,5.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9299,Injection- nivolumab,APC 9453,Per Unit,$28.86 ,OP,28.86,28.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9301,Obinutuzumab inj,APC 1476,Per Unit,$64.54 ,OP,64.54,64.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9302,Ofatumumab injection,APC 9260,Per Unit,$63.96 ,OP,63.96,63.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9303,Panitumumab injection,APC 9235,Per Unit,$130.38 ,OP,130.38,130.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9305,Inj. pemetrexed nos 10mg,APC 9213,Per Unit,$74.93 ,OP,74.93,74.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9306,Injection- pertuzumab- 1 mg,APC 1471,Per Unit,$13.56 ,OP,13.56,13.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9307,Pralatrexate injection,APC 9259,Per Unit,$314.84 ,OP,314.84,314.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9308,Injection- ramucirumab,APC 1488,Per Unit,$62.69 ,OP,62.69,62.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9309,Inj- polatuzumab vedotin 1mg,APC 9331,Per Unit,$113.57 ,OP,113.57,113.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9311,Inj rituximab- hyaluronidase,APC 9467,Per Unit,$37.94 ,OP,37.94,37.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9312,Inj.- rituximab- 10 mg,APC 9186,Per Unit,$86.94 ,OP,86.94,86.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9313,Inj.- lumoxiti- 0.01 mg,APC 9305,Per Unit,$23.39 ,OP,23.39,23.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9316,Pertuzu- trastuzu- 10 mg,APC 9390,Per Unit,$72.15 ,OP,72.15,72.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9317,Sacituzumab govitecan-hziy,APC 9376,Per Unit,$30.35 ,OP,30.35,30.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9320,Streptozocin injection,APC 0850,Per Unit,$348.51 ,OP,348.51,348.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9325,Inj talimogene laherparepvec,APC 9472,Per Unit,$57.26 ,OP,57.26,57.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9328,Temozolomide injection,APC 9253,Per Unit,$10.41 ,OP,10.41,10.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9330,Temsirolimus injection,APC 1168,Per Unit,$38.25 ,OP,38.25,38.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9340,Thiotepa injection,APC 0851,Per Unit,$305.84 ,OP,305.84,305.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9349,Inj.- tafasitamab-cxix,APC 9385,Per Unit,$12.62 ,OP,12.62,12.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9352,Injection trabectedin 0.1mg,APC 9480,Per Unit,$325.03 ,OP,325.03,325.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9353,Inj. margetuximab-cmkb- 5 mg,APC 9418,Per Unit,$42.99 ,OP,42.99,42.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9354,Inj- ado-trastuzumab emt 1mg,APC 9131,Per Unit,$34.18 ,OP,34.18,34.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9355,Inj trastuzumab excl biosimi,APC 1613,Per Unit,$89.81 ,OP,89.81,89.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9356,Inj. herceptin hylecta- 10mg,APC 9314,Per Unit,$71.85 ,OP,71.85,71.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9357,Valrubicin injection,APC 1235,Per Unit,"$1,425.37 ",OP,"1,425.37","1,425.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9358,Inj fam-trastu deru-nxki 1mg,APC 9353,Per Unit,$24.27 ,OP,24.27,24.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9371,Inj- vincristine sul lip 1mg,APC 1466,Per Unit,"$3,370.23 ",OP,"3,370.23","3,370.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9395,Injection- fulvestrant,APC 9120,Per Unit,$15.98 ,OP,15.98,15.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9400,Inj- ziv-aflibercept- 1mg,APC 9296,Per Unit,$8.42 ,OP,8.42,8.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,J9600,Porfimer sodium injection,APC 0856,Per Unit,"$21,856.35 ",OP,"21,856.35","21,856.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,K0672,Removable soft interface le,Durable Medical Equipment,Per Unit,$85.14 ,OP,85.14,85.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0112,Cranial cervical orthosis,Durable Medical Equipment,Per Unit,"$1,404.96 ",OP,"1,404.96","1,404.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0113,Cranial cervical torticollis,Durable Medical Equipment,Per Unit,$286.27 ,OP,286.27,286.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0120,Cerv flex n/adj foam pre ots,Durable Medical Equipment,Per Unit,$26.55 ,OP,26.55,26.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0130,Flex thermoplastic collar mo,Durable Medical Equipment,Per Unit,$153.23 ,OP,153.23,153.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0140,Cervical semi-rigid adjustab,Durable Medical Equipment,Per Unit,$60.09 ,OP,60.09,60.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0150,Cerv semi-rig adj molded chn,Durable Medical Equipment,Per Unit,$107.45 ,OP,107.45,107.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0160,Cerv sr wire occ/man pre ots,Durable Medical Equipment,Per Unit,$156.89 ,OP,156.89,156.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0170,Cervical collar molded to pt,Durable Medical Equipment,Per Unit,$807.10 ,OP,807.1,807.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0172,Cerv col sr foam 2pc pre ots,Durable Medical Equipment,Per Unit,$142.17 ,OP,142.17,142.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0174,Cerv sr 2pc thor ext pre ots,Durable Medical Equipment,Per Unit,$279.55 ,OP,279.55,279.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0180,Cer post col occ/man sup adj,Durable Medical Equipment,Per Unit,$452.88 ,OP,452.88,452.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0190,Cerv collar supp adj cerv ba,Durable Medical Equipment,Per Unit,$534.12 ,OP,534.12,534.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0200,Cerv col supp adj bar & thor,Durable Medical Equipment,Per Unit,$619.54 ,OP,619.54,619.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0220,Thor rib belt custom fabrica,Durable Medical Equipment,Per Unit,$129.68 ,OP,129.68,129.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0450,Tlso flex trunk/thor pre ots,Durable Medical Equipment,Per Unit,$150.15 ,OP,150.15,150.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0454,Tlso trnk sj-t9 pre cst,Durable Medical Equipment,Per Unit,$348.14 ,OP,348.14,348.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0455,Tlso flex trnk sj-t9 pre ots,Durable Medical Equipment,Per Unit,$301.39 ,OP,301.39,301.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0456,Tlso flex trnk sj-ss pre cst,Durable Medical Equipment,Per Unit,$998.38 ,OP,998.38,998.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0457,Tlso flex trnk sj-ss pre ots,Durable Medical Equipment,Per Unit,$864.31 ,OP,864.31,864.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0458,Tlso 2mod symphis-xipho pre,Durable Medical Equipment,Per Unit,$895.27 ,OP,895.27,895.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0460,Tlso 2 shl symphys-stern cst,Durable Medical Equipment,Per Unit,"$1,007.68 ",OP,"1,007.68","1,007.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0462,Tlso 3mod sacro-scap pre,Durable Medical Equipment,Per Unit,"$1,253.37 ",OP,"1,253.37","1,253.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0464,Tlso 4mod sacro-scap pre,Durable Medical Equipment,Per Unit,"$1,492.13 ",OP,"1,492.13","1,492.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0466,Tlso r fram soft ant pre cst,Durable Medical Equipment,Per Unit,$380.86 ,OP,380.86,380.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0467,Tlso r fram soft pre ots,Durable Medical Equipment,Per Unit,$333.22 ,OP,333.22,333.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0468,Tlso rig fram pelvic pre cst,Durable Medical Equipment,Per Unit,$477.29 ,OP,477.29,477.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0469,Tlso rig fram pelvic pre ots,Durable Medical Equipment,Per Unit,$420.59 ,OP,420.59,420.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0470,Tlso rigid frame pre subclav,Durable Medical Equipment,Per Unit,$660.47 ,OP,660.47,660.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0472,Tlso rigid frame hyperex pre,Durable Medical Equipment,Per Unit,$406.41 ,OP,406.41,406.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0480,Tlso rigid plastic custom fa,Durable Medical Equipment,Per Unit,"$1,516.23 ",OP,"1,516.23","1,516.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0482,Tlso rigid lined custom fab,Durable Medical Equipment,Per Unit,"$1,693.64 ",OP,"1,693.64","1,693.64",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0484,Tlso rigid plastic cust fab,Durable Medical Equipment,Per Unit,"$1,829.06 ",OP,"1,829.06","1,829.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0486,Tlso rigidlined cust fab two,Durable Medical Equipment,Per Unit,"$2,054.11 ",OP,"2,054.11","2,054.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0488,Tlso rigid lined pre one pie,Durable Medical Equipment,Per Unit,"$1,007.68 ",OP,"1,007.68","1,007.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0490,Tlso rigid plastic pre one,Durable Medical Equipment,Per Unit,$283.96 ,OP,283.96,283.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0491,Tlso 2 piece rigid shell,Durable Medical Equipment,Per Unit,$770.93 ,OP,770.93,770.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0492,Tlso 3 piece rigid shell,Durable Medical Equipment,Per Unit,$502.01 ,OP,502.01,502.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0621,Sio flex pelvic/sacr pre ots,Durable Medical Equipment,Per Unit,$79.44 ,OP,79.44,79.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0622,Sio flex pelvisacral custom,Durable Medical Equipment,Per Unit,$268.31 ,OP,268.31,268.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0623,Sio rig pnl pelv/sac pre ots,Durable Medical Equipment,Per Unit,$153.64 ,OP,153.64,153.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0625,Lo flex l1-below l5 pre ots,Durable Medical Equipment,Per Unit,$47.88 ,OP,47.88,47.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0626,Lo sag rig pnl stays pre cst,Durable Medical Equipment,Per Unit,$78.25 ,OP,78.25,78.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0627,Lo sag ri an/pos pnl pre cst,Durable Medical Equipment,Per Unit,$412.59 ,OP,412.59,412.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0628,Lso flex no ri stays pre ots,Durable Medical Equipment,Per Unit,$72.90 ,OP,72.9,72.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0630,Lso r post pnl sj-t9 pre cst,Durable Medical Equipment,Per Unit,$162.59 ,OP,162.59,162.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0631,Lso sag r an/pos pnl pre cst,Durable Medical Equipment,Per Unit,"$1,030.49 ",OP,"1,030.49","1,030.49",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0633,Lso sc r pos/lat pnl pre cst,Durable Medical Equipment,Per Unit,$287.85 ,OP,287.85,287.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0635,Lso sagit rigid panel prefab,Durable Medical Equipment,Per Unit,"$1,003.05 ",OP,"1,003.05","1,003.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0636,Lso sagittal rigid panel cus,Durable Medical Equipment,Per Unit,"$1,360.98 ",OP,"1,360.98","1,360.98",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0637,Lso sc r ant/pos pnl pre cst,Durable Medical Equipment,Per Unit,"$1,300.47 ",OP,"1,300.47","1,300.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0638,Lso sag-coronal panel custom,Durable Medical Equipment,Per Unit,"$1,323.97 ",OP,"1,323.97","1,323.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0639,Lso s/c shell/panel prefab,Durable Medical Equipment,Per Unit,"$1,300.47 ",OP,"1,300.47","1,300.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0640,Lso s/c shell/panel custom,Durable Medical Equipment,Per Unit,"$1,050.39 ",OP,"1,050.39","1,050.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0641,Lo rig pos pnl l1-l5 pre ots,Durable Medical Equipment,Per Unit,$67.74 ,OP,67.74,67.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0642,Lo sag ri an/pos pnl pre ots,Durable Medical Equipment,Per Unit,$357.24 ,OP,357.24,357.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0643,Lso sag ctr rigi pos pre ots,Durable Medical Equipment,Per Unit,$140.76 ,OP,140.76,140.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0648,Lso sag r an/pos pnl pre ots,Durable Medical Equipment,Per Unit,$892.19 ,OP,892.19,892.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0649,Lso sc r pos/lat pnl pre ots,Durable Medical Equipment,Per Unit,$249.22 ,OP,249.22,249.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0650,Lso sc r ant/pos pnl pre ots,Durable Medical Equipment,Per Unit,"$1,086.39 ",OP,"1,086.39","1,086.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0651,Lso sag-co shell pnl pre ots,Durable Medical Equipment,Per Unit,"$1,086.39 ",OP,"1,086.39","1,086.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0700,Ctlso a-p-l control molded,Durable Medical Equipment,Per Unit,"$1,998.37 ",OP,"1,998.37","1,998.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0710,Ctlso a-p-l control w/ inter,Durable Medical Equipment,Per Unit,"$2,196.75 ",OP,"2,196.75","2,196.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0810,Halo cervical into jckt vest,Durable Medical Equipment,Per Unit,"$2,683.14 ",OP,"2,683.14","2,683.14",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0820,Halo cervical into body jack,Durable Medical Equipment,Per Unit,"$2,110.65 ",OP,"2,110.65","2,110.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0830,Halo cerv into milwaukee typ,Durable Medical Equipment,Per Unit,"$3,229.60 ",OP,"3,229.60","3,229.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0859,Mri compatible system,Durable Medical Equipment,Per Unit,"$1,143.45 ",OP,"1,143.45","1,143.45",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0861,Halo repl liner/interface,Durable Medical Equipment,Per Unit,$216.37 ,OP,216.37,216.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0970,Tlso corset front,Durable Medical Equipment,Per Unit,$107.27 ,OP,107.27,107.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0972,Lso corset front,Durable Medical Equipment,Per Unit,$97.64 ,OP,97.64,97.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0974,Tlso full corset,Durable Medical Equipment,Per Unit,$175.42 ,OP,175.42,175.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0976,Lso full corset,Durable Medical Equipment,Per Unit,$150.09 ,OP,150.09,150.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0978,Axillary crutch extension,Durable Medical Equipment,Per Unit,$188.90 ,OP,188.9,188.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0980,Peroneal straps pair pre ots,Durable Medical Equipment,Per Unit,$17.15 ,OP,17.15,17.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0982,Stocking sup grips 4 pre ots,Durable Medical Equipment,Per Unit,$15.70 ,OP,15.7,15.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L0984,Protect body sock ea pre ots,Durable Medical Equipment,Per Unit,$67.93 ,OP,67.93,67.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1000,Ctlso milwauke initial model,Durable Medical Equipment,Per Unit,"$2,035.53 ",OP,"2,035.53","2,035.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1005,Tension based scoliosis orth,Durable Medical Equipment,Per Unit,"$3,212.88 ",OP,"3,212.88","3,212.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1010,Ctlso axilla sling,Durable Medical Equipment,Per Unit,$83.99 ,OP,83.99,83.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1020,Kyphosis pad,Durable Medical Equipment,Per Unit,$108.17 ,OP,108.17,108.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1025,Kyphosis pad floating,Durable Medical Equipment,Per Unit,$156.06 ,OP,156.06,156.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1030,Lumbar bolster pad,Durable Medical Equipment,Per Unit,$78.60 ,OP,78.6,78.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1040,Lumbar or lumbar rib pad,Durable Medical Equipment,Per Unit,$89.00 ,OP,89,89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1050,Sternal pad,Durable Medical Equipment,Per Unit,$100.72 ,OP,100.72,100.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1060,Thoracic pad,Durable Medical Equipment,Per Unit,$108.72 ,OP,108.72,108.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1070,Trapezius sling,Durable Medical Equipment,Per Unit,$112.62 ,OP,112.62,112.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1080,Outrigger,Durable Medical Equipment,Per Unit,$52.52 ,OP,52.52,52.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1085,Outrigger bil w/ vert extens,Durable Medical Equipment,Per Unit,$175.83 ,OP,175.83,175.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1090,Lumbar sling,Durable Medical Equipment,Per Unit,$101.01 ,OP,101.01,101.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1100,Ring flange plastic/leather,Durable Medical Equipment,Per Unit,$190.64 ,OP,190.64,190.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1110,Ring flange plas/leather mol,Durable Medical Equipment,Per Unit,$319.63 ,OP,319.63,319.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1120,Covers for upright each,Durable Medical Equipment,Per Unit,$38.18 ,OP,38.18,38.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1200,Furnsh initial orthosis only,Durable Medical Equipment,Per Unit,"$1,796.37 ",OP,"1,796.37","1,796.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1210,Lateral thoracic extension,Durable Medical Equipment,Per Unit,$245.60 ,OP,245.6,245.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1220,Anterior thoracic extension,Durable Medical Equipment,Per Unit,$239.05 ,OP,239.05,239.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1230,Milwaukee type superstructur,Durable Medical Equipment,Per Unit,$669.67 ,OP,669.67,669.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1240,Lumbar derotation pad,Durable Medical Equipment,Per Unit,$91.29 ,OP,91.29,91.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1250,Anterior asis pad,Durable Medical Equipment,Per Unit,$79.39 ,OP,79.39,79.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1260,Anterior thoracic derotation,Durable Medical Equipment,Per Unit,$94.68 ,OP,94.68,94.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1270,Abdominal pad,Durable Medical Equipment,Per Unit,$83.20 ,OP,83.2,83.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1280,Rib gusset (elastic) each,Durable Medical Equipment,Per Unit,$87.71 ,OP,87.71,87.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1290,Lateral trochanteric pad,Durable Medical Equipment,Per Unit,$78.00 ,OP,78,78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1300,Body jacket mold to patient,Durable Medical Equipment,Per Unit,"$1,730.06 ",OP,"1,730.06","1,730.06",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1310,Post-operative body jacket,Durable Medical Equipment,Per Unit,"$1,802.00 ",OP,"1,802.00","1,802.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1600,Ho flex frejka w/cov pre cst,Durable Medical Equipment,Per Unit,$129.35 ,OP,129.35,129.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1610,Ho frejka cov only pre cst,Durable Medical Equipment,Per Unit,$54.94 ,OP,54.94,54.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1620,Ho flex pavlik harns pre cst,Durable Medical Equipment,Per Unit,$157.73 ,OP,157.73,157.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1630,Abduct control hip semi-flex,Durable Medical Equipment,Per Unit,$212.06 ,OP,212.06,212.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1640,Pelv band/spread bar thigh c,Durable Medical Equipment,Per Unit,$475.20 ,OP,475.2,475.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1650,Ho abduction hip adjustable,Durable Medical Equipment,Per Unit,$247.55 ,OP,247.55,247.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1652,Ho bi thighcuffs w sprdr bar,Durable Medical Equipment,Per Unit,$357.83 ,OP,357.83,357.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1660,Ho abduction static plastic,Durable Medical Equipment,Per Unit,$181.40 ,OP,181.4,181.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1680,Pelvic & hip control thigh c,Durable Medical Equipment,Per Unit,"$1,143.62 ",OP,"1,143.62","1,143.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1685,Post-op hip abduct custom fa,Durable Medical Equipment,Per Unit,"$1,116.47 ",OP,"1,116.47","1,116.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1686,Ho post-op hip abduction,Durable Medical Equipment,Per Unit,$940.60 ,OP,940.6,940.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1690,Combination bilateral ho,Durable Medical Equipment,Per Unit,"$1,941.15 ",OP,"1,941.15","1,941.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1700,Leg perthes orth toronto typ,Durable Medical Equipment,Per Unit,"$1,561.78 ",OP,"1,561.78","1,561.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1710,Legg perthes orth newington,Durable Medical Equipment,Per Unit,"$1,988.75 ",OP,"1,988.75","1,988.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1720,Legg perthes orthosis trilat,Durable Medical Equipment,Per Unit,"$1,480.82 ",OP,"1,480.82","1,480.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1730,Legg perthes orth scottish r,Durable Medical Equipment,Per Unit,"$1,250.14 ",OP,"1,250.14","1,250.14",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1755,Legg perthes patten bottom t,Durable Medical Equipment,Per Unit,"$1,797.35 ",OP,"1,797.35","1,797.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1810,Ko elastic with joints,Durable Medical Equipment,Per Unit,$103.34 ,OP,103.34,103.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1812,Ko elastic w/joints pre ots,Durable Medical Equipment,Per Unit,$92.18 ,OP,92.18,92.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1820,Ko elas w/ condyle pads & jo,Durable Medical Equipment,Per Unit,$142.66 ,OP,142.66,142.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1830,Ko immob canvas long pre ots,Durable Medical Equipment,Per Unit,$78.26 ,OP,78.26,78.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1831,Knee orth pos locking joint,Durable Medical Equipment,Per Unit,$295.44 ,OP,295.44,295.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1832,Ko adj jnt pos r sup pre cst,Durable Medical Equipment,Per Unit,$691.44 ,OP,691.44,691.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1833,Ko adj jnt pos r sup pre ots,Durable Medical Equipment,Per Unit,$608.67 ,OP,608.67,608.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1834,Ko w/0 joint rigid molded to,Durable Medical Equipment,Per Unit,$728.61 ,OP,728.61,728.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1836,Ko rigid w/o joints pre ots,Durable Medical Equipment,Per Unit,$118.58 ,OP,118.58,118.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1840,Ko derot ant cruciate custom,Durable Medical Equipment,Per Unit,$944.00 ,OP,944,944,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1843,Ko single upright pre cst,Durable Medical Equipment,Per Unit,$900.70 ,OP,900.7,900.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1844,Ko w/adj jt rot cntrl molded,Durable Medical Equipment,Per Unit,"$1,528.66 ",OP,"1,528.66","1,528.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1845,Ko double upright pre cst,Durable Medical Equipment,Per Unit,$840.88 ,OP,840.88,840.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1846,Ko w adj flex/ext rotat mold,Durable Medical Equipment,Per Unit,"$1,174.51 ",OP,"1,174.51","1,174.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1847,Ko dbl upright w/air pre cst,Durable Medical Equipment,Per Unit,$577.37 ,OP,577.37,577.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1848,Ko dbl upright w/air pre ots,Durable Medical Equipment,Per Unit,$577.37 ,OP,577.37,577.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1850,Ko swedish type pre ots,Durable Medical Equipment,Per Unit,$261.87 ,OP,261.87,261.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1851,Ko single upright prefab ots,Durable Medical Equipment,Per Unit,$797.42 ,OP,797.42,797.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1852,Ko double upright prefab ots,Durable Medical Equipment,Per Unit,$751.54 ,OP,751.54,751.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1860,Ko supracondylar socket mold,Durable Medical Equipment,Per Unit,"$1,251.75 ",OP,"1,251.75","1,251.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1900,Afo sprng wir drsflx calf bd,Durable Medical Equipment,Per Unit,$286.39 ,OP,286.39,286.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1902,Afo ankle gauntlet pre ots,Durable Medical Equipment,Per Unit,$74.93 ,OP,74.93,74.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1904,Afo molded ankle gauntlet,Durable Medical Equipment,Per Unit,$453.09 ,OP,453.09,453.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1906,Afo multilig ank sup pre ots,Durable Medical Equipment,Per Unit,$112.88 ,OP,112.88,112.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1907,Afo supramalleolar custom,Durable Medical Equipment,Per Unit,$564.86 ,OP,564.86,564.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1910,Afo sing bar clasp attach sh,Durable Medical Equipment,Per Unit,$281.51 ,OP,281.51,281.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1920,Afo sing upright w/ adjust s,Durable Medical Equipment,Per Unit,$412.37 ,OP,412.37,412.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1930,Afo plastic,Durable Medical Equipment,Per Unit,$252.89 ,OP,252.89,252.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1932,Afo rig ant tib prefab tcf/=,Durable Medical Equipment,Per Unit,$895.75 ,OP,895.75,895.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1940,Afo molded to patient plasti,Durable Medical Equipment,Per Unit,$488.84 ,OP,488.84,488.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1945,Afo molded plas rig ant tib,Durable Medical Equipment,Per Unit,"$1,126.77 ",OP,"1,126.77","1,126.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1950,Afo spiral molded to pt plas,Durable Medical Equipment,Per Unit,$772.00 ,OP,772,772,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1951,Afo spiral prefabricated,Durable Medical Equipment,Per Unit,$843.02 ,OP,843.02,843.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1960,Afo pos solid ank plastic mo,Durable Medical Equipment,Per Unit,$622.25 ,OP,622.25,622.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1970,Afo plastic molded w/ankle j,Durable Medical Equipment,Per Unit,$694.78 ,OP,694.78,694.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1971,Afo w/ankle joint- prefab,Durable Medical Equipment,Per Unit,$470.55 ,OP,470.55,470.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1980,Afo sing solid stirrup calf,Durable Medical Equipment,Per Unit,$405.31 ,OP,405.31,405.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L1990,Afo doub solid stirrup calf,Durable Medical Equipment,Per Unit,$469.10 ,OP,469.1,469.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2000,Kafo sing fre stirr thi/calf,Durable Medical Equipment,Per Unit,"$1,122.95 ",OP,"1,122.95","1,122.95",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2005,Kafo sng/dbl mechanical act,Durable Medical Equipment,Per Unit,"$4,113.39 ",OP,"4,113.39","4,113.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2010,Kafo sng solid stirrup w/o j,Durable Medical Equipment,Per Unit,$875.89 ,OP,875.89,875.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2020,Kafo dbl solid stirrup band/,Durable Medical Equipment,Per Unit,"$1,106.22 ",OP,"1,106.22","1,106.22",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2030,Kafo dbl solid stirrup w/o j,Durable Medical Equipment,Per Unit,"$1,087.33 ",OP,"1,087.33","1,087.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2034,Kafo pla sin up w/wo k/a cus,Durable Medical Equipment,Per Unit,"$2,039.24 ",OP,"2,039.24","2,039.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2035,Kafo plastic pediatric size,Durable Medical Equipment,Per Unit,$173.91 ,OP,173.91,173.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2036,Kafo plas doub free knee mol,Durable Medical Equipment,Per Unit,"$1,861.04 ",OP,"1,861.04","1,861.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2037,Kafo plas sing free knee mol,Durable Medical Equipment,Per Unit,"$1,664.67 ",OP,"1,664.67","1,664.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2038,Kafo w/o joint multi-axis an,Durable Medical Equipment,Per Unit,"$1,341.97 ",OP,"1,341.97","1,341.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2040,Hkafo torsion bil rot straps,Durable Medical Equipment,Per Unit,$203.08 ,OP,203.08,203.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2050,Hkafo torsion cable hip pelv,Durable Medical Equipment,Per Unit,$489.17 ,OP,489.17,489.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2060,Hkafo torsion ball bearing j,Durable Medical Equipment,Per Unit,$611.86 ,OP,611.86,611.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2070,Hkafo torsion unilat rot str,Durable Medical Equipment,Per Unit,$155.80 ,OP,155.8,155.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2080,Hkafo unilat torsion cable,Durable Medical Equipment,Per Unit,$374.61 ,OP,374.61,374.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2090,Hkafo unilat torsion ball br,Durable Medical Equipment,Per Unit,$499.12 ,OP,499.12,499.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2106,Afo tib fx cast plaster mold,Durable Medical Equipment,Per Unit,$791.23 ,OP,791.23,791.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2108,Afo tib fx cast molded to pt,Durable Medical Equipment,Per Unit,"$1,154.03 ",OP,"1,154.03","1,154.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2112,Afo tibial fracture soft,Durable Medical Equipment,Per Unit,$506.43 ,OP,506.43,506.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2114,Afo tib fx semi-rigid,Durable Medical Equipment,Per Unit,$634.33 ,OP,634.33,634.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2116,Afo tibial fracture rigid,Durable Medical Equipment,Per Unit,$773.69 ,OP,773.69,773.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2126,Kafo fem fx cast thermoplas,Durable Medical Equipment,Per Unit,"$1,281.77 ",OP,"1,281.77","1,281.77",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2128,Kafo fem fx cast molded to p,Durable Medical Equipment,Per Unit,"$1,609.47 ",OP,"1,609.47","1,609.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2132,Kafo femoral fx cast soft,Durable Medical Equipment,Per Unit,$976.92 ,OP,976.92,976.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2134,Kafo fem fx cast semi-rigid,Durable Medical Equipment,Per Unit,"$1,156.80 ",OP,"1,156.80","1,156.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2136,Kafo femoral fx cast rigid,Durable Medical Equipment,Per Unit,"$1,265.95 ",OP,"1,265.95","1,265.95",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2180,Plas shoe insert w ank joint,Durable Medical Equipment,Per Unit,$133.08 ,OP,133.08,133.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2182,Drop lock knee,Durable Medical Equipment,Per Unit,$114.71 ,OP,114.71,114.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2184,Limited motion knee joint,Durable Medical Equipment,Per Unit,$116.27 ,OP,116.27,116.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2186,Adj motion knee jnt lerman t,Durable Medical Equipment,Per Unit,$154.63 ,OP,154.63,154.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2188,Quadrilateral brim,Durable Medical Equipment,Per Unit,$281.10 ,OP,281.1,281.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2190,Waist belt,Durable Medical Equipment,Per Unit,$85.62 ,OP,85.62,85.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2192,Pelvic band & belt thigh fla,Durable Medical Equipment,Per Unit,$334.67 ,OP,334.67,334.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2200,Limited ankle motion ea jnt,Durable Medical Equipment,Per Unit,$50.44 ,OP,50.44,50.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2210,Dorsiflexion assist each joi,Durable Medical Equipment,Per Unit,$63.09 ,OP,63.09,63.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2220,Dorsi & plantar flex ass/res,Durable Medical Equipment,Per Unit,$81.22 ,OP,81.22,81.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2230,Split flat caliper stirr & p,Durable Medical Equipment,Per Unit,$96.02 ,OP,96.02,96.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2232,Rocker bottom- contact afo,Durable Medical Equipment,Per Unit,$97.51 ,OP,97.51,97.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2240,Round caliper and plate atta,Durable Medical Equipment,Per Unit,$95.58 ,OP,95.58,95.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2250,Foot plate molded stirrup at,Durable Medical Equipment,Per Unit,$335.30 ,OP,335.3,335.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2260,Reinforced solid stirrup,Durable Medical Equipment,Per Unit,$188.16 ,OP,188.16,188.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2265,Long tongue stirrup,Durable Medical Equipment,Per Unit,$134.94 ,OP,134.94,134.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2270,Varus/valgus strap padded/li,Durable Medical Equipment,Per Unit,$61.87 ,OP,61.87,61.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2275,Plastic mod low ext pad/line,Durable Medical Equipment,Per Unit,$130.85 ,OP,130.85,130.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2280,Molded inner boot,Durable Medical Equipment,Per Unit,$566.69 ,OP,566.69,566.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2300,Abduction bar jointed adjust,Durable Medical Equipment,Per Unit,$252.72 ,OP,252.72,252.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2310,Abduction bar-straight,Durable Medical Equipment,Per Unit,$115.47 ,OP,115.47,115.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2320,Non-molded lacer,Durable Medical Equipment,Per Unit,$193.64 ,OP,193.64,193.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2330,Lacer molded to patient mode,Durable Medical Equipment,Per Unit,$368.55 ,OP,368.55,368.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2335,Anterior swing band,Durable Medical Equipment,Per Unit,$282.18 ,OP,282.18,282.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2340,Pre-tibial shell molded to p,Durable Medical Equipment,Per Unit,$419.50 ,OP,419.5,419.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2350,Prosthetic type socket molde,Durable Medical Equipment,Per Unit,$836.35 ,OP,836.35,836.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2360,Extended steel shank,Durable Medical Equipment,Per Unit,$51.76 ,OP,51.76,51.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2370,Patten bottom,Durable Medical Equipment,Per Unit,$321.26 ,OP,321.26,321.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2375,Torsion ank & half solid sti,Durable Medical Equipment,Per Unit,$123.52 ,OP,123.52,123.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2380,Torsion straight knee joint,Durable Medical Equipment,Per Unit,$129.54 ,OP,129.54,129.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2385,Straight knee joint heavy du,Durable Medical Equipment,Per Unit,$147.50 ,OP,147.5,147.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2387,Add le poly knee custom kafo,Durable Medical Equipment,Per Unit,$191.63 ,OP,191.63,191.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2390,Offset knee joint each,Durable Medical Equipment,Per Unit,$102.75 ,OP,102.75,102.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2395,Offset knee joint heavy duty,Durable Medical Equipment,Per Unit,$146.86 ,OP,146.86,146.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2397,Suspension sleeve lower ext,Durable Medical Equipment,Per Unit,$122.52 ,OP,122.52,122.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2405,Knee joint drop lock ea jnt,Durable Medical Equipment,Per Unit,$87.52 ,OP,87.52,87.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2415,Knee joint cam lock each joi,Durable Medical Equipment,Per Unit,$121.95 ,OP,121.95,121.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2425,Knee disc/dial lock/adj flex,Durable Medical Equipment,Per Unit,$143.90 ,OP,143.9,143.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2430,Knee jnt ratchet lock ea jnt,Durable Medical Equipment,Per Unit,$143.90 ,OP,143.9,143.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2492,Knee lift loop drop lock rin,Durable Medical Equipment,Per Unit,$117.74 ,OP,117.74,117.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2500,Thi/glut/ischia wgt bearing,Durable Medical Equipment,Per Unit,$314.13 ,OP,314.13,314.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2510,Th/wght bear quad-lat brim m,Durable Medical Equipment,Per Unit,$809.60 ,OP,809.6,809.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2520,Th/wght bear quad-lat brim c,Durable Medical Equipment,Per Unit,$539.56 ,OP,539.56,539.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2525,Th/wght bear nar m-l brim mo,Durable Medical Equipment,Per Unit,"$1,144.16 ",OP,"1,144.16","1,144.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2526,Th/wght bear nar m-l brim cu,Durable Medical Equipment,Per Unit,$642.90 ,OP,642.9,642.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2530,Thigh/wght bear lacer non-mo,Durable Medical Equipment,Per Unit,$240.74 ,OP,240.74,240.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2540,Thigh/wght bear lacer molded,Durable Medical Equipment,Per Unit,$455.54 ,OP,455.54,455.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2550,Thigh/wght bear high roll cu,Durable Medical Equipment,Per Unit,$341.55 ,OP,341.55,341.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2570,Hip clevis type 2 posit jnt,Durable Medical Equipment,Per Unit,$447.07 ,OP,447.07,447.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2580,Pelvic control pelvic sling,Durable Medical Equipment,Per Unit,$435.62 ,OP,435.62,435.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2600,Hip clevis/thrust bearing fr,Durable Medical Equipment,Per Unit,$214.10 ,OP,214.1,214.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2610,Hip clevis/thrust bearing lo,Durable Medical Equipment,Per Unit,$236.58 ,OP,236.58,236.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2620,Pelvic control hip heavy dut,Durable Medical Equipment,Per Unit,$250.96 ,OP,250.96,250.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2622,Hip joint adjustable flexion,Durable Medical Equipment,Per Unit,$319.42 ,OP,319.42,319.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2624,Hip adj flex ext abduct cont,Durable Medical Equipment,Per Unit,$391.68 ,OP,391.68,391.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2627,Plastic mold recipro hip & c,Durable Medical Equipment,Per Unit,"$2,145.41 ",OP,"2,145.41","2,145.41",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2628,Metal frame recipro hip & ca,Durable Medical Equipment,Per Unit,"$1,572.54 ",OP,"1,572.54","1,572.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2630,Pelvic control band & belt u,Durable Medical Equipment,Per Unit,$232.43 ,OP,232.43,232.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2640,Pelvic control band & belt b,Durable Medical Equipment,Per Unit,$315.42 ,OP,315.42,315.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2650,Pelv & thor control gluteal,Durable Medical Equipment,Per Unit,$138.91 ,OP,138.91,138.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2660,Thoracic control thoracic ba,Durable Medical Equipment,Per Unit,$179.86 ,OP,179.86,179.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2670,Thorac cont paraspinal uprig,Durable Medical Equipment,Per Unit,$160.11 ,OP,160.11,160.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2680,Thorac cont lat support upri,Durable Medical Equipment,Per Unit,$146.88 ,OP,146.88,146.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2750,Plating chrome/nickel pr bar,Durable Medical Equipment,Per Unit,$78.45 ,OP,78.45,78.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2755,Carbon graphite lamination,Durable Medical Equipment,Per Unit,$131.16 ,OP,131.16,131.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2760,Extension per extension per,Durable Medical Equipment,Per Unit,$57.03 ,OP,57.03,57.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2768,Ortho sidebar disconnect,Durable Medical Equipment,Per Unit,$130.78 ,OP,130.78,130.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2780,Non-corrosive finish,Durable Medical Equipment,Per Unit,$63.53 ,OP,63.53,63.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2785,Drop lock retainer each,Durable Medical Equipment,Per Unit,$29.75 ,OP,29.75,29.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2795,Knee control full kneecap,Durable Medical Equipment,Per Unit,$82.32 ,OP,82.32,82.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2800,Knee cap medial or lateral p,Durable Medical Equipment,Per Unit,$101.09 ,OP,101.09,101.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2810,Knee control condylar pad,Durable Medical Equipment,Per Unit,$81.98 ,OP,81.98,81.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2820,Soft interface below knee se,Durable Medical Equipment,Per Unit,$81.51 ,OP,81.51,81.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2830,Soft interface above knee se,Durable Medical Equipment,Per Unit,$88.18 ,OP,88.18,88.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2840,Tibial length sock fx or equ,Durable Medical Equipment,Per Unit,$43.30 ,OP,43.3,43.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L2850,Femoral lgth sock fx or equa,Durable Medical Equipment,Per Unit,$60.72 ,OP,60.72,60.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3000,Ft insert ucb berkeley shell,Durable Medical Equipment,Per Unit,$315.34 ,OP,315.34,315.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3001,Foot insert remov molded spe,Durable Medical Equipment,Per Unit,$132.78 ,OP,132.78,132.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3002,Foot insert plastazote or eq,Durable Medical Equipment,Per Unit,$162.12 ,OP,162.12,162.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3003,Foot insert silicone gel eac,Durable Medical Equipment,Per Unit,$174.89 ,OP,174.89,174.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3010,Foot longitudinal arch suppo,Durable Medical Equipment,Per Unit,$174.89 ,OP,174.89,174.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3020,Foot longitud/metatarsal sup,Durable Medical Equipment,Per Unit,$199.16 ,OP,199.16,199.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3030,Foot arch support remov prem,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3031,Foot lamin/prepreg composite,Durable Medical Equipment,Per Unit,$122.94 ,OP,122.94,122.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3040,Ft arch suprt premold longit,Durable Medical Equipment,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3050,Foot arch supp premold metat,Durable Medical Equipment,Per Unit,$47.25 ,OP,47.25,47.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3060,Foot arch supp longitud/meta,Durable Medical Equipment,Per Unit,$74.04 ,OP,74.04,74.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3070,Arch suprt att to sho longit,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3080,Arch supp att to shoe metata,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3090,Arch supp att to shoe long/m,Durable Medical Equipment,Per Unit,$40.86 ,OP,40.86,40.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3100,Hallus-valgus nt dyn pre ots,Durable Medical Equipment,Per Unit,$43.43 ,OP,43.43,43.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3140,Abduction rotation bar shoe,Durable Medical Equipment,Per Unit,$89.37 ,OP,89.37,89.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3150,Abduct rotation bar w/o shoe,Durable Medical Equipment,Per Unit,$81.72 ,OP,81.72,81.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3170,Foot plas heel stabi pre ots,Durable Medical Equipment,Per Unit,$51.06 ,OP,51.06,51.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3224,Woman's shoe oxford brace,Durable Medical Equipment,Per Unit,$67.83 ,OP,67.83,67.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3225,Man's shoe oxford brace,Durable Medical Equipment,Per Unit,$74.09 ,OP,74.09,74.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3300,Sho lift taper to metatarsal,Durable Medical Equipment,Per Unit,$52.35 ,OP,52.35,52.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3310,Shoe lift elev heel/sole neo,Durable Medical Equipment,Per Unit,$81.72 ,OP,81.72,81.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3330,Lifts elevation metal extens,Durable Medical Equipment,Per Unit,$568.10 ,OP,568.1,568.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3332,Shoe lifts tapered to one-ha,Durable Medical Equipment,Per Unit,$74.04 ,OP,74.04,74.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3334,Shoe lifts elevation heel /i,Durable Medical Equipment,Per Unit,$38.28 ,OP,38.28,38.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3340,Shoe wedge sach,Durable Medical Equipment,Per Unit,$85.56 ,OP,85.56,85.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3350,Shoe heel wedge,Durable Medical Equipment,Per Unit,$22.96 ,OP,22.96,22.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3360,Shoe sole wedge outside sole,Durable Medical Equipment,Per Unit,$35.74 ,OP,35.74,35.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3370,Shoe sole wedge between sole,Durable Medical Equipment,Per Unit,$49.79 ,OP,49.79,49.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3380,Shoe clubfoot wedge,Durable Medical Equipment,Per Unit,$49.79 ,OP,49.79,49.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3390,Shoe outflare wedge,Durable Medical Equipment,Per Unit,$49.79 ,OP,49.79,49.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3400,Shoe metatarsal bar wedge ro,Durable Medical Equipment,Per Unit,$40.86 ,OP,40.86,40.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3410,Shoe metatarsal bar between,Durable Medical Equipment,Per Unit,$93.19 ,OP,93.19,93.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3420,Full sole/heel wedge btween,Durable Medical Equipment,Per Unit,$54.90 ,OP,54.9,54.9,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3430,Sho heel count plast reinfor,Durable Medical Equipment,Per Unit,$160.86 ,OP,160.86,160.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3440,Heel leather reinforced,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3450,Shoe heel sach cushion type,Durable Medical Equipment,Per Unit,$105.93 ,OP,105.93,105.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3455,Shoe heel new leather standa,Durable Medical Equipment,Per Unit,$40.86 ,OP,40.86,40.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3460,Shoe heel new rubber standar,Durable Medical Equipment,Per Unit,$34.49 ,OP,34.49,34.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3465,Shoe heel thomas with wedge,Durable Medical Equipment,Per Unit,$58.76 ,OP,58.76,58.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3470,Shoe heel thomas extend to b,Durable Medical Equipment,Per Unit,$62.54 ,OP,62.54,62.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3480,Shoe heel pad & depress for,Durable Medical Equipment,Per Unit,$62.54 ,OP,62.54,62.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3500,Ortho shoe add leather insol,Durable Medical Equipment,Per Unit,$29.35 ,OP,29.35,29.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3510,Orthopedic shoe add rub insl,Durable Medical Equipment,Per Unit,$29.35 ,OP,29.35,29.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3520,O shoe add felt w leath insl,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3530,Ortho shoe add half sole,Durable Medical Equipment,Per Unit,$31.91 ,OP,31.91,31.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3540,Ortho shoe add full sole,Durable Medical Equipment,Per Unit,$51.06 ,OP,51.06,51.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3550,O shoe add standard toe tap,Durable Medical Equipment,Per Unit,$8.97 ,OP,8.97,8.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3560,O shoe add horseshoe toe tap,Durable Medical Equipment,Per Unit,$22.96 ,OP,22.96,22.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3570,O shoe add instep extension,Durable Medical Equipment,Per Unit,$85.56 ,OP,85.56,85.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3580,O shoe add instep velcro clo,Durable Medical Equipment,Per Unit,$65.11 ,OP,65.11,65.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3590,O shoe convert to sof counte,Durable Medical Equipment,Per Unit,$53.63 ,OP,53.63,53.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3595,Ortho shoe add march bar,Durable Medical Equipment,Per Unit,$42.10 ,OP,42.1,42.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3600,Trans shoe calip plate exist,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3610,Trans shoe caliper plate new,Durable Medical Equipment,Per Unit,$100.86 ,OP,100.86,100.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3620,Trans shoe solid stirrup exi,Durable Medical Equipment,Per Unit,$76.59 ,OP,76.59,76.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3630,Trans shoe solid stirrup new,Durable Medical Equipment,Per Unit,$100.86 ,OP,100.86,100.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3640,Shoe dennis browne splint bo,Durable Medical Equipment,Per Unit,$43.43 ,OP,43.43,43.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3650,So 8 abd restraint pre ots,Durable Medical Equipment,Per Unit,$65.83 ,OP,65.83,65.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3660,So 8 ab rstr can/web pre ots,Durable Medical Equipment,Per Unit,$94.40 ,OP,94.4,94.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3670,So acro/clav can web pre ots,Durable Medical Equipment,Per Unit,$103.86 ,OP,103.86,103.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3671,So cap design w/o jnts cf,Durable Medical Equipment,Per Unit,$823.17 ,OP,823.17,823.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3674,So airplane w/wo joint cf,Durable Medical Equipment,Per Unit,"$1,079.87 ",OP,"1,079.87","1,079.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3675,So vest canvas/web pre ots,Durable Medical Equipment,Per Unit,$160.35 ,OP,160.35,160.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3702,Eo w/o joints cf,Durable Medical Equipment,Per Unit,$263.81 ,OP,263.81,263.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3710,Eo elas w/metal jnts pre ots,Durable Medical Equipment,Per Unit,$130.45 ,OP,130.45,130.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3720,Forearm/arm cuffs free motio,Durable Medical Equipment,Per Unit,$624.22 ,OP,624.22,624.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3730,Forearm/arm cuffs ext/flex a,Durable Medical Equipment,Per Unit,$827.96 ,OP,827.96,827.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3740,Cuffs adj lock w/ active con,Durable Medical Equipment,Per Unit,$981.62 ,OP,981.62,981.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3760,Eo adj jt prefab custom fit,Durable Medical Equipment,Per Unit,$456.89 ,OP,456.89,456.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3761,Eo- adj lock joint prefab ot,Durable Medical Equipment,Per Unit,$456.89 ,OP,456.89,456.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3762,Eo rigid w/o joints pre ots,Durable Medical Equipment,Per Unit,$98.22 ,OP,98.22,98.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3763,Ewho rigid w/o jnts cf,Durable Medical Equipment,Per Unit,$683.66 ,OP,683.66,683.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3764,Ewho w/joint(s) cf,Durable Medical Equipment,Per Unit,$715.47 ,OP,715.47,715.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3765,Ewhfo rigid w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,171.43 ",OP,"1,171.43","1,171.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3766,Ewhfo w/joint(s) cf,Durable Medical Equipment,Per Unit,"$1,240.47 ",OP,"1,240.47","1,240.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3806,Whfo w/joint(s) custom fab,Durable Medical Equipment,Per Unit,$414.97 ,OP,414.97,414.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3807,Whfo w/o joints pre cst,Durable Medical Equipment,Per Unit,$228.43 ,OP,228.43,228.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3808,Whfo- rigid w/o joints,Durable Medical Equipment,Per Unit,$325.43 ,OP,325.43,325.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3809,Whfo w/o joints pre ots,Durable Medical Equipment,Per Unit,$228.43 ,OP,228.43,228.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3900,Hinge extension/flex wrist/f,Durable Medical Equipment,Per Unit,"$1,479.93 ",OP,"1,479.93","1,479.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3901,Hinge ext/flex wrist finger,Durable Medical Equipment,Per Unit,"$1,939.53 ",OP,"1,939.53","1,939.53",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3904,Whfo electric custom fitted,Durable Medical Equipment,Per Unit,"$3,083.64 ",OP,"3,083.64","3,083.64",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3905,Who w/nontorsion jnt(s) cf,Durable Medical Equipment,Per Unit,$905.97 ,OP,905.97,905.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3906,Who w/o joints cf,Durable Medical Equipment,Per Unit,$462.97 ,OP,462.97,462.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3908,Who cock-up nonmolde pre ots,Durable Medical Equipment,Per Unit,$66.98 ,OP,66.98,66.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3912,Hfo flexion glove pre ots,Durable Medical Equipment,Per Unit,$96.25 ,OP,96.25,96.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3913,Hfo w/o joints cf,Durable Medical Equipment,Per Unit,$247.41 ,OP,247.41,247.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3915,Who nontorsion jnts pre cst,Durable Medical Equipment,Per Unit,$485.63 ,OP,485.63,485.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3916,Who nontorsion jnts pre ots,Durable Medical Equipment,Per Unit,$485.63 ,OP,485.63,485.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3917,Metacarp fx orthosis pre cst,Durable Medical Equipment,Per Unit,$96.47 ,OP,96.47,96.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3918,Metacarp fx orthosis pre ots,Durable Medical Equipment,Per Unit,$96.47 ,OP,96.47,96.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3919,Ho w/o joints cf,Durable Medical Equipment,Per Unit,$247.41 ,OP,247.41,247.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3921,Hfo w/joint(s) cf,Durable Medical Equipment,Per Unit,$293.46 ,OP,293.46,293.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3923,Hfo without joints pre cst,Durable Medical Equipment,Per Unit,$88.25 ,OP,88.25,88.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3924,Hfo without joints pre ots,Durable Medical Equipment,Per Unit,$88.25 ,OP,88.25,88.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3925,Fo pip dip jnt/sprng pre ots,Durable Medical Equipment,Per Unit,$60.01 ,OP,60.01,60.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3927,Fo pip dip no jt spr pre ots,Durable Medical Equipment,Per Unit,$31.98 ,OP,31.98,31.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3929,Hfo nontorsion jnts pre cst,Durable Medical Equipment,Per Unit,$83.44 ,OP,83.44,83.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3930,Hfo nontorsion jnts pre ots,Durable Medical Equipment,Per Unit,$83.44 ,OP,83.44,83.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3931,Whfo nontorsion joint prefab,Durable Medical Equipment,Per Unit,$190.48 ,OP,190.48,190.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3933,Fo w/o joints cf,Durable Medical Equipment,Per Unit,$194.93 ,OP,194.93,194.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3935,Fo nontorsion joint cf,Durable Medical Equipment,Per Unit,$201.82 ,OP,201.82,201.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3960,Sewho airplan desig abdu pos,Durable Medical Equipment,Per Unit,$728.64 ,OP,728.64,728.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3961,Sewho cap design w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,534.92 ",OP,"1,534.92","1,534.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3962,Sewho erbs palsey design abd,Durable Medical Equipment,Per Unit,$659.00 ,OP,659,659,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3967,Sewho airplane w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,812.20 ",OP,"1,812.20","1,812.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3971,Sewho cap design w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,720.20 ",OP,"1,720.20","1,720.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3973,Sewho airplane w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,812.20 ",OP,"1,812.20","1,812.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3975,Sewhfo cap design w/o jnt cf,Durable Medical Equipment,Per Unit,"$1,534.92 ",OP,"1,534.92","1,534.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3976,Sewhfo airplane w/o jnts cf,Durable Medical Equipment,Per Unit,"$1,534.92 ",OP,"1,534.92","1,534.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3977,Sewhfo cap desgn w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,720.20 ",OP,"1,720.20","1,720.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3978,Sewhfo airplane w/jnt(s) cf,Durable Medical Equipment,Per Unit,"$1,812.20 ",OP,"1,812.20","1,812.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3980,Up ext fx orthos humeral nos,Durable Medical Equipment,Per Unit,$353.43 ,OP,353.43,353.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3981,Ue fx orth shoul cap forearm,Durable Medical Equipment,Per Unit,$919.57 ,OP,919.57,919.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3982,Upper ext fx orthosis rad/ul,Durable Medical Equipment,Per Unit,$358.87 ,OP,358.87,358.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3984,Upper ext fx orthosis wrist,Durable Medical Equipment,Per Unit,$316.13 ,OP,316.13,316.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L3995,Sock fracture or equal each,Durable Medical Equipment,Per Unit,$37.51 ,OP,37.51,37.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4000,Repl girdle milwaukee orth,Durable Medical Equipment,Per Unit,"$1,326.47 ",OP,"1,326.47","1,326.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4010,Replace trilateral socket br,Durable Medical Equipment,Per Unit,$806.25 ,OP,806.25,806.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4020,Replace quadlat socket brim,Durable Medical Equipment,Per Unit,$968.52 ,OP,968.52,968.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4030,Replace socket brim cust fit,Durable Medical Equipment,Per Unit,$615.47 ,OP,615.47,615.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4040,Replace molded thigh lacer,Durable Medical Equipment,Per Unit,$416.80 ,OP,416.8,416.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4045,Replace non-molded thigh lac,Durable Medical Equipment,Per Unit,$307.89 ,OP,307.89,307.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4050,Replace molded calf lacer,Durable Medical Equipment,Per Unit,$412.80 ,OP,412.8,412.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4055,Replace non-molded calf lace,Durable Medical Equipment,Per Unit,$250.92 ,OP,250.92,250.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4060,Replace high roll cuff,Durable Medical Equipment,Per Unit,$326.17 ,OP,326.17,326.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4070,Replace prox & dist upright,Durable Medical Equipment,Per Unit,$264.15 ,OP,264.15,264.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4080,Repl met band kafo-afo prox,Durable Medical Equipment,Per Unit,$99.72 ,OP,99.72,99.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4090,Repl met band kafo-afo calf/,Durable Medical Equipment,Per Unit,$84.84 ,OP,84.84,84.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4100,Repl leath cuff kafo prox th,Durable Medical Equipment,Per Unit,$101.94 ,OP,101.94,101.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4110,Repl leath cuff kafo-afo cal,Durable Medical Equipment,Per Unit,$79.60 ,OP,79.6,79.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4130,Replace pretibial shell,Durable Medical Equipment,Per Unit,$481.14 ,OP,481.14,481.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4350,Ankle control ortho pre ots,Durable Medical Equipment,Per Unit,$97.13 ,OP,97.13,97.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4360,Pneumat walking boot pre cst,Durable Medical Equipment,Per Unit,$259.89 ,OP,259.89,259.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4361,Pneuma/vac walk boot pre ots,Durable Medical Equipment,Per Unit,$259.89 ,OP,259.89,259.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4370,Pneum full leg splnt pre ots,Durable Medical Equipment,Per Unit,$236.26 ,OP,236.26,236.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4386,Non-pneum walk boot pre cst,Durable Medical Equipment,Per Unit,$159.16 ,OP,159.16,159.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4387,Non-pneum walk boot pre ots,Durable Medical Equipment,Per Unit,$159.16 ,OP,159.16,159.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4392,Replace afo soft interface,Durable Medical Equipment,Per Unit,$23.62 ,OP,23.62,23.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4394,Replace foot drop spint,Durable Medical Equipment,Per Unit,$17.23 ,OP,17.23,17.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4396,Static or dynami afo pre cst,Durable Medical Equipment,Per Unit,$168.46 ,OP,168.46,168.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4397,Static or dynami afo pre ots,Durable Medical Equipment,Per Unit,$168.46 ,OP,168.46,168.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4398,Foot drop splint pre ots,Durable Medical Equipment,Per Unit,$77.54 ,OP,77.54,77.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L4631,Afo- walk boot type- cus fab,Durable Medical Equipment,Per Unit,"$1,479.79 ",OP,"1,479.79","1,479.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5000,Sho insert w arch toe filler,Durable Medical Equipment,Per Unit,$576.42 ,OP,576.42,576.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5010,Mold socket ank hgt w/ toe f,Durable Medical Equipment,Per Unit,"$1,610.60 ",OP,"1,610.60","1,610.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5020,Tibial tubercle hgt w/ toe f,Durable Medical Equipment,Per Unit,"$2,523.29 ",OP,"2,523.29","2,523.29",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5050,Ank symes mold sckt sach ft,Durable Medical Equipment,Per Unit,"$2,755.91 ",OP,"2,755.91","2,755.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5060,Symes met fr leath socket ar,Durable Medical Equipment,Per Unit,"$3,397.24 ",OP,"3,397.24","3,397.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5100,Molded socket shin sach foot,Durable Medical Equipment,Per Unit,"$2,744.12 ",OP,"2,744.12","2,744.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5105,Plast socket jts/thgh lacer,Durable Medical Equipment,Per Unit,"$3,872.55 ",OP,"3,872.55","3,872.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5150,Mold sckt ext knee shin sach,Durable Medical Equipment,Per Unit,"$4,305.35 ",OP,"4,305.35","4,305.35",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5160,Mold socket bent knee shin s,Durable Medical Equipment,Per Unit,"$4,727.07 ",OP,"4,727.07","4,727.07",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5200,Kne sing axis fric shin sach,Durable Medical Equipment,Per Unit,"$3,656.04 ",OP,"3,656.04","3,656.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5210,No knee/ankle joints w/ ft b,Durable Medical Equipment,Per Unit,"$2,902.89 ",OP,"2,902.89","2,902.89",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5220,No knee joint with artic ali,Durable Medical Equipment,Per Unit,"$3,197.74 ",OP,"3,197.74","3,197.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5230,Fem focal defic constant fri,Durable Medical Equipment,Per Unit,"$4,796.11 ",OP,"4,796.11","4,796.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5250,Hip canad sing axi cons fric,Durable Medical Equipment,Per Unit,"$5,623.57 ",OP,"5,623.57","5,623.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5270,Tilt table locking hip sing,Durable Medical Equipment,Per Unit,"$6,265.76 ",OP,"6,265.76","6,265.76",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5280,Hemipelvect canad sing axis,Durable Medical Equipment,Per Unit,"$6,090.55 ",OP,"6,090.55","6,090.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5301,Bk mold socket sach ft endo,Durable Medical Equipment,Per Unit,"$2,694.66 ",OP,"2,694.66","2,694.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5312,Knee disart- sach ft- endo,Durable Medical Equipment,Per Unit,"$4,245.62 ",OP,"4,245.62","4,245.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5321,Ak open end sach,Durable Medical Equipment,Per Unit,"$3,593.24 ",OP,"3,593.24","3,593.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5331,Hip disart canadian sach ft,Durable Medical Equipment,Per Unit,"$5,262.80 ",OP,"5,262.80","5,262.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5341,Hemipelvectomy canadian sach,Durable Medical Equipment,Per Unit,"$5,594.28 ",OP,"5,594.28","5,594.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5400,Postop dress & 1 cast chg bk,Durable Medical Equipment,Per Unit,"$1,604.68 ",OP,"1,604.68","1,604.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5410,Postop dsg bk ea add cast ch,Durable Medical Equipment,Per Unit,$443.32 ,OP,443.32,443.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5420,Postop dsg & 1 cast chg ak/d,Durable Medical Equipment,Per Unit,"$2,026.64 ",OP,"2,026.64","2,026.64",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5430,Postop dsg ak ea add cast ch,Durable Medical Equipment,Per Unit,$550.12 ,OP,550.12,550.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5450,Postop app non-wgt bear dsg,Durable Medical Equipment,Per Unit,$475.67 ,OP,475.67,475.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5460,Postop app non-wgt bear dsg,Durable Medical Equipment,Per Unit,$623.89 ,OP,623.89,623.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5500,Init bk ptb plaster direct,Durable Medical Equipment,Per Unit,"$1,483.19 ",OP,"1,483.19","1,483.19",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5505,Init ak ischal plstr direct,Durable Medical Equipment,Per Unit,"$2,086.44 ",OP,"2,086.44","2,086.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5510,Prep bk ptb plaster molded,Durable Medical Equipment,Per Unit,"$1,771.18 ",OP,"1,771.18","1,771.18",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5520,Perp bk ptb thermopls direct,Durable Medical Equipment,Per Unit,"$1,587.65 ",OP,"1,587.65","1,587.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5530,Prep bk ptb thermopls molded,Durable Medical Equipment,Per Unit,"$2,087.07 ",OP,"2,087.07","2,087.07",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5535,Prep bk ptb open end socket,Durable Medical Equipment,Per Unit,"$1,945.59 ",OP,"1,945.59","1,945.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5540,Prep bk ptb laminated socket,Durable Medical Equipment,Per Unit,"$2,060.66 ",OP,"2,060.66","2,060.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5560,Prep ak ischial plast molded,Durable Medical Equipment,Per Unit,"$2,348.01 ",OP,"2,348.01","2,348.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5570,Prep ak ischial direct form,Durable Medical Equipment,Per Unit,"$2,278.83 ",OP,"2,278.83","2,278.83",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5580,Prep ak ischial thermo mold,Durable Medical Equipment,Per Unit,"$2,828.36 ",OP,"2,828.36","2,828.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5585,Prep ak ischial open end,Durable Medical Equipment,Per Unit,"$3,312.24 ",OP,"3,312.24","3,312.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5590,Prep ak ischial laminated,Durable Medical Equipment,Per Unit,"$2,948.85 ",OP,"2,948.85","2,948.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5595,Hip disartic sach thermopls,Durable Medical Equipment,Per Unit,"$4,608.29 ",OP,"4,608.29","4,608.29",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5600,Hip disart sach laminat mold,Durable Medical Equipment,Per Unit,"$5,244.91 ",OP,"5,244.91","5,244.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5610,Above knee hydracadence,Durable Medical Equipment,Per Unit,"$2,529.59 ",OP,"2,529.59","2,529.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5611,Ak 4 bar link w/fric swing,Durable Medical Equipment,Per Unit,"$1,611.13 ",OP,"1,611.13","1,611.13",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5613,Ak 4 bar ling w/hydraul swig,Durable Medical Equipment,Per Unit,"$2,450.64 ",OP,"2,450.64","2,450.64",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5614,4-bar link above knee w/swng,Durable Medical Equipment,Per Unit,"$1,697.23 ",OP,"1,697.23","1,697.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5616,Ak univ multiplex sys frict,Durable Medical Equipment,Per Unit,"$1,477.66 ",OP,"1,477.66","1,477.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5617,Ak/bk self-aligning unit ea,Durable Medical Equipment,Per Unit,$562.74 ,OP,562.74,562.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5618,Test socket symes,Durable Medical Equipment,Per Unit,$336.06 ,OP,336.06,336.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5620,Test socket below knee,Durable Medical Equipment,Per Unit,$298.16 ,OP,298.16,298.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5622,Test socket knee disarticula,Durable Medical Equipment,Per Unit,$401.70 ,OP,401.7,401.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5624,Test socket above knee,Durable Medical Equipment,Per Unit,$401.54 ,OP,401.54,401.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5626,Test socket hip disarticulat,Durable Medical Equipment,Per Unit,$635.70 ,OP,635.7,635.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5628,Test socket hemipelvectomy,Durable Medical Equipment,Per Unit,$643.74 ,OP,643.74,643.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5629,Below knee acrylic socket,Durable Medical Equipment,Per Unit,$317.79 ,OP,317.79,317.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5630,Syme typ expandabl wall sckt,Durable Medical Equipment,Per Unit,$552.17 ,OP,552.17,552.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5631,Ak/knee disartic acrylic soc,Durable Medical Equipment,Per Unit,$439.37 ,OP,439.37,439.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5632,Symes type ptb brim design s,Durable Medical Equipment,Per Unit,$270.81 ,OP,270.81,270.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5634,Symes type poster opening so,Durable Medical Equipment,Per Unit,$338.66 ,OP,338.66,338.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5636,Symes type medial opening so,Durable Medical Equipment,Per Unit,$258.86 ,OP,258.86,258.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5637,Below knee total contact,Durable Medical Equipment,Per Unit,$385.17 ,OP,385.17,385.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5638,Below knee leather socket,Durable Medical Equipment,Per Unit,$648.87 ,OP,648.87,648.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5639,Below knee wood socket,Durable Medical Equipment,Per Unit,"$1,121.15 ",OP,"1,121.15","1,121.15",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5640,Knee disarticulat leather so,Durable Medical Equipment,Per Unit,$736.94 ,OP,736.94,736.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5642,Above knee leather socket,Durable Medical Equipment,Per Unit,$683.11 ,OP,683.11,683.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5643,Hip flex inner socket ext fr,Durable Medical Equipment,Per Unit,"$2,014.84 ",OP,"2,014.84","2,014.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5644,Above knee wood socket,Durable Medical Equipment,Per Unit,$590.63 ,OP,590.63,590.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5645,Bk flex inner socket ext fra,Durable Medical Equipment,Per Unit,$979.82 ,OP,979.82,979.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5646,Below knee cushion socket,Durable Medical Equipment,Per Unit,$620.93 ,OP,620.93,620.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5647,Below knee suction socket,Durable Medical Equipment,Per Unit,$795.44 ,OP,795.44,795.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5648,Above knee cushion socket,Durable Medical Equipment,Per Unit,$733.68 ,OP,733.68,733.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5649,Isch containmt/narrow m-l so,Durable Medical Equipment,Per Unit,"$2,465.24 ",OP,"2,465.24","2,465.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5650,Tot contact ak/knee disart s,Durable Medical Equipment,Per Unit,$488.17 ,OP,488.17,488.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5651,Ak flex inner socket ext fra,Durable Medical Equipment,Per Unit,"$1,430.29 ",OP,"1,430.29","1,430.29",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5652,Suction susp ak/knee disart,Durable Medical Equipment,Per Unit,$435.97 ,OP,435.97,435.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5653,Knee disart expand wall sock,Durable Medical Equipment,Per Unit,$680.24 ,OP,680.24,680.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5654,Socket insert symes,Durable Medical Equipment,Per Unit,$394.33 ,OP,394.33,394.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5655,Socket insert below knee,Durable Medical Equipment,Per Unit,$284.71 ,OP,284.71,284.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5656,Socket insert knee articulat,Durable Medical Equipment,Per Unit,$432.53 ,OP,432.53,432.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5658,Socket insert above knee,Durable Medical Equipment,Per Unit,$456.55 ,OP,456.55,456.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5661,Multi-durometer symes,Durable Medical Equipment,Per Unit,$655.04 ,OP,655.04,655.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5665,Multi-durometer below knee,Durable Medical Equipment,Per Unit,$582.36 ,OP,582.36,582.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5666,Below knee cuff suspension,Durable Medical Equipment,Per Unit,$77.11 ,OP,77.11,77.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5668,Bk molded distal cushion,Durable Medical Equipment,Per Unit,$114.86 ,OP,114.86,114.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5670,Bk molded supracondylar susp,Durable Medical Equipment,Per Unit,$271.35 ,OP,271.35,271.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5671,Bk/ak locking mechanism,Durable Medical Equipment,Per Unit,$497.40 ,OP,497.4,497.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5672,Bk removable medial brim sus,Durable Medical Equipment,Per Unit,$359.07 ,OP,359.07,359.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5673,Socket insert w lock mech,Durable Medical Equipment,Per Unit,$790.52 ,OP,790.52,790.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5676,Bk knee joints single axis p,Durable Medical Equipment,Per Unit,$362.36 ,OP,362.36,362.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5677,Bk knee joints polycentric p,Durable Medical Equipment,Per Unit,$554.97 ,OP,554.97,554.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5678,Bk joint covers pair,Durable Medical Equipment,Per Unit,$39.70 ,OP,39.7,39.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5679,Socket insert w/o lock mech,Durable Medical Equipment,Per Unit,$658.75 ,OP,658.75,658.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5680,Bk thigh lacer non-molded,Durable Medical Equipment,Per Unit,$304.37 ,OP,304.37,304.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5681,Intl custm cong/latyp insert,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5682,Bk thigh lacer glut/ischia m,Durable Medical Equipment,Per Unit,$625.37 ,OP,625.37,625.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5683,Initial custom socket insert,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5684,Bk fork strap,Durable Medical Equipment,Per Unit,$48.13 ,OP,48.13,48.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5685,Below knee sus/seal sleeve,Durable Medical Equipment,Per Unit,$128.85 ,OP,128.85,128.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5686,Bk back check,Durable Medical Equipment,Per Unit,$57.89 ,OP,57.89,57.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5688,Bk waist belt webbing,Durable Medical Equipment,Per Unit,$61.48 ,OP,61.48,61.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5690,Bk waist belt padded and lin,Durable Medical Equipment,Per Unit,$125.50 ,OP,125.5,125.5,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5692,Ak pelvic control belt light,Durable Medical Equipment,Per Unit,$132.88 ,OP,132.88,132.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5694,Ak pelvic control belt pad/l,Durable Medical Equipment,Per Unit,$181.41 ,OP,181.41,181.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5695,Ak sleeve susp neoprene/equa,Durable Medical Equipment,Per Unit,$163.08 ,OP,163.08,163.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5696,Ak/knee disartic pelvic join,Durable Medical Equipment,Per Unit,$196.99 ,OP,196.99,196.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5697,Ak/knee disartic pelvic band,Durable Medical Equipment,Per Unit,$93.55 ,OP,93.55,93.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5698,Ak/knee disartic silesian ba,Durable Medical Equipment,Per Unit,$120.01 ,OP,120.01,120.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5699,Shoulder harness,Durable Medical Equipment,Per Unit,$205.11 ,OP,205.11,205.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5700,Replace socket below knee,Durable Medical Equipment,Per Unit,"$3,085.07 ",OP,"3,085.07","3,085.07",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5701,Replace socket above knee,Durable Medical Equipment,Per Unit,"$3,827.32 ",OP,"3,827.32","3,827.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5702,Replace socket hip,Durable Medical Equipment,Per Unit,"$4,823.75 ",OP,"4,823.75","4,823.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5703,Symes ankle w/o (sach) foot,Durable Medical Equipment,Per Unit,"$2,537.43 ",OP,"2,537.43","2,537.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5704,Custom shape cover bk,Durable Medical Equipment,Per Unit,$629.03 ,OP,629.03,629.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5705,Custom shape cover ak,Durable Medical Equipment,Per Unit,"$1,153.25 ",OP,"1,153.25","1,153.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5706,Custom shape cvr knee disart,Durable Medical Equipment,Per Unit,"$1,124.85 ",OP,"1,124.85","1,124.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5707,Custom shape cvr hip disart,Durable Medical Equipment,Per Unit,"$1,511.27 ",OP,"1,511.27","1,511.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5710,Kne-shin exo sng axi mnl loc,Durable Medical Equipment,Per Unit,$359.65 ,OP,359.65,359.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5711,Knee-shin exo mnl lock ultra,Durable Medical Equipment,Per Unit,$603.60 ,OP,603.6,603.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5712,Knee-shin exo frict swg & st,Durable Medical Equipment,Per Unit,$430.88 ,OP,430.88,430.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5714,Knee-shin exo variable frict,Durable Medical Equipment,Per Unit,$438.43 ,OP,438.43,438.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5716,Knee-shin exo mech stance ph,Durable Medical Equipment,Per Unit,$866.93 ,OP,866.93,866.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5718,Knee-shin exo frct swg & sta,Durable Medical Equipment,Per Unit,$927.01 ,OP,927.01,927.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5722,Knee-shin pneum swg frct exo,Durable Medical Equipment,Per Unit,"$1,127.32 ",OP,"1,127.32","1,127.32",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5724,Knee-shin exo fluid swing ph,Durable Medical Equipment,Per Unit,"$1,737.57 ",OP,"1,737.57","1,737.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5726,Knee-shin ext jnts fld swg e,Durable Medical Equipment,Per Unit,"$2,068.65 ",OP,"2,068.65","2,068.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5728,Knee-shin fluid swg & stance,Durable Medical Equipment,Per Unit,"$2,424.23 ",OP,"2,424.23","2,424.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5780,Knee-shin pneum/hydra pneum,Durable Medical Equipment,Per Unit,"$1,334.72 ",OP,"1,334.72","1,334.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5781,Lower limb pros vacuum pump,Durable Medical Equipment,Per Unit,"$4,024.33 ",OP,"4,024.33","4,024.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5782,Hd low limb pros vacuum pump,Durable Medical Equipment,Per Unit,"$4,242.55 ",OP,"4,242.55","4,242.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5785,Exoskeletal bk ultralt mater,Durable Medical Equipment,Per Unit,$519.54 ,OP,519.54,519.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5790,Exoskeletal ak ultra-light m,Durable Medical Equipment,Per Unit,$749.83 ,OP,749.83,749.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5795,Exoskel hip ultra-light mate,Durable Medical Equipment,Per Unit,"$1,073.66 ",OP,"1,073.66","1,073.66",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5810,Endoskel knee-shin mnl lock,Durable Medical Equipment,Per Unit,$572.04 ,OP,572.04,572.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5811,Endo knee-shin mnl lck ultra,Durable Medical Equipment,Per Unit,$789.42 ,OP,789.42,789.42,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5812,Endo knee-shin frct swg & st,Durable Medical Equipment,Per Unit,$594.07 ,OP,594.07,594.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5814,Endo knee-shin hydral swg ph,Durable Medical Equipment,Per Unit,"$3,735.37 ",OP,"3,735.37","3,735.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5816,Endo knee-shin polyc mch sta,Durable Medical Equipment,Per Unit,$850.43 ,OP,850.43,850.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5818,Endo knee-shin frct swg & st,Durable Medical Equipment,Per Unit,$960.30 ,OP,960.3,960.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5822,Endo knee-shin pneum swg frc,Durable Medical Equipment,Per Unit,"$1,761.65 ",OP,"1,761.65","1,761.65",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5824,Endo knee-shin fluid swing p,Durable Medical Equipment,Per Unit,"$1,665.27 ",OP,"1,665.27","1,665.27",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5826,Miniature knee joint,Durable Medical Equipment,Per Unit,"$3,140.97 ",OP,"3,140.97","3,140.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5828,Endo knee-shin fluid swg/sta,Durable Medical Equipment,Per Unit,"$2,963.78 ",OP,"2,963.78","2,963.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5830,Endo knee-shin pneum/swg pha,Durable Medical Equipment,Per Unit,"$1,998.37 ",OP,"1,998.37","1,998.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5840,Multi-axial knee/shin system,Durable Medical Equipment,Per Unit,"$3,922.28 ",OP,"3,922.28","3,922.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5845,Knee-shin sys stance flexion,Durable Medical Equipment,Per Unit,"$1,802.73 ",OP,"1,802.73","1,802.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5848,Knee-shin sys hydraul stance,Durable Medical Equipment,Per Unit,"$1,081.55 ",OP,"1,081.55","1,081.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5850,Endo ak/hip knee extens assi,Durable Medical Equipment,Per Unit,$127.92 ,OP,127.92,127.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5855,Mech hip extension assist,Durable Medical Equipment,Per Unit,$308.82 ,OP,308.82,308.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5856,Elec knee-shin swing/stance,Durable Medical Equipment,Per Unit,"$24,144.68 ",OP,"24,144.68","24,144.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5857,Elec knee-shin swing only,Durable Medical Equipment,Per Unit,"$8,567.44 ",OP,"8,567.44","8,567.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5858,Stance phase only,Durable Medical Equipment,Per Unit,"$18,692.70 ",OP,"18,692.70","18,692.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5859,Knee-shin pro flex/ext cont,Durable Medical Equipment,Per Unit,"$14,593.21 ",OP,"14,593.21","14,593.21",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5910,Endo below knee alignable sy,Durable Medical Equipment,Per Unit,$362.17 ,OP,362.17,362.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5920,Endo ak/hip alignable system,Durable Medical Equipment,Per Unit,$530.58 ,OP,530.58,530.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5925,Above knee manual lock,Durable Medical Equipment,Per Unit,$336.00 ,OP,336,336,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5930,High activity knee frame,Durable Medical Equipment,Per Unit,"$3,385.39 ",OP,"3,385.39","3,385.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5940,Endo bk ultra-light material,Durable Medical Equipment,Per Unit,$501.60 ,OP,501.6,501.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5950,Endo ak ultra-light material,Durable Medical Equipment,Per Unit,$777.99 ,OP,777.99,777.99,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5960,Endo hip ultra-light materia,Durable Medical Equipment,Per Unit,"$1,163.29 ",OP,"1,163.29","1,163.29",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5961,Endo poly hip- pneu/hyd/rot,Durable Medical Equipment,Per Unit,"$4,800.88 ",OP,"4,800.88","4,800.88",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5962,Below knee flex cover system,Durable Medical Equipment,Per Unit,$587.78 ,OP,587.78,587.78,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5964,Above knee flex cover system,Durable Medical Equipment,Per Unit,"$1,127.47 ",OP,"1,127.47","1,127.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5966,Hip flexible cover system,Durable Medical Equipment,Per Unit,"$1,452.38 ",OP,"1,452.38","1,452.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5968,Multiaxial ankle w dorsiflex,Durable Medical Equipment,Per Unit,"$3,654.91 ",OP,"3,654.91","3,654.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5970,Foot external keel sach foot,Durable Medical Equipment,Per Unit,$218.47 ,OP,218.47,218.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5971,Sach foot- replacement,Durable Medical Equipment,Per Unit,$218.47 ,OP,218.47,218.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5972,Flexible keel foot,Durable Medical Equipment,Per Unit,$397.97 ,OP,397.97,397.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5973,Ank-foot sys dors-plant flex,Durable Medical Equipment,Per Unit,"$17,757.02 ",OP,"17,757.02","17,757.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5974,Foot single axis ankle/foot,Durable Medical Equipment,Per Unit,$233.03 ,OP,233.03,233.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5975,Combo ankle/foot prosthesis,Durable Medical Equipment,Per Unit,$466.28 ,OP,466.28,466.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5976,Energy storing foot,Durable Medical Equipment,Per Unit,$591.07 ,OP,591.07,591.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5978,Ft prosth multiaxial ankl/ft,Durable Medical Equipment,Per Unit,$313.20 ,OP,313.2,313.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5979,Multi-axial ankle/ft prosth,Durable Medical Equipment,Per Unit,"$2,507.69 ",OP,"2,507.69","2,507.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5980,Flex foot system,Durable Medical Equipment,Per Unit,"$3,820.69 ",OP,"3,820.69","3,820.69",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5981,Flex-walk sys low ext prosth,Durable Medical Equipment,Per Unit,"$3,431.91 ",OP,"3,431.91","3,431.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5982,Exoskeletal axial rotation u,Durable Medical Equipment,Per Unit,$644.71 ,OP,644.71,644.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5984,Endoskeletal axial rotation,Durable Medical Equipment,Per Unit,$646.71 ,OP,646.71,646.71,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5985,Lwr ext dynamic prosth pylon,Durable Medical Equipment,Per Unit,$284.02 ,OP,284.02,284.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5986,Multi-axial rotation unit,Durable Medical Equipment,Per Unit,$780.11 ,OP,780.11,780.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5987,Shank ft w vert load pylon,Durable Medical Equipment,Per Unit,"$7,235.38 ",OP,"7,235.38","7,235.38",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5988,Vertical shock reducing pylo,Durable Medical Equipment,Per Unit,"$2,009.25 ",OP,"2,009.25","2,009.25",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L5990,User adjustable heel height,Durable Medical Equipment,Per Unit,"$1,824.64 ",OP,"1,824.64","1,824.64",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6000,Part hand thumb rem,Durable Medical Equipment,Per Unit,"$1,771.55 ",OP,"1,771.55","1,771.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6010,Part hand little/ring,Durable Medical Equipment,Per Unit,"$1,971.44 ",OP,"1,971.44","1,971.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6020,Part hand no fingers,Durable Medical Equipment,Per Unit,"$1,838.05 ",OP,"1,838.05","1,838.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6026,Part hand myo exclu term dev,Durable Medical Equipment,Per Unit,"$4,375.03 ",OP,"4,375.03","4,375.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6050,Wrst mld sck flx hng tri pad,Durable Medical Equipment,Per Unit,"$2,500.12 ",OP,"2,500.12","2,500.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6055,Wrst mold sock w/exp interfa,Durable Medical Equipment,Per Unit,"$3,189.04 ",OP,"3,189.04","3,189.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6100,Elb mold sock flex hinge pad,Durable Medical Equipment,Per Unit,"$2,530.04 ",OP,"2,530.04","2,530.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6110,Elbow mold sock suspension t,Durable Medical Equipment,Per Unit,"$2,676.61 ",OP,"2,676.61","2,676.61",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6120,Elbow mold doub splt soc ste,Durable Medical Equipment,Per Unit,"$3,027.26 ",OP,"3,027.26","3,027.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6130,Elbow stump activated lock h,Durable Medical Equipment,Per Unit,"$3,193.82 ",OP,"3,193.82","3,193.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6200,Elbow mold outsid lock hinge,Durable Medical Equipment,Per Unit,"$3,290.01 ",OP,"3,290.01","3,290.01",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6205,Elbow molded w/ expand inter,Durable Medical Equipment,Per Unit,"$4,538.50 ",OP,"4,538.50","4,538.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6250,Elbow inter loc elbow forarm,Durable Medical Equipment,Per Unit,"$3,236.79 ",OP,"3,236.79","3,236.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6300,Shlder disart int lock elbow,Durable Medical Equipment,Per Unit,"$4,464.43 ",OP,"4,464.43","4,464.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6310,Shoulder passive restor comp,Durable Medical Equipment,Per Unit,"$4,046.04 ",OP,"4,046.04","4,046.04",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6320,Shoulder passive restor cap,Durable Medical Equipment,Per Unit,"$2,108.67 ",OP,"2,108.67","2,108.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6350,Thoracic intern lock elbow,Durable Medical Equipment,Per Unit,"$4,891.63 ",OP,"4,891.63","4,891.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6360,Thoracic passive restor comp,Durable Medical Equipment,Per Unit,"$4,246.80 ",OP,"4,246.80","4,246.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6370,Thoracic passive restor cap,Durable Medical Equipment,Per Unit,"$2,462.85 ",OP,"2,462.85","2,462.85",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6380,Postop dsg cast chg wrst/elb,Durable Medical Equipment,Per Unit,"$1,424.44 ",OP,"1,424.44","1,424.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6382,Postop dsg cast chg elb dis/,Durable Medical Equipment,Per Unit,"$1,695.74 ",OP,"1,695.74","1,695.74",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6384,Postop dsg cast chg shlder/t,Durable Medical Equipment,Per Unit,"$2,145.20 ",OP,"2,145.20","2,145.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6386,Postop ea cast chg & realign,Durable Medical Equipment,Per Unit,$470.24 ,OP,470.24,470.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6388,Postop applicat rigid dsg on,Durable Medical Equipment,Per Unit,$517.85 ,OP,517.85,517.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6400,Below elbow prosth tiss shap,Durable Medical Equipment,Per Unit,"$2,736.86 ",OP,"2,736.86","2,736.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6450,Elb disart prosth tiss shap,Durable Medical Equipment,Per Unit,"$3,576.94 ",OP,"3,576.94","3,576.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6500,Above elbow prosth tiss shap,Durable Medical Equipment,Per Unit,"$3,512.48 ",OP,"3,512.48","3,512.48",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6550,Shldr disar prosth tiss shap,Durable Medical Equipment,Per Unit,"$4,549.39 ",OP,"4,549.39","4,549.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6570,Scap thorac prosth tiss shap,Durable Medical Equipment,Per Unit,"$5,078.79 ",OP,"5,078.79","5,078.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6580,Wrist/elbow bowden cable mol,Durable Medical Equipment,Per Unit,"$2,030.62 ",OP,"2,030.62","2,030.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6582,Wrist/elbow bowden cbl dir f,Durable Medical Equipment,Per Unit,"$1,705.44 ",OP,"1,705.44","1,705.44",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6584,Elbow fair lead cable molded,Durable Medical Equipment,Per Unit,"$2,525.30 ",OP,"2,525.30","2,525.30",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6586,Elbow fair lead cable dir fo,Durable Medical Equipment,Per Unit,"$2,250.20 ",OP,"2,250.20","2,250.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6588,Shdr fair lead cable molded,Durable Medical Equipment,Per Unit,"$3,583.73 ",OP,"3,583.73","3,583.73",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6590,Shdr fair lead cable direct,Durable Medical Equipment,Per Unit,"$3,123.36 ",OP,"3,123.36","3,123.36",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6600,Polycentric hinge pair,Durable Medical Equipment,Per Unit,$228.13 ,OP,228.13,228.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6605,Single pivot hinge pair,Durable Medical Equipment,Per Unit,$234.81 ,OP,234.81,234.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6610,Flexible metal hinge pair,Durable Medical Equipment,Per Unit,$221.98 ,OP,221.98,221.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6611,Additional switch- ext power,Durable Medical Equipment,Per Unit,$414.10 ,OP,414.1,414.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6615,Disconnect locking wrist uni,Durable Medical Equipment,Per Unit,$215.48 ,OP,215.48,215.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6616,Disconnect insert locking wr,Durable Medical Equipment,Per Unit,$64.86 ,OP,64.86,64.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6620,Flexion/extension wrist unit,Durable Medical Equipment,Per Unit,$376.69 ,OP,376.69,376.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6621,Flex/ext wrist w/wo friction,Durable Medical Equipment,Per Unit,"$2,300.54 ",OP,"2,300.54","2,300.54",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6623,Spring-ass rot wrst w/ latch,Durable Medical Equipment,Per Unit,$717.59 ,OP,717.59,717.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6624,Flex/ext/rotation wrist unit,Durable Medical Equipment,Per Unit,"$3,787.86 ",OP,"3,787.86","3,787.86",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6625,Rotation wrst w/ cable lock,Durable Medical Equipment,Per Unit,$531.84 ,OP,531.84,531.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6628,Quick disconn hook adapter o,Durable Medical Equipment,Per Unit,$572.47 ,OP,572.47,572.47,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6629,Lamination collar w/ couplin,Durable Medical Equipment,Per Unit,$195.07 ,OP,195.07,195.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6630,Stainless steel any wrist,Durable Medical Equipment,Per Unit,$287.35 ,OP,287.35,287.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6632,Latex suspension sleeve each,Durable Medical Equipment,Per Unit,$64.97 ,OP,64.97,64.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6635,Lift assist for elbow,Durable Medical Equipment,Per Unit,$207.68 ,OP,207.68,207.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6637,Nudge control elbow lock,Durable Medical Equipment,Per Unit,$406.60 ,OP,406.6,406.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6638,Elec lock on manual pw elbow,Durable Medical Equipment,Per Unit,"$2,515.20 ",OP,"2,515.20","2,515.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6640,Shoulder abduction joint pai,Durable Medical Equipment,Per Unit,$338.63 ,OP,338.63,338.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6641,Excursion amplifier pulley t,Durable Medical Equipment,Per Unit,$197.18 ,OP,197.18,197.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6642,Excursion amplifier lever ty,Durable Medical Equipment,Per Unit,$289.92 ,OP,289.92,289.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6645,Shoulder flexion-abduction j,Durable Medical Equipment,Per Unit,$366.21 ,OP,366.21,366.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6646,Multipo locking shoulder jnt,Durable Medical Equipment,Per Unit,"$3,172.24 ",OP,"3,172.24","3,172.24",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6647,Shoulder lock actuator,Durable Medical Equipment,Per Unit,$522.26 ,OP,522.26,522.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6648,Ext pwrd shlder lock/unlock,Durable Medical Equipment,Per Unit,"$3,271.71 ",OP,"3,271.71","3,271.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6650,Shoulder universal joint,Durable Medical Equipment,Per Unit,$397.20 ,OP,397.2,397.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6655,Standard control cable extra,Durable Medical Equipment,Per Unit,$77.05 ,OP,77.05,77.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6660,Heavy duty control cable,Durable Medical Equipment,Per Unit,$103.11 ,OP,103.11,103.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6665,Teflon or equal cable lining,Durable Medical Equipment,Per Unit,$46.05 ,OP,46.05,46.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6670,Hook to hand cable adapter,Durable Medical Equipment,Per Unit,$47.96 ,OP,47.96,47.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6672,Harness chest/shlder saddle,Durable Medical Equipment,Per Unit,$220.08 ,OP,220.08,220.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6675,Harness figure of 8 sing con,Durable Medical Equipment,Per Unit,$120.09 ,OP,120.09,120.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6676,Harness figure of 8 dual con,Durable Medical Equipment,Per Unit,$125.64 ,OP,125.64,125.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6677,Ue triple control harness,Durable Medical Equipment,Per Unit,$298.35 ,OP,298.35,298.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6680,Test sock wrist disart/bel e,Durable Medical Equipment,Per Unit,$309.33 ,OP,309.33,309.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6682,Test sock elbw disart/above,Durable Medical Equipment,Per Unit,$342.01 ,OP,342.01,342.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6684,Test socket shldr disart/tho,Durable Medical Equipment,Per Unit,$464.75 ,OP,464.75,464.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6686,Suction socket,Durable Medical Equipment,Per Unit,$689.63 ,OP,689.63,689.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6687,Frame typ socket bel elbow/w,Durable Medical Equipment,Per Unit,$576.80 ,OP,576.8,576.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6688,Frame typ sock above elb/dis,Durable Medical Equipment,Per Unit,$638.36 ,OP,638.36,638.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6689,Frame typ socket shoulder di,Durable Medical Equipment,Per Unit,$760.81 ,OP,760.81,760.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6690,Frame typ sock interscap-tho,Durable Medical Equipment,Per Unit,$895.74 ,OP,895.74,895.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6691,Removable insert each,Durable Medical Equipment,Per Unit,$353.58 ,OP,353.58,353.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6692,Silicone gel insert or equal,Durable Medical Equipment,Per Unit,$643.25 ,OP,643.25,643.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6693,Lockingelbow forearm cntrbal,Durable Medical Equipment,Per Unit,"$2,855.43 ",OP,"2,855.43","2,855.43",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6694,Elbow socket ins use w/lock,Durable Medical Equipment,Per Unit,$790.52 ,OP,790.52,790.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6695,Elbow socket ins use w/o lck,Durable Medical Equipment,Per Unit,$658.75 ,OP,658.75,658.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6696,Cus elbo skt in for con/atyp,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6697,Cus elbo skt in not con/atyp,Durable Medical Equipment,Per Unit,"$1,323.02 ",OP,"1,323.02","1,323.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6698,Below/above elbow lock mech,Durable Medical Equipment,Per Unit,$497.40 ,OP,497.4,497.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6703,Term dev- passive hand mitt,Durable Medical Equipment,Per Unit,$351.79 ,OP,351.79,351.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6704,Term dev- sport/rec/work att,Durable Medical Equipment,Per Unit,$679.06 ,OP,679.06,679.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6706,Term dev mech hook vol open,Durable Medical Equipment,Per Unit,$421.40 ,OP,421.4,421.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6707,Term dev mech hook vol close,Durable Medical Equipment,Per Unit,"$1,490.70 ",OP,"1,490.70","1,490.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6708,Term dev mech hand vol open,Durable Medical Equipment,Per Unit,$985.41 ,OP,985.41,985.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6709,Term dev mech hand vol close,Durable Medical Equipment,Per Unit,"$1,398.55 ",OP,"1,398.55","1,398.55",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6711,Ped term dev- hook- vol open,Durable Medical Equipment,Per Unit,$676.19 ,OP,676.19,676.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6712,Ped term dev- hook- vol clos,Durable Medical Equipment,Per Unit,"$1,245.05 ",OP,"1,245.05","1,245.05",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6713,Ped term dev- hand- vol open,Durable Medical Equipment,Per Unit,"$1,571.33 ",OP,"1,571.33","1,571.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6714,Ped term dev- hand- vol clos,Durable Medical Equipment,Per Unit,"$1,330.91 ",OP,"1,330.91","1,330.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6715,Term device- multi art digit,Durable Medical Equipment,Per Unit,"$3,175.42 ",OP,"3,175.42","3,175.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6721,Hook/hand- hvy dty- vol open,Durable Medical Equipment,Per Unit,"$2,365.59 ",OP,"2,365.59","2,365.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6722,Hook/hand- hvy dty- vol clos,Durable Medical Equipment,Per Unit,"$2,039.28 ",OP,"2,039.28","2,039.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6805,Term dev modifier wrist unit,Durable Medical Equipment,Per Unit,$385.75 ,OP,385.75,385.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6810,Term dev precision pinch dev,Durable Medical Equipment,Per Unit,$205.07 ,OP,205.07,205.07,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6880,Elec hand ind art digits,Durable Medical Equipment,Per Unit,"$24,030.68 ",OP,"24,030.68","24,030.68",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6881,Term dev auto grasp feature,Durable Medical Equipment,Per Unit,"$4,111.91 ",OP,"4,111.91","4,111.91",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6882,Microprocessor control uplmb,Durable Medical Equipment,Per Unit,"$3,119.08 ",OP,"3,119.08","3,119.08",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6883,Replc sockt below e/w disa,Durable Medical Equipment,Per Unit,"$1,997.96 ",OP,"1,997.96","1,997.96",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6884,Replc sockt above elbow disa,Durable Medical Equipment,Per Unit,"$2,733.67 ",OP,"2,733.67","2,733.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6885,Replc sockt shldr dis/interc,Durable Medical Equipment,Per Unit,"$4,246.80 ",OP,"4,246.80","4,246.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6890,Prefab glove for term device,Durable Medical Equipment,Per Unit,$200.88 ,OP,200.88,200.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6895,Custom glove for term device,Durable Medical Equipment,Per Unit,$671.68 ,OP,671.68,671.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6900,Hand restorat thumb/1 finger,Durable Medical Equipment,Per Unit,"$1,950.52 ",OP,"1,950.52","1,950.52",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6905,Hand restoration multiple fi,Durable Medical Equipment,Per Unit,"$1,930.47 ",OP,"1,930.47","1,930.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6910,Hand restoration no fingers,Durable Medical Equipment,Per Unit,"$1,897.78 ",OP,"1,897.78","1,897.78",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6915,Hand restoration replacmnt g,Durable Medical Equipment,Per Unit,$815.40 ,OP,815.4,815.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6920,Wrist disarticul switch ctrl,Durable Medical Equipment,Per Unit,"$8,425.39 ",OP,"8,425.39","8,425.39",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6925,Wrist disart myoelectronic c,Durable Medical Equipment,Per Unit,"$9,001.12 ",OP,"9,001.12","9,001.12",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6930,Below elbow switch control,Durable Medical Equipment,Per Unit,"$8,114.82 ",OP,"8,114.82","8,114.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6935,Below elbow myoelectronic ct,Durable Medical Equipment,Per Unit,"$8,958.82 ",OP,"8,958.82","8,958.82",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6940,Elbow disarticulation switch,Durable Medical Equipment,Per Unit,"$10,478.90 ",OP,"10,478.90","10,478.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6945,Elbow disart myoelectronic c,Durable Medical Equipment,Per Unit,"$11,690.57 ",OP,"11,690.57","11,690.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6950,Above elbow switch control,Durable Medical Equipment,Per Unit,"$10,459.47 ",OP,"10,459.47","10,459.47",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6955,Above elbow myoelectronic ct,Durable Medical Equipment,Per Unit,"$12,129.70 ",OP,"12,129.70","12,129.70",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6960,Shldr disartic switch contro,Durable Medical Equipment,Per Unit,"$12,759.97 ",OP,"12,759.97","12,759.97",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6965,Shldr disartic myoelectronic,Durable Medical Equipment,Per Unit,"$15,116.16 ",OP,"15,116.16","15,116.16",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6970,Interscapular-thor switch ct,Durable Medical Equipment,Per Unit,"$16,180.17 ",OP,"16,180.17","16,180.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L6975,Interscap-thor myoelectronic,Durable Medical Equipment,Per Unit,"$17,834.37 ",OP,"17,834.37","17,834.37",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7007,Adult electric hand,Durable Medical Equipment,Per Unit,"$3,673.63 ",OP,"3,673.63","3,673.63",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7008,Pediatric electric hand,Durable Medical Equipment,Per Unit,"$5,696.71 ",OP,"5,696.71","5,696.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7009,Adult electric hook,Durable Medical Equipment,Per Unit,"$3,758.57 ",OP,"3,758.57","3,758.57",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7040,Prehensile actuator,Durable Medical Equipment,Per Unit,"$3,059.23 ",OP,"3,059.23","3,059.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7045,Pediatric electric hook,Durable Medical Equipment,Per Unit,"$1,616.29 ",OP,"1,616.29","1,616.29",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7170,Electronic elbow hosmer swit,Durable Medical Equipment,Per Unit,"$6,050.00 ",OP,"6,050.00","6,050.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7180,Electronic elbow sequential,Durable Medical Equipment,Per Unit,"$39,141.46 ",OP,"39,141.46","39,141.46",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7181,Electronic elbo simultaneous,Durable Medical Equipment,Per Unit,"$40,299.84 ",OP,"40,299.84","40,299.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7185,Electron elbow adolescent sw,Durable Medical Equipment,Per Unit,"$6,360.51 ",OP,"6,360.51","6,360.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7186,Electron elbow child switch,Durable Medical Equipment,Per Unit,"$10,692.92 ",OP,"10,692.92","10,692.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7190,Elbow adolescent myoelectron,Durable Medical Equipment,Per Unit,"$8,439.80 ",OP,"8,439.80","8,439.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7191,Elbow child myoelectronic ct,Durable Medical Equipment,Per Unit,"$11,247.26 ",OP,"11,247.26","11,247.26",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7259,Electronic wrist rotator any,Durable Medical Equipment,Per Unit,"$4,121.94 ",OP,"4,121.94","4,121.94",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7360,Six volt bat otto bock/eq ea,Durable Medical Equipment,Per Unit,$266.08 ,OP,266.08,266.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7362,Battery chrgr six volt otto,Durable Medical Equipment,Per Unit,$290.68 ,OP,290.68,290.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7364,Twelve volt battery utah/equ,Durable Medical Equipment,Per Unit,$514.33 ,OP,514.33,514.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7366,Battery chrgr 12 volt utah/e,Durable Medical Equipment,Per Unit,$707.34 ,OP,707.34,707.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7367,Replacemnt lithium ionbatter,Durable Medical Equipment,Per Unit,$391.59 ,OP,391.59,391.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7368,Lithium ion battery charger,Durable Medical Equipment,Per Unit,$507.61 ,OP,507.61,507.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7400,Add ue prost be/wd- ultlite,Durable Medical Equipment,Per Unit,$308.25 ,OP,308.25,308.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7401,Add ue prost a/e ultlite mat,Durable Medical Equipment,Per Unit,$345.06 ,OP,345.06,345.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7402,Add ue prost s/d ultlite mat,Durable Medical Equipment,Per Unit,$372.68 ,OP,372.68,372.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7403,Add ue prost b/e acrylic,Durable Medical Equipment,Per Unit,$370.41 ,OP,370.41,370.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7404,Add ue prost a/e acrylic,Durable Medical Equipment,Per Unit,$559.06 ,OP,559.06,559.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7405,Add ue prost s/d acrylic,Durable Medical Equipment,Per Unit,$731.10 ,OP,731.1,731.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L7700,Pros soc insert gasket/seal,Durable Medical Equipment,Per Unit,$150.48 ,OP,150.48,150.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8000,Mastectomy bra,Durable Medical Equipment,Per Unit,$42.59 ,OP,42.59,42.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8001,Breast prosthesis bra & form,Durable Medical Equipment,Per Unit,$126.18 ,OP,126.18,126.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8002,Brst prsth bra & bilat form,Durable Medical Equipment,Per Unit,$165.94 ,OP,165.94,165.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8015,Ext breastprosthesis garment,Durable Medical Equipment,Per Unit,$60.29 ,OP,60.29,60.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8020,Mastectomy form,Durable Medical Equipment,Per Unit,$227.40 ,OP,227.4,227.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8030,Breast prosthes w/o adhesive,Durable Medical Equipment,Per Unit,$351.55 ,OP,351.55,351.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8031,Breast prosthesis w adhesive,Durable Medical Equipment,Per Unit,$351.55 ,OP,351.55,351.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8032,Reusable nipple prosthesis,Durable Medical Equipment,Per Unit,$39.39 ,OP,39.39,39.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8035,Custom breast prosthesis,Durable Medical Equipment,Per Unit,"$3,684.79 ",OP,"3,684.79","3,684.79",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8040,Nasal prosthesis,Durable Medical Equipment,Per Unit,"$2,493.50 ",OP,"2,493.50","2,493.50",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8041,Midfacial prosthesis,Durable Medical Equipment,Per Unit,"$3,005.20 ",OP,"3,005.20","3,005.20",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8042,Orbital prosthesis,Durable Medical Equipment,Per Unit,"$3,376.62 ",OP,"3,376.62","3,376.62",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8043,Upper facial prosthesis,Durable Medical Equipment,Per Unit,"$3,781.84 ",OP,"3,781.84","3,781.84",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8044,Hemi-facial prosthesis,Durable Medical Equipment,Per Unit,"$4,187.02 ",OP,"4,187.02","4,187.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8045,Auricular prosthesis,Durable Medical Equipment,Per Unit,"$3,278.72 ",OP,"3,278.72","3,278.72",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8046,Partial facial prosthesis,Durable Medical Equipment,Per Unit,"$2,701.33 ",OP,"2,701.33","2,701.33",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8047,Nasal septal prosthesis,Durable Medical Equipment,Per Unit,"$1,384.42 ",OP,"1,384.42","1,384.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8300,Truss single w/ standard pad,Durable Medical Equipment,Per Unit,$84.35 ,OP,84.35,84.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8310,Truss double w/ standard pad,Durable Medical Equipment,Per Unit,$149.44 ,OP,149.44,149.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8320,Truss addition to std pad wa,Durable Medical Equipment,Per Unit,$62.00 ,OP,62,62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8330,Truss add to std pad scrotal,Durable Medical Equipment,Per Unit,$49.37 ,OP,49.37,49.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8400,Sheath below knee,Durable Medical Equipment,Per Unit,$15.74 ,OP,15.74,15.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8410,Sheath above knee,Durable Medical Equipment,Per Unit,$20.72 ,OP,20.72,20.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8415,Sheath upper limb,Durable Medical Equipment,Per Unit,$21.44 ,OP,21.44,21.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8417,Pros sheath/sock w gel cushn,Durable Medical Equipment,Per Unit,$75.64 ,OP,75.64,75.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8420,Prosthetic sock multi ply bk,Durable Medical Equipment,Per Unit,$20.98 ,OP,20.98,20.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8430,Prosthetic sock multi ply ak,Durable Medical Equipment,Per Unit,$23.76 ,OP,23.76,23.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8435,Pros sock multi ply upper lm,Durable Medical Equipment,Per Unit,$22.58 ,OP,22.58,22.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8440,Shrinker below knee,Durable Medical Equipment,Per Unit,$46.88 ,OP,46.88,46.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8460,Shrinker above knee,Durable Medical Equipment,Per Unit,$66.65 ,OP,66.65,66.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8465,Shrinker upper limb,Durable Medical Equipment,Per Unit,$61.60 ,OP,61.6,61.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8470,Pros sock single ply bk,Durable Medical Equipment,Per Unit,$6.67 ,OP,6.67,6.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8480,Pros sock single ply ak,Durable Medical Equipment,Per Unit,$9.20 ,OP,9.2,9.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8485,Pros sock single ply upper l,Durable Medical Equipment,Per Unit,$12.39 ,OP,12.39,12.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8500,Artificial larynx,Durable Medical Equipment,Per Unit,$661.87 ,OP,661.87,661.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8501,Tracheostomy speaking valve,Durable Medical Equipment,Per Unit,$120.80 ,OP,120.8,120.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8507,Trach-esoph voice pros pt in,Durable Medical Equipment,Per Unit,$42.11 ,OP,42.11,42.11,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8509,Trach-esoph voice pros md in,Durable Medical Equipment,Per Unit,$109.85 ,OP,109.85,109.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8510,Voice amplifier,Durable Medical Equipment,Per Unit,$254.17 ,OP,254.17,254.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8511,Indwelling trach insert,Durable Medical Equipment,Per Unit,$73.14 ,OP,73.14,73.14,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8512,Gel cap for trach voice pros,Durable Medical Equipment,Per Unit,$2.19 ,OP,2.19,2.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8513,Trach pros cleaning device,Durable Medical Equipment,Per Unit,$5.22 ,OP,5.22,5.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8514,Repl trach puncture dilator,Durable Medical Equipment,Per Unit,$94.85 ,OP,94.85,94.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8515,Gel cap app device for trach,Durable Medical Equipment,Per Unit,$63.49 ,OP,63.49,63.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8615,Coch implant headset replace,Durable Medical Equipment,Per Unit,$453.62 ,OP,453.62,453.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8616,Coch implant microphone repl,Durable Medical Equipment,Per Unit,$105.64 ,OP,105.64,105.64,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8617,Coch implant trans coil repl,Durable Medical Equipment,Per Unit,$92.27 ,OP,92.27,92.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8618,Coch implant tran cable repl,Durable Medical Equipment,Per Unit,$26.38 ,OP,26.38,26.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8619,Coch imp ext proc/contr rplc,Durable Medical Equipment,Per Unit,"$8,454.02 ",OP,"8,454.02","8,454.02",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8621,Repl zinc air battery,Durable Medical Equipment,Per Unit,$0.62 ,OP,0.62,0.62,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8622,Repl alkaline battery,Durable Medical Equipment,Per Unit,$0.32 ,OP,0.32,0.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8623,Lith ion batt cid-non-earlvl,Durable Medical Equipment,Per Unit,$65.06 ,OP,65.06,65.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8624,Lith ion batt cid- ear level,Durable Medical Equipment,Per Unit,$162.20 ,OP,162.2,162.2,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8625,Charger coch impl/aoi battry,Durable Medical Equipment,Per Unit,$189.97 ,OP,189.97,189.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8627,Cid ext speech process repl,Durable Medical Equipment,Per Unit,"$7,175.59 ",OP,"7,175.59","7,175.59",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8628,Cid ext controller repl,Durable Medical Equipment,Per Unit,"$1,278.42 ",OP,"1,278.42","1,278.42",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8629,Cid transmit coil and cable,Durable Medical Equipment,Per Unit,$180.09 ,OP,180.09,180.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8681,Pt prgrm for implt neurostim,Durable Medical Equipment,Per Unit,"$1,147.11 ",OP,"1,147.11","1,147.11",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8683,Radiofq trsmtr for implt neu,Durable Medical Equipment,Per Unit,"$5,420.03 ",OP,"5,420.03","5,420.03",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8684,Radiof trsmtr implt scrl neu,Durable Medical Equipment,Per Unit,$850.48 ,OP,850.48,850.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8689,External recharg sys intern,Durable Medical Equipment,Per Unit,"$1,734.92 ",OP,"1,734.92","1,734.92",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8691,Aoi snd proc repl excl actua,Durable Medical Equipment,Per Unit,"$1,732.10 ",OP,"1,732.10","1,732.10",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8693,Aud osseo dev- abutment,Durable Medical Equipment,Per Unit,"$1,525.09 ",OP,"1,525.09","1,525.09",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8694,Aoi transducer/actuator repl,Durable Medical Equipment,Per Unit,$949.85 ,OP,949.85,949.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8695,External recharg sys extern,Durable Medical Equipment,Per Unit,$16.77 ,OP,16.77,16.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,L8696,Ext antenna phren nerve stim,Durable Medical Equipment,Per Unit,$217.98 ,OP,217.98,217.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,M0201,Covid-19 vaccine home admin,APC 1494,RVU Per Unit,$34.41 ,OP,34.41,34.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,M0243,Casirivi and imdevi inj,APC 1506,RVU Per Unit,$436.57 ,OP,436.57,436.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,M0244,Casirivi and imdevi inj hm,APC 1509,RVU Per Unit,$727.29 ,OP,727.29,727.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,M0245,Bamlan and etesev infusion,APC 1506,RVU Per Unit,$436.57 ,OP,436.57,436.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P2028,Cephalin floculation test,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P2029,Congo red blood test,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P2033,Blood thymol turbidity,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P2038,Blood mucoprotein,Lab Services,Per Unit,$4.95 ,OP,4.95,4.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P3000,Screen pap by tech w md supv,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9010,Whole blood for transfusion,APC 9510,Per Unit,$172.22 ,OP,172.22,172.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9011,Blood split unit,APC 9520,Per Unit,$169.28 ,OP,169.28,169.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9012,Cryoprecipitate each unit,APC 9511,Per Unit,$91.59 ,OP,91.59,91.59,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9016,Rbc leukocytes reduced,APC 9512,Per Unit,$216.23 ,OP,216.23,216.23,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9017,Plasma 1 donor frz w/in 8 hr,APC 9508,Per Unit,$94.81 ,OP,94.81,94.81,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9019,Platelets- each unit,APC 9515,Per Unit,$81.77 ,OP,81.77,81.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9020,Plaelet rich plasma unit,APC 9516,Per Unit,$229.41 ,OP,229.41,229.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9021,Red blood cells unit,APC 9517,Per Unit,$157.87 ,OP,157.87,157.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9022,Washed red blood cells unit,APC 9518,Per Unit,$435.72 ,OP,435.72,435.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9023,Frozen plasma- pooled- sd,APC 9509,Per Unit,$102.26 ,OP,102.26,102.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9031,Platelets leukocytes reduced,APC 9526,Per Unit,$171.96 ,OP,171.96,171.96,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9032,Platelets- irradiated,APC 9500,Per Unit,$162.52 ,OP,162.52,162.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9033,Platelets leukoreduced irrad,APC 9521,Per Unit,$244.54 ,OP,244.54,244.54,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9034,Platelets- pheresis,APC 9507,Per Unit,$371.63 ,OP,371.63,371.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9035,Platelet pheres leukoreduced,APC 9501,Per Unit,$558.38 ,OP,558.38,558.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9036,Platelet pheresis irradiated,APC 9502,Per Unit,$693.83 ,OP,693.83,693.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9037,Plate pheres leukoredu irrad,APC 9530,Per Unit,$708.10 ,OP,708.1,708.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9038,Rbc irradiated,APC 9505,Per Unit,$194.21 ,OP,194.21,194.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9039,Rbc deglycerolized,APC 9504,Per Unit,$500.86 ,OP,500.86,500.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9040,Rbc leukoreduced irradiated,APC 9522,Per Unit,$298.86 ,OP,298.86,298.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9041,Albumin (human)-5%- 50ml,APC 0961,Per Unit,$10.49 ,OP,10.49,10.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9043,Plasma protein fract-5%-50ml,APC 9514,Per Unit,$9.16 ,OP,9.16,9.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9044,Cryoprecipitatereducedplasma,APC 9523,Per Unit,$75.36 ,OP,75.36,75.36,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9045,Albumin (human)- 5%- 250 ml,APC 0963,Per Unit,$52.45 ,OP,52.45,52.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9046,Albumin (human)- 25%- 20 ml,APC 0964,Per Unit,$20.98 ,OP,20.98,20.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9047,Albumin (human)- 25%- 50ml,APC 0965,Per Unit,$52.45 ,OP,52.45,52.45,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9048,Plasmaprotein fract-5%-250ml,APC 9519,Per Unit,$183.92 ,OP,183.92,183.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9051,Blood- l/r- cmv-neg,APC 9524,Per Unit,$243.44 ,OP,243.44,243.44,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9052,Platelets- hla-m- l/r- unit,APC 9525,Per Unit,$923.57 ,OP,923.57,923.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9053,Plt- pher- l/r cmv-neg- irr,APC 9531,Per Unit,$513.08 ,OP,513.08,513.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9054,Blood- l/r- froz/degly/wash,APC 9527,Per Unit,$356.39 ,OP,356.39,356.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9055,Plt- aph/pher- l/r- cmv-neg,APC 9528,Per Unit,$550.63 ,OP,550.63,550.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9056,Blood- l/r- irradiated,APC 9529,Per Unit,$176.83 ,OP,176.83,176.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9057,Rbc- frz/deg/wsh- l/r- irrad,APC 9532,Per Unit,$298.91 ,OP,298.91,298.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9058,Rbc- l/r- cmv-neg- irrad,APC 9533,Per Unit,$279.73 ,OP,279.73,279.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9059,Plasma- frz between 8-24hour,APC 9513,Per Unit,$81.61 ,OP,81.61,81.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9060,Fr frz plasma donor retested,APC 9503,Per Unit,$74.65 ,OP,74.65,74.65,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9070,Pathogen reduced plasma pool,APC 9534,Per Unit,$60.91 ,OP,60.91,60.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9071,Pathogen reduced plasma sing,APC 9535,Per Unit,$140.88 ,OP,140.88,140.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9073,Platelets pheresis path redu,APC 9536,Per Unit,$669.72 ,OP,669.72,669.72,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9099,Blood component/product noc,APC 9537,Per Unit,$9.16 ,OP,9.16,9.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9100,Pathogen test for platelets,APC 5732,RVU Per Unit,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,P9612,Catheterize for urine spec,Lab Services,Per Unit,$3.00 ,OP,3,3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0035,Cardiokymography,APC 5732,RVU Per Case,$32.79 ,OP,32.79,32.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0091,Obtaining screen pap smear,APC 5731,RVU Per Unit,$23.91 ,OP,23.91,23.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0111,Wet mounts/ w preparations,Lab Services,Per Unit,$15.15 ,OP,15.15,15.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0112,Potassium hydroxide preps,Lab Services,Per Unit,$5.83 ,OP,5.83,5.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0113,Pinworm examinations,Lab Services,Per Unit,$4.27 ,OP,4.27,4.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0114,Fern test,Lab Services,Per Unit,$9.74 ,OP,9.74,9.74,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0115,Post-coital mucous exam,Lab Services,Per Unit,$25.00 ,OP,25,25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0138,Ferumoxytol- non-esrd,APC 1297,Per Unit,$1.00 ,OP,1,1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0139,Ferumoxytol- esrd use,APC 1485,Per Unit,$1.00 ,OP,1,1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0243,Casirivimab and imdevimab,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0245,Bamlanivimab and etesevima,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0477,Pwr module pt cable lvad rpl,Durable Medical Equipment,Per Unit,$780.34 ,OP,780.34,780.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0478,Power adapter- combo vad,Durable Medical Equipment,Per Unit,$184.82 ,OP,184.82,184.82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0479,Power module combo vad- rep,Durable Medical Equipment,Per Unit,"$12,073.17 ",OP,"12,073.17","12,073.17",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0480,Driver pneumatic vad- rep,Durable Medical Equipment,Per Unit,"$90,585.51 ",OP,"90,585.51","90,585.51",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0481,Microprcsr cu elec vad- rep,Durable Medical Equipment,Per Unit,"$14,614.95 ",OP,"14,614.95","14,614.95",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0482,Microprcsr cu combo vad- rep,Durable Medical Equipment,Per Unit,"$4,577.67 ",OP,"4,577.67","4,577.67",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0483,Monitor elec vad- rep,Durable Medical Equipment,Per Unit,"$18,857.93 ",OP,"18,857.93","18,857.93",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0484,Monitor elec or comb vad rep,Durable Medical Equipment,Per Unit,"$3,662.14 ",OP,"3,662.14","3,662.14",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0485,Monitor cable elec vad- rep,Durable Medical Equipment,Per Unit,$353.60 ,OP,353.6,353.6,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0486,Mon cable elec/pneum vad rep,Durable Medical Equipment,Per Unit,$294.28 ,OP,294.28,294.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0487,Leads any type vad- rep only,Durable Medical Equipment,Per Unit,$343.31 ,OP,343.31,343.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0489,Pwr pck base combo vad- rep,Durable Medical Equipment,Per Unit,"$16,348.80 ",OP,"16,348.80","16,348.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0490,Emr pwr source elec vad- rep,Durable Medical Equipment,Per Unit,$707.17 ,OP,707.17,707.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0491,Emr pwr source combo vad rep,Durable Medical Equipment,Per Unit,"$1,111.75 ",OP,"1,111.75","1,111.75",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0492,Emr pwr cbl elec vad- rep,Durable Medical Equipment,Per Unit,$89.58 ,OP,89.58,89.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0493,Emr pwr cbl combo vad- rep,Durable Medical Equipment,Per Unit,$255.02 ,OP,255.02,255.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0494,Emr hd pmp elec/combo- rep,Durable Medical Equipment,Per Unit,$215.79 ,OP,215.79,215.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0495,Charger elec/combo vad- rep,Durable Medical Equipment,Per Unit,"$4,201.23 ",OP,"4,201.23","4,201.23",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0496,Battery elec/combo vad- rep,Durable Medical Equipment,Per Unit,"$1,507.90 ",OP,"1,507.90","1,507.90",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0497,Bat clps elec/comb vad- rep,Durable Medical Equipment,Per Unit,$470.84 ,OP,470.84,470.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0498,Holster elec/combo vad- rep,Durable Medical Equipment,Per Unit,$516.61 ,OP,516.61,516.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0499,Belt/vest elec/combo vad rep,Durable Medical Equipment,Per Unit,$167.86 ,OP,167.86,167.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0500,Filters elec/combo vad- rep,Durable Medical Equipment,Per Unit,$30.69 ,OP,30.69,30.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0501,Shwr cov elec/combo vad- rep,Durable Medical Equipment,Per Unit,$513.63 ,OP,513.63,513.63,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0502,Mobility cart pneum vad- rep,Durable Medical Equipment,Per Unit,$653.97 ,OP,653.97,653.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0503,Battery pneum vad replacemnt,Durable Medical Equipment,Per Unit,"$1,307.87 ",OP,"1,307.87","1,307.87",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0504,Pwr adpt pneum vad- rep veh,Durable Medical Equipment,Per Unit,$690.16 ,OP,690.16,690.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q0506,Lith-ion batt elec/pneum vad,Durable Medical Equipment,Per Unit,$859.04 ,OP,859.04,859.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2017,Teniposide- 50 mg,APC 7035,Per Unit,"$2,645.71 ",OP,"2,645.71","2,645.71",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2026,Radiesse injection,APC 9094,Per Unit,$257.37 ,OP,257.37,257.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2028,Inj- sculptra- 0.5mg,APC 9095,Per Unit,$2.49 ,OP,2.49,2.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2034,Agriflu vaccine,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2035,Afluria vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2036,Flulaval vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2037,Fluvirin vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2038,Fluzone vacc- 3 yrs & >- im,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2039,Influenza virus vaccine- nos,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2041,Axicabtagene ciloleucel car+,APC 9035,Per Unit,"$395,380.00 ",OP,"395,380.00","395,380.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2042,Tisagenlecleucel car-pos t,APC 9194,Per Unit,"$434,337.60 ",OP,"434,337.60","434,337.60",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2043,Sipuleucel-t auto cd54+,APC 9273,Per Unit,"$53,017.58 ",OP,"53,017.58","53,017.58",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2049,Imported lipodox inj,APC 1421,Per Unit,$311.04 ,OP,311.04,311.04,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2050,Doxorubicin inj 10mg,APC 7046,Per Unit,$234.03 ,OP,234.03,234.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q2053,Brexucabtagene car pos t,APC 9391,Per Unit,"$395,380.00 ",OP,"395,380.00","395,380.00",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q3027,Inj beta interferon im 1 mcg,APC 1472,Per Unit,$55.29 ,OP,55.29,55.29,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5101,Injection- zarxio,APC 1822,Per Unit,$0.32 ,OP,0.32,0.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5103,Injection- inflectra,APC 1847,Per Unit,$41.19 ,OP,41.19,41.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5104,Injection- renflexis,APC 9036,Per Unit,$38.79 ,OP,38.79,38.79,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5106,Inj retacrit non-esrd use,APC 9097,Per Unit,$8.66 ,OP,8.66,8.66,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5107,Inj mvasi 10 mg,APC 9329,Per Unit,$44.56 ,OP,44.56,44.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5108,Injection- fulphila,APC 9173,Per Unit,$211.19 ,OP,211.19,211.19,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5110,Nivestym,APC 9193,Per Unit,$0.33 ,OP,0.33,0.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5111,Injection- udenyca 0.5 mg,APC 9195,Per Unit,$222.38 ,OP,222.38,222.38,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5112,Inj ontruzant 10 mg,APC 9382,Per Unit,$66.55 ,OP,66.55,66.55,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5113,Inj herzuma 10 mg,APC 9349,Per Unit,$57.30 ,OP,57.3,57.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5114,Inj ogivri 10 mg,APC 9341,Per Unit,$59.91 ,OP,59.91,59.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5115,Inj truxima 10 mg,APC 9336,Per Unit,$60.58 ,OP,60.58,60.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5116,Inj.- trazimera- 10 mg,APC 9350,Per Unit,$59.93 ,OP,59.93,59.93,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5117,Inj.- kanjinti- 10 mg,APC 9330,Per Unit,$53.18 ,OP,53.18,53.18,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5118,Inj.- zirabev- 10 mg,APC 9348,Per Unit,$52.37 ,OP,52.37,52.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5119,Inj ruxience- 10 mg,APC 9367,Per Unit,$58.80 ,OP,58.8,58.8,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5120,Inj pegfilgrastim-bmez 0.5mg,APC 9345,Per Unit,$245.43 ,OP,245.43,245.43,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5121,Inj. avsola- 10 mg,APC 9381,Per Unit,$47.12 ,OP,47.12,47.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q5122,Inj- nyvepria,APC 9406,Per Unit,$284.69 ,OP,284.69,284.69,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q9968,Visualization adjunct,APC 1446,Per Unit,$6.73 ,OP,6.73,6.73,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q9969,Non-heu tc-99m add-on/dose,APC 1442,Per Unit,$10.00 ,OP,10,10,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q9991,Buprenorph xr 100 mg or less,APC 9073,Per Unit,"$1,796.80 ",OP,"1,796.80","1,796.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,Q9992,Buprenorphine xr over 100 mg,APC 9239,Per Unit,"$1,796.80 ",OP,"1,796.80","1,796.80",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,U0001,2019-ncov diagnostic p,Lab Services,Per Unit,$35.92 ,OP,35.92,35.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,U0002,Covid-19 lab test non-cdc,Lab Services,Per Unit,$51.31 ,OP,51.31,51.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,U0003,Cov-19 amp prb hgh thruput,Lab Services,Per Unit,$75.00 ,OP,75,75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,U0004,Cov-19 test non-cdc hgh thru,Lab Services,Per Unit,$75.00 ,OP,75,75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,U0005,Infec agen detec ampli probe,Lab Services,Per Unit,$25.00 ,OP,25,25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2020,Vision svcs frames purchases,Durable Medical Equipment,Per Unit,$75.22 ,OP,75.22,75.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2100,Lens spher single plano 4.00,Durable Medical Equipment,Per Unit,$46.49 ,OP,46.49,46.49,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2101,Single visn sphere 4.12-7.00,Durable Medical Equipment,Per Unit,$44.67 ,OP,44.67,44.67,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2102,Singl visn sphere 7.12-20.00,Durable Medical Equipment,Per Unit,$77.24 ,OP,77.24,77.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2103,Spherocylindr 4.00d/12-2.00d,Durable Medical Equipment,Per Unit,$39.13 ,OP,39.13,39.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2104,Spherocylindr 4.00d/2.12-4d,Durable Medical Equipment,Per Unit,$40.34 ,OP,40.34,40.34,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2105,Spherocylinder 4.00d/4.25-6d,Durable Medical Equipment,Per Unit,$47.98 ,OP,47.98,47.98,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2106,Spherocylinder 4.00d/>6.00d,Durable Medical Equipment,Per Unit,$53.15 ,OP,53.15,53.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2107,Spherocylinder 4.25d/12-2d,Durable Medical Equipment,Per Unit,$47.33 ,OP,47.33,47.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2108,Spherocylinder 4.25d/2.12-4d,Durable Medical Equipment,Per Unit,$47.46 ,OP,47.46,47.46,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2109,Spherocylinder 4.25d/4.25-6d,Durable Medical Equipment,Per Unit,$66.10 ,OP,66.1,66.1,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2110,Spherocylinder 4.25d/over 6d,Durable Medical Equipment,Per Unit,$53.39 ,OP,53.39,53.39,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2111,Spherocylindr 7.25d/.25-2.25,Durable Medical Equipment,Per Unit,$64.70 ,OP,64.7,64.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2112,Spherocylindr 7.25d/2.25-4d,Durable Medical Equipment,Per Unit,$73.09 ,OP,73.09,73.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2113,Spherocylindr 7.25d/4.25-6d,Durable Medical Equipment,Per Unit,$73.91 ,OP,73.91,73.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2114,Spherocylinder over 12.00d,Durable Medical Equipment,Per Unit,$87.57 ,OP,87.57,87.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2115,Lens lenticular bifocal,Durable Medical Equipment,Per Unit,$88.27 ,OP,88.27,88.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2118,Lens aniseikonic single,Durable Medical Equipment,Per Unit,$96.05 ,OP,96.05,96.05,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2121,Lenticular lens- single,Durable Medical Equipment,Per Unit,$86.61 ,OP,86.61,86.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2200,Lens spher bifoc plano 4.00d,Durable Medical Equipment,Per Unit,$52.35 ,OP,52.35,52.35,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2201,Lens sphere bifocal 4.12-7.0,Durable Medical Equipment,Per Unit,$56.09 ,OP,56.09,56.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2202,Lens sphere bifocal 7.12-20.,Durable Medical Equipment,Per Unit,$69.53 ,OP,69.53,69.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2203,Lens sphcyl bifocal 4.00d/.1,Durable Medical Equipment,Per Unit,$53.92 ,OP,53.92,53.92,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2204,Lens sphcy bifocal 4.00d/2.1,Durable Medical Equipment,Per Unit,$55.48 ,OP,55.48,55.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2205,Lens sphcy bifocal 4.00d/4.2,Durable Medical Equipment,Per Unit,$61.51 ,OP,61.51,61.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2206,Lens sphcy bifocal 4.00d/ove,Durable Medical Equipment,Per Unit,$72.21 ,OP,72.21,72.21,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2207,Lens sphcy bifocal 4.25-7d/.,Durable Medical Equipment,Per Unit,$61.03 ,OP,61.03,61.03,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2208,Lens sphcy bifocal 4.25-7/2.,Durable Medical Equipment,Per Unit,$59.97 ,OP,59.97,59.97,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2209,Lens sphcy bifocal 4.25-7/4.,Durable Medical Equipment,Per Unit,$70.40 ,OP,70.4,70.4,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2210,Lens sphcy bifocal 4.25-7/ov,Durable Medical Equipment,Per Unit,$75.86 ,OP,75.86,75.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2211,Lens sphcy bifo 7.25-12/.25-,Durable Medical Equipment,Per Unit,$73.85 ,OP,73.85,73.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2212,Lens sphcyl bifo 7.25-12/2.2,Durable Medical Equipment,Per Unit,$77.30 ,OP,77.3,77.3,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2213,Lens sphcyl bifo 7.25-12/4.2,Durable Medical Equipment,Per Unit,$81.28 ,OP,81.28,81.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2214,Lens sphcyl bifocal over 12.,Durable Medical Equipment,Per Unit,$84.95 ,OP,84.95,84.95,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2215,Lens lenticular bifocal,Durable Medical Equipment,Per Unit,$106.06 ,OP,106.06,106.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2218,Lens aniseikonic bifocal,Durable Medical Equipment,Per Unit,$108.09 ,OP,108.09,108.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2219,Lens bifocal seg width over,Durable Medical Equipment,Per Unit,$49.86 ,OP,49.86,49.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2220,Lens bifocal add over 3.25d,Durable Medical Equipment,Per Unit,$44.28 ,OP,44.28,44.28,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2221,Lenticular lens- bifocal,Durable Medical Equipment,Per Unit,$88.33 ,OP,88.33,88.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2300,Lens sphere trifocal 4.00d,Durable Medical Equipment,Per Unit,$71.57 ,OP,71.57,71.57,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2301,Lens sphere trifocal 4.12-7.,Durable Medical Equipment,Per Unit,$87.77 ,OP,87.77,87.77,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2302,Lens sphere trifocal 7.12-20,Durable Medical Equipment,Per Unit,$82.00 ,OP,82,82,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2303,Lens sphcy trifocal 4.0/.12-,Durable Medical Equipment,Per Unit,$68.89 ,OP,68.89,68.89,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2304,Lens sphcy trifocal 4.0/2.25,Durable Medical Equipment,Per Unit,$69.70 ,OP,69.7,69.7,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2305,Lens sphcy trifocal 4.0/4.25,Durable Medical Equipment,Per Unit,$77.86 ,OP,77.86,77.86,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2306,Lens sphcyl trifocal 4.00/>6,Durable Medical Equipment,Per Unit,$80.17 ,OP,80.17,80.17,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2307,Lens sphcy trifocal 4.25-7/.,Durable Medical Equipment,Per Unit,$76.33 ,OP,76.33,76.33,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2308,Lens sphc trifocal 4.25-7/2.,Durable Medical Equipment,Per Unit,$83.26 ,OP,83.26,83.26,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2309,Lens sphc trifocal 4.25-7/4.,Durable Medical Equipment,Per Unit,$87.13 ,OP,87.13,87.13,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2310,Lens sphc trifocal 4.25-7/>6,Durable Medical Equipment,Per Unit,$91.01 ,OP,91.01,91.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2311,Lens sphc trifo 7.25-12/.25-,Durable Medical Equipment,Per Unit,$105.08 ,OP,105.08,105.08,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2312,Lens sphc trifo 7.25-12/2.25,Durable Medical Equipment,Per Unit,$96.32 ,OP,96.32,96.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2313,Lens sphc trifo 7.25-12/4.25,Durable Medical Equipment,Per Unit,$105.15 ,OP,105.15,105.15,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2314,Lens sphcyl trifocal over 12,Durable Medical Equipment,Per Unit,$107.48 ,OP,107.48,107.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2315,Lens lenticular trifocal,Durable Medical Equipment,Per Unit,$119.32 ,OP,119.32,119.32,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2318,Lens aniseikonic trifocal,Durable Medical Equipment,Per Unit,$146.68 ,OP,146.68,146.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2319,Lens trifocal seg width > 28,Durable Medical Equipment,Per Unit,$66.22 ,OP,66.22,66.22,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2320,Lens trifocal add over 3.25d,Durable Medical Equipment,Per Unit,$69.85 ,OP,69.85,69.85,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2321,Lenticular lens- trifocal,Durable Medical Equipment,Per Unit,$117.61 ,OP,117.61,117.61,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2410,Lens variab asphericity sing,Durable Medical Equipment,Per Unit,$102.83 ,OP,102.83,102.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2430,Lens variable asphericity bi,Durable Medical Equipment,Per Unit,$108.84 ,OP,108.84,108.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2500,Contact lens pmma spherical,Durable Medical Equipment,Per Unit,$92.01 ,OP,92.01,92.01,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2501,Cntct lens pmma-toric/prism,Durable Medical Equipment,Per Unit,$130.56 ,OP,130.56,130.56,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2502,Contact lens pmma bifocal,Durable Medical Equipment,Per Unit,$176.91 ,OP,176.91,176.91,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2503,Cntct lens pmma color vision,Durable Medical Equipment,Per Unit,$170.87 ,OP,170.87,170.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2510,Cntct gas permeable sphericl,Durable Medical Equipment,Per Unit,$122.68 ,OP,122.68,122.68,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2511,Cntct toric prism ballast,Durable Medical Equipment,Per Unit,$181.84 ,OP,181.84,181.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2512,Cntct lens gas permbl bifocl,Durable Medical Equipment,Per Unit,$209.31 ,OP,209.31,209.31,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2513,Contact lens extended wear,Durable Medical Equipment,Per Unit,$210.87 ,OP,210.87,210.87,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2520,Contact lens hydrophilic,Durable Medical Equipment,Per Unit,$122.25 ,OP,122.25,122.25,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2521,Cntct lens hydrophilic toric,Durable Medical Equipment,Per Unit,$242.09 ,OP,242.09,242.09,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2522,Cntct lens hydrophil bifocl,Durable Medical Equipment,Per Unit,$177.16 ,OP,177.16,177.16,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2523,Cntct lens hydrophil extend,Durable Medical Equipment,Per Unit,$186.00 ,OP,186,186,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2530,Contact lens gas impermeable,Durable Medical Equipment,Per Unit,$297.37 ,OP,297.37,297.37,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2531,Contact lens gas permeable,Durable Medical Equipment,Per Unit,$544.58 ,OP,544.58,544.58,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2623,Plastic eye prosth custom,Durable Medical Equipment,Per Unit,$942.94 ,OP,942.94,942.94,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2624,Polishing artifical eye,Durable Medical Equipment,Per Unit,$60.88 ,OP,60.88,60.88,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2625,Enlargemnt of eye prosthesis,Durable Medical Equipment,Per Unit,$482.12 ,OP,482.12,482.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2626,Reduction of eye prosthesis,Durable Medical Equipment,Per Unit,$199.51 ,OP,199.51,199.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2627,Scleral cover shell,Durable Medical Equipment,Per Unit,"$1,430.28 ",OP,"1,430.28","1,430.28",,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2628,Fabrication & fitting,Durable Medical Equipment,Per Unit,$304.24 ,OP,304.24,304.24,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2700,Balance lens,Durable Medical Equipment,Per Unit,$44.84 ,OP,44.84,44.84,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2710,Glass/plastic slab off prism,Durable Medical Equipment,Per Unit,$73.51 ,OP,73.51,73.51,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2715,Prism lens/es,Durable Medical Equipment,Per Unit,$14.41 ,OP,14.41,14.41,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2718,Fresnell prism press-on lens,Durable Medical Equipment,Per Unit,$31.12 ,OP,31.12,31.12,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2730,Special base curve,Durable Medical Equipment,Per Unit,$26.06 ,OP,26.06,26.06,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2744,Tint photochromatic lens/es,Durable Medical Equipment,Per Unit,$17.83 ,OP,17.83,17.83,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2745,Tint- any color/solid/grad,Durable Medical Equipment,Per Unit,$10.27 ,OP,10.27,10.27,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2750,Anti-reflective coating,Durable Medical Equipment,Per Unit,$20.02 ,OP,20.02,20.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2755,Uv lens/es,Durable Medical Equipment,Per Unit,$16.76 ,OP,16.76,16.76,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2770,Occluder lens/es,Durable Medical Equipment,Per Unit,$19.52 ,OP,19.52,19.52,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2780,Oversize lens/es,Durable Medical Equipment,Per Unit,$12.53 ,OP,12.53,12.53,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2782,Lens- 1.54-1.65 p/1.60-1.79g,Durable Medical Equipment,Per Unit,$64.75 ,OP,64.75,64.75,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2783,Lens- >= 1.66 p/>=1.80 g,Durable Medical Equipment,Per Unit,$73.02 ,OP,73.02,73.02,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2784,Lens polycarb or equal,Durable Medical Equipment,Per Unit,$47.48 ,OP,47.48,47.48,,,,,,,,,,,,,
United Healthcare MCR ADV,CPT,V2785,Corneal tissue processing,Other,Straight Discount,17.80%,OP,,,,,,,,,,,,,,,